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Clinics in Chest Medicine

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https://www.readbyqxmd.com/read/29779604/progress-in-the-treatment-of-patients-with-neuromuscular-and-nonmuscular-chest-wall-diseases
#1
EDITORIAL
F Dennis McCool, Joshua O Benditt
No abstract text is available yet for this article.
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779603/diaphragm-pacing
#2
REVIEW
Anthony F DiMarco
Diaphragm pacing (DP) is a useful and cost-effective alternative to mechanical ventilation in patients with ventilator-dependent spinal cord injury and central hypoventilation syndrome. Patients with SCI should be carefully screened to assess the integrity of their phrenic nerves. In eligible patients, DP improves mobility, speech, olfaction, and quality of life. The stigma of being attached to a mechanical device and risk of ventilator disconnection are eliminated. There is also some evidence that DP results in a reduction in the rate of respiratory tract infections...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779602/swallowing-and-secretion-management-in-neuromuscular-disease
#3
REVIEW
Deanna Britton, Chafic Karam, Joshua S Schindler
Neuromuscular disease frequently leads to dysphagia and difficulty managing secretions. Dysphagia may lead to medical complications, such as malnutrition, dehydration, aspiration pneumonia, and other pulmonary complications, as well as social isolation and reduced overall quality of life. This review provides an overview of dysphagia associated with neuromuscular disease in adults, along with a concise review of swallowing assessment and intervention options.
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779601/noninvasive-ventilation-for-neuromuscular-disease
#4
REVIEW
Dean R Hess
Noninvasive ventilation (NIV) is standard practice for patients with neuromuscular respiratory failure. The interface distinguishes noninvasive from invasive ventilation. Interfaces are commercially available in a variety of styles and sizes. There are now available portable ventilators with good leak compensation and with a variety of modes. Although much has been written about the technical aspects of interfaces and ventilators, the initiation of NIV is an art. Selection of an appropriate interface and ventilator settings requires a close working relationship between clinicians, patients, and families...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779600/obesity-hypoventilation-syndrome
#5
REVIEW
Imran H Iftikhar, Joshua Roland
Obesity hypoventilation syndrome has been noted for centuries, yet we still are trying to uncover the exact mechanisms behind the disease and best treatment modalities for patients afflicted by the condition. The syndrome, which results in symptoms based on a diverse spectrum of interactions between obesity, ventilatory drive, and sleep's impact on respiration, has been shown to worsen morbidity and mortality far beyond that of more typical sleep-disordered breathing. In this article, the authors discuss current knowledge and research about the epidemiology, pathophysiology, and clinical features, along with treatment considerations of obesity hypoventilation syndrome...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779599/traumatic-spinal-cord-injury-pulmonary-physiologic-principles-and-management
#6
REVIEW
Gregory J Schilero, William A Bauman, Miroslav Radulovic
In the United States, approximately 17,500 cases of traumatic spinal cord injury (SCI) occur each year, with an estimated 245,000 to 345,000 individuals living with chronic SCI. Acute management of respiratory dysfunction has resulted in improvement in early survival, but life expectancy remains less than that of the general population, and pulmonary complications are a leading cause of mortality. The global changes in pulmonary function, underlying pathophysiology, and the management options to improve respiratory muscle weakness and pulmonary clearance in persons with SCI are discussed...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779598/metabolic-myopathies-and-the-respiratory-system
#7
REVIEW
Patrick Koo, Jigme M Sethi
Metabolic myopathies are a heterogeneous group of disorders characterized by inherited defects of enzymatic pathways involved in muscle cellular energetics and adenosine triphosphate synthesis. Skeletal and respiratory muscles are most affected. There are multiple mechanisms of disease. The age of onset and prognosis vary. Metabolic myopathies cause exercise intolerance, myalgia, and increase in muscle breakdown products during exercise. Some affect smooth muscle like the diaphragm and cause respiratory failure...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779597/amyotrophic-lateral-sclerosis-and-the-respiratory-system
