On the other hand, there were 6 patients with equally low values for both MIP and МЕР (less than 80 cm H2O) before training, who did not suffer from postoperative pulmonary complications (Table 3). Operative procedures for these patients were lobectomy in three, segmentectomy in two, and resection of mediastinal tumor via median sternotomy in one case other canadian family pharmacy. Their MIP values after training were significantly higher than the values before training: 85.5 ±30.4 vs 60.7 ±19.5 cm H20 (p<0.05 [Fig 3]). Their МЕР values after training also were significantly higher than the values before training: 63.7 ±9.3 vs 47.2 ±16.9 cm H20 (p<0.05 [Fig 4]).
Category Archives: Pulmonary Function : Part 5
The MIP values in the training and the control groups are presented in Figure 1. In the training group, the MIP value after pulmonary muscle training was significantly higher than the value before training: 133.2 ±54.1 vs 96.6 ±34.7 cm H2O (p<0.01). In contrast, in the control group, there was no significant difference between MIP values at the first and second measurements: 111.3 ±43.3 vs 111.9 ±43.3 cm H20.
The МЕР values in the training and the control groups are presented in Figure 2. Canadian family pharmacy review In the training group, the МЕР value after training was significantly higher than the value before training: 111.6 ± 47.3 vs 94.6 ±42.0 cm H2O (p<0.01). In contrast, in the control group there was no significant difference between МЕР values at the first and second measurements: 102.9 ±41.8 vs 103.9 ±40.1 cm H2O.
Postoperative care was routinely performed by bland aerosol therapy using a mucolytic agent, continual epidural anesthesia, the IDSEP device, and deep diaphragmatic breathing and efficient coughing supported by the surgeon or physical therapists, or both. The surgeon was aware of the preoperative MIP and МЕР data, but the physical therapists were blinded as to which patients had lower respiratory muscle strength.
In order to ascertain the stability and normal values of MIP and МЕР measured by the present method, 50 healthy subjects were examined by the same technique described above. They were matched with each study case as to sex and age (± 5 years); age ranged from 28 to 75 years (55 ± 12 years).
The IDSEP device consists of a nose clip, a mouthpiece, 800 ml of dead space, and a pressure valve which allows free inspiration and opens on exhaling with a force of 15 cm H2O or more. To achieve effective diaphragmatic breathing and coughing, the chest surgeon or physical therapists, or both, instructed the patients three times a day for 10 min each session. The training with IDSEP was performed four times a day for 10 min each session. Canadian neighborhood pharmacy This training was continued from admission until the day before surgery for a mean of 14 days (range, 7 to 21 days). Pulmonary function values and respiratory muscle strength were determined before and after training (the day before thoracic surgery).
Measurements of vital capacity (VC), forced vital capacity, and FEVi were performed with the subjects in the seated position, using a dry, rolling seal spirometer (Fudac-50, Fukuda, Tokyo, Japan). The predicted normal values of VC were determined using the formulas of Baldwin and coworkers.
Patients undergoing extensive thoracic surgery commonly have an increased risk of postoperative pulmonary complications. Atelectasis and pneumonia, which are caused mainly by reduced ability to expectorate sputum and insufficient diaphragmatic breathing, are the most frequent postoperative pulmonary problems. To prevent these complications, preoperative pulmonary rehabilitation sometimes is performed. However, this preoperative respiratory muscle training has not yet been objectively evaluated.
Several authors have reported that respiratory muscle training increases maximum inspiratory (MIP) and expiratory (МЕР) mouth pressure, which are indicators of respiratory muscle strength, in patients with COPD and in normal subjects. In the present study, we assessed the efficacy of preoperative pulmonary training for increasing respiratory muscle strength and its effects on postoperative pulmonary complications by measuring MIP and МЕР in patients undergoing thoracic surgery.
Adenovirus was isolated in five patients; the two patients who were HIV-negative recovered without complication. Adult respiratory distress syndrome has been associated with adenovirus infection, but this was not seen in the present series. Adenovirus also is a rare cause of pneumonitis in AIDS patients. All three HIV-positive patients in our series also had P carinii isolated, which probably played a more significant role in the two deaths than did adenovirus. Buy allegra online Here
There is no specific treatment for adenoviral infections.
