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)

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

Traditionally, nasal oxygen therapy has been delivered at low flows through nasal cannulae. In recent years, nasal cannulae designed to administer heated and humidified air/oxygen mixtures at high flows (up to 60 L/min) have been gaining popularity. These high-flow nasal cannula (HFNC) systems enhance patient comfort and tolerance compared with traditional high-flow oxygenation systems, such as nasal masks and nonrebreathing systems. By delivering higher flow rates, HFNC systems are less apt than traditional oxygenation systems to permit entrainment of room air during patient inspiration. Combined with the flushing of expired air from the upper airway during expiration, these mechanisms assure more reliable delivery of high Fio2 levels. The flushing of upper airway dead space also improves ventilatory efficiency and reduces the work of breathing. HFNC also generates a positive end-expiratory pressure (PEEP), which may counterbalance auto-PEEP, further reducing ventilator work; improve oxygenation; and provide back pressure to enhance airway patency during expiration, permitting more complete emptying. HFNC has been tried for multiple indications, including secretion retention, hypoxemic respiratory failure, and cardiogenic pulmonary edema, to counterbalance auto-PEEP in patients with COPD and as prophylactic therapy or treatment of respiratory failure postsurgery and postextubation. As of yet, very few high-quality studies have been published evaluating these indications, so recommendations regarding clinical applications of HFNC remain tentative.
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PMID:Heated Humidified High-Flow Nasal Oxygen in Adults: Mechanisms of Action and Clinical Implications. 2643 23