Puzzling dyspnea caused by respiratory muscle weakness

Dyspnea is common in advanced stages of neuromuscular disorders, but it is infrequently the presenting symptom. However, dyspnea is a frequent complaint in a primary care setting but is rarely caused by a respiratory muscle weakness. Consequently, the diagnosis of respiratory muscle weakness often is delayed. First symptoms may occur when respiratory muscles are under increased load, such as when standing in the water higher than the chest, swimming, or in the supine position. We describe a patient in whom dyspnea was the first symptom of amyotrophic lateral sclerosis to remind clinicians of clinical features of respiratory muscle weakness and to help avoid the delay in diagnosis.     

小儿呼吸道感染病原学分析

目的　探讨本地区引起小儿呼吸道感染的病原学分布概况、临床表现特点。方法　应用ELISA法检测患儿急性期血清中 ,五种病毒 (EBV、CBV、RSV、MP、流感 )特异性抗体IgM。了解病原学种类。结果　从 14 2 9例疑似感染者血清中 ,检出五种抗体IgM阳性共 5 93例 ,阳性率 4 1.5 %。其中单一病毒感染阳性占 6 9.4 8% ,混合感染阳性占 30 .5 2 %。有些病原体除引起呼吸系统感染外 ,尚可导致肺外多系统的病变。结论　小儿呼吸道感染的病原学复杂 ,除细菌性感染外 ,病毒性感染的种类繁多 ,其流行高峰季节与临床表现各异 ,尤其是流感与柯萨奇病毒 ,尚可侵害心脏及中枢N等系统 ,引起心肌炎及无菌性脑膜炎等多种疾病 ,需引起重视     

Impact of occupation on respiratory disease

OBJECTIVES: This study identified occupations with a marked impact on sick leaves due to respiratory disease. METHODS: A national sick-leave register containing information on all sick leaves exceeding 14 days, physicians' diagnoses, and the occupational status of all manual and service employees in the private sector in Sweden was studied. Sick leaves during 1992-1994 (N=210,755) were analyzed with special attention to respiratory disease and occupation. RESULTS: Respiratory disease accounted for 4.4% of the total number of sick leaves. The incidence of long-term (> or = 90 days) sick leaves due to respiratory disease was 3 times higher in occupations with a high incidence than in those with a low incidence. There was a high correlation (r=0.80) between the incidence of long-term sick leave due to respiratory disease and sick leave due to all other conditions; this finding suggests that market and selection factors may play an important role in determining the overall risk for sick leave in various occupations. The proportion of sick leaves due to long-term respiratory disease out of all long-term disease was compared between occupations. Agricultural workers had a 46% higher proportion of long-term respiratory disease than metal workers. Industrial workers, food industry workers, and painters were also occupations with an increased risk. These findings could not be explained by differences in age or smoking habits. CONCLUSIONS: Major differences were found among manual and service occupations regarding long-term sick leave due to respiratory disease. Several occupations, in which exposure to respiratory sensitizers and irritants are known to occur, were among those in which workers had an increased risk for long-term respiratory disease.     

Neonatal respiratory insufficiency caused by maternal infection with trichomonas vaginalis

Authors presented cases of two premature newborns with severe respiratory insufficiency due to congenital maternal Trichomonas vaginalis infection requiring mechanical ventilation. They focused on this special perinatal problem and also on diagnostical and therapeutical modalities of this newly recognised syndrome in the early neonatal period.     

Evaluation of respiratory muscle strength and thoracic and abdominal amplitudes after a functional reeducation of breathing program for obese individuals

The purpose of this study was to assess the elements of respiratory mechanics in obese individuals with respect to respiratory muscle strength determined by maximum respiratory pressure (PImax and PEmax) and the amplitude of thoracoabdominal movements at the levels: axillary (AAX), xiphoid (AXf) and abdominal (AAb). Twenty nine patients (43 +/- 13 years) were divided in two groups: Experimental group (E) and Control group (C). All patients were submitted to an initial evaluation and determination of PImax, PEmax, AAx, AXiph and AAb. The E group was submitted to 18 sessions of a Functional Reeducation of Breathing Program that consisted of respiratory orientation, respiratory coordination exercise associated to trunk and limb movements and muscle relaxation two times a week during 9 weeks. Student t-test showed a significant increase in PImax, Axif and Aabd in the experimental group, but when authors compared the two groups, they did not find any statistical difference. The results showed that the Program increased the respiratory muscle strength and the amplitude of abdominal movements in obese patients.     

Improving respiratory muscle strength and health status in burn patients: a randomized controlled trial

Quality of Life Research - Pulmonary complications are among the major disadvantages of burns. The present study aimed to determine the effect of inspiratory muscle training on respiratory muscle...     

