Biomedical subjects
Dominique Vanpee
Publications and source records attributed to Dominique Vanpee.
Prolonged survival of an elderly woman with Salmonella dublin aortitis and conservative treatment.
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The use of non-invasive ventilation in the emergency department.
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Evaluation of flow limitation in elderly patients unable to perform a forced expiratory maneuver.
BACKGROUND AND AIMS: The assessment of pulmonary function in elderly persons is not often easy in the clinical practice because of poor patient collaboration. A new technique, negative expiratory pressure (NEP), should provide a simple, rapid and non-invasive method for detecting flow limitation without collaboration of the patients. Our aim was to investigate whether it is possible to detect an expiratory flow limitation during resting breathing with NEP in elderly patients unable to perform a forced expiratory maneuver. METHODS: In 15 elderly inpatients (4 males and 11 females, mean age 83+/-4.7 SD years) unable to realize the classical forced expiratory maneuver because of poor coordination or cognitive disturbance, we applied the NEP technique during spontaneous breathing. RESULTS: NEP application during resting breathing was easily and rapidly performed in all cases without side effects. During NEP (-5cmH2O and NEP -10cmH2O), 6 and 5/15 patients were flow limited; mean flow limitation was 60+/-9% and 70+/-15% respectively. These results were reproducible with repeated NEP tests. CONCLUSIONS: Application of negative pressure at the mouth during tidal expiration provides a simple method for detecting expiratory flow limitation during spontaneous breathing in elderly patients with poor collaboration.
A woman with an expanding annular rash.
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Influence of respiratory behavior on ventilation, respiratory work and intrinsic PEEP during noninvasive nasal pressure support ventilation in normal subjects.
BACKGROUND: In clinical practice, patients have different inspiratory behaviors during noninvasive pressure support ventilation (PSV): some breathe quietly, others actively help PSV by an additional effort, and others even resist the inspiratory pressure of PSV. OBJECTIVE: What is the influence of patient collaboration (inspiratory behavior) on the efficiency of PSV? METHODS: We ventilated 10 normal subjects with nasal PSV (inspiratory/expiratory: 10/0 and 15/5 cm H(2)O) and measured their flow and volume with a pneumotachograph and their esophageal and gastric pressures during three different respiratory voluntary behaviors: relaxed inspiration, active inspiratory work and resisted inspiration. RESULTS: When compared with relaxed inspiration with 10/0 cm H(2)O PSV: (1) an active inspiratory effort increased tidal volume (from 789 +/- 356 to 1,046 +/- 586 ml; p = 0.006), minute ventilation (from 10.40 +/- 4.45 to 15.77 +/- 7.69 liters/min; p < 0.001), transdiaphragmatic work per cycle (from 0.55 +/- 0.33 to 1.72 +/- 1.40 J/cycle; p = 0.002) and inspiratory work per cycle (from 0.14 +/- 0.20 to 1.26 +/- 1.01 J/cycle; p = 0.003); intrinsic positive end-expiratory pressure (PEEP(i)) increased from 1.23 +/- 1.02 to 3.17 +/- 2.30 cm H(2)O; p = 0.002); (2) a resisted inspiration decreased tidal volume (to 457 +/- 230 ml; p = 0.007), minute ventilation (to 6.93 +/- 3.04 liters/min; p = 0.028) along with a decrease in transdiaphragmatic work but no change in PEEP(i). Data obtained during a bilevel PSV of 15/5 cm H(2)O were similar to those obtained with the 10/0 cm H(2)O settings. CONCLUSIONS: Active inspiratory effort increases ventilation during PSV at the expense of an increased breathing work and PEEP(i). Resisted inspiration inversely decreases inspiratory work and ventilation with no air trapping. These differences between inspiratory behaviors could affect the expected beneficial effects of PSV in acutely ill patients.
Effects of nasal pressure support on ventilation and inspiratory work in normocapnic and hypercapnic patients with stable COPD.
OBJECTIVES: To assess and compare the effect of nasal continuous positive airway pressure (nCPAP), inspiratory pressure support (PSV), and bilevel positive airway pressure (biPAP) on ventilatory parameters and inspiratory work (WOB) in normocapnic and hypercapnic patients with stable COPD. METHODS: While administering nasal pressure support to 10 normocapnic and 10 hypercapnic patients with COPD, we measured airflow and volume with a pneumotachograph as well as esophageal and gastric pressures under nCPAP, PSV, and biPAP conditions. RESULTS: nCPAP had no influence on ventilatory parameters but decreased WOB and transdiaphragmatic work (Wdi) at 10 cm H(2)O of pressure in both groups. With PSV and biPAP, ventilatory parameters increased proportionally to the inspiratory applied pressure. WOB and Wdi decreased significantly in both groups while increasing the pressure support. A similar decrease was observed during biPAP proportionally to the level of pressure support. The diaphragmatic pressure-time product decreased similarly in both groups during PSV and biPAP. CONCLUSION: The ventilatory response under nCPAP, PSV, and biPAP conditions is similar in hypercapnic and normocapnic patients with stable COPD; PSV and biPAP increase ventilatory parameters and improve Wdi. On the contrary, nCPAP improves WOB but does not increase ventilatory parameters.