News - Part 29

The Effect of Intermittent. Negative Pressure Ventilation and Long-term Oxygen Therapy for Patients With COPD - MethodsThe remaining 35 (denoted as group A, date of enrollment from 1984 to 1986) formed the group in which we evaluated the effects of LTOT. In this group, the flow rate of oxygen was individualized in order to maintain the Pa02 value above 60 mm Hg and to avoid harmful changes in PaC02. All patients but one stopped smoking at the beginning of the follow-up. The hemoglobin carbon monoxide values were checked monthly. buy asthma inhalers

Forty-four patients with chronic respiratory insufficiency (group B, date of enrollment from 1976 to 1982) were used as a control group. These patients, who were admitted to our respiratory ICU for ARF, were not prescribed LTOT after discharge. The selection of the patients for the control group comes from the period from 1976 to 1982 where no home treatment with oxygen was prescribed at our institution. Furthermore, only patients in whom the measurements of respiratory function were available were included.
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In all patients, the following determinations were performed at the time of admission: arterial blood gas analysis and pH (BMS3 and ABL2 apparatus, Radiometer, Copenhagen), and electrocardiographic (ECG) recordings. The values of Pa02, PaC02, pH, and the ECG data were also obtained at the end of the ventilatory treatment, when a stable clinical phase was reached, and at discharge. These parameters were checked monthly at the periodic visits that the patients received at our outpatient division. Cor pulmonale on ECG was diagnosed when one or both of the following criteria were present: P pulmonale and right ventricular hypertrophy (alone or associated with right axis deviation or right ventricular overload or complete or incomplete bundle right branch block). The FEVr RV, and FEV/VC were determined at discharge when a clinically stable phase of the disease was reached. At the time of admission, all patients underwent ventilatory treatment by means of a body ventilator (Iron Lung, Pulmolife, Biella, Italy) together with oxygen therapy and administration of standard drugs (theophylline, 6-agonists, cardiokinetic agents, diuretics, mucolytic agents, and antibiotic agents). No sedative drugs were given routinely to the patients before institution of the ventilatory treatment. buy claritin online

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The Effect of Intermittent. Negative Pressure Ventilation and Long-term Oxygen Therapy for Patients With COPDThe mortality rate of patients with chronic obstructive pulmonary disease (COPD) who are hospitalized for acute respiratory failure (ARF) averages 26 percent at 1 year when mechanical ventilation is not required, but increases up to 51 percent to 64 percent when a supportive ventilatory treatment by means of intubation is needed.
Long-term oxygen therapy (LTOT) is widely used in patients with COPD, and several studies” indicate that this form of treatment can improve patient survival. However, as yet no data have been reported on the effect of LTOT in a subgroup of patients with COPD whose acute exacerbations of ARF are treated with mechanical ventilation in addition to continuous 02 maintenance.
Intubation with positive pressure ventilation is the most widely used method for providing mechanical ventilation in patients with COPD. However, a recent report showed that a conservative ventilatory method, based on the use of an iron lung, can successfully be employed to overcome both the acute episode and the subsequent relapses of ARF; this therapeutic approach was found to improve the longterm prognosis of these patients. proventil inhaler

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In contrast, what is fundamental in our opinion is the duration of treatment combining TMP-SMZ and steroids prior to the instigation of MV Initial respiratory failure when PCP has not yet been treated appears to carry a much better prognosis than respiratory failure that occurs after 5 days of correctly conducted medical treatment, ie, treatment failure. In this study, five of the six survivors were intubated at the beginning of treatment with TMP-SMZ+ methylprednisolone; 50 percent of the patients in group 1 survived, whereas the mortality rate in group 3 was 95 percent. buy antibiotics online

