Swiss medical weekly
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Among the forms of respiratory insufficiency, those of acute decompensation have the best chance of cure and require all the facilities of clinical and emergency treatment. The therapeutic bases are antibiotics, IPPB, inhalation of broncholytic and secretolytic aerosols, physiotherapy and in some cases steroids. The home care program must be established and practised in the hospital, and its performance controlled and adapted in cooperation between family doctor and lung function laboratory in the clinic.
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The techniques of ventilatory support have been improved during the last few years by two series of modifications: first, the introduction of the trigger and the IMV allows and stimulates greater participation of the patient in the regulation and work of respiration; second, higher levels of PEEP and CPAP produce an improvement in pulmonary gas exchange. The development and perfecting of these techniques has not increased the cost of modern ventilators. This article considers some of the advantages and shortcomings of a number of recent models.
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Swiss medical weekly · Oct 1979
[The respiratory intensive unit. Requirements for the treatment of patients with acute respiratory insufficiency].
Patients with acute severe respiratory insufficiency can only be correctly monitored, treated and nursed in a well-equipped intensive care unit staffed with well-trained personnel. Qualified doctors and nursing staff are more important for the monitoring and assessment of the patient's symptoms than highly sophisticated electronic monitoring systems. ⋯ Treatment calls, above all, for the use of efficient and reliable respirators capable of adjustment to suit the impaired breathing. The quality of nursing and the success of intensive medical care measures are best ensured by well-designed layouts, strict adherence to sensible and appropriate hygienic techniques, continuous and practice-related further education for personnel, and unrestricted communication inside and outside the intensive care unit.
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Setting out from the components of respiratory function, i.e., ventilation, distribution, diffusion, circulation, respiratory mechanics, and regulation of breathing, the pathogenic mechanisms leading to respiratory failure are discussed. In every case, the vital capacity is decreased by 4 factors, namely loss of ventilated lung parenchyma, diminished compliance of lungs, thorax or both, airway obstruction, and insufficient respiratory airflow. With few exceptions, these alterations can be attributed to the two general groups of obstructive and restrictive disturbances of ventilation. ⋯ Finally, disturbances of gas transport in the blood may have an essential bearing on respiratory failure, but are often overlooked in diagnostic and therapeutic considerations. Shifting of the oxygen-dissociation curve to the left may, by increased oxygen affinity of hemoglobin, create a lack of oxygen in the peripheral tissue, while right wardshifting impedes oxygenation of hemoglobin in the lung. Thus, the correction of acidosis and elevated body temperature may become an important factor in the treatment of respiratory failure.