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Biomedical subjects

M J Kampelmacher

Publications and source records attributed to M J Kampelmacher.

16 recordsLinked to original sources
PubMed2004

[Amyotrophic lateral sclerosis: mechanical ventilation--or not right?].

In two patients (men aged 64 and 62 years, respectively) with amyotrophic lateral sclerosis (ALS) tracheostomy ventilation was initiated following (imminent) acute respiratory failure; in one patient this was done because advance directives were lacking, while in the other non-invasive ventilation (NIPPV) was no longer an option. A third ALS patient, a woman aged 36 years, already had chronic respiratory failure when she presented at the local centre for home mechanical ventilation. As a result, the placement of a percutaneous endoscopic gastrostomy (PEG) was impossible. Instead, she had to use a nasopharyngeal feeding tube, which diminished the effectiveness of her NIPPV. The fourth patient, a man aged 60 years, was referred in good time and hence had sufficient time to consider domiciliary ventilation. Following the placement of a PEG he started NIPPV electively. In patients with ALS, domiciliary ventilation should be discussed early in the course of the disease. Advance directives with regard to domiciliary ventilation are important, not only to avoid undesired (invasive) ventilation, but also with respect to the placement of a PEG and the appropriate use of oxygen and morphine.

Adult↗
PubMed2004

[The symptomatic treatment of amyotrophic lateral sclerosis].

Patients with amyotrophic lateral sclerosis (ALS) have symptoms of progressive muscle weakness, of disturbed speech and swallowing, and in the terminal phase those of respiratory weakness. Treatment options, in particular those for excessive weight loss and respiratory weakness, should be introduced to the patients and their families when the patient is emotionally capable and before dysarthria severely hampers communication. Special equipment for keeping the patient as mobile as possible should be made available much earlier than in the case of other diseases of the muscles as in ALS progression is much faster. Cramps, pathological crying or laughter, spasms, and spasticity can all be treated by medication. When speech can no longer be understood, adaptive strategies such as sign language, mime, posture and communication apparatus varying from a note pad to advanced computer systems can be used. Sialorrhoea, caused by difficulty swallowing with its accompanying danger of aspiration can be halted by the use of medication, by radiotherapy and by the injection into the salivary glands of botulin A toxin. Weight loss, also a result of dysphagia, can be avoided by eating frequent small meals or if necessary performing a percutaneous endoscopic or radiological gastroscopy. Excess mucus in the respiratory tract can be treated with anticholinergics. Difficulty in coughing up thick and sticky mucus cannot always be adequately helped. Respiratory weakness is treatable by external respiratory supportive therapy using a nasal mask, as well as invasive respiratory support via a trachcostoma and by treating the symptoms of respiratory weakness. The latter form of treatment is palliative and forms part of terminal care. During the terminal phase restlessness, anxiety, pain, and dyspnoea require the most attention. Treatment requires careful multidisciplinary cooperation.

Amyotrophic Lateral Sclerosis↗
PubMed2001

[CBO guideline 'Oxygen therapy at home'].

In the Netherlands, domiciliary oxygen therapy is regularly prescribed incorrectly and thus inefficiently, and the policies surrounding this therapy are inconsistent. This applies particularly to patients with chronic hypoxaemia due to chronic obstructive pulmonary disease (COPD). In order to establish a scientific basis for a uniform prescription policy, guidelines have been developed under the auspices of the Dutch Thoracic Society with the support of the Dutch Institute for Health Care Improvement. Based on scientific research, recommendations have been formulated for the indications and aims of domiciliary oxygen therapy and long-term oxygen therapy (LTOT). The most important recommendations (summarised on the back of an oxygen application form) are: domiciliary oxygen therapy is only indicated for severe hypoxaemia by day at rest; if domiciliary oxygen therapy was prescribed following recovery from an acute exacerbation or hospitalisation, the arterial oxygen tension should be rechecked within three months of starting oxygen therapy; prescription of LTOT is only justified in case of an optimal (non-)medical regimen, clinical stability, and chronic hypoxaemia, and providing a number of preconditions, such as smoking cessation (partly due to the fire hazard), have been met; LTOT is a lifelong therapy that should be prescribed for at least 15, and preferably 24, hours per day, and the oxygen flow rate settings for rest, exertion and sleep should be adjusted to meet the patient's needs; for ambulatory patients, the prescribing physician should consider the portability of the oxygen equipment; as patient education and supervision are essential to secure the success of LTOT, the prescribing physician should cooperate with the general practitioner, the district nurse and the oxygen supplier in this respect.

