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165. Erratum

Author

MALERBA, M., primary, CLINI, E., additional, CREMONA, G., additional, RADAELI, A., additional, BIANCHI, L., additional, CORDA, L., additional, PINI, L., additional, RICCIARDOLO, F., additional, GRASSI, V., additional, and AMBROSINO, N., additional

Published
2001
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199. Comparison of five bilevel pressure ventilators in patients with chronic ventilatory failure: a physiologic study.

Author

Vitacca M, Barbano L, D'Anna S, Porta R, Bianchi L, Ambrosino N, Vitacca, Michele, Barbano, Luca, D'Anna, Silvestro, Porta, Roberto, Bianchi, Luca, and Ambrosino, Nicolino

Abstract

Objective: To compare patient-ventilator interaction and comfort in patients with chronic ventilatory failure (CVF) who are undergoing noninvasive positive-pressure ventilation with five different commercial bilevel pressure home ventilators. Also, we wanted to evaluate the short-term effects of the five ventilators on physiologic variables, namely, breathing patterns and inspiratory muscles.Design: Randomized, controlled physiologic study.Setting: Pulmonary division of a rehabilitation institution.Patients: Twenty-eight patients with CVF due to COPD (17 patients) and restrictive chest wall diseases (11 patients).Measurements: Sensation of comfort, breathing patterns and minute ventilation (E), respiratory muscles and mechanics, and patient-ventilator interaction during both unassisted and assisted ventilation with the five ventilators applied randomly.Results: The five ventilators showed different flow and pressure waveforms. The level of comfort was somehow different among the studied ventilators. When compared to unassisted ventilation, all ventilators induced a significant increase in E (p < 0.01) without any significant difference among ventilators. Use of the five ventilators resulted in significant differences in peak airway opening pressure (Pao,peak) but not in mean airway opening pressure computed over a period of 1 min (PTPao,min), and in a duty cycle. Ineffective efforts (IEs) were similar among the studied ventilators. In comparison with unassisted ventilation, all ventilators induced significant reductions in inspiratory muscle effort (p < 0.001). No significant relationship was found between level of comfort and PTPao,min, Pao,peak, or the number of IEs.Conclusions: In stable, awake patients with CVF, all of the studied ventilators were well-tolerated, although with a great intersubject variability in comfort, and performed well in terms of improvement in E and inspiratory muscle unloading, thus fulfilling the aims of mechanical ventilation. This effect was obtained with similar levels of PTPao,min, despite the fact that Pao,peak was different among some ventilators. The number of IEs was similar among the studied ventilators. [ABSTRACT FROM AUTHOR]

Published
2002
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200. Pulmonary Rehabilitation Programs: Outcomes in Patients with Chronic Obstructive Pulmonary Disease.

Author

Ambrosino, N.

Subjects
*OBSTRUCTIVE lung diseases, *DISEASE management, *PREVENTIVE medicine, *PATIENTS
Abstract

Effective management of chronic obstructive pulmonary disease (COPD) is aimed at prevention of disease progression, relief of symptoms, improvement in exercise tolerance, improvement in health status, prevention of complications, prevention of exacerbations and reduction in mortality. Pulmonary rehabilitation, aimed at restoring patients with disabling disease to an optimally functioning state, is a relatively recent practice in pulmonary medicine and is classically described as a multidisciplinary program of ‘care’ for patients with chronic respiratory impairment. Health status assessment is a central feature of studies of COPD, since treatments for this condition, other than smoking cessation and long-term oxygen therapy, are largely symptomatic. Health status measurement quantifies the impact of disease on patients' daily life, health and well-being. General health- and disease-specific questionnaires have been designed to measure health status as well as health-related quality of life (HR-QOL). Published results provide a scientific basis for the overall pulmonary rehabilitation programs and, although with a lesser degree of evidence, for the specific components of these programs. The benefits of pulmonary rehabilitation include improvements in exercise tolerance, dyspnea and HR-QOL, and, to some extent, a decrease in healthcare usage. Pulmonary rehabilitation is effective in all settings including hospital inpatient, hospital outpatient, the community and home. However, more information is needed to ensure that the appropriate rehabilitation is given to the increasing number of patients with chronic respiratory diseases. Pulmonary rehabilitation is a costly process and patients should be carefully selected in order to save resources and obtain the maximum benefit. Although several questions remain unresolved, pulmonary rehabilitation programs should be included in the comprehensive treatment of patients with COPD. [ABSTRACT FROM AUTHOR]

Published
2002
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