An outpatient approach to home mechanical ventilation follow-up
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Abstract:
The COVID-19 pandemic brought the outpatient management to the spotlight, especially in what home mechanical ventilation (HMV) is regarded. Our goal was to assess the main complaints/problems and the adjustments made in the appointment. We performed a transversal retrospective analysis of patients on HMV for at least a month, followed in the outpatient clinic of a tertiary hospital, in 2019’s 2nd semester. The HMV outpatient clinic consists of a pulmonologist, a nurse and a technician from the home respiratory care company (provider of HMV in Portugal). In a day-hospital regimen, patients are monitored on HMV with their equipment for at least 30 minutes with blood gas analysis and/or capnography. Ventilator data is observed in real time and also collected from the previous 3 months. A total of 301 patients were analyzed. No changes were made in 138 cases (45.8%). A total of 212 changes were made in the remainder 163 patients. Most detected problems were found in HMV software data (33.5%), such as usage, leakage and volumes. HMV parameters suffered the most adjustments (36.3%). Only 5 problems (2.4%) lead to stop HMV. All results are shown in this table: Almost half of the patients needed no changes. On the other hand, our results show how an outpatient approach to HMV follow-up allows clinicians to detect a diverse amount of patients’ complaints or problems regarding the treatment itself and, at the same time, address changes to try to fix them.Keywords:
Pulmonologists
Technician
Outpatient clinic
Regimen
Capnography
Key points Transthoracic US is an inexpensive, lightweight and portable technique to evaluate the lungs and the pleural space. US-guided punctures are safe procedures in the case of pathological findings in the pleural space. With the help of EBUS, the diagnosis and staging of lung cancer can be improved. US will become a practical and essential tool for the pulmonologist in the near future. Educational aims To outline the situations where US is indicated. To discuss the importance of EBUS in the diagnosis and staging of lung cancer. To encourage the pulmonologist to learn ultrasonic techniques, particularly transthoracic US, and emphasise the importance of formal training programmes. Summary Ultrasound (US) has received increased interest from chest physicians in recent years. Modern US devices are user friendly, inexpensive, lightweight and portable, which makes them suitable for outpatient settings, as well as for bedside investigations of the severely ill. However, the view during bronchoscopy is limited to the inner surface in the case of parabronchial lesions. Therefore, endobronchial ultrasound (EBUS) systems were developed. In trials, it has been shown that, with the help of EBUS, the diagnosis and staging of lung cancer and other pathologies can be improved. EBUS is a safe technique and, so far, has proved extremely useful during diagnostic and interventional procedures. US is set to become a practical and essential tool for the pulmonologist in the near future. This review aims to assess the most important and interesting articles in the field and to encourage the pulmonologist to learn ultrasonic techniques, particularly with regard to transthoracic US.
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Diagnostic ultrasound
Endobronchial ultrasound
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This chapter focuses on the use of capnography to optimize and minimize the length of mechanical ventilation. Mechanical ventilation can be divided into three phases: acute stabilization, pre-weaning, and weaning/ extubation readiness testing. Alveolar minute ventilation is determined from the volumetric capnogram. Liberation from mechanical ventilation implies the use of an extubation readiness test to withdraw mechanical ventilation as soon as the patient meets extubation criteria regardless of the level of ventilatory support. A myriad of adversities make weaning and liberation from mechanical ventilation an extremely important clinical issue. With the majority of intensive care unit (ICU) patients requiring mechanical ventilation, minimizing the duration of mechanical ventilation while optimizing the potential for successful extubation is crucial in the management of critically ill patients. Capnography, both time-based and volumetric, allows mechanical ventilatory strategies to be designed with clear, precise, objective criteria.
