Thorax
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A lifelong non-smoker who was the victim of a massive accidental exposure to anhydrous ammonia gas was followed up for 10 years. In the acute phase the patient presented with severe tracheobronchitis and respiratory failure, caused by very severe burns of the respiratory mucosa. ⋯ Isotope studies of mucociliary clearance, computed tomography, and bronchography showed mild bronchiectasis. It is concluded that acute exposure to high concentrations of ammonia may lead to acute respiratory injury but also to long term impairment of respiratory function.
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The non-invasive technique of nasal intermittent positive pressure ventilation (NIPPV) has an established role in providing domiciliary nocturnal ventilatory support in patients with chest wall disorders, neuromuscular disease, and chronic obstructive lung disease. NIPPV was used to simplify ventilatory management and assist the return of spontaneous breathing in patients with chronic respiratory insufficiency who had failed to wean from conventional intermittent positive pressure ventilation (IPPV). ⋯ NIPPV can be used to facilitate the return of spontaneous breathing and to reduce the need for intensive care accommodation in patients with an acute exacerbation of chronic respiratory insufficiency that requires intubation and IPPV.
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The likely values of inspired oxygen concentration (FIO2) of patients with chronic obstructive pulmonary disease breathing via nasal cannulas have not been assessed previously. ⋯ "Typical" values of FIO2 quoted with nasal cannulas can mislead. The results confirm that this mode of oxygen delivery is unsatisfactory if precise control of inspired oxygen is desired.
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Several alternatives to conventional ventilation in acute lung injury are now available and have been investigated to a varying degree. The assessment of all such techniques is limited by difficulties in designing proper comparative studies and by the time needed to recruit a large number of appropriate patients with acute lung injury. ⋯ The results of several large prospective comparative studies are eagerly awaited. Meanwhile we may reasonably suggest that improvements in respiratory support, together with advances in microbiological and pharmacological treatment, have the potential for improving the persistently disappointing survival rate in acute lung injury.