Rev Pneumol Clin
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Review
[Long-term oxygen therapy for chronic respiratory failure. Rationale, indications, modalities].
Long-term oxygen therapy (LOT) has become quite popular over the last 20 years due to better knowledge of the beneficial effect (improved life expectancy, improved quality of life, stabilization of the pulmonary hypertension) and to technological progress (concentrators, liquid oxygen). Ambulatory techniques have greatly contributed to the widespread use of oxygen therapy as has the decision of the French National Health Insurance System to reimburse this costly treatment. Almost all the studies devoted to the clinical and functional aspects of LOT have concerned patients with chronic obstructive pulmonary disease (COPD). ⋯ It has been established that objective results (life expectancy, improvement in pulmonary hypertension) are better for longer daily treatment. Patient compliance is however often insufficient. In addition to education, the best way to improve patient participation is to strive for improved quality of life with oxygen therapy (portable device, liquid oxygen) in these patients.
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Review Comparative Study
[Therapeutic management of non-small-cell lung carcinoma (NSCLC) of stage III A].
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Drug abuse is a growing problem in industrialized countries, opening the way to new diseases of the respiratory tract. It has been demonstrated that regular inhalation of cannabis has the same consequences as tobacco smoking. The same cannot be said for other drugs. ⋯ Summarizing, respiratory diseases in drug abuses can take on a wide range of quite complex presentations. Occasional or regular use of illicit drugs can lead, not exceptionally, to severe respiratory complications requiring rapid management. Knowledge of the principal complications and the appropriate diagnostic procedures is indispensable.
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Nosocomial pneumonia is one of the primary causes of nosocomial infection in intensive care patients, leading to high mortality and prolonged hospitalization. Mechanical ventilation and its duration are major risk factors. When invasive ventilation is indispensable, preventive measures should aim at optimizing patient care by carefully applying basic rules of hygiene and recommended procedures for use of ventilation equipment. Different preventive measures have been proposed and should be considered in light of several criteria: the cost/benefit ratio, the level of proof (size of the study population, quality and pertinence of judgement criteria), feasibility, routine cost, and absence of secondary collateral adverse effects.
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Nosocomial infections are recognized as a major problem in patients with endotracheal ventilation, but the risk of nosocomial pneumonia is less well known and considered to be lower for patients on noninvasive ventilation. The risk factors for endotrachial ventilation involve the presence of the endoracheal canula and the direct consequences of the reclining position, use of a respirator, sedation, presence of a nosgastric tube, antiulcer treatment, etc. Most of these risk factors are not present in noninvasive ventilation while others, for example the use of a respirator and a ventilation circuit, persist. ⋯ The principal actions involve taking advantage of the noninvasive nature of the ventilation to reduce the risk factors and other invasive procedures indirectly related with the use of artificial ventilation. Patients should be mobilized as rapidly as possible and oral food intake instituted early. Certain measures concerning humidification of the ventilation circuit remain important as well as other nonspecific measures including hand washing, for the prevention of cross contamination.