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N Ambrosino

Publications and source records attributed to N Ambrosino.

At least 19 recordsLinked to original sources
PubMed1995

Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success.

BACKGROUND: Non-invasive mechanical ventilation is increasingly used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to identify simple parameters to predict the success of this technique. METHODS: Fifty nine episodes of acute respiratory failure in 47 patients with COPD treated with non-invasive mechanical ventilation were analysed, considering each one as successful (78%) or unsuccessful (22%) according to survival and to the need for endotracheal intubation. RESULTS: Pneumonia was the cause of acute respiratory failure in 38% of the unsuccessful episodes but only in 9% of the successful ones. Success with non-invasive mechanical ventilation was associated with less severely abnormal baseline clinical and functional parameters, and with less severe levels of acidosis assessed during an initial trial of non-invasive mechanical ventilation. CONCLUSIONS: The severity of the episode of acute respiratory failure as assessed by clinical and functional compromise, and the level of acidosis and hypercapnia during an initial trial of non-invasive mechanical ventilation, have an influence on the likelihood for success with non-invasive mechanical ventilation and may prove to be useful in deciding whether to continue with this treatment.

Aged↗
PubMed1995

Clinical evaluation of oscillating positive expiratory pressure for enhancing expectoration in diseases other than cystic fibrosis.

The benefit of chest physiotherapy in patients with cystic fibrosis has been well documented. However, the benefit of similar rehabilitation in patients with large amounts of sputum who have diagnoses other than cystic fibrosis has not been clearly demonstrated. The aim of this study was to evaluate the acute effectiveness of a device advised for home chest physiotherapy in comparison to postural drainage combined with chest percussion in removing secretions in patients with high sputum production due to diseases other than cystic fibrosis. Fourteen in-patients, known to spontaneously produce more than 25 mL sputum.day-1, underwent two sessions each of two treatment modalities in random order. Treatment A consisted of postural drainage and manual chest percussion. Treatment B included breathing through a commercial device claimed to combine oscillating positive expiratory pressure with oscillations of the airflow. Expiratory flows and oxygen saturation were monitored and recorded throughout the study. The amount of sputum produced in the 30 min preceding, during, and in the 60 min after completing each treatment session was recorded, together with the sensation of "chest unpleasantness due to secretions" as assessed by means of a modified visual analogue scale. The mean time that the patients tolerated treatment was not different for A and B (18.7 +/- 5 and 19.3 +/- 5 min, respectively). Sputum significantly increased during both treatment periods and in the same amount for the two modalities (2.9 +/- 2.9 to 10.9 +/- 7.1 and 2.8 +/- 3.1 to 10.1 +/- 10.8 mL for A and B, respectively). Visual analogue scale score significantly decreased at the end of each treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1994

Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 days.

We studied survival and failure or success of weaning from mechanical ventilation (MV) in 42 consecutive chronic obstructive pulmonary disease (COPD) patients requiring prolonged MV (more than 21 days) after an episode of acute respiratory failure requiring admission to our Intermediate Intensive Care Unit (IICU). Parameters including arterial blood gases, pulmonary function tests, respiratory muscle force, neuromuscular drive, and nutritional status were recorded during a phase of clinical stability, in order to identify the features related to survival and weaning. All the patients were submitted to a comprehensive rehabilitation programme. Successful weaning from MV was defined as complete respiratory autonomy for at least 48 h. Twenty three patients were successfully weaned from MV after an average period of 44 days (Group A), requiring no further MV during their stay in hospital, whilst the remaining 19 patients were not able to be disconnected from the ventilator (Group B). The discriminant analysis showed that weaning from MV was significantly associated with arterial carbon dioxide tension (PaCO2), neuromuscular drive (P0.1), maximal inspiratory pressure (MIP), arterial oxygen tension (PaO2), the ratio of respiratory frequency to tidal volume (f/VT) and the serum protein level. Other pulmonary function tests (forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC), anthropometric data, nutritional status, number of pulmonary exacerbations during MV and evidence of cor pulmonale, were similar in the two groups. The discriminant equation considering PaCO2 and MIP could separate the two groups with an accuracy of 84%. The overall survival at 2 yrs was 40%; in Group B it was significantly lower than in Group A (22 vs 68%). Most of the deaths occurred within the first 120 days after intubation.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1994

Location and architectural structure of IICU.

