Tüberküloz ve toraks
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Tüberküloz ve toraks · Jan 2010
Acute improvement of pulmonary artery pressure by non-invasive positive pressure ventilation in the patients with hypercapnic respiratory failure.
It is very important to decrease pulmonary artery pressure (PAP) in patients with chronic obstructive pulmonary disease (COPD) in order to prevent progression to right heart failure. We showed an acute improvement of PAP by non-invasive positive pressure ventilation (NPPV) treatment in patients with hypercapnic respiratory failure. In 26 patients with COPD (18 males and 8 females), physical examination, Doppler echocardiographic evaluation and arterial blood gases analysis were performed on admission and at discharge. ⋯ Mean and systolic PAPs of the patients (43.8 ± 16.9 mmHg and 66.7 ± 23.3 mmHg) were significantly decreased with NPPV treatment (26.6 ± 8.4 mmHg, p< 0.0001 and 41.8 ± 14.6 mmHg, p< 0.0001). Also, each parameter of the arterial blood gases was improved significantly with NPPV usage. An echocardiographic assessment in the COPD patients having NPPV treatment due to acute respiratory failure, might be a useful and easy method to show an improvement of PAP as a supportive measure in the management of those patients, in addition to beneficial effects of that treatment on respiratory acidosis, hypercapnia and hypoxemia.
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Tüberküloz ve toraks · Jan 2010
Comparative Study[Comparison of the patients with pandemic (H1N1) influenza A virus pneumonia and community-acquired pneumonia].
Prognosis of pandemic influenza A (H1N1) virus pneumonia is worse than community-acquired pneumonia (CAP), therefore it is important to know distinctive clinical features of both pneumonias. The aims of this study were to compare clinical features and prognosis of patients with pandemic influenza A (H1N1) pneumonia and CAP due to other agents. Demographic features, symptoms and findings of 20 pandemic influenza A (H1N1) pneumonia and 18 CAP patients hospitalized between October 1st and December 30th, 2009 were evaluated. ⋯ None of the CAP patients were followed-up in the intensive care, whereas five pandemic influenza A (H1N1) pneumonia patients (25.0%) required intensive care and three of them died despite invasive mechanical ventilation. In conclusion, in the presence of fever, dyspnea with non-pulmonary symptoms and accompanying radiological alveolar opacities should be considered as pandemic influenza A (H1N1) pneumonia should be suspected in patients admitted with findings of pneumonia during influenza season. Admission to the intensive care unit and mechanical ventilation should be considered in patients with dyspnea and diffuse radiological findings.
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Tüberküloz ve toraks · Jan 2010
Review[Update on pulmonary hypertension in chronic obstructive pulmonary disease].
Secondary pulmonary hypertension (PH) is a well known possible feature in patients with chronic respiratory diseases. Owing to its frequency advanced chronic obstructive pulmonary disease (COPD) is the most common cause of PH. ⋯ Unfortunately, there is another subset of patients whom have minimal airway obstruction with greater PAP values called as 'out of proportion'. These two groups need special interest for further evaluation diagnosis and treatment strategy.
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Tüberküloz ve toraks · Jan 2010
Associated factors with non-invasive mechanical ventilation failure in acute hypercapnic respiratory failure.
Our aim was to determine associated factors with non-invasive mechanical ventilation (NIMV) failure in acute hypercapnic respiratory failure ninety live patients treated with NIMV for acute hypercapnic respiratory failure were evaluated. While success of NIMV was defined as absence of need of intubation with the patient's discharge from hospital, failure of NIMV was defined as death or need of intubation. The pretreatment pH level was 7.30 in success and 7.28 in failure group (p> 0.05), PaCO(2) was 71.45 mmHg in success and 72.17 mmHg in failure group (p> 0.05). ⋯ After 1h of treatment, in success group there was significant increase of pH and decrease of PaCO(2) in contrast to baseline levels, while there was no significant change in failure group. The pretreatment Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II score, serum C-reactive protein level and frequency of associated complication on admission were significantly higher and Glasgow Coma Score was lower in failure group. In conclusion, high APACHE II and C-reactive protein level, low Glasgow Coma Score, associated complication on admission and inadequate response in pH and PaCO(2) after first hour of NIMV are associated factors with NIMV failure.
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Tüberküloz ve toraks · Jan 2010
The efficacy of non-invasive positive pressure ventilation in ARDS: a controlled cohort study.
Few studies have investigated non-invasive positive pressure ventilation (NPPV) in acute respiratory distress syndrome (ARDS). The aim of this controlled cohort study was to determine the efficacy of NPPV in ARDS. Two hundred and eighty- seven patients were monitored in the respiratory intensive care unit over two years. ⋯ Mean duration of NPPV was 58.3 hours. There was no difference in Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II scores and initial PaO(2)/FiO(2) values between successful and unsuccessful NPPV groups; but the difference between PaO(2)/FiO(2) ratios at 24 hours between these groups was statistically significant (193.0 and 93.3, respectively; p= 0.003). While using NPPV in ARDS patients, if improvement is not seen in the first day, invasive mechanical ventilation should be implemented immediately.