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Schmallenberg, Germany

Spirometry is a simple test and considered the gold standard in lung function. An obstructive ventilatory defect is a disproportionate reduction of maximal airflow from the lung in relation to the maximal volume that can be displaced from the lung. It implies airway narrowing and is defined by a reduced FEV1/FVC ratio below the 5th percentile of the predicted value (lower limit of normal, LLN). A restrictive disorder may be suspected when vital capacity (FVC) is reduced and FEV1/FVC is normal. It is definitely proven, however, only by a decrease in TLC below the 5th percentile of predicted value (LLN). The measurement of TLC by body plethysmography is necessary to confirm or exclude a restrictive defect or hyperinflation of the lung when FVC is below the LLN. 2012 a task force of the ERS published new reference values based on 74187 records from healthy non-smoking males and females from 26 countries. The new reference equations for the 3-95 age range are now available that include appropriate age-dependent mean values and lower limits of normal (LLN). This presentation aims at providing the reader with recommendations dealing with standardization and interpretation of spirometry. © Georg Thieme Verlag KGStuttgart. New York. Source

Siemon K.,Fachkrankenhaus Kloster Grafschaft
Atemwegs- und Lungenkrankheiten | Year: 2015

In some patients with severe pulmonary disease and reduced physical capacity, noninvasive ventilation (NIV) could be an additional therapeutic option to achieve a higher training stimulus. However, as NIV is a difficult and work (staff) intensive therapy, it should only be used in patients who will benefit from it. Further studies are required to investigate the future role of NIV in pulmonary rehabilitation. © 2015 Dustri-Verlag Dr. Karl Feistle. Source

Indication for oxygen therapy is not related to the patient's age but to their underlying disease. It is important to know whether hypoxemic (ICD J96.10) or hypercapnic respiratory failure (J96.11) is present. Oxygen insufflation has strong placebo effects. In hypoxemic respiratory failure, oxygen supplementation is usually only necessary during physical exercise and should be dosed accordingly. In hypercapnic respiratory failure, which is virtually always caused by chronic fatigue of the respiratory pump, continuous oxygen supplementation is necessary to relieve the respiratory pump. The subsequently slightly increased hypercapnia is a sign for reduction of the respiratory minute volume or the respiratory work and thus desired. When the respiratory pump needs to work more (i.e., PaCO2 > 50 mmHg or bicarbonate > 32 mmol/L), respiratory muscle failure should generally be treated with intermittent artificial ventilation. © 2015 Dustri-Verlag Dr. Karl Feistle. Source

Haidl P.,Fachkrankenhaus Kloster Grafschaft | Kroegel C.,Friedrich - Schiller University of Jena | Kohlhaufl M.,Klinik Schillerhohe | Voshaar T.,Medizinische Klinik III
Pneumologie | Year: 2012

This paper describes the possibility of targeting the small airways. In addition to aiding in the therapy for chronic obstructive lung diseases this may prove to be invaluable in the development of treatment strategies for diseases of the bronchioli. Essential factors in peripheral lung deposition include extra-fine particles, a slow and controlled inspiratory flow and an endexspiratory breathhold of 5 - 10 sec (especially for steroids). Due to methodological difficulties, clinical data comparing steroids with larger or extra-fine particles are limited in the field of asthma therapy. However, research suggests a trend for reduced symptoms, positively affected biomarkers and decreased lung hyperinflation when steroids with extra-fine particles are used. © Georg Thieme Verlag KG Stuttgart · New York. Source

The prevalence of difficult or prolonged weaning from the ventilator is increasing due to a growing number of multi-morbid, elderly and pulmonary deficient patients being mechanically ventilated. Intensive care units (ICU) tend to refer difficult to wean patients to specialised weaning facilities. A survey of 38 centres performed in 2006 included a total number of 2718 patients with difficult or prolonged weaning. Almost three quarters of the patients were transferred to a weaning centre from an external ICU. The weaning success rate was 66.3%. After weaning in 31.9% of the patients, home mechanical ventilation was started. The overall hospital mortality rate was 20.8%. Recently the task force WeanNet a network of weaning units was founded under the auspices of the German Thoracic Society. The main aim of WeanNet is to improve cooperation among the weaning centres and the quality of patient management. Important tools of WeanNet are (i) the register of weaning patients and (ii) accreditation of the weaning centres. To develop the register an intensive cooperation between the task force and the Institute for Lung Research (ILF) was necessary. The finished register is now logistically run by ILF. In less than 1 year after the official start, already 70 weaning units with ca. 3000 patients are registered. In future WeanNet, in particular in terms of the register and the accreditation, will stand for the quality of weaning centres in Germany. © 2010 Georg Thieme Verlag KG Stuttgart · New York. Source

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