Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The ventilator support utilized in acute respiratory failure can exacerbate an underlying lung injury. Various ventilation techniques have been introduced to prevent such damage by limiting tidal volume and inflation pressure, ensuring uniform expansion of the lung, and stabilizing lung volume during expiration. Acceptance of such methods has been limited. Intermittent-flow expiratory ventilation (IFEV) is the latest development in limited-excursion pulmonary ventilation. The method involves the delivery of fresh gas to the respiratory tree during expiration, thereby flushing out the anatomic deadspace and ensuring that the gas initially delivered to the alveolus with the succeeding inspiration is able to participate in gas exchange. By eliminating end-tidal gas in the conducting air passages, series deadspace is functionally reduced, permitting lowering of tidal volume and airway pressures without a corresponding reduction in CO2 removal. This effect may benefit patients who have acute lung injury by permitting ventilator settings with lower tidal volumes and peak airway pressures. The technique of IFEV delivery, a successful clinical application, and possible ways to improve IFEV efficiency are discussed.
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PMID:Intermittent-flow expiratory ventilation (IFEV): delivery technique and principles of action--a preliminary communication. 177 67

Conventional medical treatment of COPD patients with acute respiratory failure (ARF) was associated with an overall mortality ranging 12-29%. When conservative treatment fails, ARF is usually managed by means of mechanical ventilation (MV) via an endotracheal tube (ET) or tracheostomy. Mortality of COPD patients with ARF treated with invasive MV ranged 21-54%. Invasive MV is associated with several complications. Positive pressure ventilation (PPV) by means of facial or nasal masks have been used in place of endotracheal intubation in ARF: the results are promising. Advantages of mask ventilation include the possibility of intermittent delivery of ventilation, use of different modalities of ventilation, the ability to undertake normal swallowing, feeding and speech, the possibility of physiological air warming and humidification, the possibility of coughing, and an easier weaning whilst still maintaining possibilities of ET intubation. Reported side-effects during mask PPV include mask discomfort, skin reddening, dry nose, air leaks, eye irritation and gastric distension. Mortality of COPD patients treated with noninvasive PPV ranged 6-25%. The level of severity of basal acidosis and blood gas response to a short trial of noninvasive PPV were predictive of success of this modality of MV. Preliminary results suggest that one year mortality after MV is reduced with noninvasive PPV in comparison to ET ventilation.
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PMID:Ventilation techniques: invasive versus noninvasive. 771 93

Although patients with COPD often have elevated pulmonary artery pressures (PAP) and pulmonary vascular resistance (PVR), it is uncertain whether treatment of this pulmonary hypertension is beneficial. We evaluated the extent of pulmonary hypertension in 16 patients with severe COPD complicated by acute respiratory failure and pulmonary hypertension. We assessed the hypothesis that the vasodilator prostacyclin (PGI2) would reduce PVR and improve systemic O2 transport. Patients with a COPD exacerbation requiring mechanical ventilation, and mean PAP greater than 30 mm Hg, were randomized to receive PGI2 or placebo, in addition to conventional therapy. Randomization to PGI2 or placebo therapy occurred 1 to 12 h after intubation, while the patient was mechanically ventilated. An optimal PGI2 dose (2 to 12 ng/kg/min, IV) was established in an initial dose-ranging study and then this dose was infused continuously for 48 h. PGI2 initially reduced PVR, but this effect dissipated within 24 h, indicating the development of tachyphylaxis. Tolerance to the adverse effects of PGI2 (tachycardia, hypotension, flushing, and headache) also developed over time. PGI2 treatment was associated with a significant fall in PaO2 but no increase in systemic oxygen transport. PGI2 proved to be a nonselective vasodilator that caused mild hypoxemia. Despite acute respiratory failure, pulmonary hypertension is mild in patients with severe COPD receiving mechanical ventilation and IV PGI2 is not beneficial in such patients.
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PMID:A placebo-controlled trial of prostacyclin in acute respiratory failure in COPD. 861 59