PubMed Health⌕ Search

Biomedical subjects

B Schucher

Publications and source records attributed to B Schucher.

12 recordsLinked to original sources
PubMed2004

[Noninvasive mechanical ventilation in patients with stable severe COPD].

Noninvasive positive pressure ventilation in patients with stable chronic obstructive pulmonary disease. The role of non-invasive positive pressure ventilation (NIPPV) is well documented in patients with restrictive thoracic diseases like kyphoscoliosis, tuberculosis sequelae or neuromuscular disease. There is also a good evidence for the use of NIPPV in acute respiratory failure in patients with an exacerbation of COPD. The application of NIPPV in patients with chronic respiratory failure is growing, but there is less evidence than in restrictive disorders. NIPPV can unload the respiratory muscles in patients with chronic hypercapnic COPD and so alleviates fatigue of the respiratory pump, but improvement in the maximal inspiratory pressure (Pi (max)) is small or even absent. An improvement of sleep quality has also postulated, there was an increase in total sleep time and sleep effectiveness when using higher inspiratory pressure. An increase of the walking distance was shown in short term studies, only. In most studies, there was an increase in quality of life as a main topic. Mortality was unchanged in the two long-term randomised controlled studies. Current data suggest a possible role of NIPPV in patients with severe hypercapnia. A high effective inspiratory pressure and a ventilator mode with a significant reduction in the work of breathing should be choosen. NIPPV should be started in hospital, a close reassessment must be performed. Patients who accepted NIPPV in the first weeks had a good compliance for long-term use.

Humans↗
PubMed2004

[Respiratory therapist: introduction of a new profession].

Respiratory therapists are healthcare professionals taking care of patients with pulmonary disorders. They are an allied health specialty, practicing under medical direction. The professionalism of nurses and therapists must grow up to act successfully in new fields of medicine, where evidence-based independent action is necessary. Specialized therapists can help us coordinate separated processes (diagnoses, therapy and nursing). The profession "Respiratory Therapist" was created in the United States 50 years ago. We intend to introduce this profession also in Germany. We follow many other countries who have already taken this step. We hope that we can reach yet a higher quality of patient care.

Evidence-Based Medicine↗
PubMed1999

[Acceptance and long-term results of home mechanical ventilation in various thoracic diseases].

BACKGROUND: Home mechanical ventilation (HMV) is an important therapy for patients with respiratory insufficiency on the basis of neuromuscular diseases (NMD), chest wall deformities (CWD) and chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: We retrospectively analyzed the long-term results of all 144 patients (CWD = 47, COPD = 54, NMD = 43) who underwent a trial of non-invasive HMV from March 1990 to September 1997. RESULTS: Twenty-eight patients did not accept the HMV (19%), 7 with CWD (15%), 17 with COPD (32%) and 4 with NMD (9%). Thirty-nine of 113 patients, who accepted HMV, completed nasal ventilation for a minimum of 1 year. For all 3 groups the hypercapnia improved significantly (CWD 58 +/- 6 to 48 +/- 4 mm Hg, p < 0.001, COPD 61 +/- 7 to 46 +/- 6 mm Hg, p < 0.001, NMD 53 +/- 8 to 42 +/- 6 mm Hg, p < 0.001). CONCLUSION: HMV improves the hypercapnic ventilatory failure independent of the underlying disease. The rate of acceptance is lower in patients with COPD in comparison to CWD and NMD.

Home Nursing↗
PubMed1999

[Quality of life of various patient groups during home mechanical ventilation].

BACKGROUND: During home mechanical ventilation quality of life depends on improvement of ventilation and progress of the underlying disease. PATIENTS AND METHODS: Patients with chronic obstructive pulmonary disease (COPD; n = 11), neuromuscular diseases (NMD; n = 8) and scoliosis (n = 8) answered before and after 306 +/- 232 (64 to 910) days home mechanical ventilation a standardized and validated questionnaire (SF 36, Medical Outcomes Trust, Boston, USA). RESULTS: For all patients together physical functioning (16 +/- 22 to 24 +/- 26%), general health (33 +/- 15 to 41 +/- 20%) and vitality (25 +/- 16 to 45 +/- 22%) improved significantly (p < 0.05). For COPD vitality (22 +/- 15 to 46 +/- 22%), for patients with NMD mental health (62 +/- 9 to 70 +/- 10%) and for patients with scoliosis vitality (35 +/- 15 to 59 +/- 22%) and mental health (61 +/- 11 to 74 +/- 4%) improved. CONCLUSION: Home mechanical ventilation improves quality of life, but the improvement depends on the underlying disease.

