Acute respiratory failure in a regional respiratory unit

One thousand, six hundred and sixteen patients with acute respiratory failure were managed in a regional respiratory unit. The patients are classified according to cause, the need for artificial ventilation and results.     

呼吸专科护士慢性呼吸疾病管理现状调查

目的调查呼吸专科护士慢性呼吸疾病管理现状,为提高慢性呼吸疾病的管理水平提供参考。方法依据《中国成人慢性呼吸疾病患者护理管理指南》设计调查问卷,对重庆、四川、贵州、陕西、河北、湖北、海南7省市的205名呼吸专科护士进行问卷调查。结果呼吸专科护士慢性呼吸疾病管理总分为(140.72±23.90)分。慢性呼吸疾病管理得分最低的3个条目有评估工具应用、个性化管理计划的实施、慢阻肺随访的次数及指导哮喘患者使用峰流速仪;呼吸专科护士所在单位慢性呼吸疾病管理平台建设均低于50%。结论呼吸专科护士慢性呼吸疾病管理处于中等偏下水平,评估是慢性呼吸疾病管理的薄弱点。需加强呼吸专科护士专业能力培养,规范慢性呼吸疾病全程管理,强化医院平台建设等,提高慢性呼吸疾病的管理水平。     

Postoperative respiratory failure

This analysis differentiates the causes of postoperative respiratory failure. Respiratory failure in thoracic patients is broken down into two distinct groups, aspiration and pneumonia, promoting actions to prevent respiratory failure. The goal is to develop different strategies to avoid postoperative respiratory failure using an active approach (what can be done in the management of patients undergoing lung resection to prevent problems) rather than passive approach (what patient factors caused problems after surgery). Before that analysis, the operative risks after lung resections (lobectomies, pneumonectomies, elderly patients) and esophagectomies are reviewed to understand the data.     

Diagnosis and treatment strategies in respiratory infections for respiratory surgeons

This review discusses the diagnosis and treatment strategies for respiratory infections those are useful for respiratory surgeons. To make a differential diagnosis between respiratory infections caused by several pathogens, it is important to consider the defects of normal defensive barriers, the location of the infection, and the route of infection. To analyze the location of the infection, it is very important to analyze the radiological findings based on normal anatomical structures; such as pulmonary lobulus, acinus, and respiratory bronchioles. Through analyzing chest computed tomography (CT) findings and distribution patterns based on normal anatomical structures, estimation of causative pathogens could be possible. If clinicoradiological analyses could make these differentiations, the appropriate treatment strategy for respiratory infections could be established. For respiratory surgeons, most important pathogens related to respiratory infections (frequently observed as nosocomial pneumonia) are Gram-negative rods as well as anaerobes. Therefore, it is important to select broad-specrum antibiotics ; such as broad-spectrum cephalosporins, carbapenems and new qunolones with or without clindamycin.     

Applied respiratory physiology

Anaesthesia has many effects on respiratory physiology, the knowledge of which is relevant to clinical practice. Anaesthesia causes decreased muscle tone in the upper airway, which can lead to airway obstruction. Pulmonary hypoventilation occurs in the spontaneously breathing patient. There is a progressive decrease in the ventilatory response to CO₂ with increasing concentration of volatile agents, and even low doses of volatile have a profound effect on the ventilatory response to hypoxia. Functional residual capacity (FRC) is significantly reduced in the anaesthetized patient. Airway closure occurs when closing capacity exceeds FRC, with a reduced FRC this is more likely to happen especially in older patients or patients with coexisting lung pathology when closing capacity may be increased. The resulting atelectasis will affect oxygenation. Respiratory system compliance reduces very early during anaesthesia and there is little difference between the paralysed and spontaneously breathing patient. Alveolar dead space is decreased due to impairment of V/Q matching. During anaesthesia, venous admixture accounts for 10% of cardiac output due to increased shunt and changes in V/Q scatter. During anaesthesia and surgery patient position, type of surgery, smoking and obesity all have specific effects on respiratory physiology. Exercise physiology parameters such as anaerobic threshold have a role as a measure of cardiorespiratory fitness such as in cardiopulmonary exercise testing (CPX). CPX is increasingly used in risk stratification in patients undergoing major surgery. Anaerobic threshold is the point at which oxygen delivery mechanisms can no longer match the oxygen demand required in exercise.     

Applied respiratory physiology

Anaesthesia has many effects on respiratory physiology, the knowledge of which is relevant to clinical practice. Anaesthesia causes decreased muscle tone in the upper airway, which can lead to airway obstruction. Pulmonary hypoventilation occurs in the spontaneously breathing patient. There is a progressive decrease in the ventilatory response to CO₂ with increasing concentration of volatile agents, and even low doses of volatile have a profound effect on the ventilatory response to hypoxia. Functional residual capacity (FRC) is significantly reduced in the anaesthetized patient. Airway closure occurs when closing capacity exceeds FRC, with a reduced FRC this is more likely to happen especially in older patients or patients with coexisting lung pathology when closing capacity may be increased. The resulting atelectasis will affect oxygenation. Respiratory system compliance reduces very early during anaesthesia and there is little difference between the paralysed and spontaneously breathing patient. Alveolar dead space is decreased due to impairment of V/Q matching. During anaesthesia venous admixture accounts for 10% of cardiac output due to increased shunt and changes in V/Q scatter. During anaesthesia and surgery patient position, type of surgery, smoking and obesity all have specific effects on respiratory physiology. Exercise physiology parameters such as anaerobic threshold have a role as a measure of cardiorespiratory fitness such as in cardiopulmonary exercise testing (CPX). CPX is increasingly used in risk stratification in patients undergoing major surgery. Anaerobic threshold is the point at which oxygen delivery mechanisms can no longer match the oxygen demand required in exercise     

Applied respiratory physiology

Anaesthesia has many effects on respiratory physiology, the knowledge of which is relevant to clinical practice. Anaesthesia causes decreased muscle tone in the upper airway, which can lead to airway obstruction. Pulmonary hypoventilation occurs in the spontaneously breathing patient. There is a progressive decrease in the ventilatory response to CO₂ with increasing concentration of volatile agents, and even low doses of volatile agents have a profound effect on the ventilatory response to hypoxia. Functional residual capacity (FRC) is significantly reduced in the anaesthetized patient. Airway closure occurs when closing capacity exceeds FRC; with a reduced FRC this is more likely to happen especially in older patients or patients with coexisting lung pathology when closing capacity may be increased. The resulting atelectasis will affect oxygenation. Respiratory system compliance reduces very early during anaesthesia and there is little difference between the paralysed and spontaneously breathing patient. Alveolar dead space is decreased due to impairment of V/Q matching. During anaesthesia, venous admixture accounts for 10% of cardiac output due to increased shunt and changes in V/Q scatter. During anaesthesia and surgery, patient position, type of surgery, smoking and obesity all have specific effects on respiratory physiology. Exercise physiology parameters such as anaerobic threshold have a role as a measure of cardiorespiratory fitness such as in cardiopulmonary exercise testing (CPX). CPX is increasingly used in risk stratification in patients undergoing major surgery. Anaerobic threshold is the point at which oxygen delivery mechanisms can no longer match the oxygen demand required in exercise.