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2.
BMJ Support Palliat Care ; 1(3): 339-42, 2011 Dec.
Article in English | MEDLINE | ID: mdl-24653481
7.
Anaesthesia ; 54(2): 166-7, 1999 Feb.
Article in English | MEDLINE | ID: mdl-10215711

ABSTRACT

Fatal oesophageal perforation occurred as a complication of elective general anaesthesia for cataract extraction in a 77-year-old female patient. Tracheal intubation had been achieved, albeit with difficulty, in the course of a clinical trial of the intubating laryngeal mask.


Subject(s)
Esophageal Perforation/etiology , Laryngeal Masks/adverse effects , Aged , Anesthesia, General , Cataract Extraction , Fatal Outcome , Female , Humans
8.
Anaesthesia ; 48(1): 8-13, 1993 Jan.
Article in English | MEDLINE | ID: mdl-8434761

ABSTRACT

Effective intermittent positive pressure ventilation can be achieved noninvasively using a nasal mask, but patient comfort may be compromised and respiratory effort increased unless the trigger threshold is low and the response time of the ventilator short. The effect of nasal ventilation upon inspiratory muscle effort and the functional characteristics of the trigger of a purpose-built ventilator were evaluated in five patients with chronic obstructive airways disease. A measure of inspiratory muscle effort, the average pressure time integral per minute, decreased by at least 80% in four patients and by 50% in one. Only two patients had significant numbers of triggered breaths (17% and 47% of total) during 1 h of ventilation with settings as used at home. Therefore trigger function was evaluated when the patients were made to trigger the ventilator by slowing the control rate. A high resting end-expiratory intrathoracic pressure decreased the effective trigger sensitivity so that a mean (SD) change in oesophageal pressure of 14.8 cmH2O was required to lower mask pressure by 2.4 (0.3) cmH2O and activate the trigger. Even under these conditions of lowest trigger sensitivity inspiratory muscle effort was not increased compared to spontaneous ventilation.


Subject(s)
Intermittent Positive-Pressure Ventilation , Lung Diseases, Obstructive/physiopathology , Respiratory Muscles/physiopathology , Carbon Dioxide/blood , Esophagus/physiopathology , Evaluation Studies as Topic , Female , Humans , Intermittent Positive-Pressure Ventilation/instrumentation , Male , Masks , Middle Aged , Nose , Oxygen/blood , Pressure , Respiratory Mechanics/physiology
9.
Thorax ; 47(5): 342-8, 1992 May.
Article in English | MEDLINE | ID: mdl-1609376

ABSTRACT

BACKGROUND: Domiciliary assisted ventilation, using negative or positive pressure devices, is an effective treatment for respiratory failure due to chest wall deformity and neuromuscular disease. Negative pressure ventilators have been used with some success in patients with chronic obstructive lung disease in hospital, but attempts to continue treatment at home have been disappointing. This study evaluates the practicalities of nasal intermittent positive pressure ventilation at home in patients with chronic obstructive lung disease and the effect on sleep and quality of life. METHODS AND RESULTS: Twelve patients with chronic obstructive lung disease and hypercapnic respiratory failure received nasal intermittent positive pressure ventilation at home during sleep. At six months eight were continuing with the ventilation. One patient had died and three had withdrawn because they were unable to sleep with the equipment. Full polysomnography performed during ventilation in patients continuing treatment at six months showed an increase in mean PaO2 of 11% (+2% to +23%) and lower mean transcutaneous carbon dioxide tensions (by -2.7 (-1.3 to -5.1) kPa) overnight compared with spontaneous breathing before the start of nasal intermittent positive pressure ventilation. Total sleep time and sleep efficiency changed during ventilation by +72.5 (+21 to +204) minutes and +5% (-3% to +30%) respectively; sleep architecture and the number of arousals were unchanged. Quality of life did not change but was no worse during ventilation. At one year seven patients were still using the ventilator and PaCO2 and bicarbonate ion concentration during the day had improved further by comparison with the values at six months (change from baseline -1.7 (-2.1 to -0.6) kPa, p less than 0.05, and -6.3 (-11.9 to -4) mmol/l, p less than 0.05). CONCLUSIONS: Nasal intermittent positive pressure ventilation can be used effectively at home during sleep in selected patients with chronic obstructive lung disease. Its future place in management can be established only by formal comparison with long term oxygen therapy.


Subject(s)
Home Nursing , Hypercapnia/therapy , Intermittent Positive-Pressure Ventilation/methods , Lung Diseases, Obstructive/therapy , Quality of Life , Respiratory Insufficiency/therapy , Sleep/physiology , Female , Humans , Hypercapnia/blood , Lung Diseases, Obstructive/blood , Male , Middle Aged , Oxygen/blood , Respiratory Insufficiency/blood
10.
Eur Respir J ; 4(9): 1044-52, 1991 Oct.
Article in English | MEDLINE | ID: mdl-1756837

ABSTRACT

The improvement in arterial blood gas tensions following assisted ventilation in chronic obstructive pulmonary disease (COPD) has usually been attributed to the relief of incipient or established respiratory muscle fatigue. The contribution of changes in the load placed upon and the drive to the respiratory muscle pump have not been evaluated. We have investigated the contribution of changes in respiratory muscle strength, the ventilatory response to CO2 and ventilatory function to changes in arterial blood gas tensions in eight patients with severe COPD completing six months domiciliary nasal intermittent positive pressure ventilation. Six patients showed a reduction and two an increase in arterial carbon dioxide tension (PaCO2), median (range) for eight patients, -0.9 kPa (-1.5 to +0.4) (p less than 0.05) and seven showed an improvement in arterial oxygen tension (PaO2), +0.7 kPa (-0.4 to +1.7) (p less than 0.05) during daytime spontaneous breathing. The reduction in PaCO2 was not related to increased inspiratory muscle strength but was correlated with a decrease in gas trapping (Spearman rank correlation coefficient (r(S)) 0.85, p less than 0.05) and in the residual volume (r(s) 0.78, p less than 0.05), suggesting reduced small airway obstruction and, therefore, a reduction in load. The change in PaCO2 also correlated with the increase in ventilation at an end-tidal CO2 of 8 kPa during rebreathing (r(s) -0.76, p less than 0.05) suggesting improved chemosensitivity to CO2. Our data do not support the hypothesis that improvements were due to the relief of muscle fatigue. We suggest that the contribution of changes in load and central drive warrant further investigation.