#8
REVIEW
Andrew T Braun, Candelaria Caballero-Eraso, Noah Lechtzin
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder that always affects the respiratory muscles. It is characterized by degeneration of motor neurons in the brain and spinal cord. Respiratory complications are the most common causes of death in ALS and typically occur within 3 to 5 years of diagnosis. Because ALS affects both upper and lower motor neurons, it causes hyperreflexia, spasticity, muscle fasciculations, muscle atrophy, and weakness. It ultimately progresses to functional quadriplegia...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779596/muscular-dystrophies
#9
REVIEW
John C Carter, Daniel W Sheehan, Andre Prochoroff, David J Birnkrant
Muscular dystrophies represent a complex, varied, and important subset of neuromuscular disorders likely to require the care of a pulmonologist. The spectrum of conditions encapsulated by this subset ranges from severe and fatal congenital muscular dystrophies with onset in infancy to mild forms of limb and girdle weakness with onset in adulthood and minimal respiratory compromise. The list and classification of muscular dystrophies are undergoing near-constant revision, based largely on new insights from genetics and molecular medicine...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779595/disorders-of-the-chest-wall-clinical-manifestations
#10
REVIEW
Mazen O Al-Qadi
Chest wall disorders represent deformities and/or injuries that alter the rib cage geometry and result in pulmonary restriction, increased work of breathing, exercise limitations, and cosmotic concerns. These disorders are congenital or acquired and affect all ages. Disorders affecting the spine (kyphoscoliosis, ankylosing spondylitis), ribs (flail chest), and sternum (pectus excavatum) are discussed in this article, with emphasis on clinical presentations, pulmonary function abnormalities, diagnosis, and treatment...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779594/disorders-of-the-diaphragm
#11
REVIEW
F Dennis McCool, Kamran Manzoor, Taro Minami
Pathologic processes that involve the central nervous system, phrenic nerve, neuromuscular junction, and skeletal muscle can impair diaphragm function. When these processes are of sufficient severity to cause diaphragm dysfunction, respiratory failure may be a consequence. This article reviews basic diaphragm anatomy and physiology and then discusses diagnostic and therapeutic approaches to disorders that result in unilateral or bilateral diaphragm dysfunction. This discussion provides a context in which disorders of the diaphragm and their implications on respiratory function can be better appreciated...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779593/assessing-diaphragm-function-in-chest-wall-and-neuromuscular-diseases
#12
REVIEW
Taro Minami, Kamran Manzoor, F Dennis McCool
Diaphragm dysfunction is defined as the partial or complete loss of diaphragm muscle contractility. However, because the diaphragm is one of only a few skeletal muscles that is not amenable to direct examination, the tools available for the clinician to assess diaphragm function have been limited. Traditionally, measures of lung volume, inspiratory muscle strength, and radiographic techniques such as fluoroscopy have provided the major method to assess diaphragm function. Measurement of transdiaphragmatic pressure provides the most direct means of evaluating the diaphragm, but this technique is not readily available to clinicians...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779592/pulmonary-function-testing-in-neuromuscular-and-chest-wall-disorders
#13
REVIEW
Eric J Gartman
Neuromuscular and chest wall disorders frequently compromise pulmonary function, and thorough respiratory evaluation often can assist in diagnosis, risk assessment, and prognosis. Because many of these disorders can be progressive, serial assessments are necessary to best define a trajectory of impairment (or improvement with therapy). This article covers the major respiratory testing modalities available in the evaluation of these patients, emphasizing both the benefits and shortcomings of each approach. Most parameters are available in a standard pulmonary laboratory (flows, volumes, static pressures), although referral to a specialized center may be necessary to conclusively evaluate a given patient...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779591/sleep-disordered-breathing-in-neuromuscular-and-chest-wall-diseases
#14
REVIEW
Janet Hilbert