Female↗
PubMed1999

[Intermittent assisted ventilation in neuromuscular diseases: course and quality of life].

Intermittent non-invasive home ventilation is expected to improve the quality of life, but progression of underlying neuromuscular diseases may lead to a deterioration. We observed after 82-1085 days of such home mechanical ventilation (7 patients with muscular dystrophy (age [mean/std.) 33 +/- 15 years), 8 patients with amyotrophic lateral sclerosis (ALS. age 60 +/- 8 years) a nonsignificant decrease of vital capacity (1.6 +/- 0.4 rp. 1.2 +/- 0.4 l) and an improvement of hypercapnia (49.3 +/- 8.5 rp. 43 +/- 18.5 mmHg). Quality of life (SF-36, Medical Outcomes Trust, Boston, USA) increased significantly only for mental health in patients with ALS (55 +/- 13 rp. 64 +/- 17%). Despite progression of the underlying disease the quality of life remained stable under home mechanical ventilation and mental health improved.

Adult↗
PubMed1999

[Use of home mechanical ventilation in patients with high grade chronic obstructive lung disease (COPD)].

UNLABELLED: Nasal intermittent positive pressure ventilation (NIPPV) ist well established in the treatment of chronic hypercapnic ventilatory failure in patients with scoliosis or neuromuscular diseases. It has been introduced in acute respiratory failure in patients with COPD. The role of NIPPV in the long term treatment in severe stable hypercapnic COPD patients has not been well established (Thorax 1996; 51: 455-7). PATIENTS AND METHODS: We analysed the results of blood gases and lung function in all stable chronic hypercapnic COPD patients (PaCO2 59 +/- 6 mmHg), who underwent a trial of NIPPV from 11/95 to 1/98 (n = 25; 12 f/13 m; mean age 62 +/- 10 years). Patients with acute respiratory failure or an additional obstructive sleep apnoea syndrome were excluded. NIPPV was performed over an individual hand-molded nasal mask in the assisted/controlled mode (4 volume-, 21 pressure-cycled). At the time of discharge (25 +/- 15 days after the initiation of NIPPV) patients were able to apply the ventilator during night for al least 6 h. At the time PaCO2 during NIPPV was 43 +/- 6 mmHg. RESULTS: 5 patients failed to continue NIPPV for long-term treatment, so it was discontinued after a period of 6 weeks. 20 patients (80%) continued NIPPV for 13 +/- 8 months (range 1-27 months), 2 patients died during NIPPV (after 1 and 13 months). NIPPV had no significant influence on lung function (FEV1 predicted 28 +/- 13 vs. 30 +/- 11%; intrathoracic lung volume 6.9 +/- 2.5 vs. 6.2 +/- 1.7 l) or respiratory muscle strength (Pimax 4.2 +/- 0.9 vs. 4.5 +/- 1.6 kPa). However, we observed a significant improvement in PaCO2 during spontaneous breathing (59 +/- 6 vs. 48 +/- 8 mmHg; p < 0.001) and in case of base excess (7.4 +/- 4.1 vs. 3.4 +/- 2.4 mmol/l; p < 0.003). CONCLUSION: NIPPV can improve hypercapnic ventilatory failure in a subgroup of severe stable COPD, provided patients are motivated and home mechanical ventilation is adequately performed.

Adult↗
PubMed1997

[The etiology of chronic hypercapnia].

