摘要:

Gastroesophageal reflux (GER) and asthma are both very common diseases, occurring in approximately 40% and 6% of the population, respectively. Research in this area has focused on three questions: (a) Is there a higher prevalence of GER in asthmatics than in the normal population? (b) Can asthma be induced in the laboratory setting by spontaneous or induced GER? and (c) Does treatment of GER ameliorate the symptoms of asthma? Most studies have found a higher prevalence of GER in asthmatics than in the normal population. However, studies attempting to show an induction of asthma symptoms by reflux, in a laboratory setting, have produced contradictory results. Nevertheless, a number have studies have suggested that effective treatment of GER leads to improvement in asthma symptoms in patients with evidence of both processes.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although saccular bronchiectasis is becoming rare, cylindrical bronchiectasis is increasingly recognized now that thin section computed tomography (CT) scanning is more commonly performed. Patients present with regular sputum production, which may be chronically infected, and frequently with rhinosinusitis. There is often an associated history of wheezy bronchitis in childhood, resolution of symptoms in teenage years, and relapse as an adult, often following a viral illness. The disease may progress insidiously, and undue tiredness is a common symptom. Pathogenesis of established disease involves bacteria-provoked host-mediated inflammatory lung damage. Investigation should include establishing the diagnosis of bronchiectasis and the microbiology of the infection, elucidating the cause if known (in about 40% of cases with the rest being idiopathic), assessing lung structure (by CT) and function, and measuring disease activity. Management might involve prevention, surgery, treatment of specific conditions such as antibody deficiency, as well as treatment of airflow obstruction and sinusitis. Physiotherapy should be taught and practiced regularly to drain the affected lobes. At one extreme antibiotics should be used to eliminate bacteria during an exacerbation, and at the other extreme may be used continuously when lung damage is severe to suppress bacterial numbers and thus control inflammation. If deterioration in lung function occurs despite optimal medical treatment, then lung transplantation might be considered. Improved mucus clearance or control of inflammation seems to be the most likely way future therapy might be improved.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Immune-mediated diffuse alveolar hemorrhage (DAH) occurs in anti-basement membrane antibody (ABMA) disease, systemic vasculitis (Wegener's granulomatosis and microscopic polyangi-itis), systemic lupus erythematosus (SLE), idiopathic pulmonary hemosiderosis, and rarely in other immune disorders. Systemic vasculitis is the most frequent cause of autoimmune DAH. Regardless of the underlying etiology, autoimmune DAH is usually due to necrotizing pulmonary capillaritis. In the vast majority of cases, autoimmune DAH is associated with acute glomerulonephritis. Differentiation of the various causes of autoimmune DAH is accomplished primarily by serologic studies and by renal biopsy; lung biopsy is seldom indicated. Initial treatment in all cases consists of high doses of corticosteroids. Patients who have ABMA disease are treated with both immunosuppression and plasma exchange. Patients with vasculitis are usually treated with corticosteroids and cyclophosphamide, and sometimes with plasma exchange.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Training of medical, nursing, and respiratory therapy personnel in suctioning techniques continues to be done on unresponsive individuals or those who cannot communicate adequately. Some patients also lack the experience or knowledge necessary to provide helpful feedback about their dissatisfaction with the methods of tracheal toilet used. Thus, several questionable and probably undesirable suctioning techniques have become widely used.The availability of the “PEEP-Keep” adapter should help eliminate such traumatic practices as rapid, in-and-out suction catheter passage, which necessitates multiple passes and twisting of the catheter. Unfortunately, such devices are not ordered routinely and even when used are often not accompanied by changes in suctioning technique.For tracheotomized patients who have vocal cord function, there appears to be inadequate dissemination of information about and employment of devices such as the Passy-Muir valve and “talking” tracheostomy tubes. A method of speech allowing complete control by the tracheotomized quadriplegic patient employing a switching device, remote control, “talking” tracheostomy tube, and suction is described.