Archivos de bronconeumología
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Arch. Bronconeumol. · Oct 2010
Review[Extracorporeal lung assist in severe respiratory failure and ARDS. Current situation and clinical applications].
Despite improvements in ventilation support techniques, lung protection strategies, and the application of new support treatment, acute respiratory distress syndrome continues to have a high mortality rate. Many strategies and treatments for this syndrome have been investigated over the last few year. However, the only therapeutic measure that has systematically shown to be able to improve survival is that of low volume lung protective ventilation. ⋯ On the other hand, it could be a potentially useful complementary method for an ultra-protective ventilation strategy, that is, by using even lower tidal volumes. The currently available extracorporeal lung assist systems are described in this article, including high flow systems such as traditional extracorporeal membrane oxygenation, CO₂ removal systems (interventional lung assist or iLA, with or without associated centrifugal pumps), and the new low flow and less invasive systems under development. The aim of this review is to update the latest available clinical and experimental data, the indications for these devices in adult respiratory distress syndrome (ARDS), and their potential indications in other clinical situations, such as the bridge to lung transplantation, multiple organ dysfunction syndrome, or COPD.
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Arch. Bronconeumol. · Aug 2010
[Prognosis following acute exacerbation of COPD treated with non-invasive mechanical ventilation].
Patients with chronic obstructive pulmonary disease (COPD) who survived an acute exacerbation with acute respiratory failure that required non-invasive mechanical ventilation (NIMV) are a group with a poor medium-term prognosis. ⋯ This group of COPD patients has a high mortality rate and need for re-hospitalisation in the ensuing year following discharge. The variables relating to the severity of the baseline disease and the actual exacerbation have been shown to be associated with these events, and could be applied to this subgroup of patients in specific follow-up programs.
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Arch. Bronconeumol. · Aug 2010
[Indications and compliance of home mechanical insufflation-exsufflation in patients with neuromuscular diseases].
Neuromuscular disease (NMD) patients frequently have impaired cough. Mechanical insufflation-exsufflation (MI-E) has proven efficacy in improving airway clearance, however data related to its long-term home use is lacking. The purpose of this study was to describe indications, safety and compliance of home MI-E in NMD patients. ⋯ Home MI-E is well tolerated, effective and safe if used by well trained caregivers. MI-E should be considered as a complement to mechanical ventilation.
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Arch. Bronconeumol. · Jul 2010
Case Reports[Unilateral painful diaphragm paralysis as the only sign of amyotrophic neuralgia].
Amyotrophic neuralgia is an inflammatory and idiopathic neuropathy which is characterised by neuropathic pain. It was described for the first time in 1948 as condition that only affected the brachial plexus and was called Parsonage-Turner syndrome. Although this syndrome is more common in the brachial plexus, it can concomitantly, or in isolation affect the phrenic nerve, and in this case the diagnosis is very difficult if there is no high clinical suspicion. We present a case of a patient with amyotrophic neuralgia in which the only sign was left phrenic involvement, and we highlight the resistance of the pain to analgesics, as well as the persistence of the symptoms and diaphragm problems for over 6 months.