[The Review of Respiratory Diseases on the verge of the XXIst century].
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France↗
Biomedical subjects
J F Muir
Publications and source records attributed to J F Muir.
[Series on "respiratory resuscitation" published under the aegis of the Resuscitation Group of the French-Language Society of Pneumology].
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Cardiopulmonary Resuscitation↗
Respiratory high dependency care units (RHDCU) in France.
The concept of intermediary intensive care units appeared in France with the progress of respiratory intensive care in the 1970s and an increment of the percentage of patients who were surviving an acute respiratory episode. It then became necessary to provide them with an optimal transition between the medical intensive care unit (ICU) and the home, thus explaining the emerging need for units of post-intensive care. At the present time, French health regulations recognize medical and surgical ICUs with a specific budget for equipment and nurses, and the specialized ICU which exists through a means share with the medical units (pulmonology, cardiology, etc.) inside which they are located. New regulations should make official the separation between medical and surgical intensive care units, intermediate (specialized) intensive care units and wards of reinforced follow-up, in a general perspective of improvement of the health network between the patient, home, and the different sectors of hospitalization (acute/chronic, public and private).
France↗
[A rare cause of intra-alveolar hemorrhage: a transfusion-related incident with leukoagglutination due to antigranulocyte antibodies (Trali syndrome)].
INTRODUCTION: Transfusion-related acute lung injury (TRALI) is an infrequent but life-threatening complication of hemotherapy, usually secondary to passive transfer of antibody from the donor's plasma to the recipient. TRALI is a diagnosis of exclusion often masked by underlying factors. EXEGESIS: We report a new case of TRALI in a patient with severe multinevritis associated with Sjögren's syndrome and cryoglobulinemia, who had received intravenous immunoglobulins. CONCLUSION: This case report underlines the difficulty to establish a diagnosis in both acute respiratory failure and intra-alveolar hemorrhage in patients with auto-immune disorders. This case report also emphasizes the necessity of taking precautions in these immunocompromised patients in whom hemoglobin transfusion is required.
Aged↗
[Nebulization in worsening of chronic obstructive lung diseases: importance of anticholinergic agents. The Multicenter Group].
COPD exacerbations frequently require an hospitalization. Hospital management of severe exacerbations is based upon their initial severeness; an emergency treatment of bronchospasm is mandatory, in ICU if necessary. A French multicenter study, including 54 patients, was designed to determine the optimal number of ipratropium nebulizations in COPD exacerbations, together with intravenous corticosteroids. The response rate to treatment was 100% after 48 hours; the number of nebulizations for each patient was often high, in average 6 to 7. Evolution of haemodynamic parameters (cardiac rate and blood pressure) was satisfactory. It was impossible to point up any initial predictive factor. The authors, in conclusion, explain the best strategy to choose a bronchodilator treatment.
Administration, Inhalation↗
[Treatment of tracheobronchomegaly using the Freitag prosthesis].
Tracheobronchomegaly (TBM) is a rare disorder. It is characterised by a dilatation of the trachea and subsequent bronchial divisions associated with a dynamic pathology, in particular a cough which explains the symptomatology of the patients. We report the observation of a patient suffering from TBM whose clinical progress rapidly improved after the insertion of a Freitag prosthesis. This 60-year-old male presented with a year's history of chronic cough which was painful, cavernous and had been incapacitating associated with moderate dyspnoea of effort. Bronchial endoscopy showed dyskinesia extending almost totally throughout the tracheobronchial tree with complete expiratory collapse. The FEV1, the Vital Capacity and the TLC were subnormal and the PEF was 57% of the predicted. The total airways resistance (RAW) was elevated (306% of the predicted), the arterial blood gases were normal. A CT scan showed a deformed trachea with increased diameter. A tracheobronchial prosthesis of Freitag or Dynamic stent (Rüsch) was inserted with the help of a rigid bronchoscope. One month later the cough had regressed and the effort dyspnoea had disappeared. One year later the clinical improvement persisted with very good tolerance of the prosthesis with normal spirometry despite the persistence of an elevated RAW. Despite a recoil which is still imperfect the tracheobronchial endoprosthesis seems to be a useful treatment for forms of TBM which are potentially progressive.
