1/29. Real-time continuous visual biofeedback in the treatment of speech breathing disorders following childhood traumatic brain injury: report of one case.The efficacy of traditional and physiological biofeedback methods for modifying abnormal speech breathing patterns was investigated in a child with persistent dysarthria following severe traumatic brain injury (TBI). An A-B-A-B single-subject experimental research design was utilized to provide the subject with two exclusive periods of therapy for speech breathing, based on traditional therapy techniques and physiological biofeedback methods, respectively. Traditional therapy techniques included establishing optimal posture for speech breathing, explanation of the movement of the respiratory muscles, and a hierarchy of non-speech and speech tasks focusing on establishing an appropriate level of sub-glottal air pressure, and improving the subject's control of inhalation and exhalation. The biofeedback phase of therapy utilized variable inductance plethysmography (or Respitrace) to provide real-time, continuous visual biofeedback of ribcage circumference during breathing. As in traditional therapy, a hierarchy of non-speech and speech tasks were devised to improve the subject's control of his respiratory pattern. Throughout the project, the subject's respiratory support for speech was assessed both instrumentally and perceptually. Instrumental assessment included kinematic and spirometric measures, and perceptual assessment included the Frenchay dysarthria Assessment, Assessment of Intelligibility of Dysarthric speech, and analysis of a speech sample. The results of the study demonstrated that real-time continuous visual biofeedback techniques for modifying speech breathing patterns were not only effective, but superior to the traditional therapy techniques for modifying abnormal speech breathing patterns in a child with persistent dysarthria following severe TBI. These results show that physiological biofeedback techniques are potentially useful clinical tools for the remediation of speech breathing impairment in the paediatric dysarthric population.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/29. Unexpectedly severe sleep and respiratory pathology in patients with amyotrophic lateral sclerosis.Daytime fatigue and sleep disturbance are frequent complaints in patients with amyotrophic lateral sclerosis (ALS). However, polysomnographic data are sparse. Nocturnal respiratory insufficiency may occur despite nearly normal daytime pulmonary function. We describe the clinical presentation and polysomnographic findings in two patients with clinically and electrophysiologically confirmed ALS with minimal weakness but excessive daytime sleepiness. polysomnography in the first patient showed a respiratory disturbance index of 43.5, and profound oxygen desaturations to 62%. The second patient had prolonged periods of hypoventilation, with oxygen saturations oscillating between 86 and 83%. Both patients showed severe sleep maintenance insomnia with a sleep efficiency < 40% and frequent arousals while asleep. Application of continuous positive airway pressure (CPAP) restored normal nocturnal ventilation, blood oxygenation and sleep parameters in the first patient; compliance, however, was poor. The second patient was unable to tolerate CPAP. We conclude that ALS patients with excessive daytime sleepiness or insomnia should undergo polysomnography to adequately diagnose nocturnal respiratory insufficiency and sleep disturbance. compliance with treatment, however, may be poor.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/29. Patient-ventilator interactions during volume-support ventilation: asynchrony and tidal volume instability--a report of three cases.During pressure-support ventilation, tidal volume (V(T)) can vary according to the level of the patient's respiratory effort and modifications of the thoraco-pulmonary mechanics. To keep V(T) as constant as possible, the Siemens Servo 300 ventilator proposes an original modification of pressure-support ventilation, called volume-support ventilation (VSV). VSV is a pressure-limited mode of ventilation that uses V(T) as a feedback control: the pressure support level is continuously adjusted to deliver a preset V(T). Thus, the ventilator adapts the inspiratory pressure level, breath by breath, to changes in the patient's inspiratory effort and the mechanical thoraco-pulmonary properties. The clinician sets V(T) and respiratory frequency, and the ventilator calculates a preset minute volume. It has been shown that ineffective respiratory efforts can occur during pressure-support ventilation.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
4/29. External stabilization of flail chest using continuous negative extrathoracic pressure.On rare occasions after total sternectomy, patients develop persistent flail chest deformities requiring long-term mechanical respiratory assistance. We report the use of a temporary external chest shell to deliver constant negative extrathoracic pressure (CNEP) to a long-term ventilated patient with flail chest. The patient's anterior thoracic cage stabilized, and significant improvement in pulmonary function was observed. With these data in hand, an operation was done to permanently stabilize the anterior chest wall by bone grafting.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
