Anti-IgE therapy in children with asthma. (73/424)

The prevalence of asthma continues to grow rapidly among children in areas undergoing urbanization. Current pharmacotherapy for asthma reduces inflammation and provides symptomatic relief, but it does not work for all patients and it does not entirely suppress the underlying disease. For these reasons new therapeutic approaches are still needed. Anti-IgE, the newest therapeutic modality for asthma, a biologic agent to control allergic disorders, represents a fundamentally new concept in treatment.  (+info)

Heliox in the treatment of chronic obstructive pulmonary disease. (74/424)

OBJECTIVE: To determine if breathing helium oxygen mixtures in addition to conventional therapy in non-intubated adult chronic obstructive airways disease (COPD) patients reduces the arterial partial pressure of carbon dioxide (Paco(2)) more than conventional treatment alone, and confers an advantage in terms of the odds of intubation in the acute setting. DESIGN: Meta-analysis. SETTING: Diverse settings. PARTICIPANTS: Adult patients with a diagnosis of either stable severe or acute COPD. MAIN OUTCOME MEASURES: Decrease in partial pressure of arterial Paco(2) and intubation rates. RESULTS: Combination of the results from trials measuring change in Paco(2) in COPD subjects receiving conventional therapy but breathing helium-oxygen estimated a reduction of 0.78 KPa (1.44-0.13) beyond that produced by conventional therapy with air-oxygen breathing (n = 234). Using quantitative and qualitative measures of validity it was found that most trials were unsatisfactory. Chief concerns were poor concealment of allocation and lack of blinding. Analysis excluding all papers with low methodological quality (Jadad<2) estimated the reduction in Paco(2) conferred by use of Heliox breathing to be 0.22 KPa (+0.57 to -0.14). A non-significant reduction (p = 0.2). When combined, the results from trials measuring the intubation rates of patients treated conventionally or with Heliox (n = 121) the odds ratio of intubation was 0.096 (0.03-0.27). CONCLUSION: Definitive evidence of a beneficial role of Heliox in treatment of severe COPD is lacking and therefore its wide scale use cannot be recommended based on this analysis. However, as a beneficial effect of Heliox breathing was reported in all trials, further investigation with a well conducted randomised controlled trial is warranted.  (+info)

Evidence underlying breathing retraining in people with stable chronic obstructive pulmonary disease. (75/424)

The efficacy of pursed-lip breathing (PLB) and diaphragmatic breathing (DB) in the rehabilitation of people with chronic obstructive pulmonary disease (COPD) remains unclear. This review examines the evidence regarding the usefulness of these techniques in improving the breathing of people with stable COPD. The studies included in our review of the literature used either PLB or DB in isolation, contained a clear description of the methods, and used outcomes that were measured with what we considered to be appropriate procedures. Pursed-lip breathing slows the respiratory rate, and evidence suggests that this decreases the resistive pressure drop across the airways and, therefore, decreases airway narrowing during expiration. This decrease in airway narrowing may account for the decreased dyspnea some people experience when using this technique. Diaphragmatic breathing has negative and positive effects, but the latter appear to be caused by simply slowing the respiratory rate. Evidence supports the use of PLB, but not DB, for improving the breathing of people with COPD.  (+info)

Perceptions of physicians, nurses, and respiratory therapists about the role of acute care nurse practitioners. (76/424)