Airway Resistance↗
[Instrumental management of chronic respiratory insufficiency: contribution of long-term therapeutic assistance at home].
Chronic respiratory failure represents an important problem of public health if we consider the potential high number of patients needing to be treated and the expenses linked to a complex treatment having to be applied at home. Progress of knowledge about chronic respiratory failure conducted in the early' 80 to the publication of the BMRC and NOTT studies where long-term oxygen therapy was demonstrated to be efficient in severe hypoxic patients with chronic obstructive pulmonary disease, reducing need for hospitalisation for acute respiratory failure and thus improving quality of life. In the early '80, several retrospective studies showed the interest of mechanical ventilation in the management of chronic respiratory failure secondary to restrictive defects mainly due to chest wall deformities, neuromuscular diseases and tuberculous sequelae. Tracheostomy was initially used as a connection mode to the respiratory; the technological progress obtained with the treatment of sleep apnea syndrome with nasal continuous positive airway pressure made convenient masks available, which were in turn used with success to ventilate "non invasively" patients with restrictive defects at home as well as in acute respiratory failure. Nowadays, chronic respiratory failure is largely managed at home with the help of respiratory assistance organizations, which manage in France through the public ANTADIR network more than 50,000 patients.
Chronic Disease↗
Mechanical ventilation in elderly patients.
Elderly patients are increasingly opting for intensive care unit (ICU) treatment with mechanical ventilation (MV). The aim of this study was to review specific aspects of MV in the older elderly (80-yrs-old and older). We retrospectively studied all patients who underwent MV during a 2-year-period in our respiratory ICU. Older elderly were compared with younger patients. Of 478 patients admitted to our unit, 58 underwent endotracheal ventilation (ETV) and 243 noninvasive ventilation (NIV). At the time of admission, older elderly patients (n = 106) were more severely ill than the younger ones, according to simplified acute physiology scores (SAPS). The history of older patients was characterized by a lower frequency of neurological abnormalities, and in the ETV group, a lower frequency of days previously spent in hospital. NIV was performed more often in older elderly (64%) than in younger patients (47%) and for a shorter time-period (8 compared to 10 days). The ICU mortality rate was higher in the older patients than in the younger ones in the overall population admitted to the unit (38 compared to 12%) and in the NIV population (21 compared to 9%) but not in the ETV population (40 compared to 44%). Long-term survival (2 yrs) was low (12%) in the older patients admitted to the unit. Several studies from the literature were reviewed. All authors agreed that age alone should not be a criterion to exclude the older elderly from intensive care, regardless of whether they found them to have the same or a poorer prognosis than younger patients. Selection biases are rarely studied. Our results indicate that some selection procedures on admission to the intensive care unit and before endotracheal ventilation are present despite the absence of any selection policy in our department. This selection enables us to obtain results from older populations which are as good as those from nonselected younger populations. When its use is practicable, noninvasive ventilation is associated with less discomfort, fewer complications and better short-term results than is endotracheal ventilation. In all cases, the long-term prognosis is poor.
Age Distribution↗
Modalities of ventilation in obesity.
Obesity is nowadays the most frequently found health risk in the USA, where more than 1 in 3 adults have a weight > or = 20% over the ideal value. Obese patients are more prone to developing sleep apnoea syndrome and obesity hypoventilation syndrome as well as more frequent postoperative complications. Thus, acute and chronic respiratory failure episodes represent current presentations in clinical practice where noninvasive ventilation is very efficient and must be guided by polysomnographic data in order to decide on long-term respiratory treatment to avoid recurrence of acute on chronic decompensation.
Acute Disease↗
Long-term efficiency of home nasal mask ventilation in patients with diffuse bronchiectasis and severe chronic respiratory failure: a case-control study.
