Acute on chronic respiratory failure

Article Abstract:

Chronic obstructive pulmonary disease (COPD) affects an estimated 10 million Americans. In 1982 there were nearly 60,000 deaths from this disorder, making it the fifth leading cause of deaths in the U.S. This disease includes individuals with chronic bronchitis and emphysema; and patients usually show both symptoms. Tobacco abuse is highly correlated with these lung diseases, which are normally seen in smoking patients who are in their fifth, sixth, or seventh decade of life. COPD patients are often severely impacted by conditions to their respiratory or other organ systems which would not significantly affect a normal individual. Such results can tip a precarious balance in the patient and lead rapidly to respiratory failure; such acute deterioration superimposed on a stable COPD is referred to as acute on chronic respiratory failure (ACRF). The pathophysiology of ACRF has led to the useful notion that fatigue of the respiratory muscles of the chest wall and the diaphragm is a primary cause of ventilatory failure. This fatigue occurs when the mechanical load imposed on the lung system cannot be counterbalanced by the active neuromuscular action of the muscles of respiration due to a lack of strength and endurance. This concept has proven useful in understanding the mechanisms of the disease itself, in designing useful therapies and in warding off the need to use a mechanical respirator. The approach allows reversible factors during the treatment of decompensated COPD to be identified and corrected before they lead to inspiratory muscle fatigue and respiratory failure. Oxygen therapy to reduce or eliminate hypoxia (decreased oxygen transport) in these patients is encouraged, despite erroneous views which are held by some physicians based on older, outdated information. A careful presentation of the various treatment options open to physicians is developed, including cases in which deterioration is irreversible and mechanical ventilation is mandatory. Approaches to eventual liberation from the ventilators are also delineated.

Lung diseases, Obstructive, Chronic obstructive lung disease, Respiratory insufficiency

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Use of the Pulmonary Artery Catheter in Critically III Patients: Was Invention the Mother of Necessity?

Article Abstract:

The case of the pulmonary artery catheter illustrates how difficult it can be to abandon a widely used technique if clinical trials show it provides no benefit. This catheter is inserted into the pulmonary artery to monitor cardiopulmonary function in critically ill patients. However, a 1996 study showed that the technique actually increased mortality rates. In response to this study, two doctors called for a moratorium on its use or randomized clinical trials to demonstrate its benefit. In the future, all critical care interventions should be thoroughly tested before their widespread implementation.

Editorial, Analysis, Arterial catheterization

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Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation

Article Abstract:

Discontinuing sedatives while patients on a ventilator are asleep can reduce the amount of time they spend on the ventilator. Patients on a ventilator are often given intravenous sedatives to make them less anxious. In many intensive care units, patients on a ventilator are given sedatives continuously. Researchers randomly assigned 128 patients on a ventilator to receive continuous intravenous sedatives or only when they were awake. Those who did not receive continuous sedatives spent less time on the ventilator and less time in the intensive care unit.

Health aspects, Usage, Artificial respiration, Mechanical ventilation, Sedatives, Hypnotics and sedatives

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