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Three major systems are currently available in most urban settings for the delivery of long-term oxygen therapy. These are compressed oxygen in tanks, liquid oxygen, and oxygen concentrators. Each system has advantages and disadvantages. The choice of system for any individual patient must be based on relative cost, the need for portability, and safety features. The cost of oxygen and regulations governing its reimbursement vary widely throughout the country. Oxygen should be supplied by reputable vendors who meet specific criteria for assuring quality service. In many instances referral to a home care agency for teaching and supervision of the patient is essential. Patient compliance with long-term oxygen therapy is often poor due to factors such as lack of significant subjective improvement, unrealistic fears or embarrassment concerning use of oxygen, and feelings of depression or hopelessness that the patient may experience when told he needs oxygen.  相似文献   

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Thoracic physicians in New South Wales, Australia, and conservative in their administration of long-term oxygen therapy. Relatively few patients are being treated with it at present. Those who are use oxygen cylinders and concentrators in their homes. Use of long-term therapy is restricted to two groups: first, well-motivated patients who, after investigation and treatment, continue to have PaO2 values below 60 mm Hg and evidence of complications arising from hypoxia; and second, a few patients who have central apnea and severe desaturation of hemoglobin during sleep.  相似文献   

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J M Luce 《Respiratory care》1983,28(7):866-875
Long-term oxygen therapy appears to be a safe means of treating hypoxemia. It can provide many physiologic improvements and prolongs life in persons with severe chronic arterial hypoxemia at rest. Recent studies suggest that arterial hypoxia is common during exercise and sleep, and it is likely that some patients with intermittent desaturation would benefit physiologically from supplemental oxygen. Oxygen is an expensive drug, and we do not know whether its benefits are greater than its costs in patients who are not hypoxic at rest. I believe that low-flow oxygen administered as continuously as possible should be strongly considered for all patients whose PaO2 is 55 mm Hg or less at rest, regardless of whether they have cor pulmonale, and for all patients with cor pulmonale, regardless of their PaO2.  相似文献   

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Hess DR 《Respiratory care》2002,47(12):1471-1476
Most physicians and respiratory therapists are knowledgeable of the use of aerosolized drugs, but many are less familiar with the performance characteristics of the nebulizer. In fact, the general opinion is that the performance of the nebulizer is relatively unimportant. However, there is accumulating evidence that the nebulizer itself does make a difference. The decision to replace a good performing nebulizer with a poor performing nebulizer may decrease the delivered dose in half or more. Although this is less important for routine bronchodilator therapy, it may make a big difference with newer aerosolized drugs. Increasingly, the Food and Drug Administration is approving drugs to be used with a specific nebulizer brand and new nebulizer designs are becoming available for use with these drugs. There are several reasons why I think this conference was important. First, new aerosol drug formulations are becoming available and these will require better performing nebulizers. Second, we as clinicians need to be knowledgeable of the newer generations of nebulizers so that we can make informed purchase decisions. Third, and perhaps most important, we must gain an increased appreciation for aerosol therapy as a science. The proceedings of this conference do much to synthesize the current state-of-the art related to new nebulizer systems. This provides, in a complete and cogent manner, the scientific basis for which clinicians can improve their knowledge of the new generation of nebulizers.  相似文献   

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Wedzicha JA 《Respiratory care》2000,45(2):178-85; discussion 186-7
The use of positive-pressure nasal ventilation in combination with LTOT in stable COPD patients with hypercapnic respiratory failure controls hypoventilation and improves daytime ABGs, sleep, and quality of life. Nasal ventilation in COPD is unlikely to produce benefit unless used with supplemental oxygen therapy at night. The patients who show the greatest reduction in overnight PaCO2 with ventilation are the patients most likely to benefit from long-term ventilatory support. Although there is now evidence for short-term benefit from NPPV in hypercapnic COPD, large multicenter studies with survival, exacerbations, and hospital admissions as the primary end points are required to evaluate longer-term effects of this potentially important intervention.  相似文献   

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Invasive mechanical ventilation in adults: conference summary   总被引:3,自引:0,他引:3  
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Asthma is actually a complex set of wheezing disorders driven by dysregulated inflammation in the airways. The profound redundancy of the inflammatory milieu in the asthmatic airway has resulted in an as yet incomplete understanding of the pathophysiology. Despite tremendous research efforts over the past several decades, defining the asthma phenotype, unraveling its genetics, and accurately diagnosing the condition remain difficult. Application of standardized testing for diagnosis and management of asthma, such that control is maintained and risk of future impairment in the form of exacerbations minimized, is vital. Newer techniques and biomarkers are being developed that may help identify ongoing airway inflammation in a noninvasive and clinically useful fashion. Knowledge of the current treatment armamentarium and its accurate application to maximize effectiveness and reduce risk is also important for all practitioners. New immunomodulatory medications and treatments are being developed that may offer hope for those patients whose asthma is refractory to current treatments. The development and dissemination of new evidence-based guidelines, and strong patient self-management, may help reduce the substantial morbidity suffered by the asthmatic population. This Journal Conference addressed the current state of the art in asthma diagnosis and management.  相似文献   

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A summary of the 2-day Journal Conference on Current Trends in Neonatal and Pediatric Respiratory Care is provided. Topics included: diagnosis and management of common respiratory disorders of infants and children such as asthma, respiratory syncytial virus bronchiolitis, and cystic fibrosis; and common pediatric respiratory emergencies such as croup, epiglottitis, and inhalation injuries. Also discussed were developments in diagnostic and therapeutic modalities, including pulmonary function testing and pulse oximetry. Evidence-based strategies for the resuscitation of critically ill newborns and subsequent ventilator management strategies were presented. Several faculty members discussed controversies regarding mechanical ventilation and extracorporeal membrane oxygenation for treatment of acute respiratory distress syndrome and other causes of respiratory failure in children and infants.  相似文献   

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Pharmacy practice transformation was the focus of an invitational conference held in June 2011 to address the current status of the practice of pharmacy in Virginia and elucidate the consensus on future directions from pharmacists across the commonwealth. The series of presentations provided visionary perspectives on the role that pharmacists can have in the collaborative management of patients with chronic disease states, the optimal pharmacy practice model for direct patient care delivery in acute care settings, and payment for pharmacists' cognitive services, such as medication therapy management (MTM). The discussion groups were structured to have conference participants first identify future goals for pharmacy practice and then consider strategies to achieve these goals. The conference concluded with a consensus development dialogue that revealed the priorities as well as the strategies that needed to be employed to move the profession toward its goals.  相似文献   

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