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Biomedical subjects

A A Jeffrey

Publications and source records attributed to A A Jeffrey.

10 recordsLinked to original sources
PubMed2003

Is preparation for bronchoscopy optimal?

The results of a questionnaire survey, of the current preparation for and practice of diagnostic bronchoscopy in England and Wales, are reported in this paper. The British Thoracic Society (BTS) has recently published guidelines on bronchoscopy and these provide a consensus statement on the current evidence base. There is no specific guidance on drugs or techniques, although it is recommended that all patients should be offered sedation, except where there are contraindications. In the present survey, there was a response rate of 76%, (344 responses to 452 questionnaires) and the median number of bronchoscopies performed per session was 5 (interquartile range 4-6). Most operators use lignocaine gel to the nose (65%), spray to the throat (70%), followed by the "spray as you go" method (84%), recommended by the BTS. Atropine is routinely used by 13% contrary to the guidelines and despite concerns about its side-effects. Most operators use sedation with midazolam (85%) or a wide variety of combinations of sedative, analgesic, and anaesthetic agents (27%), and 27% perform unsedated bronchoscopies, with only 0.1% routinely performing unsedated bronchoscopies. A total 251 (77%) responders stated they assessed adequacy of sedation, with most using patient observation alone (149 (46%)). Only three operators assessed sedation using a formal sedation score. Thus, most centres routinely perform sedated bronchoscopies and the systematic level of monitoring is poor. The current controversies about sedation and safe sedation practice are discussed. There is a need for more evidence to allow more specific guidance to be produced in this difficult area.

Adult↗
PubMed1994

Community acquired lobar pneumonia in patients with HIV infection and AIDS.

BACKGROUND: Community acquired bacterial pneumonia is increasingly encountered in HIV infected individuals and some patients have a radiographic lobar pneumonia. METHODS: A retrospective review of clinical features, microbiological diagnosis, and outcome of community acquired lobar pneumonia was carried out in HIV positive patients admitted to a specialist unit from 1987 to 1993. RESULTS: Forty nine episodes occurred in 45 patients, all of whom were men. CD4 counts ranged widely. A bacteriological diagnosis was made in 25 episodes (51%), seven patients had more than one infective cause. The commonest pathogens were Streptococcus pneumoniae (11 episodes), Staphylococcus aureus (six), Pneumocystis carinii (three), Haemophilus influenzae (three), and Pseudomonas aeruginosa (two). Four patients died. Other complications included intrapulmonary cavitation or abscess formation (11 episodes), empyema (three), and pleural effusion (10 episodes). CONCLUSIONS: Many different infections cause community acquired lobar pneumonia in HIV positive men. Some patients have co-infections and there is a high complication rate.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Acute hypercapnic respiratory failure in patients with chronic obstructive lung disease: risk factors and use of guidelines for management.

BACKGROUND: On the basis of a retrospective survey by this unit it was suggested that patients with acute ventilatory failure should be given sufficient controlled oxygen treatment to raise the arterial oxygen tension (PaO2) to above 6.6 kPa, with the addition of a respiratory stimulant if the hydrogen ion concentration ([H+]) rose above 55 nmol/l and assisted ventilation if the patient remained acidotic despite these measures. This study was designed to verify the prognostic factors that determine survival in acute ventilatory failure and determine the outcome when our guidelines were implemented. METHODS: One hundred and thirty nine episodes of acute hypercapnic (type II) respiratory failure were studied prospectively in 95 patients admitted with acute exacerbations of chronic obstructive lung disease. Patients had to have a PaO2 below 6.6 kPa and an arterial carbon dioxide tension (PaCO2) above 6.6 kPa while breathing air. RESULTS: The mortality associated with episodes of acute ventilatory failure was 12%. Patients who died tended to be older and were significantly more acidotic, hypotensive, and uraemic on admission than those who survived, but they had similar degrees of hypoxaemia and hypercapnia. Death occurred in 10 of the 39 episodes in which arterial [H+] rose to 55 nmol/l or above, compared with seven of the 100 episodes in which it remained below 55 nmol/l. The respiratory stimulant doxapram was used in 37 episodes and was associated with a reduction in [H+] below 55 nmol/l within 24 hours in 23 episodes. Assisted ventilation was used in only four episodes. CONCLUSION: Arterial [H+] is an important prognostic factor for survival. Most patients treated according to the guidelines outlined above can be managed successfully without assisted ventilation.

Doxapram↗
PubMed1992

Should we judge a mask by its cover?

