Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
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Data on the outcome of patients with chronic obstructive pulmonary disease (COPD) are limited. We know that the prognosis is poor when respiratory insufficiency develops, but we have little information on the actual cause of death. Epidemiological studies are suitable for the assessment of the prevalence of the disease, but give no details on the actual cause of death. ⋯ Results from pivotal studies have been encouraging, although survival is far less impressive than in neuromuscular disorders. In patients with end-stage lung disease, lung transplantation can be considered the only possibility of increasing pulmonary functional capacity. However the technique is reserved only for a highly selected group of patients and data on the long-term outcome are awaited.
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Monaldi Arch Chest Dis · Feb 1997
ReviewNoninvasive mechanical ventilation in acute on chronic respiratory failure: determinants of success and failure.
Mechanical ventilation (MV) has been indicated in the treatment of acute respiratory failure (ARF) if conservative treatment fails. The recent innovations of noninvasive methods of mechanical ventilation (NMV) make it possible to avoid the complications of invasive MV, at the same time ensuring a similar degree of efficacy. A review of the literature from 1989 to 1996 shows that use of NMV in ARF has been reported in several studies involving more than 500 patients, mostly with chronic obstructive pulmonary disease (COPD). ⋯ With these limitations, NMV in selected patients with ARF is well-tolerated and may be useful in avoiding ET intubation in most cases of COPD, and with a wide range of success rates in other diseases. This in turn has several advantages in terms of avoiding complications of invasive MV, reducing the length of stay in the Intensive Care Unit (ICU), and probably the number of ICU readmissions. Side-effects of NMV appear less severe than those induced by invasive MV.
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Monaldi Arch Chest Dis · Feb 1997
ReviewNoninvasive pressure support ventilation: physiological and clinical results in patients with COPD and acute respiratory failure.
Noninvasive ventilation may bring considerable benefits in the treatment of acute respiratory failure, especially in patients with chronic obstructive pulmonary disease. Reduction in the need for endotracheal intubation has been well-documented. In selected groups a reduction in morbidity, mortality, and length of hospital stay have been demonstrated. The efficacy of the technique is very dependent on the skill and motivation of the team.
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Monaldi Arch Chest Dis · Feb 1997
ReviewWhere and how must we perform noninvasive mechanical ventilation?
The classic experience of mechanical ventilation (MV) has recently been integrated with the use of devices providing noninvasive ventilatory assistance in the Intermediate Intensive Care Unit (IICU), to which patients suffering from acute on chronic respiratory insufficiency may be admitted for therapy. Noninvasive mechanical ventilation (NMV) has been demonstrated to be mandatory during severe relapses of chronic obstructive pulmonary disease (COPD). This method of ventilation can reduce mortality, morbidity and time spent in the Intensive Care Unit (ICU) when related to standard medical therapy alone. ⋯ Advanced COPD may frequently need periods of intensive treatment, monitoring and nursing. These patients may benefit from NMV which provides a specific intermediate treatment. With regard to an optimal cost/benefit ratio, the IICU is a reasonable alternative for COPD patients with less severe acute respiratory failure (ARF), reducing superfluous ICU stays.
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Monaldi Arch Chest Dis · Feb 1997
ReviewInterstitial lung disease: basic mechanisms and genetic predisposition.
Diffuse (interstitial) lung disease comprises a wide variety of relatively uncommon conditions, which present with characteristic clusters of clinical features and often with aberrant lung function. These diseases cause major morbidity and mortality due to lung injury and fibrosis. ⋯ However, since not all individuals exposed to a common environment develop interstitial diseases, we can hypothesize that there is a genetic predisposition to their development. Therefore, if we can identify individuals who are genetically predisposed to develop diseases characterized by lung injury and fibrosis, then management strategies can be designed which will attempt to identify early disease and, in the longer term, to develop targeted genetic interventional approaches to treatment.