BACKGROUND: The ventilatory and the pressure response to CO2 in patients with advanced thoracic disorders are critically dependent on the mechanics of the lung and the respiratory muscles. Changes in drive, therefore, can not be directly assessed with that method. However during changes as a result of intermittent mechanical ventilation, changes in drive can be assessed, if lung and muscle mechanics remain unaffected. In addition, to study changes in ventilatory drive independently in patients successfully treated by intermittent mechanical ventilation, we determined the recruitment threshold, pCO2RT, of the unloaded ventilatory pump to CO2. PATIENTS: 16 patients with various disorders (4 COPD, 4 COPD and sleep apnoea, 7 scoliosis, 1 fibrothorax) were studied, 14 during nasal IPPV and 2 during mechanical ventilation via tracheostomy. RESULTS: After they had been successfully adapted to the ventilator, they were entered into the study. The apnoea threshold in all cases had already been reached during the adaptation period. pCO2AT was determined 32 +/- 5 mm Hg. While the patients were passively ventilated, the inspiratory CO2 was increased every 5 minutes, resulting in a stepwise increase in arterial pCO2 by 3 mm Hg. The recruitment threshold pCO2RT was then defined as the lowest pCO2, which resulted in a deformation of the inspiratory pressure curve by the patients own inspiratory efforts. pCO2RT was reproducible within trials and in different trials with a standard error of 1.2 mm Hg. It was found 6 +/- 4 mm Hg above the pCO2 during spontaneous breathing (p < 0.01) in all patients. pCO2RT decreased from 58 +/- 10 to 47 +/- 4 mm Hg during intermittent IPPV and so did the threshold during CO2 rebreathing, while spontaneous pCO2 decreased from 53 +/- 12 to 42 +/- 5 mm Hg. The slope, reflecting drive was decreased to 0.28 compared to normals but remained unchanged 0.32 (n. s.) during the study. Lung function did not change. A highly significant increase in the indices of maximal inspiratory force was observed (p < 0.002) and as a result a decrease in the inspiratory demand (p < 0.008). CONCLUSION: Intermittent IPPV does efficiently suppress phasic respiratory drive via thoracic afferent inhibition and therefore effectively unloads the ventilatory pump. The CO2 threshold is increased in patients with hypercapnic ventilatory failure, probably to minimise the load to the ventilatory muscles. With the increase in inspiratory capacity the pCO2 threshold can be restored to normal by intermittent noninvasive or invasive IPPV.

Adult↗
PubMed1997

[Problems in adjustment to negative pressure ventilation].

We tried to establish a nasal intermittent positive pressure ventilation for a 54-year old patient with post-polio kyphoscoliosis. Due to intractable rhinitis the patient stopped the treatment. A negative pressure ventilation via a cuirass exhibited an inverse ventilation: during the inspiratory cycle of the ventilator the diaphragm was elevated and the patient was forced to exhale, afterwards he needs to inhale by himself. The ventilatory support is now done via a combined nasal-mouth mask and intermittent positive pressure ventilation.

Combined Modality Therapy↗
PubMed1997

[Prospective study of the quality of life in intermittent self-ventilation].

PATIENTS AND METHOD: We assessed quality of life for 17 patients (age 14 to 74 years) before and during intermittent (nightly) nasal home mechanical ventilation with a standardized questionnaire (SF 36, Medical Outcomes Trust, Boston, USA). Underlying diseases were amyotrophic lateral sclerosis, bronchiectasis, kyphoscoliosis, pulmonary emphysema, muscular dystrophy and sequelae of tuberculosis. Blood gas and lung function data were collected during every examination. RESULTS: We observed statistically significant increases for items of general health, mental health, vitality and capillary oxygen partial pressure. CONCLUSION: The SF 36 allows to assess quality of life for patients under intermittent mechanical ventilation at home.

Adolescent↗
PubMed1995

[Effects of intermittent self-ventilation on ventilatory drive and respiratory pump function].

BACKGROUND: A chronic hypercapnic ventilatory failure appears in patients with restrictive chest wall disorders, chronic obstructive pulmonary disease (COPD) or obstructive sleep apnea (OSA), but it can also appear in patients with a disorder of the central respiratory drive. PATIENTS AND METHOD: We studied the lung function, the respiratory muscle function and the PCO2 recruitment threshold (pCO2RT) during nasal intermittent positive pressure ventilation (IPPV) in 16 chronic hypercapnic patients (scoliosis = 8, COPD = 4, OSA = 4). RESULTS: The pCO2RT decreased from 61 +/- 6 mm Hg to 48 +/- 4 mm Hg (p < 0.0001) during intermittent IPPV, while spontaneous pCO2 decreased from 55 +/- 6 mm Hg to 42 +/- 5 mm Hg (p < 0.0001). The load of the respiratory pump decreased (P0.1/P0.1 max:0.27 +/- 0.18 before, 0.15 +/- 0.08 after intermittent IPPV; p < 0.04). CONCLUSION: We conclude, that the pCO2RT can be normalized by intermittent nasal IPPV as well as the pCO2 under spontaneous breathing. The load of the respiratory pump decreases due to an increase of the inspiratory muscle strength.

Adult↗