Revue française des maladies respiratoires
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Oxygen therapy is justified both on theoretical grounds and by clinical studies. Chronic hypoxia bodes ill for the system and is a prognostic factor in pulmonary disease. Low flow oxygen therapy has not shown any risk of pulmonary toxicity from anatomical or physiological studies. ⋯ It should be reserved for hypoxic patients in a stable state: the exact degree of hypoxaemia at which oxygen therapy is permissible cannot be defined precisely and depends on other criteria (such as polycythaemia, pulmonary arterial hypertension, nocturnal desaturation). Account should be taken of the PaCO2 level and the cause of the disease in deciding the oxygen flow. Polycythaemia, pulmonary arterial hypertension, nocturnal desaturation despite a normal waking PaO2, may represent some indications for oxygen therapy but further studies are necessary.
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The authors report three cases of unilateral pulmonary oedema following the re-expansion of a spontaneous pneumothorax. The importance of the duration of the pneumothorax and the use of too negative pressure while re-expanding the lung were both underlined. The different physiopathological hypotheses responsible for the appearance of pulmonary oedema were discussed, notably altered mechanical properties of the lung and alveolar-capillary permeability. The numerous precautions to take to avoid the appearance of oedema, as well as the therapeutic measures to adopt for severe pulmonary oedema were reviewed.
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The incidence of pleural mesothelioma (PM), chronic fibrosing pleurisy (CFP) and calcified pleural plaques (CPP) has been studied in Anatolia (Turkey) in relation with environmental pollution by mineral fibers: 1) In central Anatolia, where asbestos deposits have been described, the frequency of CFP and CPP was in the range 2-25%; several cases of PM have been encountered. 2) One area (Cappadoce) is free of asbestos, but contains another kind of mineral fiber: zeolite. In this area, an outbreak of PM has been described in some villages. Among the 600 inhabitants of Karain, 28 cases of PM occurred for the period January 1975-June 1979.
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This study points out that in acute respiratory distress syndrome, the positive end-expiratory pressure (PEEP) had in every case the same action on functional residual capacity and static lung compliance. However its results on PaO2, PaCO2 and circulation are often different from patient to patient according also to the different levels of PEEP. The level of optimal PEEP is that which opens the largest number of alveoli; it is better defined by the value of PaO2 on 100% oxygen than by static compliance.
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[Optimal positive and expiratory pressure in adult respiratory distress syndrome (author's transl)].
We defined a new optimal positive end expiratory pressure (PEEP) in the adult respiratory distress syndrome (ARDS). The optimal PEEP is the one which allows to obtain a PaO2 greater than or equal to 400 mmHg and/or an intrapulmonary shunt less than or equal to 15 p. cent, the cardiac output being held constant. 14 cases of ARDS have been treated by this method with encouraging results. The earlier optimal PEEP was applied, the more effective it was.