The aim of this study was to evaluate long-term efficacy and tolerance of nasal mask ventilation (NMV) in a comparative case-control study. Fourteen patients with diffuse bronchiectasis and severe chronic respiratory failure (CRF), treated by long-term oxygen-therapy (LTO) and NMV, were case matched with 14 patients with diffuse bronchiectasis and severe CRF treated with only LTO. Patients and control subjects were compared based on the following parameters: blood gases, FEV1, vital capacity, hospitalizations, and survival. Symptoms, Karnofsky function score, and clinical evolution were also monitored in patients. Three subgroups may be identified according to outcome: two early deaths (subgroup 1), six patients with initial improvement and subsequent deterioration (subgroup 2), and six patients whose conditions remained improved for >2 years (subgroup 3). PaO2 decrease slope was slighter in this last subgroup than subgroup 2. The days of hospitalization were significantly reduced after institution of NMV in the patient group. Comparison between patients and control subjects did not show any difference on PaO2 evolution and on the overall median survival (46 and 40 months in NMV and control group, respectively). Long-term tolerance and compliance remained satisfactory for 11 patients. These results suggest that NMV is feasible as a long-term home treatment in patients with diffuse bronchiectasis. Although our results may have failed to prove a long-term efficiency on the course of blood gases and survival, a beneficial effect is observed with reduction of hospitalizations and improvement of functional status. This study warrants further investigation, in a prospective series, with a larger number of patients.
Adult↗
[Purulent pleurisy].
Management of thoracic empyema remains controversial considering local treatment and place of surgical intervention. If French practitioners use primarily iterative thoracentesis and pleural lavage, reserving thoracic drainage for cases of failure of thoracentesis, American authors recommend a more aggressive initial approach, with thoracic drainage and surgical intervention. However, conservative attitude, combining immediate thoracocentesis and pleural lavage with intrapleural fibrinolytic therapy of loculation occurs, may also be proposed. Prospective studies are warranted to evaluate the different methods used to evacuate empyema and validate new procedures as pleural catheters inserted under radiologic guidance and thoracoscopy versus conventional approach.
Biopsy, Needle↗
Selection criteria and programmes for pulmonary rehabilitation in COPD patients. Rehabilitation and Chronic Care Scientific Group of the European Respiratory Society.
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Activities of Daily Living↗
[Metalloproteinases in the extracellular matrix: structure and activity].
The matrix metalloproteinases (MMP) are a multigenic family involving 14 enzymes which can cleave most, if not all, the components of the extracellular matrix (interstitium and basement membranes). The present work reports on the main structural characteristics, the substrate preference and the site synthesis of these proteinases and their inhibitors (TIMP). Human MMPs are produced by various cell types and are involved in the remodelling of the extracellular matrix in many physiological and pathophysiological circumstances. Elastolytic MMPs produced by monocytes and/or macrophages (matrilysin, gelatinases, macrophage elastase) are likely to be implicated in the development of acquired pulmonary emphysema.
Extracellular Matrix↗
Noninvasive mechanical ventilation and acute respiratory failure: indications and limitations.
Noninvasive mechanical ventilation (NMV) now represents the first step in the management of acute on chronic respiratory failure (A/CRF). During the last 5 yrs, many studies have confirmed the feasibility of NMV in an acute setting, either by facial or nasal interface, used in addition to volumetric or barometric respirators, to manage A/CRF. The best indications for NMV are slowly progressive A/CRF, frequently represented by chronic obstructive pulmonary disease (COPD), or restrictive pulmonary disease. The criteria to initiate NMV in such patients are worsening of respiratory status and arterial blood gas (ABG) values, with increased hypoxia, hypercapnia and respiratory acidosis, despite optimal management with medication, physiotherapy and oxygen therapy. Respiratory encephalopathy is not an absolute contraindication; however, bronchial hypersecretion indicates that care is needed under NMV. Invasive mechanical ventilation with endotracheal (ET) intubation is discussed in the case of failure of NMV, when clinical status and ABG values worsen in spite of it. The signal for ET intubation is then obvious, represented by severe dyspnoea leading to respiratory pauses or arrest, severe cyanosis, and signs of haemodynamic instability. Despite immediate evidence of ominous cardiorespiratory inefficiency, ET intubation may be delayed and often avoided with the help of NMV. Criteria should be studied to identify guidelines for cessation of NMV, in order not to continue with the technique too long considering the safety of the patient. Indications for NMV in other kinds of ARF have received less study and are more controversial.
