[Unilateral pulmonary hyperlucency with diffuse bronchiectasis and chronic obstructive respiratory insufficiency (secondary to a respiratory infection in childhood)].
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Adolescent↗
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Results for “Respiratory Insufficiency”
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Altered factor VIII complexes in patients with acute respiratory insufficiency.
Acute respiratory failure is an often-fatal syndrome of multiple etiologies in which altered factor VIII may be a marker of endothelial disease. 12 women with overwhelming viral pneumonia were studied with serial factor VIII antigen, procoagulant activity, and von Willebrand's factor assays. Antigen levels were elevated (range: 86--1644%) out of proportion to procoagulant activity (range: 35--521% by a one-stage assay), and factor VIII antigen to activity ratios were as high as 16:1. Von Willebrand's factor was normal but correlated best with procoagulant activity. All patients had abnormal antigen patterns on crossed immunoelectrophoresis, with increases in protein of both fast and slow mobility. These changes in factor VIII correlated with the patient's clinical courses.
Acute Disease↗
Bilateral tube thoracostomy to preclude fatal tension pneumothorax in patients with acute respiratory insufficiency.
Two patients with acute respiratory insufficiency requiring prolonged mechanical ventilation are described. Both patients developed fatal unilateral tension pneumothoracies after the respiratory insufficiency appeared to be improving. The pneumothorax in each patient appeared to be the result of high inspiratory pressures resulting from high tidal volumes and positive end expiratory pressure. Currently, we recommend bilateral chest tube thoracostomies for those patients with inspiratory pressures greater than 40 cm H2O as a prophylaxis against this fatal complication.
Adult↗
[Animal model of acute respiratory insufficiency by HCl aspiration in Lewe mini-pigs].
Acute respiratory insufficiency or adult respiratory distress syndrome is a common medical emergency in intensive medicine complicated by high mortality. To study the acute respiratory insufficiency under standardized conditions an animal model in Lewe-mini-pigs has been developed. This model is based on aspiration pneumonitis produced by intrabrochial atomisation of 0.2 N hydrochloric acid. General anesthesia was performed by neuroleptanalgesia. In all animals the profound changes in gas exchange, pulmonary mechanics and hemodynamics as well as quasi-static volume-pressure relationships after hydrochloric acid aspiration were described. The results suggest that this model is suitable to outline the profound changes in pulmonary function in this type of acute respiratory insufficiency.
Acute Disease↗
[Respiratory insufficiency in surgery].
Acute respiratory insufficiency (ARI) (reduced PaO2 and/or increased PaCO2) in surgical patients is mostly caused by atelectasis or bronchopneumonia. These complications may develop if functional residual capacity (FRC) is reduced. Even in surgical patients with normal lungs the supine position, some pulmonary disorders after any general anaesthesia, pain, and atonic intestine cause reduced FRC in the postoperative phase. Successful prophylaxis is based on these mechanisms, which are described. The adult respiratory distress syndrome (ARDS, termed "shock lung" a few years ago) is the most dangerous pulmonary complication leading to ARI. The evaluation of clinical data sugggests that noxious factors only active for a short time (so called "triggers") may start the development of ARDS when some physiological conditions (so called "constellations"), such as low flow syndrome, reduced FRC and overhydration, pave the way for this. In the early state prognosis is good if the patient is ventilated (CPPV) and kept on the dry side, and if cardiac output is elevated compared to the normal value at rest. Once fully established, ARDS has such a poor prognosis that the need for earliest possible commencement of therapy must be stressed emphatically. The following values may be taken as clear and simple symptoms for early diagnosis: vital capacity below 15 ml/kg (reflects decreased FRC), PaO2 breathing spontaneously room air below 60 mm Hg or 8 kPa (reflects increased intrapulmonary right to left shunt or regional hypoventilation), and respiratory rate above 25/min (reflects loss of compliance).
Adult↗
Aggressive treatment of acute respiratory insufficiency.
Treatment of patients with severe acute respiratory insufficiency included application of end-expiratory pressure to an optimal level, precise cardiovascular monitoring, and adaptation of conventional respirators to provide intermittent mandatory ventilation. Of 90 patients with acute respiratory insufficiency secondary to trauma, sepsis, or complicated surgery, 65% survived. Mortality appeared to be independent of the level of end-expiratory pressure required. The goal of therapy was maximal reduction of intrapulmonary shunt without significantly decreasing cardiac function. In the group requiring more than 20 cm H2O end-expiratory pressure, shunt decreased from 48% at 5 cm of positive end-expiratory pressure to 21% at the optimal level. In only 6% of the entire group was significant pulmonary dysfunction present at the time of death. Most deaths (75%) were deemed secondary to failure of multiple organ systems, occurring late in the hospital course. Pneumothorax was recorded in 10% of the entire group. Acute respiratory insufficiency should be rapidly reversible in most cases if aggressive measures are employed with the intent of reversing functional impairment rather than improving arterial oxygenation to "satisfactory levels."