Nutrition and respiratory disease

Weight loss is a frequently occurring complication in patients with chronic obstructive pulmonary disease (COPD) and is a determining factor of functional capacity, health status and mortality. Weight loss in COPD is a consequence of increased energy requirements that are not balanced by dietary intake. Both metabolic and mechanical inefficiency contribute to an elevated total daily energy expenditure. Alterations in anabolic and catabolic mediators resulting in a dysbalance between protein synthesis and protein breakdown may cause a disproportionate depletion of fat-free mass in some patients. Nutritional support is indicated for depleted patients with COPD because it provides not only supportive care, but direct intervention through improvement in respiratory and peripheral skeletal muscle function and in exercise performance. A combination of oral nutritional supplements and exercise or anabolic stimulus appears to be the best approach to obtaining significant functional improvement. Patients responding to this treatment even demonstrated a decreased mortality. Poor response was related to the effects of systemic inflammation on dietary intake and catabolism. The efficacy of anti-catabolic modulation requires further investigation.     

Dose response effect of cement dust on respiratory muscles competence in cement mill workers

Electromyography (EMG) of respiratory muscles is a reliable method of assessing the ventilatory muscle function, but still its use has not been fully utilized to determine the occupational and environmental hazards on respiratory muscles. Therefore, EMG of intercostal muscles was performed to determine the dose response effect of cement dust on respiratory muscles competence. Matched cross-sectional study of EMG in 50 non-smoking cement mill workers with an age range of 20 - 60 years, who worked without the benefit of cement dust control ventilation or respiratory protective devices. EMG was performed by using surface electrodes and chart recorder. Significant reduction was observed in number of peaks (p < 0.0005), maximum peak amplitude (p < 0.0005), peak-to-peak amplitude (p < 0.0005) and duration of response (p < 0.0005) in cement mill workers compared to their matched control. Cement dust impairs the intercostal muscle competence and stratification of results shows a dose-effect of years of exposure in cement mill.     

火箭推进剂呼吸防护装备研究现状及发展趋势

本文对呼吸防护装备的应用、发展进行了综述，分析了火箭推进剂毒性对呼吸防护的要求和国内推进剂呼吸防护研究现状，对推进剂专用呼吸防护装备的发展趋势进行了探讨。     

郑州市小儿呼吸道病毒性感染病原学初析

目的探讨本市小儿呼吸道病毒性感染的病原学分布现状,为防治工作提供资料。方法应用ELISA法检测患儿急性期血清中7种病毒(IV、PIV、RSV、ADV、CBV、EBV、MP)特异性IgM抗体,以了解病原学分布。结果从8 594例被检患儿血清中,检出相关IgM抗体阳性2 907例,总阳性率为34.0%。含单一病毒感染占85.6%,2种混合感染占14.4%。单一病毒感染中IV占首位(29.4%),其余依次为MP(21.0%)、ADV(14.3%)、RSV(13.1%)、PIV(12.9%)、EBV(4.7%)、CBV(4.6%)。结论IV、MP、ADV、RSV、PIV为本地致小儿呼吸道感染的主要流行病原体。3岁前(新生儿除外)因免疫力低,对各种病毒的易感率高,故需关注此年龄段的预防工作。对疑似病例作IgM检测,能及时提供病原学诊断依据,并可作为流行病学调查的信息资料。     

Immunologic status, respiratory symptoms and ventilatory function in soybean-processing workers

Immunological and respiratory findings were studied in a group of 19 male soy-bean workers. A group of 31 control workers were examined for the prevalence of respiratory symptoms and 20 control workers were included in the immunological study. All soy-bean workers had positive immediate skin reaction to soy-bean dust, 18 to soy antigen after separation from oil, three to lecithin antigen and only one to soy oil. Only three soy-bean workers had increased levels of specific IgE. Among 20 control workers, 19 reacted to soy-bean dust, 20 to soy after separation of oil and none to soy oil. One demonstrated increased specific IgE. The prevalence of chronic respiratory symptoms was considerably higher in exposed than in control workers, being statistically different for dyspnea (P less than 0.01). The statistically significant acute reductions in ventilatory capacity were particularly pronounced for FEF50 (-4.7%) and FEF25 (-9.4%). The mean ventilatory capacity values before shift on Monday were significantly lower than those on the following Friday for FVC, FEF50 and FEF25. There was no difference in ventilatory capacity between soy-bean workers with positive and those with negative skin tests to house dust or between those with increased and those with normal IgE serum levels. A water soluble extract of soy-bean dust was also assayed in organ bath containing guinea pig trachea. This model showed the extract to be highly reactive causing a dose-related constriction of airway smooth muscle. Our data suggest that immunologic sensitization to soy-bean products is very frequent. In addition to possible humoral contribution to respiratory disorders, soy dust seems to directly affect airway smooth muscle.     