When an Intermediate Intensive Care Unit (IICU) is planned, three groups of professionals are usually involved: the managers of the hospital, the architects and the staff. Although several aspects and problems related with the building of IICUs are considered in the specialized literature, lack of communication and discussion of the appropriate issues at the appropriate time is the origin of several errors during the planning and building of IICUs. Standards of IICU for respiratory departments have been proposed by the Working Group "Rehabilitation and Intensive Care" of the Italian Hospital Pneumologist Society. An ideal IICU should include 4-6 beds for a hospital with more than 500 patients. Alternatively, an IICU should have 1-2 beds per 100,000 inhabitants. IICU should be located in the hospital, integrated with, but well distinguished from, the respiratory department, and with easy accessibility to surgery, Intensive Care Unit (ICU), laboratory, radiodiagnostics, cardiology, etc. No more than two beds should be included per room, and isolation should be necessary only for those patients suffering from communicable or infectious diseases, and also for those patients requiring protective isolation or suffering from disorientation or severe emotional disturbance. Limitation of single room usage is due also to economic considerations; isolation requiring 50-100% more personnel per bed than an open ward. Individual continuous monitoring should be allowed. Visits and nursing by relatives and/or care-givers should be encouraged, with appropriate space and facilities.(ABSTRACT TRUNCATED AT 250 WORDS)

Centralized Hospital Services↗
PubMed1994

Ventilation techniques: invasive versus noninvasive.

Conventional medical treatment of COPD patients with acute respiratory failure (ARF) was associated with an overall mortality ranging 12-29%. When conservative treatment fails, ARF is usually managed by means of mechanical ventilation (MV) via an endotracheal tube (ET) or tracheostomy. Mortality of COPD patients with ARF treated with invasive MV ranged 21-54%. Invasive MV is associated with several complications. Positive pressure ventilation (PPV) by means of facial or nasal masks have been used in place of endotracheal intubation in ARF: the results are promising. Advantages of mask ventilation include the possibility of intermittent delivery of ventilation, use of different modalities of ventilation, the ability to undertake normal swallowing, feeding and speech, the possibility of physiological air warming and humidification, the possibility of coughing, and an easier weaning whilst still maintaining possibilities of ET intubation. Reported side-effects during mask PPV include mask discomfort, skin reddening, dry nose, air leaks, eye irritation and gastric distension. Mortality of COPD patients treated with noninvasive PPV ranged 6-25%. The level of severity of basal acidosis and blood gas response to a short trial of noninvasive PPV were predictive of success of this modality of MV. Preliminary results suggest that one year mortality after MV is reduced with noninvasive PPV in comparison to ET ventilation.

Humans↗
PubMed1994

Hygroscopic condenser humidifiers in chronically tracheostomized patients who breathe spontaneously.

The aim of this study was to test the usefulness of hygroscopic condenser humidifiers on secretion and on inspired gas temperature in tracheostomized patients. Forty spontaneously breathing chronically tracheostomized patients were divided into two groups: Group 1 received a hygroscopic condenser humidifier connected to the tracheostomy, 24 h daily for 10 days; Group 2, without any protection system, was chosen as the control group. The daily number of tracheal suctions, quantity of aspirate and thickness and colouring of secretions was evaluated. At baseline, and at days 5 and 10, patients were submitted to blood gas analysis, respiratory function tests and sputum analysis. The temperature of gases breathed was measured at rest and during a hyperventilation test, with and without the hygroscopic condenser humidifier. Statistically significant differences were found in thickness and colouring of secretions between the two groups during the period of 10 days. Group 2 showed a significantly greater trend in number of bacteria than Group 1. The group with the hygroscopic condenser humidifier showed respiratory function improvement over time for forced expiratory volume in one second (FEV1) and tidal volume (VT), maximal inspiratory pressure (MIP), and maximal voluntary ventilation (MVV) in comparison to the control group, who did not. Significant differences in the temperature between rest and hyperventilation, with and without a hygroscopic condenser humidifier were also found. In conclusion, a hygroscopic condenser humidifier may be useful in chronically tracheostomized patients who breathe spontaneously, improving viscosity and colouring of secretions, preventing further bacterial colonization, heating inspiratory flow, and helping to improve the functional outcome.