Algorithms↗
PubMed2000

[Mechanical ventilation in neuromuscular diseases: do not start too early, but certainly not too late].

Three patients had chronic respiratory disorders: a 42-year-old man with glycogenosis type II was tired, had headaches, poor pulmonary function values and, according to the arterial blood gas values, hypercapnia; a man aged 24 with Duchenne's muscular dystrophy had variable moderate dyspnoea with hypoxia and hypercapnia, and a man aged 64 years with an mitochondrial myopathy complained of dyspnoea and headache but had good blood gas values. The symptoms and abnormalities of the first patient were suppressed by nocturnal ventilatory support through a nasal mask system, the second preferred to refrain from ventilatory support and died a few weeks later and the symptoms of the third patient decreased without ventilatory support. Assessing a ventilatory disorder in patients with a neuromuscular disease is not always simple. Symptoms suggestive of nocturnal hypoventilation may occur in patients without respiratory insufficiency. It is also possible for patients with chronic respiratory insufficiency to be free of symptoms. Determinations of the arterial blood gas values are the most reliable method. Since normal daytime values do not exclude a nocturnal respiratory insufficiency, it is advisable in case of suspicion of nocturnal hypoventilation to measure the arterial blood gas values at night, as well. Nocturnal pulse oximetry does not always adequately reflect the degree of hypoventilation. In view of the positive effects of assisted respiration, adequate diagnostic examinations and early referral to a centre for home mechanical ventilation are advisable.

Adult↗
PubMed1999

Prescription and usage of long-term oxygen therapy in patients with chronic obstructive pulmonary disease in The Netherlands.

Long-term oxygen therapy (LTOT) has been shown to improve survival in hypoxaemic patients with chronic obstructive pulmonary disease (COPD). This has resulted in recommending the prescription of oxygen for at least 15 h day-1 in most European countries. In order to examine the prescription and usage of LTOT and to assess the adherence to international recommendations for its prescription, a survey was set up in a random sample of clients of the largest oxygen company in the Netherlands. After patients had been visited for an interview, additional postal surveys were sent to the physician who had prescribed LTOT and to the oxygen company. For 175 COPD patients the mean oxygen prescription and mean oxygen usage were 15.6 +/- 5.8 and 14.1 +/- 6.8 h day-1, respectively. In 62 patients (35%) oxygen was prescribed < 15 h day-1, more often by non-chest physicians than by chest physicians (P < 0.0001), and 91 patients (52%) used oxygen < 15 h day-1. Of 113 patients with a prescription > or = 15 h day-1, 39 (35%) used oxygen < 15 h day-1 and 74 for > or = 15 h day-1. The latter were prescribed oxygen for more h day-1, had been longer on LTOT, had a higher resting flow rate, were prescribed a concentrator, employed portable cylinders and used oxygen in public significantly more often than the former. We conclude that in a selected group of LTOT patients with COPD both oxygen prescription and usage were often inadequate, particularly if LTOT was prescribed by non-chest physicians.

Aged↗
PubMed1998

Characteristics and complaints of patients prescribed long-term oxygen therapy in The Netherlands.

In patients prescribed long-term oxygen therapy (LTOT), compliance is often poor. Both patient- and treatment-related factors seem to be involved. As a base for improvements in LTOT, the characteristics and complaints of LTOT patients were investigated. A survey was set up in a random sample of clients of the largest oxygen company in the Netherlands. Patients were selected if they were > or = 18 years old, had a phone and if they had had oxygen equipment for > or = 6 months. All patients were visited at home by a medical student. Data are presented for a total of 528 patients (response rate 62%). The typical LTOT patient was a 70-year-old male with chronic obstructive pulmonary disease (COPD), who had had oxygen equipment for 3.5 years and who used oxygen cylinders and nasal cannulae for 13 h day-1. Twenty percent of the patients still smoked. Although LTOT was prescribed in 80% of the patients by a chest physician, prescription was often inadequate. Only 33% of the patients were informed adequately about the therapy. Twenty percent of the patients used oxygen for fewer hours per day than prescribed. Non-compliant patients were mainly men (P = 0.006) and more often ashamed of their therapy (P = 0.023) than compliant patients. The blood oxygen level was monitored regularly in 73% of the patients. Most complaints concerned the oxygen equipment, especially the concentrator. The single most important complaint had to do with restricted autonomy. Only 19% of the patients had no complaints at all. It is concluded that LTOT should be improved with regard to the education, motivation and monitoring of patients. The prescribing physician needs to be included in an education programme. Given the numerous problems these patients experience, LTOT should be improved in particular with regard to equipment convenience.

