PubMed · 5637244
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E J Campbell. 1968-03-07. Oxygen therapy.. https://doi.org/10.1056/nejm196803072781015
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Dyspnea is a common symptom and, in most cases, can be effectively managed in the office by the family physician. The differential diagnosis is composed of four general categories: cardiac, pulmonary, mixed cardiac or pulmonary, and noncardiac or nonpulmonary. Most cases of dyspnea are due to cardiac or pulmonary disease, which is readily identified with a careful history and physical examination. Chest radiographs, electrocardiograph and screening spirometry are easily performed diagnostic tests that can provide valuable information. In selected cases where the test results are inconclusive or require clarification, complete pulmonary function testing, arterial blood gas measurement, echocardiography and standard exercise treadmill testing or complete cardiopulmonary exercise testing may be useful. A consultation with a pulmonologist or cardiologist may be helpful to guide the selection and interpretation of second-line testing.
Partial liquid ventilation (PLV) is a relatively new therapeutic approach to acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). The idea of combining the intrapulmonary application of an oxygen-carrying substance and positive pressure ventilation was introduced by Fuhrman in 1991 and originally called perfluorocarbon-associated gas exchange (PAGE). Nowadays, the technique is mostly known as partial liquid ventilation (PLV). The efficacy of PVL treatment has been demonstrated in numerous animal studies in different models of lung injury. The results of those studies led to multicenter phase I-II studies in patients of all age groups in the United States and Canada. Recently, the first randomized, controlled study in 90 adult patients suffering from ALI and ARDS was completed and first results have been published. Comparison of overall mortality and number of ventilator-free days (VFD's) in a 28-day period showed no differences between PLV and conventionally treated patients. A post-hoc stratification by age (< 55 years) demonstrated a tendency to lower mortality (PLV 25.6%; CMV 36.8%) and a significant increase of VFD (PLV 8.95 days; CMV 4.11 days; p = 0.03) in PLV when compared to conventionally treated patients. Perfluorocarbons (PFCs) are chemically stable and inert. They are mostly eliminated via exhalation (> 99%). The unique physicochemical properties of PFCs permit access to atelectatic, non-ventilated lung areas, enhance gas exchange and decrease inflammation. The dense PFCs prevent the endexpiratory collapse of alveoli and reestablish functional residual capacity (FRC). Comparable to positive endexpiratory pressure (PEEP), these effects have been described as "liquid or fluid PEEP". These properties offer a new approach to the underlying pathophysiology of ALI and ARDS. In addition, the combination with other therapeutic approaches to ALI and ARDS like high-frequency oscillations (HFO), inhaled nitric oxide (NO) therapy, and surfactant replacement can be considered and is already the subject of recent publications. However, combination therapy is still experimental and further investigation is necessary to evaluate efficacy and potential risks. Many questions still exist which need to be answered by experimental as well as human pilot studies. Based on these studies, the results of ongoing human trials can be assessed properly and new multicenter trials can be planned effectively.
UNLABELLED: Within the last few years the use of Point-of-Care Analyzers increased. These testing is primarily performed in the emergency room, intensive care units, and in the operating room using small portable analyzers. The fact of being transportable and working with rechargeable or changable batteries and disposable cartridges caused us to use blood gas analysis in the prehospital setting. METHODS: We tested three available blood gas analyzers: AVL OPTI 1, IRMA Blood Analyzer and the i-Stat Portlab System. All analyzers work with single-use cartridges and the calibration procedure is automatic. The AVL OPTI 1 uses a calibration gas and sucks in the blood by itself. The IRMA and the i-Stat system use a containing calibration gel, which must be removed from the sensory by injecting the blood sample. In all analyzers the results appear within 2-4 min on the screen. The OPTI 1 and the IRMA are able to print out the results automatically, the i-Stat uses an additional printer connected over an infrared adapter. RESULTS: During the observation period of 2 years more than 320 prehospital blood gas analyses were performed (200 with the OPTI 1.70 with IRMA and 50 with the i-Stat). All devices served their purpose. The main problems appeared with the application of the blood samples at the IRMA and the i-Stat. Because of this intricate procedures 21.4% and 20% of all tries failed. The time spent on the measurement was 2 to 5 minutes. CONCLUSIONS: All tested devices worked satisfactorily. Relating to the safety, the performance and the use the AVL OPTI 1 has to become the best notes. But this system is much more bigger and heavier than the others, especially the i-Stat Blood analyzer.