Articles: function.
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Failure of a double-lumen endotracheal tube (DLT) to isolate the lung during thoracic surgery can have significant consequences. In this report, we examine an approach for rescuing a malpositioned DLT. ⋯ A 7-Fr Arndt bronchial blocker was positioned through the tracheal lumen of the DLT to obtain 1-lung ventilation. This technique can be used to rescue a malfunctioning DLT without the need for extubating and reintubating the trachea.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2013
Review[Monitoring of the respiratory muscle function during weaning from mechanical ventilation].
Early weaning and discontinuation of mechanical ventilation can help prevent respiratory muscle dysfunction in critically ill patients. Prolonged mechanical ventilation and failure to use adequate strategies to discontinue mechanical ventilation can even enhance and perpetuate respiratory muscle dysfunction. ⋯ Therefore, accurate monitoring of the respiratory muscle function is a valuable tool for the clinician at the bedside to assess to optimal weaning strategy and, ideally, would predict either weaning failure or success. In this review, we briefly summarize the available techniques, measurements and equipment required for the monitoring of respiratory muscle function in the intensive care unit.
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Total hip and knee arthroplasty (THA and TKA) are frequently performed surgical procedures with excellent long-term functional outcomes. However, pain is pronounced in the early post-operative phase, especially after TKA. Glucocorticoids have proven to relieve post-operative pain, but a higher dose might be needed, as compared with the lower dose recommended to reduce post-operative nausea and vomiting (PONV). Prior to this PhD study, procedure-specific data were limited on the effects of high-dose glucocorticoid on post-operative pain and recovery in THA and TKA. So, the following question remained to be answered: does high-dose glucocorticoid added to a multimodal analgesic regime reduce pain and improve recovery after THA and TKA? ⋯ This PhD thesis render new knowledge by demonstrating - for the first time - detailed procedure-specific beneficial effects of a single pre-operative dose of MP, 125 mg IV, on acute post-operative analgesia in THA, and on acute post-operative analgesia and on other immediate recovery aspects in TKA. Noteworthy, these benefits were observed with MP added to a comprehensive multimodal oral analgesic regime consisting of paracetamol, celecoxib and gabapentin - and in TKA also to an intra-operative local infiltration analgesia regimen. However, current data in hip and knee surgery preclude firm safety conclusions, and call for large-scale studies to definitively clarify the risk-benefit ratio, before final recommendations can be made. Also, the shortage of dose-finding data calls for studies to define the minimal effective dose to provide post-operative analgesia.
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J Pain Symptom Manage · Oct 2013
Functional impairments as symptoms in the symptom cluster analysis of patients newly diagnosed with advanced cancer.
Symptoms and subsequent functional impairment have been associated with the biological processes of disease, including the interaction between disease and treatment in a measurement model of symptoms. However, hitherto cluster analysis has primarily focused on symptoms. ⋯ Functional impairments in patients newly diagnosed with late-stage cancers behave as symptoms during the diagnostic phase. Health care providers need to expand their assessments to include both symptoms and functional impairments. Early recognition of functional changes may accelerate diagnosis at an earlier cancer stage.
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Sarcoidosis Vasc Dif · Sep 2013
Long-term management of IPF with pirfenidone - a clinical case study with 5 years follow-up.
Idiopathic pulmonary fibrosis (IPF) is a progressively fibrotic interstitial lung disease that is associated with a median survival of 2-5 years from initial diagnosis. To date, the search for an effective treatment has involved numerous clinical trials of investigational agents but without significant success. Nevertheless, research over the past 10 years has provided us with a wealth of information on its histopathology, diagnostic work-up, and a greater understanding of its pathophysiology. ⋯ Emerging clinical data from recently published and ongoing trials investigating new potential pharmacological agents should be considered in the routine clinical management of these patients. Based upon encouraging results from randomised-controlled trials showing a positive effect in slowing decline in pulmonary function and reducing disease progression, pirfenidone was approved in 2011 as the first treatment in patients with IPF. This case study describes the clinical course of a patient enrolled into the Phase III and open-label extension studies of pirfenidone.