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At least 19 recordsLinked to original sources
PubMed1995

Postoperative respiratory insufficiency.

Respiratory insufficiency is one of the most common and most serious complications of the postoperative period. Preexisting risk factors include cardiopulmonary disease, significant smoking history, obesity and advanced age. The risk of postoperative respiratory insufficiency is increased in emergency surgical procedures (particularly those related to trauma), procedures involving the chest or upper abdomen and procedures requiring prolonged anesthesia. Postoperatively, prolonged sedation or neuromuscular blockade, cardiovascular instability, respiratory problems and immobilization are important risk factors. Common clinical causes of respiratory insufficiency are atelectasis, aspiration, pulmonary edema and pulmonary embolism. Management strategies are directed at treatment of the cause of the insufficiency and restoration of pulmonary function. All surgical patients should be carefully assessed before surgery, monitored closely during and after the procedure, and aggressively treated to prevent or correct respiratory insufficiency.

Humans↗
PubMed1996

[Respiratory mechanics of chronic obstructive lung disease in acute respiratory insufficiency].

Respiratory mechanics abnormalities in patients with chronic obstructive pulmonary disease (COPD) in acute respiratory failure (ARF) consist of the followings : 1) expiratory flow limitation, 2) marked increase in airway resistance, 3) dynamic hyperinflation. As a results, both resistive and elastic loads to the respiratory muscles are increased. These abnormalities, which are already present in stable COPD patients, are considerably more marked in ARF. Our contribution was to systematically describe the passive mechanical properties of lung and chest wall of COPD patients tracheally intubated, mechanically ventilated, sedated-paralyzed for ARF. Mechanical properties, i.e. resistances and elastances, were obtained from the rapid end-inspiratory airway occlusion technique during constant-flow inflation. This method allows to partition the resistance into its two components, namely the interrupter resistance, which reflects airway resistance, and additional tissue resistance, which pertains to time constant unequalities and/or viscoelastic behavior. We also determined the static and dynamic elastances of both lung and chest wall. Static intrinsic positive end-expiratory pressure (PEEPi) was obtained from end-expiratory airway occlusion. By changing, for one breath, inflation flow, at constant volume, and inflation volume, at constant flow, we investigated the time, and hence the frequency dependence of resistance and elastance. In addition, we divided the inspiratory work of breathing into its four components which are the PEEPi component, the static work, the purely resistive work and the additional work. Finally we compared our results with those of normal anesthetized and paralyzed subjects. We found that airway resistance was markedly higher in COPD, as were also the additional resistance and the dynamic elastance of the lung. Additional resistance and dynamic elastance of lung and chest wall exhibited a marked frequency dependence in COPD. Shortening the inspiratory time could result not only to reduce the hyperinflation but also to increase expiratory flow through the increased dynamic pulmonary elastance. The inspiratory work was twice higher in COPD than in normals because of the PEEPi and the resistive components. Due to their flow and volume dependence, the results of resistances and elastances should be standardized.

Acute Disease↗
PubMed1977

Intravascular platelet aggregation and acute respiratory insufficiency.

Respiratory effects of long-lasting episodes of intravascular platelet aggregation have been studied in cats. Animals in 1 group had the chest opened and were given mechanical ventilation with a constant tidal volume. Animals of another group were breathing spontaneously. Platelet aggregation was induced by intravenous infusion (for 1 hr) of a suspension of collagen fibrils. Such infusions caused acute respiratory distress in both groups. Severe arterial hypoxemia and rapid breathing as well as constriction of airways and lung vessels occurred. Most of these changes were reversed within 2 hr after collagen infusion had ended. Deep lung inflations markedly improved lung function. It is concluded that an acute, but reversible pulmonary insufficiency might be caused by pulmonary microembolization due to intravascular platelet aggregation. The arterial hypoxemia is suggested to be caused by disturbances in the ventilation-perfusion ratio secondary to airway constriction and closure. The present findings also imply that besides platelet aggregation, some additional factors are necessary for irreversible or progressive respiratory insufficiency to develop.

Animals↗
PubMed1997

[The rehabilitation of chronic respiratory insufficiency].

