China
Africa
Explore chapters and articles related to this topic
Palliative care in geriatric patients with neurological diseases
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Respiratory insufficiency: It is common in elderly patients with neurological diseases to have respiratory symptoms like dyspnea. Opioids are mainstay of dyspnea and can be given via oral, nasal, subcutaneous, transdermal, and inhalation route. In addition, benzodiazepines like lorazepam and midazolam may be required to reduce anxiety. Respiratory insufficiency is also common and may be due to progression of neurological disease as in ALS, or secondary to pulmonary infections or debility (12). The patient's preferences for prolonged invasive ventilation and tracheostomy should be asked for and documented. All efforts should be made to prevent respiratory infections by vaccination (influenza vaccinations or polyvalent pneumococcal vaccines). If feasible, noninvasive positive pressure ventilation (NIPPV) should be preferred. It may often be difficult to wean these patients from NIPPV and this needs to be carefully discussed beforehand (13).
Rehabilitation of the child with injuries
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
In children with injuries at C5 or above, respiratory compromise is of great concern in the acute inpatient rehabilitation setting. The anatomic structures of import are the phrenic nerves (origin C3–5) that innervate the main muscle of respiration, the diaphragm; the intercostal nerves that innervate the secondary muscles of respiration, the internal and external intercostal muscles; and the abdominal muscles that serve to increase cough effectiveness. When affecting this musculature, forced vital capacity drops and the efficacy of coughing/clearing mucus from the respiratory system is severely compromised. This can lead to a higher predisposition to pneumonia, chronic atelectasis, mucus plugging, nocturnal hypoventilation, hypoxemia, hypercapnia, and obstructive sleep apnea. Primary management of respiratory compromise due to SCI includes the use of abdominal binders, incentive inspirometry, chest percussion, and postural drainage. This is followed by the use of Flutter valves, Acapella devices, and continuous positive airway pressure (CPAP)/bilevel positive airway pressure (BIPAP) that provide noninvasive positive pressure ventilation [79]. At times, diaphragmatic pacing can be considered [80]. While the literature suggests that the diaphragm may recover at least partially in the first year after injury [81], two essential techniques that must be learned by children with SCIs are glossopharyngeal (GP) breathing [82] and the assisted cough or “quad cough” [83]. In GP breathing, the “muscles of the mouth and pharynx are used to propel small volumes of air through the larynx into the lower airways. The glottis is used to trap the air into the lungs while the next gulp of air is being processed. The process is repeated until a satisfactory breath is obtained” (Figure 22.5).
Perioperative care of geriatric patients
Published in Hospital Practice, 2020
Aditya P. Devalapalli, Deanne T. Kashiwagi
Several risk-prediction tools exist to assess the overall risk of PPCs [69], as well as the risk of specific PPCs like pneumonia and respiratory failure [70,71]. Actions to decrease PPC risk can be carried out throughout the perioperative period and include preoperative smoking cessation, at least 4–8 weeks before surgery, optimization of COPD treatment, and lung expansion exercise [72]. Intra-operatively, consideration of spinal anesthesia and laparoscopic over open approaches may help decrease PPCs [72]. Postoperatively, early mobilization, ongoing lung expansion exercises, and adequate pain control can help decrease PPCs [72]. Noninvasive positive-pressure ventilation may be needed to help compensate for the physiologic changes of anesthesia. It is applied both prophylactically and for rescue, and has been most studied in patient after cardiothoracic and abdominal surgeries. Recent studies have compared high-flow oxygen by nasal cannula to BiPAP and it has proven non-inferior to BiPAP in both preventing and treating acute respiratory failure in patients after cardiac surgery [73].
Is positive airway pressure therapy underutilized in chronic obstructive pulmonary disease patients?
Published in Expert Review of Respiratory Medicine, 2019
Hrishikesh Kulkarni, Sairam Parthasarathy
Noninvasive positive pressure ventilation (NIPPV) administered by home ventilators, bilevel positive airway pressure therapy (bilevel PAP) with or without back-up rate (collectively termed Respiratory Assist Device [RAD]) in the US as well as continuous positive airway pressure (CPAP) therapy for coexistent obstructive sleep apnea are available therapies in the domiciliary setting. Such therapy in patients with stable COPD in the home-setting may have a significant impact on patient outcomes in COPD, but the use of such devices remains controversial. Despite recent randomized controlled trials and observational studies suggesting potential benefits, there is an apparent underutilization of such therapy in patients with stable COPD. The reasons for such underutilization in the home-setting are likely multifactorial, but we provide our perspective on the adequacy of scientific evidence and implementation barriers that may underlie the observed underutilization.