An atypical case of neuralgic amyotrophy with respiratory muscle weakness: case report and review of literature

This report is of an atypical case of neuralgic amyotrophy with a Horner's syndrome, bilateral brachial plexus, lumbar plexus and phrenic nerve involvement. The diagnosis isconfirmed based on a classical history and examination findings with typical neurophysiological investigations for this condition. This report also highlights the novel use of positional magnetic resonance imaging to investigate patients with respiratory muscle weakness. This case report expands the recognised clinical features of neuralgicamyotrophy and the literature concerning atypical features of this condition is reviewed.     

呼吸内科抗菌药物使用强度分析

目的 为开展抗菌药物专项整治活动提供依据,提高医院抗菌药物合理使用水平.方法 回顾性调查2012年1-4月医院呼吸内科315例出院患者的基本用药情况,以限定日剂量(DDD)分析法对用药频率(DDDs)和使用强度(AUD)进行统计分析.结果 2012年1-4月AUD分别为120.4、163.2、132.7、100.9 DDD;送检率均＞70.0％,DDDs排序前3位的药物分别为左氧氟沙星、哌拉西林/舒巴坦、头孢唑肟.结论 医院呼吸内科抗菌药物临床使用中以β-内酰胺类抗菌药物占主导地位,使用强度与卫生部要求力争＜40 DDD相差较大;随着抗菌药物的大量使用,细菌耐药性不断发展,应严格按照《抗菌药物临床应用指导原则》合理使用.     

Mechanical ventilation in the acute respiratory distress syndrome

The management of the acute respiratory distress syndrome (ARDS) patient is fundamental to the field of intensive care medicine, and it presents unique challenges owing to the specialized mechanical ventilation techniques that such patients require. ARDS is a highly lethal disease, and there is compelling evidence that mechanical ventilation itself, if applied in an injurious fashion, can be a contributor to ARDS mortality. Therefore, it is imperative for any clinician central to the care of ARDS patients to understand the fundamental framework that underpins the approach to mechanical ventilation in this special scenario. The current review summarizes the major components of the mechanical ventilation strategy as it applies to ARDS.     

腺病毒引起呼吸道感染疫情调查分析

目的探讨一起家庭呼吸道感染疫情的病原学,及腺病毒感染流行病学特征。方法采用相应的流行病学个案调查表进行现场调查,描述流行特征;采集患者咽拭子或呼吸道吸取物,利用反转录-聚合酶链式反应(RT-PCR)技术进行病毒核酸检测,确定致病原。结果累计发病7例,其中1例中老年患者出现重症肺炎并死亡,RT-PCR病毒核酸检测确认腺病毒感染;临床表现主要为发热,38℃以上,伴有乏力、肌肉酸痛、咳嗽、咽痛等症状,潜伏期大约4～10d,病程1W左右,通过封闭环境短距离长时间接触呼吸道传播。结论此起疫情由腺病毒感染引起,通过不明原因肺炎监测报告机制发现。     

Air pollution and acute respiratory diseases in children: regression analysis of morbidity data

The aim of this study was to investigate the relationship between acute respiratory diseases and the air quality in the urban area of the Upper Silesian Industrial Zone during autumn and winter with special emphasis on temporal variability in the air concentrations of pollutants. The survey was carried out in 5 primary care units in Chorzów where the morbidity data on the selected respiratory diseases were collected from 1 November 1992 to 31 March 1993. The air pollution data were obtained from the monitoring station, being a part of the Sanitary and Epidemiological Station Network. Regression analysis with mean values of concentrations of air pollutants as explanatory variables revealed a positive effect of combined suspended particulate matter and SO2 concentration on the increased prevalence of bronchitis and bronchiolitis. Similar and even stronger effect was observed at the level of temporal variability coefficients of the air pollutants. A hypothesis that temporal variability of the air concentration of pollutants might be a more relevant factor for determining the prevalence of respiratory diseases than simple mean values of the pollutant concentrations is very interesting worthy of further investigations.     

An update of respiratory cancer and occupational exposure to arsenicals

Mortality was updated through 1982 for 611 arsenic-exposed employees originally studied through 1973. In the earlier report, total mortality was observed to have been below the comparable U.S. population; however, mortality was significantly elevated for respiratory cancer. The focus of the update was on respiratory cancer and of special interest was whether the risk of respiratory cancer remained in excess for individuals alive as of the end of the last study. In the update, 9 additional respiratory cancers were observed subsequent to 1973, the end of the follow-up in the original study, versus 7.8 expected. The risk ratio for the time-interval 1974-1982 (standardized mortality ratio SMR = 116) was diminished compared to that reported in the original study (SMR = 330). When the entire study period was analyzed, the risk of respiratory cancer did not appear to decline with interval since exposure cessation. Analyses by duration of arsenic exposure and interval since first exposure did not reveal any obvious dose-response relationships.     