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Mechanical Ventilation for Pneumocystis сarinii Pneumonia in Patients With the Acquired Immunodeficiency Syndrome: ConclusionMore recently, Nielsen et al also reported an improved prognosis after a first episode of PCP requiring MY with a survival rate of 50 percent and a mean survival duration of 20.5 months after discharge from the hospital. However, these authors did not mention either the time between intubation and bronchoscopy or between the beginning of treatment and M V These reports did, nevertheless, lead physicians to reappraise their approach to patients with PCP, ARF, and AIDS. The reasons for the improvement in the prognosis are unclear. They could involve a better knowledge of this opportunistic infection, an improvement in diagnostic methods, a widespread use of prophylaxis, and the introduction of zidovudine in 1986.* An important point is the use of steroids, which has been combined with antiparasitic chemotherapy only since 1986. Indeed, Montaner et al showed not only that steroids prevented the development of ARF in moderately severe PCP but also that the use of steroids significantly reduced mortality among patients receiving M V (39 percent with steroids vs 84 percent without). canadian neighbor pharmacy

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The mean duration of stay in the ICU was 22.5 ± 19.6 days (range, 6 to 57 days). Two patients died in the hospital, 12 and 15 days after being discharged from the ICU (patients 2 and 6). The other four patients returned home 8, 18, 18, and 23 days after being discharged from the ICU. One patient is alive with 6 months’ follow-up, 1 has been unavailable for follow-up, and the other 2 died 10 and 13 months after being discharged from hospital.
Lung histologic studies were available in 11 patients. Lung tissue from patients was obtained during open chest surgery for different diagnostic purposes (n = 3), for surgical fixation of pneumothorax (n = 5), and/or on necropsy samples (n = 7). Moderate to severe interstitial fibrosis was found in all cases. Two patients showed signs of destructive emphysematous lesions, and suppurative areas were found in one case. Respiratory failure sufficiently severe to require MV has been associated with a very poor prognosis in AIDS patients with PCP Together with the fatal outcome of AIDS, this poor prognosis led clinicians, between 1984 and 1987, to question the usefulness of MV for PCF-related ARF. Indeed, in a study conducted at San Francisco General Hospital, 32 of the 45 patients ventilated because of ARF associated with PCP died in the ICU, 7 other patients died before leaving hospital, and 5 others died within 12 months of being discharged; only 1 patient was alive at 33 months. Similar results were reported by Schein et al in Miami, where 91 percent of patients requiring MV died. canadian pharmacy.com

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Mechanical Ventilation for Pneumocystis сarinii Pneumonia in Patients With the Acquired Immunodeficiency Syndrome: TreatmentFourteen patients were initially hospitalized in ICUs (3 survivors and 11 nonsurvivors). The 19 others (3 survivors and 16 nonsurvivors) were hospitalized for 6.9 ±6.3 days (range, 1 to 22 days) before they were transferred to ICUs. The antiparasitic treatment had been started in 14 patients 7 ±5.6 days before their transfer (range, 3 to 22 days) and in almost all of them, the steroids were associated to cotrimoxazole four times.
Three patient groups were defined according to the period during which TMP-SMZ and steroids were given before the beginning of MV, as follows: group 1 (n = 10) less than 5 days of TMP-SMZ with (n = 9) or without (n = 1) steroids; group 2 (n = 4) 5 days or more of TMP-SMZ and less than 5 days of steroids; group 3 (n = 19) 5 days or more of TMP-SMZ and steroids. This latter group represented the treatment failures (Table 2). canadianneighborpharmacy.com

The overall mortality rate was 81.8 percent (27/33 patients). Death associated with ARF occurred 20 ±9.8 days after the beginning of treatment (range, 6 to 54 days) and after 11.4 ±9.9 days of MV (range, 1 to 46 days). The mortality rate among patients placed on a regimen of M V after failure of medical treatment (group 3) was 94.7 percent, compared with 50 percent in group 1 (p = 0.02).
Among the survivors (Table 3), five were in group 1 and one was in group 3. There was no significant difference between the survivors and nonsurvivors in terms of duration of symptoms before admission, age, simplified acute physiology score, P&02, lactate dehydrogenase activity or the CD4 lymphocyte count at admission (Table 4).

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