Respiratory rehabilitation is defined as a medical practice including a multidisciplinary medical program fitting each individual. Personalized retraining by means of exercises, is the master part of it, its aim is to improve the physical fitness in specialised institution then to maintain it when he becomes an out patient. In both cases, this retraining complies with strict rules concerning the mode of exercises (imposed power--duration of sessions--weekly frequency--progressiveness of overloading ...). This codification rests mainly on the recommendations of the American College of Sports Medicine. The choice of intensity at the beginning of the stay will be determined either by the maximal reserve of cardiac frequency or by the ventilatory threshold. This training has to involve extensive muscular mass and must not neglect the upper limbs. Ventilatory physiotherapy also plays an important part. The other components of rehabilitation concern optimisation of bronchodilator treatment, cessation of smoking, health education, physical education and relaxation, appraisal of nutritional status, assessment of therapeutic programs, of the quality of life and a long-term program for reinforcement of acquisitions. The therapeutic programs improve ventilatory performance, maximal oxygen intake, maximal tolerated power and quality of life. An adaptation of the St. George's Respiratory Questionnaire to patients hosted at the TOKI EDER Medical Center points out that the quality of life of patients with chronic respiratory failure is improved very highly significantly by this rehabilitation.

Chronic Disease↗
PubMed1983

[Home treatment of chronic respiratory insufficiency. Sociodemographic aspects of chronic respiratory insufficiency in France. Preliminary results of a survey concerning 3120 patients registered in a district association for assistance to patients with respiratory insufficiency].

The observations of the National Association for the Domiciliary treatment of respiratory failure (A.N.T.A.D.I.R.) affords the opportunity for some hard information on the complex problem of chronic respiratory failure in France. The objectives were to perceive the demographic fluctuations of the population, to follow the development of the distribution of health care, to assess the cost effectiveness of the activities and to place the different participants in the overall schema of the system. The initial results on 3,120 patients show one female for every 2.5 males with a mean age of 62.87. Disorders with chronic airflow obstruction account for 60% and restrictive disorders for 20%. Assisted tracheal ventilation (20% overall) was applied, particularly to this latter type, long term oxygen (O.L.D.) 28% or assisted ventilation with a mouthpiece (VAB) to 45% with chronic airflow obstruction. VAB is still widely practised in France but there is a trend towards O.L.D. VAT and VAB use oxygen bottles as a supply while O.L.D. uses nitrogen extraction in 2 cases out of 3. These are preliminary results and it will be interesting to follow the outcome of these techniques of assisted ventilation in the home, so that there efficacy by gathering functional data (particularly blood gases) may be assessed and either the survival curves analysed or the time spent in hospital.

Adult↗
PubMed2006

[Air breath control radiotherapy in severe insufficiency respiratory patients with NSCL: application for deformable registration method in thoracic radiotherapy].

PURPOSE: Using deformable registration methods from a phase two clinical study of air breath control during radiotherapy in patients suffering from severe respiratory insufficiency and non-small cell lung carcinoma. PATIENTS AND METHODS: Between April 2002 and November 2005, 22 patients with severe respiratory insufficiency were treated with curative intent by conformal therapy combined with active breathing control. RESULTS: After a mean of follow-up of 22 months, the local control rate is 28% and the method is feasible despite the severe respiratory insufficiency. However the overall survival is still poor due to metastatic widespread. For the second part of the study, the clinical protocol was also used for two studies using deformable registration methods. In the first study, a deformable registration method has been developed in order to register several breath-hold 3D CT of the same patient acquired at several days of interval. It allowed quantifying the interfraction breath-hold reproducibility by analysing the resulting displacement field. For 6 patients, the breath-hold was effective, while for 2 patients, motion greater than 10 mm were detected. The second study aimed to simulate 4D images from 3D breath-hold images. Developing an ad-hoc methodology based on the interpolation of 3D dense deformation fields performed it. The approach has been validated with expert selected landmarks, with accuracy lower than 3 mm. CONCLUSION: ABC is feasible, even in case of severe insufficiency respiratory syndrome but metastatic widespread disease is still a major challenge even with an acceptable local control rate without serious side effects: regarding the deformable registration method. Such artificial 4D images could allow decreasing the dose need to acquire a full 4D image, to simulate irregular breathing pattern and to be used for 4D dosimetry planning.

Adenocarcinoma↗