State of the ventilatory function of the lungs in heavy smokers

Computed spirography, He/O test and capnography evaluation of external respiration has been carried out for 52 subjects. Of these 27 were nonsmokers, 25 smoked but had no history of respiratory diseases. The integral criteria of external respiration obstruction (MOCmax, MOC50, MOC75) proved inadequate diagnostic tool for early detection of ventilatory alterations in smokers who are at risk to develop chronic nonspecific pulmonary diseases. Pharmacological tests, He/O investigation and capnography did reveal defects in small bronchi permeability in all the smokers. Problems of pathogenesis of obstructive affections of distal regions of the bronchial tree are under consideration.     

Terminology and the current limitations of time capnography: A brief review

The carbon dioxide (CO₂) trace versus time (time capnography) is convenient and adequate for clinical use. This is the method most commonly utilized in capnography. However, the current terminology in time capnography has not yet been standardized and is, therefore, a potential source of confusion. Standard terminology that is based on convention and logic to represent the various phases of a time capnogram is essential. The time capnogram should be considered as two segments: an inspiratory segment and an expiratory segment. The inspiratory segment is termed as phase 0; the expiratory segment is divided into phases I, II, III, and, occasionally, IV, Phase I represents the CO₂-free gas from the airways (anatomical dead space); phase II consists of a rapid S-shaped upswing on the tracing due to mixing of dead space gas with alveolar gas; and phase III, the alveolar plateau, represents CO₂-rich gas from the alveoli. The physiologic basis of phase IV, the terminal upswing at the end of phase III, which is observed in capnograms recorded under certain circumstances (such as in pregnant subjects and obese subjects) is discussed in detail. The clinical implications of the alpha angle, which is the angle between phases II and III, and the beta angle, which is the angle between phases III and the descending limb of phase 0, are outlined. The subtle but important limitations of time capnography are reviewed; its current status as well as its future potential are explored.     

Capnography in the gastroenterology lab.

This article provides the reader with information and education regarding the use of capnography for both adult and pediatric patients undergoing procedural sedation during endoscopy by: reviewing the basics of capnography, in addition to the physiology of ventilation and oxygenation; illustrating how capnography may provide an earlier warning of hypoxemia than does pulse oximetry; briefly discussing current guidelines for procedural sedation and the potential role of capnography; and reviewing clinical situations causing changes in the capnogram waveforms and the nursing interventions that should be made in response to such changes.     

Capnographic waveforms in the mechanically ventilated patient

A focus on patient safety has heightened the awareness of patient monitoring. The importance of clinical applications of capnography continues to grow, as reflected by the increasing number of medical societies recommending its use. Recognition of changes in the capnogram assists in clinical decision making and treatment and can increase patient safety by alerting the clinician to important situations and changes. This article describes the interpretation of capnograms and how capnogram interpretation influences airway management.     

Capnography application in acute and critical care

The use of capnography has expanded over recent years. Currently, capnography is used in a variety of acute care settings. This article describes what capnography is and how it is used. The normal and abnormal capnogram or waveforms are described to assist in identifying various clinical situations. The multiplicity of clinical indications include detection of pulmonary embolism as well as malpositioned endotracheal/tracheal, gastric, and small bowel tubes. Capnography also provides clinicians with information regarding expiratory breathing patterns and assists in perfusion assessments such as those for cardiopulmonary resuscitation. Finally, case studies are provided to help the reader apply the concepts of capnography to a variety of acute care settings.     

Model-based approach and signal detection theory to evaluate the performance of recruitment centers in clinical trials with antidepressant drugs

The objective of this study was to characterize the performance of each recruitment center in multicenter clinical trials and to provide criteria to discriminate between informative and noninformative centers using the signal detection approach. Data were derived from the GlaxoSmithKline Clinical Trial database on paroxetine and bupropion, totaling 4,016 subjects with major depressive disorders (MDDs) across nine trials. The probability of observing clinically relevant difference of active treatment from placebo was estimated in each center as a function of the placebo Hamilton Depression Rating Scale (HAMD-17) scores at baseline and at week 8. The center's performance was defined using the posterior probability (PP) of detecting a signal of a treatment effect. Only 60% of the centers were classified as informative. In these centers, the signal of treatment effect increased by approximately 80%. The signal detection approach appears to be a useful methodology to rank the performance of recruitment centers and to classify each center as informative or not in respect of detection of clinically relevant signals of efficacy. A further analysis indicated that a minimal sample of four subjects is required in order to predict the typical placebo response in each center.     

