Respiration; international review of thoracic diseases
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Inhaled nitric oxide (INO) can improve hypoxemia and reduce pulmonary hypertension, but there is a wide range of response to INO. ⋯ The optimal doses for improving oxygenation and reducing PAP differ. The maximum PaO(2)/FiO(2) was observed at a lower INO concentration than that required for the minimal MPAP. There was no further improvement in PaO(2)/FiO(2) when the INO dose was adjusted above 20 ppm. Higher doses of INO treatment worsened oxygenation.
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Interventional bronchoscopy is widely used for the diagnosis and therapy of many lung and airway diseases. Concern has been raised about its complications. ⋯ Bronchoscopy is a safe procedure. The increased rate of severe complications and death associated with bronchoscopy may be ascribed to the increasingly wide use of bronchoscopy.
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Randomized Controlled Trial
Inhaled corticosteroids as additional treatment in alpha-1-antitrypsin-deficiency-related COPD.
No consistent data are available regarding the effect of inhaled corticosteroids (ICS) in alpha(1)-antitrypsin-deficiency (AATD)-related COPD. Recent data report inflammatory effects of the polymers of alpha(1)-antitrypsin on the peripheral lung. ⋯ In AATD-related COPD patients (ZZ genotype) the addition of extra-fine ICS to LABAs decreases airway narrowing, mostly in the small airways, further reducing dynamic hyperinflation with a marked improvement in exercise tolerance and dyspnea, suggesting that a peripheral inflammatory process contributes to airflow obstruction in these patients.
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Randomized Controlled Trial Comparative Study
Comparison of automatic and continuous positive airway pressure in a night-by-night analysis: a randomized, crossover study.
Long-term compliance is suboptimal in the treatment of the obstructive sleep apnea syndrome (OSAS). ⋯ Treatment efficacy and adherence are similar with CPAP and APAP. There is a trend towards lower leakage with APAP therapy. Patients prefer the automatic mode to fixed pressure.
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At least 40% of all patients with pneumonia will have an associated pleural effusion, although a minority will require an intervention for a complicated parapneumonic effusion or empyema. All patients require medical management with antibiotics. Empyema and large or loculated effusions need to be formally drained, as well as parapneumonic effusions with a pH <7.20, glucose <3.4 mmol/l (60 mg/dl) or positive microbial stain and/or culture. ⋯ Local expertise and availability are likely to dictate the initial choice between tube thoracostomy (with or without fibrinolytics) and thoracoscopy. Open surgical intervention is sometimes required to control pleural sepsis or to restore chest mechanics. This review gives an overview of parapneumonic effusion and empyema, focusing on recent developments and controversies.