Archive for September, 2008

SOURCE: Journal of the American Medical Association, September 24, 2008.

The long-term use of inhaled drugs, referred to as “anticholinergic,” such as ipratropium and tiotropium, for chronic obstructive pulmonary disease may increase the risk of heart attack, stroke and death, the results of a review study suggest.

Spiriva3

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Second related link

We have seen more and more children coming into our emerg dept. with respiratory issues, so it may be time to brush up on Respiratory Syncytial Virus.Bronchiolitis_anatomy

It is probaby the most common cause of pneumonia and bronchiolitis in children under the age of 1. Symptons can include runny nose,fever, cough, and wheezing.

3dvirus

To get more info, head on over to this excellent lung disease info site found HERE

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There is an interesting article in “Chest, Jun 2001; 119: 1913 – 1929.” by Heinrich A. Werner, MD which may serve as a refresher in the diagnosis and treatment of children (and adults) in Status Asthmaticus. Although the definition varies, Status Asthmaticus may be defined as a condition of a patient deteriorating into respiratory failure from asthma which becomes unresponsive to conventional treatment modalities such as bronchodilator therapy.
The article describes presenting signs and symptoms and goes on to indicate that degree of chest wheeze does not correlate with severity of illness. Pulsus paradoxsis was found to be an excellant prognosticator of severity of asthma attack and can be one of the variables to be followed to determine effacacy of treatment, so long as fatigue and decreased level of conscientious do not occur.

astma

The authour goes on to indicate that ABG’s should not be a basis for intubation, but rather be determined on clinical grounds.
Fluid replacment is important in the treatment of an asthmatic but NOT during an attack. Abics are not routinely considered as most attacks initiated by an infection are viral in nature.
During nebulizer therapy with a B-agonist such as salbutamol, the authour indicates that much less than 10% is depositied into the lung under ideal conditions. As a consequence he recommends an increase in dosage and a proper flow rate setting to optimize particulate size and depositon. (10-12 lpm for a particle size of 1-3 um).

Interesting article by P Phipps and C S Garrard (Intensive Care Unit, John Radcliffe Hospital, Oxford OX3 9DU, UK) regarding the treatment and managemnet of acute asthma. Management of the patient before intubation, during and post intubation are discussed

asthma2

You can find the link Here

VANCOUVER, BRITISH COLUMBIA—An elevated risk of asthma among respiratory therapists has been previously reported in two studies, one showing nearly a fivefold risk increase and the other more than a twofold risk increase.1,2 In both studies, the excess risk appeared following participants’ entry into the respiratory therapy profession.
Respiratory Reviews
Timothy Begany

Read the full article in:

Pulmonary Reviews.Com

….Respiratory support should only be delivered when the patient wants it. Traditionally, it has been a matter of supplying a ventilation support that sustains a certain level of minute ventilation, but the ventilator must take care of the lung, chest wall and abdomen, and the work of breathing increases. The patient does not receive what he needs…..

Acuity Care Technology (read more)

Dr. Christer Sinderby with a demonstration of NAVA

in operation at the Maquet Booth at the Las Vegas Conference.

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Guillain-Barré Syndrome is the leading cause of nontraumatic acute paralysis in industrialized countries. About 30% of patients have RESPIRATORY failure requiring intensive care unit (ICU) admission and invasive mechanical ventilation. Progressive weakness of both the inspiratory and the expiratory muscles is the mechanism leading to respiratory failure. Aspiration pneumonia and atelectasis are common consequences of the bulbar muscle weakness and ineffective cough.

From the Department of Neurology at the Mayo Clinic, there appears to be diagnostic and clinical techniques in deciding when/if a patient requires admission to the I.C.U.

r7_myelinsheath

In the study ( from Vol. 58 No. 6, June 2001 Archives of Neurology) 114 patients with GBS who were admitted to the Intensive Care unit were studied.
In summery the results they found were the following:

Those requiring mechanical ventilation were found to have bilateral facial weakness, or dysautonomia, and bulbar dysfunction. Spirometry values indicated concern with VC <20 ml/kg, MIP ,30 cmH20 and a maximum expiratory pressure of <40 cmH20.

ARDS – a refresher –

Pathophysiology of ARDS
I came across a readable artice about ARDS in American Family Physician with the PDF available hereDOWNLOAD ARTICLE

 

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