Prehospital determination of tracheal tube placement in severe head injury

Methods: All adult patients (>18 years) with severe head injury, maxillofacial injury with need of protection of airway, or polytrauma were intubated by an emergency physician in the field. Tube position was initially evaluated by auscultation. Then, capnometry and capnography was performed (infrared method). Emergency physicians evaluated capnogram and partial pressure of end tidal carbon dioxide (EtCO₂) in millimetres of mercury. Determination of final tube placement was performed by a second direct visualisation with laryngoscope. Data are mean (SD) and percentages.

Results: There were 81 patients enrolled in this study (58 with severe head injury, 6 with maxillofacial trauma, and 17 politraumatised patients). At the first attempt eight patients were intubated into the oesophagus. Afterwards endotracheal intubation was undertaken in all without complications. The initial capnometry (sensitivity 100%, specificity 100%), capnometry after sixth breath (sensitivity 100%, specificity 100%), and capnography after sixth breath (sensitivity 100%, specificity 100%) were significantly better indicators for tracheal tube placement than auscultation (sensitivity 94%, specificity 66%, p<0.01).

Conclusion: Auscultation alone is not a reliable method to confirm endotracheal tube placement in severely traumatised patients in the prehospital setting. It is necessary to combine auscultation with other methods like capnometry or capnography.

     

Clinical presentation of connective tissue dysplasia in adults

Connective tissue dysplasia (CTD) markers (anthropometric parameters, joint hypermobility, state of the skin, osteomuscular system, etc.) as well as external respiration function, echocardiography, occlusive plethysmography data were assessed in 402 healthy subjects (142 males and 260 females, mean age 28.4 +/- 0.5 years). Four basic CTD symptom complexes were identified: ligamentous-articular, cutaneous, osteomuscular and cardial. Control group consisted of subjects free of CTD markers (n = 61). Combination of the above four symptom complexes occurred in 8.5% examinees. These show psychoemotional disorders, impaired function of external respiration, decreased size of the heart, low arterial pressure, affection of capillary and venous circulation.     

Effect of Different Positions on FVC and FEV1 Measurements of Asthmatic Patients

[Purpose] The purpose of our study was to investigate the effect of different positions on pulmonary function test (PFT) values such as forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁) of asthmatic patients .[Subjects and Methods] Thirty subjects with severe asthma aged between 20–39 years were enrolled after they had signed a written consent. Subjects were selected using the inclusion criteria, and PFT were randomly administered. Spirometer measurements (FVC, FEV₁) were taken in the supine, side lying on right, side lying on left, sitting and standing positions. Each measurement was taken three times, and the average values were analyzed. [Results] One- way analysis of variance (ANOVA) and Tukey’s Test (post hoc) for pair- wise comparison indicated that there was a significant difference in the FEV₁ values of the asthmatic patients however a significant difference was obtained between standing and supine positions. There was also a significant difference in the FVC values between the standing and supine lying position in the pair -wise comparison. [Conclusion] This study showed standing is the best position for measuring FEV₁ and FVC of asthmatic subjects. The more upright the position, the higher the FEV₁ and FVC will be.Key words: Pulmonary function test, Standing position, Spirometry     

Functional-diagnostic criteria of chronic bronchitis

Basing on the findings gained at investigation of external respiration with measurement of the forced expiration rate in a large group of chronic bronchitis sufferers, subjects exposed to occupational respiratory irritants and in healthy subjects, the conclusion was made on a high informative content in relation to chronic bronchitis diagnosis of a maximal expiration rate at the level of 75% expiratory vital capacity, especially in combination with Tiffeneau test.     