Capnography
Ventilator weaning
Mechanical ventilator
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Introduction: An understanding of the level of activation for self-management, defined as patients' knowledge, skills and self-efficacy regarding self-management is important. It gives clues how self-management may be improved in the individual patient. In this study, the level of activation for self-management was assessed in patients with asthma or COPD at the time of referral by their General Practitioner to a pulmonologist. Method: Between September 2014-December 2016, the integrated health status was determined in patients with asthma or COPD referred to a pulmonologist using a specifically developed diagnostic pathway. Part of this diagnostic pathway is to examine the level of activation for self-management using the 13-item Patient Activation Measurement (PAM-13). The PAM-13 measures patients' activation for self-management. Four different levels of activation can be distinguished, from very low (PAM-1) to high (PAM-4). Results: 112 valid PAMs were obtained in patients with asthma and 90 in patients with COPD. The distribution of PAM scores in asthma patients was: 35% of the PAM-1, 21% PAM-2, 38% PAM-3 and 5% PAM-4. In COPD patients the distribution was: 30% PAM-1, 28% PAM-2, 36% PAM-3 and 7% PAM-4. Conclusion: In 56% of the asthma patients and in 58% of the COPD patients there is little or no degree of activation for self-management (PAM-1 and PAM-2) at the time of referral from primary to secondary care.
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Foreign body aspiration
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Primary care physician
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Objective: To determine whether the workers’ periodic chest x-ray screening techniques in accordance with the quality standards is the responsibility of physicians. Evaluation of differences of interpretations by physicians in different levels of education and the importance of standardization of interpretation.Methods: Previously taken chest radiographs of 400 workers who are working in a factory producing the glass run channels were evaluated according to technical and quality standards by three observers (pulmonologist, radiologist, pulmonologist assistant). There was a perfect concordance between radiologist and pulmonologist for the underpenetrated films. Whereas there was perfect concordance between pulmonologist and pulmonologist assistant for over penetrated films.Results: Pulmonologist (52%) has interpreted the dose of the films as regular more than other observers (radiologist; 44.3%, pulmonologist assistant; 30.4%). The frequency of interpretation of the films as taken in inspiratory phase by the pulmonologist (81.7%) was less than other observers (radiologist; 92.1%, pulmonologist assistant; 92.6%). The rate of the pulmonologist (53.5%) was higher than the other observers (radiologist; 44.6%, pulmonologist assistant; 41.8%) for the assessment of the positioning of the patients as symmetrical. Pulmonologist assistant (15.3%) was the one who most commonly reported the parenchymal findings (radiologist; 2.2%, pulmonologist; 12.9%).Conclusion: It is necessary to reorganize the technical standards and exposure procedures for improving the quality of the chest radiographs. The reappraisal of all interpreters and continuous training of technicians is required.doi: https://doi.org/10.12669/pjms.326.11267How to cite this:Binay S, Arbak P, Safak AA, Balbay EG, Bilgin C, Karatas N. Does periodic lung screening of films meets standards? Pak J Med Sci. 2016;32(6):1506-1511. doi: https://doi.org/10.12669/pjms.326.11267This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Concordance
Pulmonology
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Thoracic ultrasound, once thought to be of least consideration due to presence of air in the lungs has now become standard practice in the evaluation of various pleuro-pulmonary disorders. Pulmonary physician-led bed side chest ultrasound is authentic, safe, quick, cost effective and helps in clinical decision making, in patients with complicated pleural, pulmonary and chest wall processes.
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Clinical Practice
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This chapter aims at introducing the interested Pulmonologist/Interventional Pulmonologist to the esophageal ultrasound. In this chapter, we give short descriptions of some technical aspects of the endobronchial ultrasound (EBUS) scope and explain in detail why we believe the EBUS scope is well suited to be an esophageal scope in the hands of the trained pulmonologist. The chapter then explains indications and benefits of this procedure that we consider central to the practice of chest physicians. We also describe in steps how to reach each lymph node station using the EBUS scope as a EUS scope (EUS-B) from our own experience. Procedure-related complications and contraindications are also described.
Pulmonologists
Scope (computer science)
Endobronchial ultrasound
Scope of Practice
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