Chest
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A patient presented the rare complication of a dissecting aneurysm of the ascending aorta ruptured into the superior vena cava producing a left-right fistula. Continuous oximetric measurements by a fiberoptic pulmonary artery floated catheter was used to localize the site of the shunt. Emergency surgical repair was successfully performed.
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Breathlessness is a common symptom in patients with respiratory disorders and contributes significantly to functional disability. Recent studies of the psychophysics of respiratory sensation suggest that dyspnea is a function of the forces generated by the respiratory muscles during the act of breathing and may simply represent the intensity of the sense of effort arising from central respiratory motor command signals. It is important to recognize the multidimensional nature of respiratory sensations that include not only sensory aspects but also affective and cognitive components. ⋯ Efforts to minimize abnormalities in ventilatory system impedance are limited by the largely irreversible nature of most chronic lung diseases. Sedatives and narcotic agents have not proved to be effective in altering perceptual responses and may have an adverse effect, worsening respiratory failure. Physical measures to improve overall conditioning and respiratory muscle performance may be most effective in relieving breathlessness and improving exercise capacity in patients with chronic lung disease.
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Aerosol delivered through metered-dose inhalers (MDI) offers a potentially convenient way to deliver bronchodilator agents and corticosteroids to the lungs of patients with asthma and COPD. Unfortunately, most patients are unable to coordinate satisfactorily their actuation with inhalation, a problem overcome by using auxiliary MDI aerosol delivery systems. Left to their own judgment, patients often inhale the aerosol with a high inspiratory flow rather than slowly to produce optimal aerosol deposition within the airways. ⋯ All the auxiliary MDI aerosol systems promote delivery of small aerosol particles and markedly diminish oropharyngeal impaction. Of all the systems, only InspirEase provides volume and flow feedback controls to ensure an optimal inhalation maneuver. Auxiliary MDI aerosol systems should always be used for aerosolized corticosteroid administration because they minimize oropharyngeal deposition and improve aerosol delivery efficiency.