Influenza and other actue respiratory diseases in the Czech Socialist Republic, 1969-1974.

Since 1969, the incidence of acute respiratory diseases (ARD) in the Czech Socialist Republic of Czechoslovakia has been monitored by a special programme based on reports from 85 district epidemiological centres. In this paper, the incidence of ARD in three age groups, together with the incidence of complications and death rates, are presented for each season during the period 1969-1974. The significance of epidemiological observations and laboratory investigations relating to influenza and other ARD agents, such as parainfluenza viruses, adenoviruses, rhinoviruses, RS virus, coronaviruses, and Mycoplasma pneumoniae, is discussed.     

不同营养方式对呼吸科老年重症患者呼吸肌力及临床预后的影响

目的 比较不同营养方式对呼吸科老年重症患者呼吸肌力和临床结局的影响.方法 采用随机数字表法,将147例呼吸科老年重症患者按入院先后顺序随机分为肠内(EN)肠外(PN)混合营养组,EN组和PN组,每组49例,观察营养支持前后患者能量代谢指标和呼吸肌力的变化情况及短期结局.结果 营养支持后第7天,各组患者的血浆白蛋白(ALB)、血红蛋白(Hb)、肌酐(Cr)水平和氮平衡均较营养支持前明显升高(P均＜0.01),血尿素氮(BUN)水平较营养支持前明显下降(P＜0.01);混合营养组ALB、Hb、Cr和氮平衡升高幅度均明显高于EN组和PN组(P＜0.05或P＜0.01),BUN下降幅度明显高于EN组(P＜0.05).混合营养组(P=0.021)和EN组(P=0.011)的最大吸气压水平明显高于营养支持前,混合营养组的气道阻断压水平明显低于营养支持前(P=0.025).PN组患者感染性并发症及非感染性并发症发生率明显高于EN组 (P=0.002,P=0.017)和混合营养组(P=0.005,P=0.004),EN组患者的胃潴留发生率明显高于PN组(P=0.035).混合营养组患者的脱机时间、呼吸重症监护病房停留时间、住院时间与20 d死亡率均明显小于EN组和PN组(P均＜0.05).结论 EN与PN联用改善呼吸科老年重症患者营养状况和呼吸肌力的效果明显优于单用EN和PN,其短期临床结局也好于单用EN和PN.

Abstract：

Objective To compare the influences of different routes of nutrition on the outcome and respiratory muscle strength of elderly patients in respiratory intensive care unit (RICU). Methods Totally 147 elderly patients in RICU were equally randomized into combined nutrition group ( combinination of parenteral nutrition and enteral nutrition), total enteral nutrition (EN) group, and total parenteral nutrition (PN) group. The changes of energy metabolism, respiratory muscle strength, and short-term outcome were observed or determined.Results Plasma albumin (ALB), hemoglobin (Hb), creatinine (Cr) levels, and nitrogen balance significantly increased in all group 7 days later ( all P ＜ 0. 01 ), while blood urea nitrogen (BUN) significantly decreased ( P ＜0.01 ). The increase of ALB, Hb, Cr levels, and nitrogen balance were significantly more remarkable than that in EN group and PN group (P＜0.05 or P＜0.01). The decrease of BUN level in the combined nutrition group was significantly more remarkable than that in EN group ( P ＜ 0. 05 ). After nutritional support, the maximum inspiratory pressure in the combined nutrition group (P =0. 021 ) and EN group (P = 0. 011 ) became significantly higher, and occlusion pressure at 0.1 second inspiration level in the combined nutrition group became significantly lower ( P =0. 025). The incidences of infectious and non-infectious complications in PN group were significantly higher than those in EN group (P = 0. 002 and 0. 017, respectively) and combined nutrition group ( P = 0. 005 and 0. 004, respectively). Gastric retention was more common in EN group than that in PN group ( P = 0. 035). The weaning time,length of RICU stay, length of hospital stay and 20-day-mortality were significantly decreased in the combined nutrition group than those in the other two groups ( all P ＜ 0. 05 ). Conclusion The effectiveness of the combined application of PN and EN is superior to PN or EN alone in improving nutritional status and respiratory muscle strength as well as in improving the short-term outcome in elderly patients in RICU..     

呼吸机动力学参数监测模块设计

针对目前大多数小型呼吸机中呼吸动力学参数监测模块功能较弱的现状，采用新型传感器和基于ARM核的微处理器，设计了一种新型呼吸机动力学参数监测模块。该模块提高了呼吸动力学参数检测的精度，满足了实时监测的需要。通过使用USB接口，既提供了模块供电电源又实现了即插即用功能，控制系统通过USB接口可实时设置测量模块各种参数，对测量功能进行灵活配置。测试结果表明该模块适用于呼吸机及ICU病房中呼吸动力学参数的监测。