[Prehospital noninvasive ventilation in a 102-years old patient]. / Kasuistik interaktiv - Respiratorische Insuffizienz bei 102-Jährigem: Intubation vs. NIV in der Präklinik.

Guidelines for the therapy of cardiogenic pulmonary edema or acute exacerbation of COPD imply the use of noninvasive ventilation (NIV). Clinical studies show a decrease in intubation frequency, mortality and length of stay with inhospital NIV. First prehospital reports show a safe and feasible use of NIV in this setting. We report the case of a 102-year old patient who was successfully treated with preclinical NIV.

Pulmonary gas exchange does not worsen during repeat exercise in women.

The purposes were to determine (1) if repeat exercise worsens pulmonary gas exchange in women, and, (2) if the level of pulmonary edema obtained in these same women is related to the gas exchange impairment during exercise. Fourteen women (27 +/- 4 yrs; maximal oxygen uptake = 3.12 +/- 0.42 L/min) with minimal arterial PO2 (PaO2) ranging from 76 to 104 mmHg with a maximal alveolar-arterial PO2 difference (AaDO2) ranging from 7 to 35 mmHg performed three bouts of near-maximal exercise on a cycle ergometer (236 +/- 27 W) for 5 min each with 10 min of rest between sets. Cardiorespiratory parameters and oxygenation were measured at rest, throughout exercise and recovery. Chest radiographs were obtained before and 30 min after the interval training session (see Respir Physiol Neurobiol, 153 (2006) 181-190). Repeat exercise did not affect pulmonary gas exchange between sets 1 and 3 (change in PaO2 = 3 +/- 2 mmHg; change in AaDO2 = 1 +/- 2 mmHg P > 0.05). Arterial PCO2 decreased by 4 +/- 2 mmHg (P < 0.05) between sets 1 and 2, which did not reduce further in set 3. The level of PaO2 or AaDO2 was not related to the change in edema score or the post-exercise edema score (P > 0.05). In conclusion, pulmonary gas exchange is not worsened in women during interval training despite the mild edema triggered by exercise.

Randomized trial of high nutrient density formula versus standard formula in chronic lung disease.

To test the hypothesis that the nutrient intake and growth of infants with chronic lung disease would be improved by providing nutrients in more concentrated form, and that the lower volume would improve respiratory status, 60 preterm infants requiring supplemental oxygen at 28 days of age were randomly assigned a low-density (24 kcal/oz) formula fed at 180 ml/kg/day, or a high-density (30 kcal/oz) formula at 145 ml/kg/day. There was no difference in growth, respiratory outcome, oedema or diuretic requirement between dietary groups. Infants fed the high nutrient density formula had significantly greater total energy (143 vs 134 kcal/kg/day) and protein (3.9 vs 3.6 g/kg/day) intakes, largely because the low-density formula group did not achieve the designated 180 ml/kg/day. In conclusion, use of a high-density formula in infants with chronic lung disease did not improve growth or respiratory outcome, despite a small increase in total energy and protein intake.

Coordinating a successful discharge plan.

Whether you're working with a team or serving as liaison to a specially designated home care coordinator, your role is crucial in paving the way home for your patient. Here are the essential steps to take.