Current Issue : April - June Volume : 2018 Issue Number : 2 Articles : 7 Articles
Background and objective: The British Thoracic Society (BTS) recommends that sedation for fiber-optic\nbronchoscopy (FOB) should be offered to all patients. This study evaluates the safety of FOB under sedation in\npatients with COPD.\nMethods: Is a prospective observational study, with the approval of institutional review board. Sedation was\nadministered by a board-certified anaesthetist. Patients were premedicated (IV) with metoclopramide 10 mg, fentanyl\ninitial dose: 25 �¼g, midazolam initial dose 2-3 mg. After an initial 50 mg IV propofol, the dose was then carefully\ntitrated according to the ASA physical status classification.\nResults: The duration of the procedure was not different between the two groups (14.7 �± 3.551 vs. 14.9 �± 3.8 min\np=0.695). Serious complications were very infrequent in both groups (2.1 vs. 0.07%, p=0.148). In the group of COPD\npatients there was no correlation between the lowest SaO2 during the procedure (r=0.03, p=0.518) or the SaO2 at the\nend of the procedure (r=-0.006, p=0.909) and the baseline FEV1. Neither the presence of a fall in the SaO2 greater\nthan 4 points (HR 0.895, IC 0.452-1.773, p=0.750) nor a SaO2 lower than 90% during the procedure (HR 0.346, IC\n0.060-1.918, p=0.233) or the general rate of complications (including desaturation) (HR: 0.627, CI: 0.257-1.529,\np=0.305) were predicted by a baseline FEV1 lower than 50%.\nConclusions: We conclude that FOB under conscious sedation by a certified anesthesiologist is a safe procedure\nin patients with COPD with a low incidence of adverse effects....
Rationale: Inspiratory muscle endurance as expressed by the tension-time index of the diaphragm [TTI=(Pdi/\nPdimax) Ã?â?? (Ti/Ttot)] in normal subjects and cardiorespiratory disorders requires the use of esophageal and gastric\nballoons. A noninvasive technique can be used in which the ratio of tidal volume to vital capacity Vt/FVC is substituted\nfor Pdi/Pdimax, with the resulting relationship [(Ti/Ttot) Ã?â?? (Vt/FVC)] called the breathing intolerance index (BIT). The\nresponse to medical management of BIT in patients with cardiomyopathy with chronic heartfailure has not been\nassessed before and after medical management.\nObjectives: To compare control of ventilation and BIT in patients with stable dilated cardiomyopathy at rest and\nexercise, and to analyze BIT, oxygen uptake and carbon dioxide elimination at baseline and approximately one year\nafter initiating medical management.\nMethods: Control of ventilation and BIT were assessed in 24 patients (mean age 55.5 years; 17 males) at rest\nand at peak exercise during bicycle ergometry, at baseline and approximately 14 months later.\nResults: Median peak VO2 was 12.9 mL/kg/min and 14.3 mL/kg/min at baseline and followup, respectively\n(p<0.036, adjusted for age, gender and BMI). It increased 4.3 times from rest to peak exercise at baseline and 4.7\ntimes at followup (NS). Peak Vââ?¬â?¢O2 increased by 10.5% between baseline and followup (p=0.036 after adjusting for\nage, sex and BMI). BIT did not change significantly. Peak Vââ?¬â?¢O2/BIT increased significantly from baseline to follow-up\n(p=0.008, adjusted for age, sex and BMI). No patients died or experienced acute heart failure during the study.\nConclusions: Peak Vââ?¬â?¢O2 in relation to non-invasively measured peak tension-time index of the respiratory\nmuscles (BIT) increases significantly after one year of medical management, indicating increased efficient oxygen\nutilization as cardiac function improves. BIT is useful for noninvasively assessing inspiratory muscle endurance and\nrelating oxygen uptake to ventilation in patients with dilated cardiomyopathy and chronic congestive heart failure...