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PubMed1994

Noninvasive mechanical ventilation in the treatment of acute respiratory failure due to infectious complications of lung transplantation.

Patients that have undergone lung and heart-lung transplantation may contract severe respiratory infections, often leading to acute respiratory failure requiring mechanical ventilation. Endotracheal intubation may induce infectious complications of the respiratory tract, which can be avoided by noninvasive modes of ventilation. We describe the use of noninvasive modes of ventilation in three cases of acute respiratory failure induced by infectious complication of lung and heart-lung transplantation. In two cases endotracheal intubation was avoided and treatment was successful.

Acute Disease↗
PubMed1994

[Nasal pressure support ventilation (NPSV) in a case of Pneumocystis carinii pneumonia in single-lung transplantation].

In patients who underwent lung transplantation one of the primary determinants of patient survival is infection. Contributing factors in the development of pneumonia include immunosuppression and alterations in the natural lung defense mechanism induced by transplantation. We describe a case of a Pneumocystis carinii pneumonia occurring in the recipient of single lung transplantation for interstitial lung disease four months after surgery. The patient developed severe acute respiratory failure (ARF) requiring mechanical ventilation. Because of the increased infectious risk, tracheal intubation was avoided and pressure support ventilation was performed by the nasal route (NPSV) with PEEP (PS: 16 cm H2O PEEP: 8 cm H2O). NPSV and PEEP were applied 20-22 hours/day in the first 4 days, thereafter 2 to 6 hours 3 times a day, together with medical therapy. This treatment was performed for 15 days. This mode of ventilation was well tolerated and was successful. We conclude that NPSV may be useful in the treatment of ARF in patients with lung transplantation, particularly to avoid invasive mechanical ventilation related infectious complications.

Humans↗
PubMed1992

Evidence of acute diaphragmatic fatigue in a "natural" condition. The diaphragm during labor.

Acute diaphragmatic fatigue has been experimentally shown to occur in normal healthy subjects and in patients with chronic obstructive pulmonary disease by asking them to modify their pattern of breathing or to breathe against high inspiratory resistances. During the expulsive period of labor women are asked periodically to make strong expulsive efforts and to sustain them isometrically for many seconds; this is likely to produce "natural" diaphragmatic fatigue. To investigate whether this was the case, six women were studied in the delivery room from the moment of the rupture of the amnion until delivery of the infant occurred. The development of diaphragmatic fatigue was assessed both by measuring the static maximal inspiratory pressure (MIP) and by analyzing the electromyographic power spectrum of the diaphragm (H/L ratio). The majority of contractions were concentrated in the expulsive period of labor. MIP, recorded in the supine position, significantly decreased from 103.2 +/- 17.2 cm H2O (at the beginning of the expulsive period) to 73.8 +/- 10.1 cm H2O (after the delivery). The H/L ratio fell progressively during the expulsive period; after the delivery, it was 59.2 +/- 15.7% of the value recorded at the beginning of the expulsive period. This study demonstrates that (1) the diaphragm is active in the expulsive efforts during labor and (2) the tension developed and the time each contraction is maintained may lead to the development of diaphragmatic fatigue. Therefore, we provide evidence of acute diaphragmatic fatigue in a natural condition.

Acute Disease↗
PubMed1992

Physiologic evaluation of pressure support ventilation by nasal mask in patients with stable COPD.