Acupuncture correction of autonomic nervous system disorders in patients with bronchial asthma

Acupuncture was added to medicines in the treatment of 192 patients suffering from bronchial asthma with autonomic dysfunction. The effect was assessed by changes in rhythmogram, external respiration function, psychological status. It was found that corporal acupuncture not only improves bronchial permeability but also reduces psychovegetative disorders. The effect of acupuncture was not related to that of placebo.     

Effectiveness of fenspiride in patients with chronic obstructive bronchitis

Patients with chronic obstructive pulmonary disease of moderate severity were investigated for two months for assessment of fenspiride activity. Examination of the patients (age 42.6 +/- 5.3) took place before and after fenspiride therapy. In comparison to the control group, fenspiride patients showed improvement of external respiration function: FEV 1, FVC, FEF 50-75, PEF increased. Dienic conjugates, malonic dialdehyde levels decreased, alpha-tocopherol in platelet membranes rose, functional activity of platelets fell. Side effects were rare and not serious. It is concluded that fenspiride has an antiinflammatory effect, reduces bronchoconstriction and depresses platelet aggregation, is well tolerated. Fenspiride is an effective drug for the treatment of moderate chronic obstructive bronchitis.     

Intra-session repeatability of FET and FEV6 in the general population

BACKGROUND: The recent American Thoracic Society/European Respiratory Society spirometry guidelines harmonized quality criteria and included assessment of forced expiratory time (FET) in bronchodilation testing when an isolated significant forced vital capacity (FVC) bronchodilation effect is observed. No consensus exists on the criteria of accepted variability of FET. Forced expiratory volume in 6 s (FEV6) has been suggested to replace FVC, especially in primary care. We examined the variability of FET and FEV6 and its determinants in the general population. METHODS: We studied the results of acceptable flow-volume measurements from a general population sample of 603 subjects aged 25-74 years. Intra-class correlation coefficients (ICC), coefficients of variation (CoV), absolute and relative differences of FET, forced expiratory volume in 1 s (FEV1), FEV6 and FVC from the three acceptable curves were calculated. RESULTS: FET had a mean CoV of 11.3% and ICC of 0.873. The average CoV and ICC for FEV1, FVC and FEV6 were 1.4% and 0.996, respectively. The 95th percentile of FET difference was 2.7 s. Older age was associated with slightly higher variability. Reproducibility of FET (CoV 10.6%) was better, that of both FEV6 (1.5%) and FVC (1.7%) slightly worse, in subjects with airflow limitation (FEV1/FVC < 88% predicted). CONCLUSIONS: Intra-session variability of FET was eightfold compared with other flow-volume variables. Variability of FEV1, FEV6 and FVC were similar. The findings suggest that the upper limit of intra-session repeatability of FET is around 3.0 s. In subjects with airflow limitation FEV6 was slightly but not significantly less variable than FVC.     

Experience in treating patients with chronic obstructive bronchitis with fenspirid

AIM: To study a clinical effect of fenspirid and its impact on external respiration function in patients with chronic obstructive bronchitis (COB) in the exacerbation phase. MATERIAL AND METHODS: 30 COB patients participated in the trial (20 males, 10 females, age 39-80 years). The severity of clinical symptoms (cough, sputum, dyspnea) was studied using special scales. External respiration function was examined by a spirometric system "Tamrac system spiro sense Y2 14". Fenspirid treatment was conducted in a dose 80 mg twice a day for 3 months. Control examinations were made 2 weeks, 1 and 3 months after the treatment start. RESULTS: A 3-month treatment with fenspirid resulted in regression of COB symptoms: cough and sputum ceased, dyspnea decreased. This led to improvement in external respiration function, especially in patients with mixed ventilatory disorders with prevailing restriction. CONCLUSION: Fenspirid is an effective and well tolerated treatment of chronic obstructive bronchitis.     