BACKGROUND: Information about the contributions of acute care nurse practitioners to medical management teams in critical care settings is limited. OBJECTIVE: To examine contributions of acute care nurse practitioners to medical management of critically ill patients from the perspectives of 3 disciplines: medicine, respiratory care, and nursing. METHODS: Attending physicians, respiratory therapists, and nurses in 2 intensive care units were asked to list 3 advantages and 3 disadvantages of collaborative care provided by acute care nurse practitioners. Qualitative methods (coding/constant comparative analysis) were used to identify common themes and subthemes. Overall response rate was 35% (from 69% for attending physicians to 26% for nurses). RESULTS: Responses were grouped into 4 main themes: accessibility, competence/knowledge, care coordination/communication, and system issues. Acute care nurse practitioners were valued for their accessibility, expertise in routine daily management of patients, and ability to meet patient/family needs, especially for "long-stay" patients. Also, they were respected for their commitment to providing quality care and for their communication skills, exemplified through teaching of nursing staff, patient/family involvement, and fluency in weaning protocols. Physicians valued acute care nurse practitioners' continuity of care, patient/family focus, and commitment. Nurses valued their accessibility, commitment, and patient/family focus. Respiratory therapists valued their accessibility, commitment, and consistency in implementing weaning protocols. CONCLUSION: Responses reflected unique advantages of acute care nurse practitioners as members of medical management teams in critical care settings. Despite perceptions of the acute care nurse practitioner's role as medically oriented, the themes reflect a clear nursing focus.  (+info)

Nebulizer use and maintenance by cystic fibrosis patients: a survey study. (77/424)

INTRODUCTION: Patients with cystic fibrosis (CF) suffer from chronic infection of the airways, and typical CF therapies include aerosolized medications. There is recent evidence that home nebulizers become contaminated by bacteria, causing concern that nebulizers may be a source of bacterial infection of the lower airways. A recent consensus document on infection-control issues for the CF population included recommendations on cleaning and disinfecting nebulizers. METHODS: We surveyed 39 patients and their parents, as well as 54 respiratory therapists, regarding their routine nebulizer use and maintenance practices. RESULTS: All the patients used at least one nebulized medication, and they used a variety of nebulizers, obtained from a wide variety of sources. Thirty percent of the patients used nebulizers well beyond the manufacturer's recommended replacement date. Ninety percent of the patients rinsed their nebulizers following use, but only 15% performed any routine disinfection. The respiratory therapists' nebulizer cleaning methods were widely disparate, with only 70% performing some method of rinsing. The respiratory therapists' self-report of cleaning methods and their instructions to patients regarding frequency of cleaning were so diverse that no standard is evident. CONCLUSION: This study demonstrates that CF patients and their respiratory therapists should immediately address and improve their nebulizer cleaning methods and replacement practices. There should be more focus on teaching patients to regularly clean and replace nebulizers.  (+info)

Pulmonary tuberculosis and extreme prematurity. (78/424)

A mother, newly found to be positive for HIV, delivered her first baby at 25 weeks gestation. The infant initially did well in spite of a symptomatic patent duct and a severe intraventricular haemorrhage, but became severely unwell needing further respiratory support on day 18. Acid fast bacilli were found in endotracheal secretions. After the baby's death, the bacilli were confirmed to be Mycobacterium tuberculosis, and the same organism was grown from the mother's urine. The case raised challenging issues in relatively uncharted territory in terms of treatment of the infant, public health issues, ethical decision making, and media management.  (+info)

The intensive care of infants with hypoplastic left heart syndrome. (79/424)

Until a little over two decades ago, hypoplastic left heart syndrome was considered an inoperable and fatal condition, with most deaths occurring in early infancy, and almost all of those affected dying before their first birthday. However, the advent of surgical palliation and advances in peri-operative care, have offered hope to these patients and their families.  (+info)

Peak pressures during manual ventilation. (80/424)

INTRODUCTION: Manual (bag) ventilation sometimes achieves better oxygenation than does a mechanical ventilator. We speculated that clinicians might generate very high airway pressure during manual ventilation (much higher than the pressure delivered by a mechanical ventilator), and that the high airway pressure causes alveolar recruitment and thus improves oxygenation. Such high pressure might injure alveoli in some patients. METHODS: We tested the hypothesis that manual ventilation may involve substantially higher pressure than is delivered by a mechanical ventilator. We asked experienced respiratory therapists to manually ventilate a lung model that was set to represent several typical clinical scenarios. RESULTS: We found that the peak airway pressure generated by the therapists was sometimes in excess of 100 cm H(2)O. CONCLUSIONS: The high airway pressure during manual ventilation would be considered extreme in the context of conventional mechanical ventilation, which raises questions about whether manual ventilation causes barotrauma.  (+info)