We evaluated the physiologic effects of pressure support ventilation by nasal route (NPSV) in eight patients with severe stable COPD and chronic hypercapnia who were randomly submitted to 2-h sessions of NPSV both with a portable ventilator (Respironics BIPAP device) and with a standard ventilator (Bird 6400ST device) at an inspiratory airway pressure of 22 cm H2O. Two sessions with each ventilator were performed using an FIO2 of 0.21 in each patient on two consecutive days. One patient did not tolerate either form of ventilation. Comparison of spontaneous with BIPAP ventilation showed a significant improvement in pH, PaCO2, and PaO2. Ventilatory pattern assessed by a respiratory inductive plethysmograph showed a significant increase in minute ventilation (VE), VT, and Ttot. Integrated surface diaphragmatic EMG activity measured only during BIPAP device ventilation decreased from that measured during spontaneous breathing. Similar changes in blood gases and ventilatory pattern were observed during ventilation by the Bird 6400ST except for VT/Ti ratio, which significantly increased. Comparison of baseline with measurements performed 12 h after the whole cycle of treatment showed a significant increase in pH and VE and a decrease in PaCO2. We conclude that short-term NPSV may be useful in improving respiratory pattern and blood gases in stable COPD patients with chronic hypercapnia.

Humans↗
PubMed1992

Acute exacerbations in severe COLD patients. Treatment using positive pressure ventilation by nasal mask.

We retrospectively evaluated the clinical effectiveness of a treatment schedule with intermittent positive pressure ventilation via nasal mask in 49 patients with acute exacerbations of COLD. According to the ability to successfully tolerate a preliminary trial with NIPPV, patients were submitted either to standard treatment plus NIPPV (25 patients) or to ST alone (24 patients). The ST consisted of medical, oxygen and physical therapy. The NIPPV was delivered by a volume cycled ventilator in control mode at least 4 h a day for five consecutive days a week, for three weeks. Comparison of baseline with measurements performed after 10 and 21 days of treatment respectively showed a significant improvement in PaO2 and in PaCO2 in both groups. After 21 days of treatment, VC, FEV1, inspiratory muscle strength, and dyspnea significantly improved in both groups. No significant difference was found between groups at any time of treatment. We conclude that the treatment schedule of NIPPV used is not more effective than ST alone in acute exacerbations of COLD.

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PubMed1992

Time course of pulmonary function before admission into ICU. A two-year retrospective study of COLD patients with hypercapnia.

Changes in cardiopulmonary function were retrospectively evaluated back to two years before acute exacerbations requiring ICU admission in 16 COLD patients with chronic hypercapnic respiratory insufficiency (age: 61 +/- 6 years, group A). Fifteen hypercapnic COLD patients matched for age, sex, lung function, and blood gas values not requiring an ICU admission in a period of two years, served as control subjects (age: 66 +/- 7, group B). Periodic assessments of spirometry, arterial blood gas values, echocardiography, body weight, and red blood cell count performed in stable state were compared for differences between groups and changes over a period of two years. The results indicated that basal body weight, rate of deterioration over time in FEV1, VC, blood gas values, bicarbonates, and RVD may be related to the necessity of ICU admission in COLD patients with hypercapnic respiratory insufficiency.

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PubMed1992

Dyspnea on exercise. Pathophysiologic mechanisms.

To evaluate the frequency of the causes of exercise limitation in patients with chronic pulmonary disease and to assess the relationship between the resting pulmonary functional parameters and the degree of exercise dyspnea, we reviewed the data from 88 consecutive stable patients with chronic lung disease (62 COPD, 16 interstitial lung disease [ILD]). In each patient, the intensity of dyspnea was measured by a Borg scale (BS) during an incremental symptom-limited exercise test. COPD patients stopped exercise due to fatigue (46%), dyspnea (36%), cardiac limitation (12%), and peripheral circulatory limitation (6%). ILD patients stopped exercise due to dyspnea (62%), fatigue (25%), and cardiac limitation (12%). In all patients, dyspnea severity increased linearly with exercise intensity as measured as VO2, VE, and VE/MVV. The severity of dyspnea expressed as the slope of the relationship between BS and VE/MVV (DBS/D[VE/MVV]) showed in COPD a significant inverse correlation with VC, FEV1, MIP, and a positive correlation with PaCO2 and VE/MVV at rest. In ILD, DBS/D(VE/MVV) showed a significant inverse correlation with VC, FEV1, TLC, and PaO2 and a positive correlation with VE/MVV at rest. The predicting power of all equations was very low.

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