摘要:

Chronic lung disease (CLD) and any consequent disease-related muscle myopathy along with deconditioning can cause both dyspnea and/or leg discomfort during exertion. These unpleasant experiences frequently lead an individual to reduce or even eliminate daily tasks which adversely impacts quality of life for the individual. The primary goal of exercise training is to restore the individual patient to the highest possible level of independent function. Improvements in exertional breathlessness observed following an exercise training program may be due to a physiologic training effect, enhanced mechanical efficiency, and/or psychologic desensitization. Any symptomatic patient with CLD who is motivated to participate should be referred to a pulmonary rehabilitation program. Exercise prescription is based on the principle of “overload” training. Although there is no optimal or best training regimen established for patients with CLD, we provide general guidelines for the mode, frequency, intensity, and duration of exercise training. The recommendedminimalintensity of exercise training is 50% of peak work rate, although exercise at “maximal limits tolerated by symptoms” may also be prescribed. The recommendedminimalduration of training is 20 to 30 minutes of continuous exertion. Resistance training should be incorporated into a comprehensive exercise program. One approach for patients with CLD to monitor their training intensity is to use a “dyspnea target” as a guide for intensity of training effort.

ISSN:1068-0640    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Recent data confirm the role ofChlamydia pneumoniaeinfection in a wide range of infections involving the upper and lower respiratory tract. Furthermore, it has now been shown that this previously considered relatively benign infection may be associated with severe forms of both pneumonia and chronic obstructive pulmonary disease exacerbations. An association betweenC. pneumoniaeand asthma has more convincingly been established, and the line of research has now shifted to addressing whether chronic infection may actually affect the natural history of bronchial asthma.C. pneumoniaeinfection in immunocompromised patients is a relatively new and unexplored field that may open interesting future research. Given the increasing importance of this microorganism in respiratory medicine, the precise definition of optimal diagnostic techniques becomes mandatory. Specifically, the relative role of serology, culture, and nucleic acid amplification tests must still be determined. Although convincing in vitro data have been gathered on antibiotic activity towardC. pneumoniae, optimal dosing and length of treatment in vivo have not yet been defined. Should the role ofC. pneumoniaeinfection be confirmed in chronic respiratory and extrapulmonary diseases, eradication of this microorganism and/or prevention of infection by means of large scale vaccination may prove to have a major impact on public health world wide.

ISSN:1068-0640    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Prominent alveolar fibrin deposition characterizes the adult respiratory distress syndrome (ARDS). Increased local expression of procoagulant activity and concurrently decreased fibrinolytic activity promote alveolar fibrin deposition in the lungs in ARDS. Thrombi in the lung vasculature and disseminated intravascular coagulation also occur in association with ARDS, further suggesting that disordered fibrin turnover may contribute to the pathogenesis of the syndrome. The fibrinolytic defect in ARDS potentiates alveolar fibrin deposition and organization of the fibrinous neomatrix, resulting in lung dysfunction and fibrotic repair. Similar disorders of pathways of fibrin turnover occur in systemic sepsis and these have recently been exploited to clinical advantage. Anticoagulant strategies have successfully been used in recent interventional trials in septic patients. The results of these trials suggest the possibility that this approach could be extrapolated to protect the lung in ARDS. Recent preclinical trials demonstrate that that similar anticoagulant strategies are feasible and effective in primates with evolving ARDS. Additional preclinical studies are now being performed to determine if fibrinolytic interventions likewise protect against lung injury in ARDS. Small clinical trials and case reports suggest that fibrinolysins can be of clinical benefit in selected patients with ARDS and support this approach. However, these agents increase the risk of bleeding. At this time, the use of fibrinolysins in ARDS patients is not routine and their place in the therapy of ARDS remains to be established.

ISSN:1068-0640    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Lung diseases that are frequently seen in young people, such as bronchial asthma, pneumonia, and tuberculosis, occur with comparable prevalence in pregnant women. Their treatments do not greatly differ from those used in the nonpregnant state. However, pharmacokinetics of these drugs undergo changes due to the physiologic variations induced by pregnancy that we must consider. On the other hand, some drugs used for lung disease have a teratogenic potential and thus carry a risk for the fetus. In this article, we review the drugs most commonly used for the treatment of respiratory diseases in pregnancy and lactation and discuss the current data of their possible effects on the fetus and neonate. Asthma is the most common potentially serious medical disease complicating pregnancy and should be treated as aggressively in pregnant women as in nonpregnant women, because the perceived risk to the fetus caused by pharmacologic therapy is much less than the risk of uncontrolled asthma and the resulting hypoxia. Antepartum pneumonia and tuberculosis require prompt evaluation and empiric antimicrobial therapy. The clinician must choose antimicrobial agents considering efficacy as well as safety for both mother and fetus. Among the agents for antithrombotic therapy, heparin is the anticoagulant of choice during pregnancy. Data on the use of low molecular weight heparins are encouraging, but clinical experience with these agents is still limited. Oral anticoagulant therapy should be avoided because of its teratogenic potential and increased risk of fetal complications, and the use of thrombolytic agents must be limited to life-threatening situations.

