1,720,992 research outputs found
Intermediate respiratory intensive care units in Europe: A European perspective
No full textThe increasing amount of clinical and scientific data support- ing the use of non-invasive mechanical ventilation as a “first line treatment” for acute respiratory failure7 has increased the interest in HDUs and NRCUs. We performed a survey of HDRUs in Europe. In Europe the number of respiratory units is still small, but it is rapidly increasing with major differences between countries
SALBUTAMOL DELIVERY DURING NON-INVASIVE MECHANICAL VENTILATION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A RANDOMIZED, CONTROLLED STUDY
No full textObjective: We investigated the clinical response to equivalent doses of salbutamol delivered, via metered dose inhaler (MDI) during non-invasive mechanical ventilation (NIMV-MDI), during spontaneous breathing using a spacer (MDI-Spacer), and also during intermittent positive pressure breathing (IPPB). Setting: A respiratory intensive care unit. Design: Prospective, randomized, and placebo-controlled study. Patients: Eighteen stable patients with chronic obstructive pulmonary disease (mean FEV1 = 38.5 ± 8.8 % predicted). Results: Overall salbutamol administration induced, compared to placebo, a significant improvement in FEV1, irrespective of the mode of administration (+7.9 ± 7.1% or +108 ± 91 ml for IPPB, +9.6 ± 8.8 % or 112 ± 67 ml for MDI-NIMV (inspiratory pressure = 14.3 ± 1.8 cmH2O; expiratory pressure = none), and +10.8 ± 11.4 % or 119 ± 114 ml for MDI-Spacer, respectively). ΔAFVC significantly increased from placebo only in MDINIMV (+214 ± 182 ml P = 0.02). A second set of experiments performed in eight patients to ascertain the possible effect of NIMV on pulmonary function tests, showed a significant improvement from baseline values in FVC both after the delivering of placebo or salbutamol via NIMV-MDI (+206 ± 147 ml and 208 ± 145, respectively). FEV1 significantly increased only after salbutamol. No changes in gas exchange were observed after bronchodilator delivery. Conclusions: We show that delivery of bronchodilators via MDI with a spacer chamber during NIMV is feasible and induces a significant bronchodilator effect compared to placebo, even though it may be slightly less effective than the classical delivery system (MDI-Spacer)
Effect of salbutamol and inhaled sodium cromoglycate on the airway and neutrophil chemotactic activity in "fog"induced bronchospasm
No full textTo investigate whether salbutamol and sodium cromoglycate (SCG) inhibit airway response and the associated mediator release induced by ultrasonic nebulation of distilled water (UNDW, "fog"), we measured the serum neutrophil chemotactic activity (NCA) during bronchial challenge with "fog" with and without premedication with placebo, salbutamol, or SCG in 10 subjects with asthma, in four sets of studies. To assess changes in airway caliber, we measured FEV1. To assess changes in NCA, we measured the maximal distance reached by neutrophils in a filter when neutrophils were challenged with the subject's serum in a Boyden chamber. Treatment with placebo did not change baseline FEV1 or serum NCA; however, FEV1 decreased and serum NCA increased (p less than 0.05) after inhalation of "fog". Treatment with SCG did not affect either FEV1 and baseline serum NCA. After inhalation of "fog", no significant bronchoconstriction nor NCA increase was observed in eight of 10 patients with maximal mean percent decrease in FEV1 of -4.26, SEM 0.99, and maximal mean percent increase in NCA of +8.6, SEM 5.28. In the two patients who developed a bronchoconstriction after challenge with SCG pretreatment, an associated significant increase in NCA was observed but did not affect baseline NCA. After inhalation of "fog", no significant decrease in FEV1 (maximal mean percent decrease FEV1, -6.71, SEM 0.17) nor significant increase in serum NCA (maximal mean percent increase NCA, +3.6, SEM 7.1) was observed in nine of 10 patients. After salbutamol, only one patient developed a bronchoconstrictive response to "fog" associated with a significant increase in serum NCA. These results suggest that both SCG and salbutamol may prevent the bronchoconstriction induced by "fog" by inhibiting mediator release
Physiological effects of flow and pressure triggering during non-invasive mechanical ventilation in patients with chronic obstructive pulmonary disease
No full textBACKGROUND:
The effect of the type of trigger system on inspiratory effort has been studied in intubated patients, but no data are available in non-invasive mechanical ventilation where the "trigger variable" may be even more important since assisted modes of ventilation are often employed from the beginning of mechanical ventilation.
METHODS:
The effect of flow triggering (1 and 5 1/min) and pressure triggering (-1 cm H2O) on inspiratory effort during pressure support ventilation (PSV) and assisted controlled mode (A/C) delivered non-invasively with a full face mask were compared in patients with chronic obstructive pulmonary disease (COPD) recovering from an acute exacerbation. The patients were studied during randomised 15 minute runs at zero positive end expiratory pressure (ZEEP). The oesophageal pressure time product (PTPoes), dynamic intrinsic PEEP (PEEPi,dyn), fall in maximal airway pressure (delta Paw) during inspiration, and ventilatory variables were measured.
RESULTS:
Minute ventilation, respiratory pattern, dynamic lung compliance and resistances, and changes in end expiratory lung volume (delta EELV) were the same with the two triggering systems. The total PTPoes and its pre-triggering phase (PTP due to PEEPi and PTP due to valve opening) were significantly higher during both PSV and A/C with pressure triggering than with flow triggering at both levels of sensitivity. delta Paw was larger during pressure triggering, and PEEPi,dyn was significantly reduced during flow triggering in the A/C mode only.
CONCLUSIONS:
In patients with COPD flow triggering reduces the inspiratory effort during both PSV and A/C modes compared with pressure triggering. These findings are likely to be due to a reduction in PEEPi,dyn and in the time of valve opening with a flow trigger
Use of bronchodilators during non-invasive mechanical ventilation
No full textBronchodilators represent one of the most important therapeutic weapons for the treatment of airway obstructive diseases and the inhaled route of administration is very often employed due to the greater drug availability and reduced magnitude of side effects. During acute exhacerbations, it is not unfrequent that the elastic and resistive loads imposed on the ventilatory pump overcome the force sustainable by the respiratory muscles and the patient requires ventilatory assistance, in order to relieve fatigue and to optimize alveolar gas exchange. During these episodes, inhaled bronchodilators, far from being discontinued, sometime must be administered during mechanical ventilation, that, in hypercapnic ventilatory failure can be frequently applied noninvasively with a good rate of success. While in the current literature there are a lot of data about inhaled drug administration during invasive mechanical ventilation, very few data are available on the topic of aerosol therapy during noninvasive mechanical ventilation. With the present paper we want to analyze the rationale, the feasibility and the current data dealing with the administration of inhaled drugs during noninvasive mechanical ventilation
[Kinetocardiographic curve in chronic cor pulmonale caused by chronic obstructive bronchopneumopathy]
No full text[Respiratory oscillations of right intraventicular pressures in chronic obstructive bronchopneumopathies]
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