Neuromuscular and chest wall diseases include a diverse group of conditions that share common risk factors for sleep-disordered breathing, including respiratory muscle weakness and/or thoracic restriction. Sleep-disordered breathing results from both the effects of normal sleep on ventilation and the additional challenges imposed by the underlying disorders. Patterns of sleep- disordered breathing vary with the specific diagnosis and stage of disease. Sleep hypoventilation precedes diurnal respiratory failure and may be difficult to recognize clinically because symptoms are nonspecific...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779590/pathophysiology-of-neuromuscular-respiratory-diseases
#15
REVIEW
Joshua O Benditt
Gas exchange between the atmosphere and the human body depends on the lungs and the function of the respiratory pump. The respiratory pump consists of the respiratory control center located in the brain, bony rib cage, diaphragm, and intercostal, accessory, and abdominal muscles. A variety of muscles serve to fine-tune adjustments of ventilation to metabolic demands. Appropriate evaluation and interventions can prevent respiratory complications and prolong life in individuals with neuromuscular diseases. This article discusses normal function of the respiratory pump, general pathophysiologic issues, and abnormalities in more common neuromuscular diseases...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779589/chest-wall-diseases-respiratory-pathophysiology
#16
REVIEW
George E Tzelepis
The chest wall consists of various structures that function in an integrated fashion to ventilate the lungs. Disorders affecting the bony structures or soft tissues of the chest wall may impose elastic loads by stiffening the chest wall and decreasing respiratory system compliance. These alterations increase the work of breathing and lead to hypoventilation and hypercapnia. Respiratory failure may occur acutely or after a variable period of time. This review focuses on the pathophysiology of respiratory function in specific diseases and disorders of the chest wall, and highlights pathogenic mechanisms of respiratory failure...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29433729/revolution-in-respiratory-medicine
#17
EDITORIAL
Ali I Musani
No abstract text is available yet for this article.
March 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29433728/bronchoscopy-education-an-experiential-learning-theory-perspective
#18
REVIEW
Septimiu D Murgu, Jonathan S Kurman, Omar Hasan
Bronchoscopy programs implementing the experiential learning model address different learning styles. Problem-based learning improves knowledge retention, critical decision making, and communication. These modalities are preferred by learners and contribute to their engagement, in turn leading to durable learning. Follow-up after live events is warranted through spaced education strategies. The objectives of this article are to (1) summarize and illustrate the implementation of experiential learning theory for bronchoscopy courses, (2) discuss the flipped classroom model and problem-based learning, (3) illustrate bronchoscopy checklists implementation in simulation, and (4) discuss the importance of feedback and spaced learning for bronchoscopy education programs...
March 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29433727/point-of-care-ultrasound-in-the-intensive-care-unit
#19
REVIEW
Steven J Campbell, Rabih Bechara, Shaheen Islam
Spreading beyond the realm of tertiary academic medical centers, point-of-care ultrasound in the intensive care unit is an important diagnostic tool. The real-time feedback garnered can lead to critical and clinically relevant changes in management and decrease potential complications. Bedside ultrasound evaluation in the intensive care setting with a small, portable equipment is well-suited for placement of central lines, lumbar puncture, thoracentesis or other bedside ICU procedures and in the evaluation of cardiac activity, pleural and abdominal cavity and the overall fluid volume...
March 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29433726/sedation-in-bronchoscopy-a-review
#20
REVIEW
Amanda J McCambridge, Richard Paul Boesch, John J Mullon
Bronchoscopy has long been used as a diagnostic and therapeutic tool in medicine, with a wide range of appropriate sedative options. Flexible bronchoscopy is generally performed with sedation, and the choice of sedative is generally left to the practice pattern of the performing bronchoscopist. The concept of sedation is complex, with varying degrees of consciousness. A literature search was conducted on MEDLINE from 1969 to 2016, and appropriate data were reviewed. Randomized, controlled trials and prospective cohort studies were considered of highest impact...
March 2018: Clinics in Chest Medicine
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