ISSN:1068-0640    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This study was undertaken to document the costs of nosocomial infections in the intensive care unit (ICU) and the impact of programs to reduce risks and costs of these infections. MEDLINE was searched from 1990 to 2000. The search strategy was: costs OR economics AND intensive care unit AND nosocomial infection ‘AND guidelines’ was added in a secondary search. The overall additional costs associated with hospital-acquired infections in the ICU varied from $3000 to $40,000 per patient and is associated with an additional length of stay of 5 days to roughly 3 weeks. The mean cost of antibiotics has been estimated from $1000 to $16,000. Implementing guidelines and screening and isolation programs reduced the rate of infection and the costs both of both antiinfectious agents and hospital days. The expected savings from reduction in the rate and severity of nosocomial infections offset the costs of implementing prevention programs.

ISSN:1068-0640    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Pulmonary surfactant is a complex mixture of lipids and protein, which works principally to lower the surface tension of the air liquid interface within the airways and reduce the work of breathing. Deficiency of surfactant in the premature newborn is a principal mechanism in the development of respiratory distress in that population. Over the past decade, surfactant replacement therapy in premature infants has significantly increased survival and decreased the likelihood of significant long-term pulmonary sequelae. Surfactant deficiency in adults with acute respiratory distress syndrome has long been recognized. Although clinical trials of surfactant therapy in adults have not achieved the level of success seen in neonates, multiple recent trials have suggested that success is possible. These results have fueled currently ongoing large clinical trials. The past decade has also revealed that surfactant’s roles are far more numerous than lowering alveolar surface tension. Surfactant also contributes to maintaining the patency of conducting airways, host defense, and mucociliary clearance. The importance of these newly identified roles has been supported by evidence of surfactant dysfunction in airway diseases other than adults respiratory distress syndrome, including asthma and chronic bronchitis. This report reviews the following: (1) surfactant synthesis and composition, (2) surfactant functions, (3) clinical states of surfactant deficiency, and (4) the status of surfactant replacement therapies.

ISSN:1068-0640    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Surgery is currently the only potentially curative treatment modality for patients with early-stage non–small-cell lung cancer. Because of a high prevalence of chronic obstructive pulmonary disease in patients with lung cancer, they represent a special subset of patients for whom preoperative evaluation of cardiopulmonary status is especially important. The goal of preoperative evaluation of patients with lung cancer is to assess whether the neoplasm is surgically resectable and to estimate the risk of perioperative morbidity and mortality. Screening spirometry should be obtained in all patients. If the preoperative FEV1is less than 60% of the predicted normal, predicted postoperative FEV1(PPO-FEV1) should be estimated based upon the preoperative value and the functional contribution of the lung to be resected. Patients with PPO-FEV1of more than 40% of predicted normal can tolerate pneumonectomy. In patients who appear borderline candidates for surgery based on static lung function criteria, cardiopulmonary exercise testing with measurement of maximum oxygen consumption (&OV0312;O2max) can further help stratify patients in terms of their risk for perioperative mortality or complications of surgical resection.

ISSN:1068-0640    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Benzocaine is widely used as a topical anesthetic and is also present in a number of over-the-counter preparations. Methemoglobinemia is a rare, but potentially serious, complication of its use; a fact that is not well documented in thePhysician’s Desk Referenceor product inserts. Unfamiliarity with this complication may delay diagnosis and appropriate therapy. A case of methemoglobinemia occurring as a complication of using benzocaine during bronchoscopy is presented and is followed by a review of the literature and discussion of the pathophysiology, clinical presentation, diagnosis, and treatment of acquired methemoglobinemia. Methemoglobin is incapable of carrying oxygen and is formed when the ferrous iron in the heme molecule is oxidized to the ferric state. The normal mechanisms that convert methemoglobin back to hemoglobin can be overwhelmed by many oxidant drugs, resulting in toxic methemoglobinemia. The diagnosis should be entertained when cyanosis, unresponsive to 100% oxygen therapy, appears suddenly, especially when exposure to an oxidant drug is established. Diagnosis is confirmed by multiple-wavelength cooximetry. Most cases require only decontamination and supportive care. Methylene blue is the specific antidote, but should be reserved for more severe cases or if comorbid conditions make mild hypoxia unadvisable. Exchange transfusion or hemodialysis may be indicated in patients who fail to respond to methylene blue.

ISSN:1068-0640    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Synopsis:In patients with emphysema characterized as high risk by both physiologic and radiographic evidence, lung volume reduction surgery has been shown to increase mortality as compared to medical treatment alone.Source:National Emphysema Treatment Trial Research Group. Patients at high risk of death after lung-volume-reduction surgery. N Engl J Med. 2001;345:1075–1083.

ISSN:1068-0640    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Synopsis:Endoscopic ultrasound-guided fine-needle aspiration is a safe and sensitive method for obtaining lymph node samples for cytology and mycobacterial cultures and provides an alternative diagnostic modality in patients With suspected sarcoidosis.Source:Fritscher-Ravens A et al. Diagnosing sarcoidosis using endosonography-guided fine-needle aspiration. Chest. 2000;118:928–935.

ISSN:1068-0640    

出版商:OVID    

年代:2002

数据来源: OVID