Acute Disease↗
[Asymptomatic mediastinal parathyroid adenoma].
A 74-year-old woman was hospitalised for pleuro-pneumonia of the right base. The chest x-ray showed the presence of a right paratracheal opacity which persisted during the course of the infectious episode. A computed tomographic scan of the thorax showed a voluminous anterior mediastinal mass which compressed the trachea without invading it. Surgical excision enabled the ablation of a tumour which was haemorrhagic and the histological examination established a diagnosis of cystic parathyroid adenoma. At anytime did the patient present either clinical symptoms or biochemical signs suggesting primary hyperparathyroidism.
Adenoma↗
Substitution of carbonate by acetate buffer for IgG coating in sandwich ELISA.
The first step of sandwich ELISA, namely adsorption of antibodies to plastic microtiter plates, was studied as a function of the pH of the coating buffer. Coating efficiency was assessed in terms of maximum signal (absorbance) observed in ELISA and also estimated by measuring the amount of functional antibodies adsorbed to the plate. While goat antibodies displayed better results after coating with acetate pH 5 buffer, rabbit IgGs generally worked well at pH 7.4. On average, the classical carbonate pH 9.6 buffer was only 50% as efficient.
Acetates↗
Effects of repeated administration of zolpidem on sleep, diurnal and nocturnal respiratory function, vigilance, and physical performance in patients with COPD.
STUDY OBJECTIVE: To assess the effects of repeated 10-mg oral doses of zolpidem on diurnal and nocturnal respiratory function, as well as on diurnal vigilance and physical performance in COPD patients with disordered sleep. DESIGN: Prospective single-blind placebo-controlled clinical study. SETTING: Outpatients of a respiratory medicine department. PATIENTS AND METHODS: Patients with stable COPD were enrolled for 10 days (D0 to D10), ie, 9 consecutive nights (N1 to N9). They received placebo on N1 and N9 and zolpidem, 10 mg, from N2 to N8. MEASUREMENTS: The following parameters were measured: nocturnal polysomnographic recordings with respiratory signals and arterial blood gas values on retiring and awakening on N0, N1, N2, N8, and N9; subjective evaluation of the quality of sleep and of diurnal vigilance by visual analog scales every day from D0 to D10; pulmonary function test, central control of breathing, and walking test on D0 and D9; biological laboratory tests and theophylline level on D0 and D8. RESULTS: Ten COPD patients (PaO2 = 72.7 +/- 7.6 mm Hg; PaCO2 = 47.7 +/- 5.4 mm Hg; FEV1 = 0.84 +/- 0.3 L; FEV1/vital capacity = 42.5 +/- 12.3%), 56.8 +/- 8.3 years old, were studied. Compared with placebo, no significant change was found for the various sleep architecture parameters, except an increase in the duration of stage 2 during the D8/N8 night (p < 0.05). In contrast, the autoevaluation score for the quality of sleep was significantly improved during the D6/N6 night relative to that with placebo (p < 0.05), with no change in the other subjective criteria. No variable of the nocturnal respiratory parameters, pulmonary function test, central control of breathing, and physical performance was altered by zolpidem. Arterial blood gas values on awakening were not altered. Clinical and biological tolerance of zolpidem was correct with no significant variation of the theophylline level. CONCLUSION: This study shows that repeated 10-mg oral doses of zolpidem during 8 days does not impair nocturnal respiratory and sleep architecture parameters or diurnal pulmonary function tests, central control of breathing, and physical performances in patients with stable COPD.
Administration, Oral↗