The evaluation of cardiopulmonary parameters is an essential factor for ascertaining of functional operability\nprior to anatomical lung resection. A predictive formulae for estimating of functional operability based on analysis of\ncardiorespiratory parameters have not yet been described. In marginal cases, a precise assessment is an important\ndecisive factor under fear of postoperative complication regarding more radical parenchymal resection.\nThe functional tests such as spirometry, spiroergometry, stair climbing exercise, 6-Minute walk test,\nechocardiography, stress echocardiography and lung perfusion scintigram under consideration of general health\nsituation could provide predictive postoperative information for ascertaining of functional operability.\nWe describe in this review the meaningful cardiorespiratory tests for estimating of the outcome prior to anatomical\nlung resection....
Portable inhalers are divisible into those that deliver medication by patient triggering (pMDIs: a gentle slow inhalation) and those\nthat use the patientââ?¬â?¢s inspiratory effort as the force for deaggregation and delivery (DPIs: a stronger deeper inspiratory effort). Patient\nconfusion and poor technique are commonplace.The use of training tools has become standard practice, and unique amongst these\nis an inspiratory flow meter (In-Check) which is able to simulate the resistance characteristics of different inhalers and, thereby,\nguide the patient to the correct effort. In-Checkââ?¬â?¢s origins lie in the 1960s peak expiratory flow meters, the development of theMini-\nWright peak flow meter, and inspiratory flow assessment via the nose during the 1970sââ?¬â??1980s. The current device (In-Check DIAL\nG16) is the third iteration of the original 1998 training tool, with detailed and ongoing assessments of all common inhaler resistances\n(including combination and breath-actuated inhaler types) summarised into resistance ranges that are preset within the device.The\ndevice works by interpolating one of six ranges with the inspiratory effort. Use of the tool has been shown to be contributory to\nsignificant improvements in asthma care and control, and it is being advocated for assessment and training in irreversible lung\ndisease....
This study offers a cheap and rapid method for the measuring of breath or measuring the size and capacity of\nthe lung. In this innovative method, the respiration flowmeter than other conventional methods with high costs will\nbe done very fast and accurate. In this device, the measurement accuracy and speed will increase dramatically,\nbecause of the high-frequency response than other methods. In this paper, the results of design and manufacturing\nthe spirometry device using nanotechnology are discussed, which including synthesis of piezoelectric ceramics PMNPT\nand the amplifier circuit design....
Pulmonary alveolar proteinosis (PAP) is a rare lung disorder in which defects in alveolar macrophage maturation or function\nlead to the accumulation of proteinaceous surfactant in alveolar space, resulting in impaired gas exchange and hypoxemia.\nPAP is categorized into three types: hereditary, autoimmune, and secondary. We report a case of secondary PAP in a 47-yearold\nman, whose risk factors include occupational exposure to inhaled toxins, especially aluminum dust, the use of anabolic\nsteroids, and alcohol abuse, which in mice leads to alveolar macrophage dysfunction through a zinc-dependent mechanism that\ninhibits granulocyte macrophage-colony stimulating factor (GM-CSF) receptor signalling. Although the rarity and vague clinical\npresentation of PAP can pose diagnostic challenges, clinician awareness of PAP risk factors may facilitate the diagnostic process\nand lead to more prompt treatment....
Familial interstitial lung disease (ILD) is defined as presence of ILD in 2 or more family members. Surfactant protein C (SFTPC)\ngene mutations are rare, but well-known cause of familial ILD. We reported a 20-year-old male, who was referred for lung\ntransplantation. He was symptomatic at age 3 and underwent surgical lung biopsy at age 6, which revealed a nonspecific interstitial\npneumonia (NSIP) pattern. Genetic workup revealed a novel SFTPC mutation in the first intron with a C to A transversion. At\nage 21, he underwent bilateral lung transplantation. Explanted lung histology suggested NSIP. In addition there was pulmonary\nneuroendocrine cell (PNEC) hyperplasia and carcinoid tumorlets. His mother had undergone lung transplantation several years\nearlier, and her explanted lung showed similar pathology. SFTPCmutations are inherited in an autosomal dominant pattern.Various\ntypes of ILD have been associated with SFTPC mutation including NSIP, usual interstitial pneumonia (UIP), and desquamative\ninterstitial pneumonia (DIP). PNEC hyperplasia has been described to occur in association with lung inflammation but has not\nbeen previously described with familial ILD associated with SFTPC mutation....
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