Rhinovirus is the major cause of the common cold and may precipitate exacerbations of asthma and obstructive lung disease. On occasion, rhinovirus may be associated with pneumonia. There is a higher prevalence of infection in the spring and fall, and treatment usually is symptomatic. The eight patients infected in our study had uneventful hospital courses and recovered as expected without significant morbidity.
The isolation of herpesvirus from the lower respiratory tract does not distinguish between active disease, oropharyngeal contamination, or asymptomatic shedding of the virus. However, in the present study herpesvirus frequently was the only pathogen, was associated with neutrophils in the BAL fluid, and in patients without HIV infection, was associated with an increased WBC count and increased mortality. This suggests that herpesvirus may have been the cause of pneumonia. Too few patients were treated with acyclovir to determine if treatment would affect outcome. To further assess the role of herpesvirus would require transbronchial biopsies or careful postmortem studies of patients from whom herpesvirus is recovered. It would be reasonable to treat patients with acyclovir if herpesvirus is the only pathogen recovered during BAL and severe disease is present. Since we had incomplete information on some of the patients undergoing BAL, we cannot provide mortality data for the group as a whole to compare with data for the patients with herpesvirus infection.
There were 28 BAL cultures from which a virus was the only potential pathogen isolated, and a BAL differential cell count was performed (Table 4). Seventeen of these cultures grew herpesvirus; the remaining cultures included five influenza (four type A, one type B), three rhinovirus, one parainfluenza type 3, and two adenoviruses. Twenty-four of the differential cell counts were abnormal, with an increased percentage of neutrophils, lymphocytes, or both. The normal differential cell counts occurred in three patients with herpesvirus isolated and one with influenza A. The mean percentages and standard errors of the mean for the combined group were as follows: macrophages, 62 percent (11.7); neutrophils, 23 percent (4.3); and lymphocytes, 15 percent (2.9). There was a significant difference between BAL differential cell counts when comparing the herpesvirus group (neutrophils, 28 percent; lymphocytes, 12 percent) with the non-herpesvirus isolates (neutrophils, 17 percent; lymphocytes, 20 percent), which yielded a probability of less than 0.05.
Recovery of Viruses Other Than Cytomegalovirus From Bronchoalveolar Lavage Fluid: Inflammatory Response
Parainfluenza virus was found in six patients, and in three, parainfluenza was the only pathogen isolated. There were three type 1 and three type 3 isolates. All patients were immunocompromised including three with malignant tumors, two with AIDS, and one with systemic lupus erythematosus. Three patients had an associated coinfection, including Haemophilus influenzae, Nocardia asteroides, or P carinii carinii. Three patients were receiving corticosteroids, and they all had localized bibasilar (two patients) or lobar infiltrates. Diffuse infiltrates were present in the other three patients. There was no clear association between roentgenogram appearance and coinfections being present. No antiviral therapy was given to any patient. All patients recovered from their acute events without significant morbidity.
Eleven patients undergoing diagnostic BAL had influenza virus isolated, and in eight of these influenza was the only pathogen isolated. There were nine type A and two type В isolates. All positive cultures were obtained between December and the first week in March. Medical records were available for 9 of 11 patients. Seven of the patients were immunocompromised, but none of the patients had HIV infection and their influenza immunization status could not be determined. The median age was 52 years, with a range of 33 to 78 years (Table 3). Chest roentgenograms revealed diffuse infiltrates in five patients and lobar infiltrates in three. Five patients experienced acute respiratory failure requiring mechanical ventilation; three died. Amantadine was used in only one patient, a 33-year-old who experienced acute respiratory failure requiring mechanical ventilation; he survived. Overall, three of nine (33 percent) evaluable patients infected with influenza virus died. Canadian health & care mall Source All three had influenza A and none received amantadine therapy. Their deaths were from acute respiratory failure occurring within 5 days of diagnosis. A contributing factor to death in one patient with melanoma was sepsis from Streptococcus pneumoniae.