Interrelation between the lipid composition of expirates and lung ventilation function in patients with acute pneumonia

A study was made of the lung surfactant (LS) according to the results of an analysis of neutral lipid fractions, examination of total phospholipids (PL) and surface tension (ST) in expirates (EX) of 127 patients with acute pneumonia (AP), 30 patients with acute bronchitis (AB) and in 77 healthy persons. As compared to the control and AB patients, AP patients demonstrated a significant increase in EX of the level of cholesterol (CS), esters of cholesterol (ECS), free fatty acids (FFA), PL, ST and a decrease of the content of tri- and diglycerides (TG, DG). Linear negative correlations were established between external respiration and CS, ECS, FFA, ST and positive ones between external respiration and TG and DG. Relations between ventilation and PL were of nonlinear character. Parameters that characterize the pulmonary volumes and capacities correlated most closely with some lipid fractions whereas parameters of bronchial patency had relations of medium and low intensity. It is concluded that destructive processes in the LS are likely to be coupled. The given processes are reflected in the rise of lipid fractions in EX, with ventilation function of the lungs being deranged in AP.     

Hyperventilation syndrome in bronchial asthma, essential hypertension and organic neurosis. Clinical picture and external respiration function

The external respiration function was studied in 100 patients with hyperventilation syndrome (HVS) divided into 3 groups: 40 patients with HVS and bronchial asthma (group 1) consisting of 15 males and 25 females (age median--45 years, 25 percentile--37 years, 75 percentile--53 years); 39 patients with HVS and essential hypertension (group 2) consisting of 8 males and 31 females (age median 49, 25 percentile--40 years, 75 percentile--57 years); 21 patients with HVS without concurrent somatic diseases of group 3 (7 males, 14 females, age median 45 years, 25 percentile--28 years, 75 percentile--45 years). It is shown that different disorders of pulmonary ventilation correspond to different clinical manifestations of HVS. Thus, in bronchial obstruction (group 1) HVS manifests with "weak respiration", in restrictive pulmonary disorders (group 2) HVS manifests as "heavy respiration", in high parameters of bronchial permeability (group 3)--"shallow respiration".     

Therapeutic fibro-bronchoscopy with the sanative controlled high-frequency jet ventilation

Sanative effect of the target high-frequency jet oxygen ventilation was utilized at fibro-bronchoscopy of the bronchial tree. The procedure improved external respiration in 81.5% of patients with marked disorders of tracheobronchial permeability while in control subjects no effect was observed. A marked clinical response and high oxygenating potential of the technique (a 102.3% increase in pO2) make in useful for wide clinical introduction.     

Measures in the campaign against smoking and their efficacy according to the results of a 3-year observation under the conditions of a district polyclinic

Examination of 4185 men aged 30 to 59 years, carried out within the framework of investigations into multifactorial prevention of coronary heart disease enabled one to establish that the number of tobacco-smokers among that group men amounts to 45.1%. The percentage of tobacco-smokers appreciably decreases with age. Every second tobacco-smoker starts smoking at the age of 15 to 25 years and smokers out up to 20 and over cigarettes a day. It has been established that 86% of the tobacco-smokers have been smoking for more than 20 years, which allows attributing them to a group of persons suffering from stage III-IV tobacco-smoking, needing therapeutic care. Tobacco-smoking control consisting in group and individual interviews made it possible to lower the populational level of tobacco-smoking by 8.4% for 2 years. In the reference group, that indicator decreased by 1.4%. A new narcologic method of the treatment of tobacco-smoking has been elaborated, the efficacy of which amounted to 85.3% for a year. The use of the method led to the lowering of the populational level of tobacco-smoking by 15.1% during 3 years. In the reference group, the number of tobacco-smokers dropped by 4.7%.     

Ergospirometry in the diagnosis of disorders of the oxygen transport system in patients with chronic bronchitis]

Ergospirometry was used to carry out a study with the increasing exercise in 56 patients with chronic bronchitis and 46 healthy subjects. The limit physical potentialities, qualitative and quantitative characteristics of ventilation, hemodynamics, gas exchange at the height of the exercise were compared. It has been established that in the early disease stages, there was a tendency to hyperventilation during exercise in response to the deterioration of bronchial patency, which was accompanied by significant deterioration of the efficacy of ventilation with respect to the level of gas exchange attained. A close relationship has been discovered between the magnitude of energy activity and bronchial patency. The authors give practical recommendations for determining work fitness prognosis on the basis of the linear regression equation with the use of the parameters of external respiratory function.