Adult↗
PubMed1998

Accuracy of oxygen delivery by liquid oxygen canisters.

The oxygen flow rate delivered by liquid oxygen canisters may be less than intended, owing to inaccuracies of the set flow rates and/or as a result of the outflow resistance caused by the humidifier, oxygen tubing, delivery or conserving device. The aim of this study was to investigate the accuracy of oxygen delivery by liquid oxygen canisters at different flow rates and levels of outflow resistance. Four stationary and 18 portable liquid oxygen canisters from three manufacturers were tested. All flows were measured using a Timemeter RT 200 Calibration Analyser. An adjustable obstruction was used to calculate the effect of the outflow resistance on the delivered flow rate. The measured and set flow rates of both stationary and portable canisters were strongly correlated. Expressed as a percentage of the set flow rate, the measured flow rate of the canisters varied from 36-128%, with the lowest values at flow rates <1 L x min(-1). Sixty-two (26%) of the measured flow rates differed > or =10% from the set flow rate. A difference of 0.5-1.0 L x min(-1) occurred in 16 (7%) of the measurements, but only at set flow rates >2 L x min(-1). Irrespective of the set flow rate, the measured flow rate was hardly affected by the outflow resistance. We conclude that the accuracy of oxygen delivery by liquid oxygen canisters depends on the inaccuracy of the set flow rates rather than on the outflow resistance, even at high flow rates. Although the differences between the measured and set flow rates were mostly small, they may have clinical significance, particularly in patients with chronic obstructive pulmonary disease. To prevent inaccuracy, monthly checks of the canisters by the oxygen provider at the patient's home are more important than yearly maintenance.

Calibration↗
PubMed1997

Instrumental variability of respiratory blood gases among different blood gas analysers in different laboratories.

The aim of this study was to test the hypothesis that differences in oxygen tension (PO2) and carbon dioxide tension (PCO2) values from measurements performed on different blood gas analysers in different laboratories are clinically insignificant. Samples of fresh whole human tonometered blood (PO2 8.1 kPa (60.8 mmHg); PCO2 5.3 kPa (39.9 mmHg)) were placed in airtight glass syringes and transported in ice-water slush. Blood gas analysis was performed within 3.5 h by 17 analysers (10 different models) in 10 hospitals on one day. The mean of the differences between the measured and target values was -0.01+/-0.19 and 0.21+/-0.13 kPa (-0.06+/-1.45 and 1.55+/-1.01 mmHg) for PO2 and PCO2, respectively. The mean of the differences between two samples on one analyser was 0.06+/-0.06 and 0.04+/-0.03 kPa (0.47+/-0.48 and 0.29+/-0.24 mmHg), respectively. For PO2 and PCO2 the interinstrument standard deviations (s(b)) were 0.18 and 0.13 kPa (1.38 and 0.99 mmHg), respectively, whereas the intra-instrument standard deviations (s) were 0.06 and 0.03 kPa (0.47 and 0.26 mmHg), respectively. Both for PO2 and PCO2 the ratios of s(b)2 and s2 were statistically significant (analysis of variance (ANOVA) p<0.001). The standard deviations of a random measurement on a random analyser were 0.19 and 0.14 kPa (1.46 and 1.02 mmHg) for PO2 and PCO2, respectively. We conclude that the variability in measurement of blood gas values among different blood gas analysers, although negligible, depends much more on inter- than intra-instrument variation, both for oxygen tension and carbon dioxide tension. Technical improvements and adequate quality control programmes, including tonometry, may explain why the variability in blood gas values depends mainly on errors in the pre-analytical phase.

Blood Gas Analysis↗
PubMed1997

Transtracheal oxygen therapy: an effective and safe alternative to nasal oxygen administration.