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The goal of extracorporeal membrane oxygenation (ECMO) is oxygenation of the arterial blood. Complete saturation of arterial blood with oxygen requires the extracorporeal treatment of almost all of the blood (extracorporeal blood flow of about 90% of the baseline cardiac output). Venoarterial ECMO provides cardiopulmonary bypass and is employed for cardiac support. During venoarterial ECMO, pulmonary blood flow is reduced to less than 25% of normal. In venovenous ECMO there is no cardiopulmonary bypass, and all blood flow passes through the natural heart and lung of the patient. The goal of low frequency positive pressure ventilation-extracorporeal C02 removal (LFPPV-ECC02R) is removal of C02 to rest the patient's natural lung. All of the metabolically produced C02 can be removed with an extracorporeal blood flow of 20%-25% of baseline cardiac output. Bleeding is the most common and serious complication of prolonged extracorporeal support. It appears from published data that survival of adult respiratory distress syndrome patients meeting ECMO criteria is the same whether supported with mechanical ventilation alone or with LFPPV-ECCO2R. Controlled clinical trials have failed to show a favorable impact of ECMO or LFPPV-ECCO2R on survival of adults with ARDS. We think that the use of extracorporeal support techniques for adults with ARDS should be limited to developmental centers or to controlled clinical trials.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Patients with acute respiratory failure (ARF) or chronic respiratory failure (CRF) require a systematic approach to nutritional assessment and support. Anthropomorphic measurements coupled with serum albumin and prealbumin levels indicate initial nutritional status. Nutritional support should address both protein and caloric needs. A 24-hour urine collection for urinary urea nitrogen can help predict total protein needs in patients with stable renal function. Indirect calorimetry can accurately measure energy expenditure under resting or weaning conditions for patients receiving less than 60% oxygen. Compared with parenteral nutrition, enteral feedings reduce hospital morbidity and mortality. Measurement of protein and caloric needs for ARF patients can be difficult because of fluctuating energy demands and renal function. CRF patients are metabolically more stable than ARF patients. This difference allows for direct measurement of caloric and protein needs of patients with CRF. Algorithms for managing patients with CRF in various nutritional states are provided. Principles important in nutritional support for patients with respiratory failure include defining the goal of nutritional support, assessing the patient's caloric and protein needs, and documenting the maintenance of protein stores. Innovations in nutritional support include the use of omega-3 fatty acids, glutamine, argi-nine, and other compounds to help enhance immune function.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Abstract from LiteratureSYNOPSIS:Understanding diffuse panbronchiolitis, an inflammatory COPD-like syndrome seen commonly in the Orient, may provide insight into mechanisms and treatment of COPD and cystic fibrosis, diseases that are common in Western countries.SOURCES:Koyama H et al.: Bronchial responsiveness and acute bronchodilators response in chronic obstructive pulmonary disease and diffuse panbronchiolitis. Thorax 1994;49:540–4. Tamaoki J et al.: Effect of long term treatment with oxitropium bromide on airway secretion in chronic bronchitis and diffuse panbronchiolitis. Thorax 1994;49:545–8.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Abstract from LiteratureSYNOPSIS:TWO recent cost-effectiveness analyses suggest that the use of HEPA filter masks—mandated in recent Centers for Disease Control and Prevention and Occupational Safety and Health Administration guidelines—are an extremely costly method offering only marginal improvement over previously employed techniques of tuberculosis prevention.SOURCES:Nettleman M et al.: Tuberculosis control strategies: the cost of particulate respirators. Ann Intern Med 1994;121:37–40. Adal KA et al.: The use of high-efficiency particulate air-filter respirators to protect hospital workers from tuberculosis. New Engl J Med 1994;331:169–73.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Abstract from LiteratureSynopsis:Two reports in animal models of sepsis suggest that induction of heat shock proteins of the 72-kilodalton family enhance survival and reduce lung injury.SOURCES:Villar J et al.: Induction of the heat shock response reduces mortality rate and organ damage in a sepsis-induced acute lung injury model. Crit Care Med 1994;22:914–21. Ribeiro SP et al.: Sodium arsenite induces heat shock protein-72 kilodalton expression in the lungs and protects rats against sepsis. Crit Care Med 1994;22:922–9.

ISSN:1068-0640    

出版商:OVID    

年代:1994

数据来源: OVID