1,721,034 research outputs found
Where to perform long-term ventilation
No full textGiven that most VAI prefer to be cared for at home and that their return home is the desire of families, health care professionals, and others concerned with LTMV, the effort to transform prolonged mechanical ventilation from a hospital-centered to a home-centered treatment needs to be continued and further developed. Nevertheless, the future of high-technology home care will undoubtedly be influenced by improvements in quality and containment of costs, as in its current status treatment of VAI at home too often leads to family disruption and presents a dramatically increasing cost burden. Careful selection of patients, closer attention to education and training, and collection of outcome data are all factors that presumably will facilitate the development of better-quality and cost-saving home care
Death following malfunction of mechanical ventilation in ALS patient: “natural” or “mechanical” asphyxia?
No full textHow Artificial Intelligence is changing scientific publishing? Unrequested advices for young researchers II
No full textIs There Any Additional Effect of Tele-Assistance on Long-Term Care Programmes in Hypercapnic COPD Patients? A Retrospective Study
No full textThe evidence for tele-assistance (TA) in hypercapnic chronic obstructive pulmonary disease (COPD) patients on long-term oxygen therapy (LTOT) is scarce. The aim of this study was to evaluate the effects of addition of long-term TA to LTOT with or without non-invasive ventilation (NIV) in these patients. Retrospective analysis of a previous randomised study of patients on LTOT. According to the care programme patients were divided into Group 1: LTOT; Group 2: LTOT + NIV; Group 3: LTOT + TA and Group 4: LTOT + NIV+TA. Primary outcomes: time to first exacerbation and hospitalisation during 12 months of long-term care. Risk of exacerbation was statistically different among groups (p = 0.0002). TA addition to NIV significantly reduced exacerbation risk when compared with that to all groups. Hospitalisation risk was statistically different among groups (p = 0.049). Addition of TA to LTOT but not to NIV significantly reduced hospitalisation risk when compared to Group 1 (p = 0.013). Risk of mortality did not differ among groups (p = 0.074). In chronically hypercapnic COPD patients on LTOT, 1. TA alone and with greater efficacy when combined with NIV may reduce the frequency of exacerbations and 2. TA added to LTOT, but not to NIV, may reduce the frequency of hospitalisations
Assessment of Symptoms in Patients with COPD: Strengths and Limitations of Clinical Scores
No full textPurpose of Review: Health questionnaires are valuable tools to quantify, in an objective and standardized manner, the impact of chronic obstructive pulmonary disease on the health status of patients and on their well-being, and to track changes over time.Therefore, filling out these questionnaires allows clinicians to obtain the necessary information that can be easily related to clinical outcomes. Recent Findings: Most importantly, symptoms’ assessment represents a very relevant part of these clinical tools when applied to patients suffering from chronic respiratory diseases. Comparing scores between visits is also indicative of the patient’s health status, as changes in quality of life are related to worse outcomes such as hospitalization and exacerbation. However, each respiratory questionnaire may be peculiar in catching specific aspects of a similar symptom (i.e., dyspnoea); therefore, different tools are not interchangeable or comparable.Summary: Detecting the minimal clinically important difference is a necessary evaluation procedure which affords the change inpatient’s management and directs the therapeutic action towards more active treatments
Aerobic Exercise Training in Very Severe Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis
No full textOBJECTIVE: To evaluate the effectiveness of exercise training in patients with very severe chronic obstructive pulmonary disease (COPD). DESIGN: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature databases using the following as search terms: COPD, Chronic Obstructive Pulmonary Disease, Exercise, and Pulmonary Rehabilitation. We included randomized controlled trials (RCTs) of subjects with forced expiratory volume in the first second of less than 35% of the predicted normal value enrolled in in-patient, outpatient, or home- or community-based training programs lasting at least 4 weeks with respect to usual care. We included RCTs with outcome measures including the 6-minute walking test and/or health-related quality of life assessed by the St. George's Respiratory Questionnaire (SGRQ). RESULTS: Of 580 articles screened, 10 were included. The programs' duration ranged from 4 to 52 weeks with 1 to 5 sessions per week lasting 15 to 40 minutes each. The intervention group improved in 6-minute walking test [weighted mean difference, 67.1 (95% confidence interval [CI], 37.897-98.927); standardized mean difference, 3.86 (95% CI, 2.04-5.67)], and St. George's Respiratory Questionnaire [weighted mean difference, -8.041 (95% CI, -15.273 to -0.809); standardized mean difference, -1.23 (95% CI, -2.14 to -0.31)]. CONCLUSIONS: Exercise training improves exercise tolerance and health-related quality of life in patients with very severe COPD. However, because few studies on severely affected patients are available and the training programs are Highly heterogeneous, larger RCTs are needed
The role of respiratory management of Pompe disease
No full textSummaryRespiratory failure is an unavoidable event in the natural history of some neuromuscular diseases, while appearing very infrequently in others. In some cases, such as Pompe disease, respiratory failure progresses more rapidly than motor impairment, sometimes being the onset event. Home mechanical ventilation improves survival and quality of life of these patients, with a reduction in healthcare costs. Therefore, pulmonologists must improve their skills in order to play a more relevant role in the care of these patients. The aim of this statement is to provide pulmonologists with some simple information in order for them to fulfil their role of primary caregiver, enabling appropriate and rapid diagnosis and treatment
Increased number and expertise of Italian respiratory high-dependency care units: The second national survey
Full text linkBACKGROUND:
The imbalance between the increasing prevalence of acutely decompensated respiratory diseases and the shortage of intensive care unit beds has stimulated the growth of respiratory high-dependence care units (RHDCUs).
METHODS:
We conducted a national survey to analyze the changes, in the past 10 years, in the number, structures, staff, procedures, diagnoses, and outcomes in Italian RHDCUs that satisfy the European Respiratory Society's criteria (modified according to the Italian Association of Hospital Pneumologists) for high level (respiratory intensive care unit), intermediate level (respiratory intermediate intensive care unit), and low level (respiratory monitoring unit) RHDCU care.
RESULTS:
The number of RHDCUs increased from 26 to 44. The relative prevalence among all the RHDCUs increased only for the low-level units (P = .03). Compared to 1997, in 2007 a higher percentage of Italian RHDCUs were located within respiratory wards than located outside of respiratory wards (P = .03), and the physician-to-patient mean ratio and the nurse-to-patient mean ratio per shift were lower (P = .001 and P = .002, respectively). Admissions for only monitoring decreased (P < .001), and admissions for active interventions increased: noninvasive ventilation (P = .002), invasive ventilation (P < .001), weaning from invasive ventilation (P < .001), and tracheal decannulation (P < .001). The complexity of RHDCU patients' conditions increased: there was a reduction in the percentage of COPD patients (P < .001) and an increase in the percentage of patients with neuromyopathies (P < .001) and de novo hypoxemia (P = .006).
CONCLUSIONS:
Between 1997 and 2007 there was an increase in the number and expertise of Italian RHDCUs, with a shift toward less expensive care, and greater complexity of interventions and patient dysfunctions. These findings support the crucial role of RHDCUs in the management of respiratory critical patients
Hemoptysis due to a large endobronchial mass successful regression after the use of high flow nasal cannula
Full text linkIn recent years, high flow nasal cannula is being increasingly used. Most studies showed positive results when used in hypoxaemic respiratory failure. Its use in a patient with a large endobronchial mass has not yet being described. We report a patient who presented with hemoptysis and hypoxaemic respiratory failure second to a large mass obstructing the right main bronchus. High flow oxygen via nasal cannula was initiated with a quick improvement of the hemoptysis and the oxygen saturation. Thus, allowing the patient to be rapidly stabilized
Effects of interactive game-based training in pulmonary rehabilitation: preliminary results
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