Transtracheal oxygen therapy (TTOT) improves the efficiency of oxygen delivery and overcomes the discomfort associated with nasal oxygen delivery in patients on long-term oxygen therapy (LTOT). In addition, TTOT improves compliance and quality of life, and may reduce morbidity. Experience with TTOT in Europe is, however, scarce and the safety of TTOT has not yet been completely determined. These were reasons for testing the acceptance, efficacy and safety of TTOT. Patients were selected on the basis of the accepted indications and contraindications for TTOT. In 75 patients (48 males and 27 females) the mean follow-up time was 16 (range 0.5-51.5) months. Compared to nasal cannulae, TTOT caused a reduction in the oxygen flow rate of 47 (33-60)% at rest and a significant increase in the number of hours that oxygen was used. All patients on TTOT used oxygen for at least 20 h x day(-1). Most patients saw the procedure as a minor intervention. It was usually performed on an out-patient basis. In 34 patients, 51 mainly minor complications were seen, and most of these occurred in the first 10 patients. After precautions had been taken, complications occurred less frequently. No patient needed to be hospitalized because of a complication. TTOT had to be stopped in two patients; nevertheless, all patients preferred TTOT to the nasal cannulae. We conclude that transtracheal oxygen therapy is an effective and safe alternative to nasal oxygen administration, provided that it is restricted to a well-defined group of patients and applied by a motivated and experienced group of physicians.

Administration, Intranasal↗
PubMed1994

[Favorable results of nocturnal nasal positive-pressure ventilation in 64 patients with neuromuscular disorders; 5-year experience].

OBJECTIVE: Evaluation of the effectiveness of chronic nightly mechanical ventilation through a nasal mask system in patients with neuromuscular diseases or patients with thorax malformations or COPD. SETTING: Centre for Home Mechanical Ventilation, University Hospital Utrecht. DESIGN: Retrospective study. METHOD: During the period June 1988-May 1993, 64 patients (11-69 years old) were treated with nasal mask ventilation during the night: 37 men (most of whom had Duchenne's disease (18) and 27 women (most of whom had (post-polio) kyphoscoliosis (n = 13). The effects on arterial blood gases were analysed. Complications during use of the nasal mask systems were recorded. RESULTS: The duration of the nasal mask ventilation was 2 to 56 months. Arterial PCO2 and PO2 improved during the night as well as by day during spontaneous respiration. The most common problems were necrosis of the skin of the bridge of the nose, leakage of air through the mouth or insufflation of air into the stomach. After the start of the mechanical ventilation quality of life improved considerably. CONCLUSION: Nasal ventilation at night is sufficient and simple. The installation of a tracheostoma can be postponed or avoided with this non-invasive kind of ventilation.

Adolescent↗
PubMed1994

Long-term oxygen therapy.

This review discusses the different aspects of long-term oxygen therapy (LTOT). In selected patients with chronic hypoxaemia, LTOT may increase the life-span and quality of life. Since identification of these patients is both important and difficult, the indications for LTOT are discussed. Next, the appropriate time at which LTOT should be initiated is discussed in the section on the physiological criteria. Even in patients who qualify for LTOT, the effectiveness of this therapy may vary. Because they are important in this context, the prescription guidelines are considered. Finally, possible ways of increasing the efficiency of LTOT are reviewed in the sections on home oxygen systems, oxygen-conserving methods and the organization of LTOT in the Netherlands.

Humans↗
PubMed1987

Provocation test with a living insect as a diagnostic tool in systemic reactions to bee and wasp venom: a prospective study with emphasis on the clinical aspects.

The use of the sting challenge (SC) in insect allergy has brought into doubt the widely held belief that clinical data, specific IgE and the skin test are reliable tools in diagnosis and decision making with regard to therapy. We subjected ninety patients, known to have a systemic reaction to SC, in the Intensive Care Unit. Of these patients, 28% once more showed a systemic reaction; 72% had only a local reaction. No statistically significant difference could be demonstrated between positive and negative SC patients with regard to age; sex; the presence of allergic disease(s)--other than allergy to insects--and the severity of the preceding systemic reaction; the sting site and the related time interval; or specific IgE, IgG1, IgG4, their ratios and the skin test. A negative skin test and/or specific IgE, however, does not exclude the possibility of a recurrent systemic reaction. The long-term value of the SC appeared to be good since the results of the revision SC remained unchanged. Skin test and specific IgE are useful as diagnostic tools in establishing the insect concerned. SC provides information on the likelihood of a recurrent systemic reaction.

Adolescent↗