Acute Disease↗
[Problems of therapy in acute respiratory insufficiency in patients with chronic respiratory disease (author's transl)].
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Acute Disease↗
[Clincial aspects and treatment of exacerbated chronic respiratory insufficiency in silicosis patients].
The clinical picture and treatment of exacerbated chronic respiratory insufficiency is studied in 189 silicosis patients with different stage and degree of decompensation. It is found out that chronic respiratory insufficiency determination in these patients is conditioned by the exacerbation of a chronic inflammtory process in the bronchi and lungs (68.2 per cent), or by intercurrent acute inflammtory pulmonary process (15.9 per cent). The clinical manifestation of the disease is aggravated and modified by the appearance of new clinical elements, resulting in the typical clinical picture of inflammatory decompensation of silicosis. It is stressed that the effect of treatment is greater, the milder the stage of the disease, and the earlier and less marked the decompensation-induced derangements. Lethality in patients with III degree silicosis amounts to 8,2 per cent, and in patients with III degree respiratory insufficiency -- to 30.7 per cent. A complex active therapy program for silicosis patients with exacerbated chronic respiratory insufficiency is proposed.
Chronic Disease↗
The effects of intrapleural pressure on respiratory insufficiency.
Newborns with congenital diaphragmatic hernia generally survive operative repair of the hernia but develop progressive respiratory insufficiency that proves fatal. One cause for the progressive respiratory insufficiency may be the overexpansion of the contralateral lung. It is postulated that the overexpansion occurs due to the empty space created by the lack of expansion of the hypoplastic lung on the side of the hernia. To test this theory, an animal experiment was devised to mimic the postoperative state in patients with diaphragmatic hernia. It was concluded that (1) A decrease in intrapleural pressure below normal in an empty hemithorax causes the opposite lung to overexpand into the empty hemithorax in neonatal Beagle puppies. (2) The overexpansion resulted in progressive respiratory insufficiency. (3) Increasing the intrapleural pressure by insufflation of air into the empty hemithorax stopped the overexpansion of the contralateral lung. (4) By not allowing the contralateral lung to overexpand, progressive respiratory insufficiency was prevented. (5) This may be a useful technique in neonates with congenital diaphragmatic hernia.
Animals↗
[Use of a membrane oxygenator for correcting acute, experimental respiratory insufficiency].
A model of acute respiratory insufficiency ARI was created in the experiments on 16 dogs by means of a valvular device furnishing a free inhalation and a limited expiration. The diaphragmatic oxigenator devised in VNIIP with an armoured diaphragm of "Sigma"--type was switched on at the height of ARI. 3 hours' perfusion corrected successfully the manifestation of hypercapnic hypoxia. The pulmonary function restored after the experiment.
Acute Disease↗
[The respiratory intensive unit. Requirements for the treatment of patients with acute respiratory insufficiency].
Patients with acute severe respiratory insufficiency can only be correctly monitored, treated and nursed in a well-equipped intensive care unit staffed with well-trained personnel. Qualified doctors and nursing staff are more important for the monitoring and assessment of the patient's symptoms than highly sophisticated electronic monitoring systems. Continuous controls of vital and mechanical functions are however essential , as are the services of well-run laboratories. Treatment calls, above all, for the use of efficient and reliable respirators capable of adjustment to suit the impaired breathing. The quality of nursing and the success of intensive medical care measures are best ensured by well-designed layouts, strict adherence to sensible and appropriate hygienic techniques, continuous and practice-related further education for personnel, and unrestricted communication inside and outside the intensive care unit.
Humans↗
[Treatment of acute respiratory insufficiency in an intensive care unit (author's transl)].
The clinical records of 304 patients with acute respiratory insufficiency were studied in retrospect. All of them had been treated in an Intensive Care Unit during its first year and a half of operation. One hundred and thirty-one patients suffered from chronic obstructive lung disease and acute episodes of chronic respiratory insufficiency. The remaining 173 had acute respiratory insufficiency due to various etiologies. The overall survival for patients with acute episodes of chronic respiratory insufficiency was 66 percent, significantly higher than the 53 percent survival of patients with acute conditions (p less than 0.02). Sixty percent of the chronic cases had to be treated with mechanical ventilation; the mortality rate was 45 percent. Mortality was 70 percent among individuals with acute conditions who received mechanical ventilation. Almost two thirds of deaths occurring in acute cases resulted from non-respiratory complications. Mortality due to respiratory causes was significantly higher in patients with chronic conditions (p less than 0.01). Twenty-three of the 171 patients given artificial ventilation (13 percent) presented secondary respiratory complications as a result. The incidence of pneumothorax was 5 percent and a statistically significant association between barotrauma and PEEP was found (p less than 0.05).