Subject(s)
Home Care Services , Intermittent Positive-Pressure Ventilation/methods , Lung Diseases, Obstructive/therapy , Pulmonary Gas Exchange/physiology , Respiratory Muscles/physiopathology , Female , Humans , Lung Diseases, Obstructive/physiopathology , Male , Middle Aged , Respiratory Mechanics/physiology , Spirometry , Time Factors
15.
Eur Respir J ; 3(7): 743-5, 1990 Jul.
Article in English | MEDLINE | ID: mdl-2261962
16.
Eur Respir J ; 3(7): 746-51, 1990 Jul.
Article in English | MEDLINE | ID: mdl-2124540

ABSTRACT

Treatment of nocturnal hypoventilation in patients with restrictive chest wall disease and respiratory failure, results in improved daytime arterial blood gas tensions, increase in functional ability and longer survival. Success has been achieved with the use of protriptyline which reduces the duration of rapid eye movement (REM) sleep during which nocturnal hypoventilation occurs. Eighteen patients with severe chronic airflow limitation (CAL), took part in a randomized, double-blind, crossover trial of protriptyline and placebo. Seventeen patients completed the study. The use of protriptyline was associated with a fall in the median percentage of total sleep time spent in REM from 16 to 8.8% (p less than 0.01). This was associated with a reduction in the median daytime arterial carbon dioxide tension from 6.4 kPa (range 5.2-8.5 kPa) to 5.8 kPa (range 5.0-8.1 kPa) (p less than 0.01); increased respiratory muscle strength (p less than 0.05), and increased six minute walking distance from a median of 258 m (range 58.5-585 m) to 275 m (range 171-598 m) (p less than 0.02). We found pharmacological treatment of REM-related nocturnal hypoventilation in patients with CAL to be effective, but anticholinergic side-effects, particularly in older male patients, might preclude long-term treatment.


Subject(s)
Protriptyline/therapeutic use , Respiratory Insufficiency/drug therapy , Adult , Aged , Carbon Dioxide/blood , Female , Humans , Hypoventilation/drug therapy , Male , Middle Aged , Oxygen/blood , Protriptyline/pharmacology , Respiratory Insufficiency/blood , Respiratory Mechanics/drug effects , Sleep, REM/drug effects
18.
BMJ ; 300(6721): 358-60, 1990 Feb 10.
Article in English | MEDLINE | ID: mdl-2106984

ABSTRACT

The value of mechanical ventilation using intermittent positive pressure ventilation delivered non-invasively by nasal mask was assessed in six patients with life threatening exacerbations of chronic respiratory disease. Median (range) arterial oxygen and carbon dioxide tensions were 4.4 (3.5-7.2) kPa and 8.7 (5.5-10.9) kPa respectively, with four patients breathing air and two controlled concentrations of oxygen. The arterial oxygen tension increased with mechanical ventilation to a median (range) of 8.7 (8.0-12.6) kPa and the carbon dioxide tension fell to 8.2 (6.5-9.2) kPa. Four patients discharged after a median of 10 (8-17) days in hospital were well five to 22 months later. One died at four days of worsening sputum retention and another after five weeks using the ventilator for 12-16 hours each day while awaiting heart-lung transplantation. This technique of mechanical ventilation avoids endotracheal intubation and can be used intermittently. Hypercapnic respiratory failure can be relieved in patients with either restrictive or obstructive lung disease in whom controlled oxygen treatment results in unacceptable hypercapnia. Respiratory assistance can be tailored to individual need and undertaken without conventional intensive care facilities.


Subject(s)
Intermittent Positive-Pressure Breathing , Positive-Pressure Respiration , Respiratory Insufficiency/therapy , Acute Disease , Adult , Carbon Dioxide/blood , Female , Humans , Length of Stay , Male , Middle Aged , Oxygen/blood , Prognosis
19.
Cardiology ; 77(1): 25-9, 1990.
Article in English | MEDLINE | ID: mdl-2354475

ABSTRACT

Two groups of patients with nocturnal arterial oxygen desaturation were compared. The degree of nocturnal oxygen desaturation, as reflected by the percentage of total sleep time spent with an oxygen saturation less than 90 and 80%, was similar in patients with the obstructive sleep apnoea syndrome (OSAS) and in those with nocturnal hypoventilation (NH) secondary to restrictive chest wall disease. Systemic hypertension was present in 16 of the 24 OSAS patients but in only 6 of the 24 with NH (p less than 0.005). Multiple regression analysis demonstrated that this difference remained significant even after adjustment for age, sex, weight and history of smoking. It is likely that factors other than nocturnal hypoxaemia are important in the aetiology of systemic hypertension in patients with sleep-related breathing disorders.


Subject(s)
Hypertension/blood , Hypoxia/etiology , Sleep Apnea Syndromes/complications , Female , Humans , Hypertension/complications , Male , Middle Aged , Oxygen/blood , Respiration Disorders/complications , Scoliosis/complications , Sleep Apnea Syndromes/blood
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