5/29. Tracheocoele in a Duchenne muscular dystrophy patient. Case report.Tracheocoele, a congenital or acquired lesion, is rarely detected radiologically and even more rarely diagnosed clinically. This tracheal lesion is characterised by the presence of a single cystic lesion filled with air or a mixture of liquid and air, of extremely variable size, occurring in almost all cases, in a locus minoris resistentiae situated in the right posterolateral portion of the trachea. The rare case is described of a voluminous tracheocoele located in the left paratracheal region, extending from the cricoid to sternal notch, manifesting clinically, 3 months prior to evaluation in our hospital in a 27-year-old male suffering from Duchenne muscular dystrophy since the age of 5 years. For 10 years, the patient had been treated with intermittent positive pressure ventilation via nasal mask, due to progressive deterioration of respiratory function. diagnosis of tracheocoele, initially made at computed axial tomography scan, was confirmed by flexible laryngotracheoscopy under local anaesthesia. Due to severe comorbidity associated with the clinical picture described, the absence of a significant set of symptoms, and the problems concerning anaesthesiological management of the patient, palliative treatment was the only choice. This consisted in cervical compression bandaging during assisted nasal ventilation. Close follow-up was performed in order to monitor any progression of the lesion or onset of related complications. This is the second case of tracheocoele originating in the left paratracheal region reported in the literature, and the first associated with Duchenne muscular dystrophy and prolonged use of a positive pressure respirator. The aetiopathogenic mechanisms that may have determined the formation of this rare lesion are then taken into consideration.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/29. Anaesthesia for thoracoscopic pleurectomy and ligation of bullae.A patient is described who, despite severe pre-operative respiratory disability, had her persistent pneumothorax successfully managed by thoracoscopic pleurectomy. The technique causes considerably less pain and interference with respiratory function postoperatively than does conventional thoracotomy. Potential anaesthetic problems arise because of the necessity of insufflating carbon dioxide at pressures of up to 1 kPa to maintain a pneumothorax during surgery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/29. pneumothorax associated with long-term non-invasive positive pressure ventilation in Duchenne muscular dystrophy.Long-term non-invasive positive pressure ventilation (NPPV) is effective for improving the quality of life and survival of neuromuscular patients. This treatment is usually easy to administer and severe complications have rarely been reported. We describe two cases in which the development of pneumothorax was associated with long-term NPPV administered to Duchenne muscular dystrophy patients. Given the wide scale utilization of chronic NPPV, we suggest that care-givers and patients be made aware of this serious complication.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
8/29. Isolated pulmonary hypertension secondary to rheumatoid arthritis.The authors report a case of a woman with pulmonary hypertension secondary to rheumatoid arthritis, whose treatment with azathioprine resulted in normalization of pulmonary artery pressure and resolution of clinical symptoms. Different etiologies for pulmonary hypertension are discussed and literature review is presented.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/29. Successful treatment of respiratory dysfunction in cystinosis by nocturnal non-invasive positive pressure ventilation.cystinosis is a rare metabolic disorder characterized by lysosomal cystine accumulation leading to multi-organ damage, with kidneys being clinically first affected. Longer survival of cystinosis patients due to successful renal replacement therapy, revealed previously unknown extra-renal symptoms of cystinosis, generally appearing after the first decade. respiratory insufficiency caused by overall respiratory muscle myopathy is a severely invalidating and sometimes a life-threatening complication of cystinosis. We report a successful treatment of hypoventilation, due to diaphragm myopathy in a cystinosis patient, by nocturnal non-invasive positive pressure ventilation (NIPPV). After initiation of NIPPV the clinical condition of the patient improved and blood-gasses normalized, indicating that this treatment modality should be considered in cystinosis patients with severe respiratory insufficiency.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
10/29. Haemodynamic effects of periodic ventilation: abolition with supplementary oxygen.A 63-yr-old man was noted to breathe with a periodic pattern of ventilation during sleep, both before and after operation for coronary artery grafting, and 6 weeks later after aortic aneurysm repair. Periodic ventilation was associated with cyclic oxygen desaturations and increases in heart rate and arterial pressure. Administration of oxygen was found to abolish consistently the periodic pattern and the associated haemodynamic changes.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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