BACKGROUND: A table of the approximate ranges of inspired oxygen delivered at given oxygen flow rates is often given on the packaging of oxygen masks. A study was carried out to check the inspired oxygen concentration given by one of the new masks, which has been designed to be used with or without the Venturi attachment as a result of the proposal to use it without the Venturi attachment as a general purpose mask for emergency use. METHODS: Measurements were made at resting respiratory rate and 26 breaths/min in 12 normal subjects. Continuous oxygen and carbon dioxide concentrations were recorded at the lips with a mass spectrometer, and inspired oxygen concentrations were calculated from end tidal values by means of the alveolar gas equation. Measurements were made at oxygen flow rates of 2, 4, and 6 l/min for the mask alone and at 2 and 4 l/min with both the 24% and the 28% Venturi attachments. RESULTS: Without the Venturi attachment the mask gave average inspired oxygen concentrations 8-10% greater than are stated on the packaging at oxygen flow rates of 2, 4, and 6 l/min at resting respiratory rates of 8-20 breaths/min, some individuals receiving 30% more than expected. Addition of the interchangeable Venturi attachments designed to give 24% and 28% inspired oxygen delivered average concentrations within 2% of the expected concentrations, no individual receiving more than 5% above the expected concentrations. CONCLUSIONS: The labelling on the packaging of oxygen masks may lead to inappropriate use by those not expert in prescribing oxygen therapy. Caution is still needed when a single multipurpose mask is being selected for emergency use, where accurate delivery of low concentrations of oxygen is vital for some patients.

Adult↗
PubMed1991

Dose of nebulized ipratropium bromide in acute severe asthma.

The aim of the study was to determine the maximum effective dose of nebulized ipratropium bromide, 0.5 or 1.0 mg, in the treatment of acute severe attacks of asthma. Thirty-two patients (ten males, 19-53 years) who were admitted with acute severe asthma were, in a double-blind trial, randomized to receive either 0.5 or 1.0 mg of isotonic, preservative-free ipratropium bromide nebulized in saline. Ear oxygen saturation, peak flow and heart rate were measured on admission and regularly following nebulization. Two hours after nebulization of the ipratropium, terbutaline (5 mg) was administered by nebulizer and further measurements taken 30 min later. Twenty-six patients completed the study, 13 in each group. Peak expiratory flow (PEF) increased by 51% [1211 min-1 increasing to 1831 min-1 (mean)] in the 0.5-mg ipratropium group, and by 37% (1551 min-1 to 2071 min-1) in the 1.0-mg group. There were no significant differences in heart rate or ear oxygen saturation changes between the groups. Nebulized terbutaline led to a small further rise in peak flow in both groups (341 min-1 in the 0.5-mg group; 411 min-1 in the 1.0-mg group). No side-effects were noticed in either group. We conclude that 0.5 mg of nebulized ipratropium is as effective as 1.0 mg in the treatment of acute severe asthma.

Acute Disease↗
PubMed1991

HIV isolation from pulmonary cells derived from bronchoalveolar lavage.

In a study of 75 alveolar cell co-cultures from 55 HIV-seropositive subjects, p24 antigen production was identified by ELISA in 11 out of 26 (42%) of unseparated cell cultures, 15 out of 39 (38%) purified alveolar macrophage cultures and eight out of 10 purified alveolar lymphocyte samples. Positivity in unseparated cell cultures was associated with an alveolar lymphocytosis greater than 30%. Negative macrophage cultures were significantly more likely in the early stages of HIV infection with none positive when the subject had a peripheral CD4+ cell count greater than 300/microliters. Alveolar macrophage infection thus appears to increase with HIV disease progression.

Bronchoalveolar Lavage Fluid↗
PubMed1990

Comparison of perfusion lung scanning and angiography in the estimation of vascular obstruction in acute pulmonary embolism.

To determine the relationships between perfusion scan defect and angiographic severity (Miller index) in acute pulmonary embolism, we analysed examinations obtained before and after thrombolytic therapy in 34 consecutive patients free from underlying cardiopulmonary disease. The overall agreement between the two techniques was excellent (r = 0.82; mean absolute difference = 2.8%), although when embolic involvement was extensive (greater than 50% angiographic obstruction), the perfusion scan moderately underestimated (4%) the defect seen angiographically. These findings suggest that the pulmonary lung scan is a reliable method of assessing the initial pulmonary vascular obstruction as well as of quantifying any changes induced by or associated with the treatment.

Angiography↗
PubMed1989

Accuracy of inpatient oxygen administration.

The accuracy of supplemental oxygen delivery was assessed in two medical units. Only 90 of 206 patients (44%) were receiving oxygen as prescribed. The ward oxygen rotameters were inaccurate at normal clinical flow rates, the range of flows being delivered as a percentage of the indicated flow varying from 15% at 8 l/min to 40% at 1 and 2 l/min.

Equipment Design↗
PubMed1989

Clinical features of the sleep apnoea/hypopnoea syndrome.

The sleep apnoea/hypopnoea syndrome has been reported to be rare in Britain. We have offered a clinical service for the diagnosis and treatment of this condition in Scotland for four years during which there has been an increase in referral rate from 19 patients in year 1 to 61 in year 4. We report the clinical features of the 80 patients. Seventy-eight snored and 70 were somnolent, each falling asleep at least once each day when not in bed. Ten reported falling asleep whilst driving or flying. Twenty-nine slept restlessly, 28 were not refreshed by sleep and 21 had nocturnal choking attacks. Ankle swelling was reported by 26 and 25 were hypertensive (diastolic BP greater than 95 mmHg). Two had hyperthyroidism and one acromegaly. Nineteen have been successfully treated by continuous positive airway pressure therapy at home. The data suggest that regional centres should be established in Britain to diagnose and treat this condition.

Adolescent↗