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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Monaldi Arch Chest Dis · Oct 1996
ReviewHome mechanical ventilation in children: techniques, outcomes and ethics.
Various neuromuscular and pulmonary disorders can cause ventilatory failure in children. Tracheostomy ventilation in the home is especially valuable in younger children who require ventilatory support for most of the day and who have bulbar dysfunction but newer noninvasive techniques especially nasal mask ventilation are often preferable. It is important to select the type of ventilator and to choose the interface with the patient carefully in order to maximise the child's quality of life.
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Monaldi Arch Chest Dis · Aug 1996
ReviewThe complications of lung resection in adults: acute respiratory distress syndrome (ARDS).
Postoperative lung injury is a recognized complication of pulmonary resection. In adults, this is manifest in its most severe form as the acute respiratory distress syndrome (ARDS). ARDS is characterized by high permeability pulmonary oedema resulting in refractory and often terminal hypoxaemia. ⋯ Perioperative fluid overload, increased blood flow through the remaining lung postoperatively, reoxygenation injury and activation of inflammatory mediators have been postulated as possible causes. Conventional parameters for preoperative assessment do not predict those patients most likely to develop lung injury in these circumstances. Clinical management strategies for acute respiratory distress syndrome complicating lung resection are discussed.
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Monaldi Arch Chest Dis · Jun 1996
ReviewRespiratory function in children with neuromuscular disease.
Respiratory failure is the most common cause of death in children with neuromuscular disease (NMD). This article provides a conceptual framework for understanding failure of the respiratory pump in these children. Pump failure can be attributed to faulty control of respiration, to mechanical defects, and to respiratory muscle fatigue. ⋯ The combination of a weak, inefficient respiratory pump and an abnormally high elastic load can predispose these patients to respiratory muscle fatigue. Respiratory muscle rest with nocturnal assisted ventilation, therefore, provides a rational approach to the treatment of chronic respiratory failure in patients with NMD. Areas of future research that may prove useful in the care of children with respiratory failure due to NMD include: the development of better ways of assessing respiratory muscle fatigue; studies to increase understanding of the role of mechanical ventilation in improving chest wall and respiratory pump function; and studies delineating the role of respiratory muscle training in these patients.
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Wegener's granulomatosis and Churg-Strauss syndrome are the predominant pulmonary vasculitides. Next in frequency are the various diffuse alveolar haemorrhage syndromes, which may be related to the antineutrophil cytoplasmic autoantibody (ANCA)-associated diseases, such as Wegener's granulomatosis and Churg-Strauss syndrome, or may be a part of a collagen vascular disease, such as lupus erythematosus, or associated with antiglomerular basement membrane antibody (AGBM) and fall within the definition of Goodpasture's syndrome. ⋯ Entities previously confused with pulmonary vasculitis include lymphomatoid granulomatosis or polymorphic reticulosis, and benign lymphocytic angiitis and granulomatosis, which are probably in the spectrum of T-cell lymphomas. Necrotizing sarcoid and sarcoidosis can involve blood vessels, but do not follow a typical course associated with the traditional concept of vasculitis.