Acute Disease↗
[Treatment of acute respiratory insufficiency in cardiac surgery].
An analysis of the main causes of acute respiratory insufficiency as a frequently observed and severe complication of the early postoperative period after open-heart surgery is presented. To permit differentiated employment of respiratory resuscitation measures, subcompensated and decompensated forms of acute postoperative respiratory insufficiency were distinguished on the basis of clinical and laboratory data. The most efficient methods of treatment of this complication are described, including the employment of helium, ultrasonic inhalator, therapeutic intubation, bronchoscopy, long-term automated artificial pulmonary ventilation. A combined employment of the modified methods of respiratory resuscitation permitted to improve the course of acute respiratory insufficiency and to reduce the mortality nearly three-fold.
Acute Disease↗
Nerve conduction impairment in patients with respiratory insufficiency and severe chronic hypoxemia.
Sixteen patients with chronic respiratory insufficiency and severe hypoxemia were studied to determine the effect of chronic respiratory insufficiency on peripheral sensory and motor nerve conduction. When matched with a control group, a statistically significant slowing (from p less than 0.02 to p less than 0.001) of nerve conduction was noted in the motor median, ulnar peroneal, and tibial nerves and also in the sensory median nerve. The peripheral neuropathy was probably due to chronic hypoxemia.
Aged↗
Pulmonary edema and respiratory insufficiency in acute pancreatitis.
Pulmonary edema, cardiac enlargement, and respiratory insufficiency may occur in patients with acute pancreatitis. The mechanisms are complex and incompletely understood, but probable etiologic factors include fluid overload, left ventricular failure, impaired respiratory excursion and microatelectasis, and a nonspecific response of the lung to various types of pulmonary injury including hypotension, intravenous crystalloids, and the effects of circulating pancreatic enzymes. Recognition of the association of pulmonary edema and respiratory insufficiency with pancreatitis is importance because early treatment with positive pressure breathing, careful fluid management and diuretics, and corticosteroids may prevent the development of irreversible respiratory failure.
Acute Disease↗
Diaphragm pacing as an adjunct in respiratory insufficiency.
Most neurosurgical patients with permanent partial or complete respiratory insufficiency are managed with a mechanical ventilator and tracheostomy. This method presents many medical, technical, emotional, and social problems. A case is presented that illustrates the potential usefulness of electrical stimulation of the phrenic nerve ("diaphragm pacing") as an alternate method of therapy for respiratory insufficiency. This paper outlines the indications for, methods of, and problems with such a system and is intended to make its availability more widely appreciated among neurosurgeons.
Adolescent↗
[Respiratory insufficiency in severely burned patients].
The increasing number of respiratory insufficiency, as well as of pulmonary complications after burns and their role in the post-traumatic mortality are pointed out by the author. The pathophysiological processes responsible for the development of post-traumatic pulmonary complications are shortly resumed. In respect of the clinical picture, three groups are distinguished by the author. One case is reported in detail. In the development of post-traumatic respiratory insufficiency important role is attributed by the author to the syndromes of micro-embolism. This supposition is supported by the laboratory examination of 10 patients. Finally the problems of prevention and therapy are discussed and the importance of the iatrogenic damages is emphasized.
Adult↗
[Chronic respiratory insufficiency in general practice].
The clinical entity of chronic respiratory insufficiency involves a variety of lung diseases with different etiology. Diagnosis, treatment and follow-up are mainly a problem of ambulatory medicine. The most common representative is the patient with chronic obstructive lung disease. The wide array of diagnostic tools makes the selection of appropriate tests difficult for the general practitioner. The clinical findings, as the most important aspect, together with a simple spirometric test (VC and FEV1), however, provide the physician with sufficient parameters to evaluate the current status. Blood gas analysis are indispenable, but can be performed at lengthy intervals. The main therapy relies on selective beta-agonists in combination with steroids. For long-term administration of steroids, however, inhaled steroids should be preferred. Antibiotics should be used liberally and without delay. Cardiac therapy is an important cornerstone in the treatment of chronic respiratory insufficiency. The frequency of glycoside intolerance makes diuretics the ideally suited drug for treatment of concomitant cardiac insufficiency. It is advantageous to use consistent inhalation therapy for drug administration, mainly due to the milder systemic side-effects. A choice must be made between the simple electric nebulizer or the more demanding IPPB-respirator, which requires more demanding patient selection. Both types can be leased through Cantonal institutions, which also provide for regular control of inhalation techniques and maintenance of the inhalation devices. Physiotherapy plays an important part in the instruction of patients as well as providing them with psychological assistance and support in everyday problems. Regular monthly controls by a physician with a standardized questionnaire have proven most useful in guiding the patients and adjusting therapy to individual needs. The frequency of hospitalization can only be reduced by observing all the above mentioned factors.
Adrenal Cortex Hormones↗