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1/5. A patient with a severe chronic airway obstruction and preserved exercise capacity (a case report).

    We report a patient with chronic obstructive pulmonary disease (COPD) in whom severe lung function disorders are combined with completely preserved exercise capacity. We assessed the exercise capacity of a 44-year-old man (height 155 cm, BMI 19.6 kg.m-2, FEV1%pred. = 30.9%, FRC%pred. = 158%, KCO%pred. = 46.2%, PaO2 = 64.0 mmHg, Medical research Council dyspnea scale = 1, Baseline dyspnea Index = 10) by the 6-minute walking distance test (6MWD) and the symptom-limited cardiopulmonary exercise test (CPET) on a treadmill using the Bruce protocol. The patient was able to walk 667 meters in the test and achieved peak relative oxygen consumption (VO2/kg) of 21.9 mL.min-1.kg-1. We attribute the preserved exercise capacity of the patient to the combined beneficial effect of the following factors: 1. Efficient extraction of the hemoglobin-transported oxygen from the alveoli (P50 = 3.10 kPa). 2. Optimal right ventricle remodelling with mild hypertrophy, without dilatation and congestion. 3. Hypoxic normoxemia without polyglobulia, resulting in good rheologic properties of blood. 4. A preserved locomotory activity of the patient. Such a combination of severe lung function disorders with mildly pronounced dyspnea and preserved exercise capacity supports the concept that the function profile of COPD patients is multidimensional and therefore such patients should have a complete assessment of their disability condition.
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keywords = capacity
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2/5. Withdrawal of life support: intensive caring at the end of life.

    The technology and expertise of critical care practice support patients through life-threatening illnesses. Most recover; some die quickly; others, however, linger--neither improving nor acutely dying, alive but with a dwindling capacity to recover from their injury or illness. Management of these patients is often dominated by the question: Is it appropriate to continue life-sustaining therapy? patients rarely participate in these pivotal discussions because they are either too sick or too heavily sedated. As a result, the decision often falls to the family or the surrogate decision maker, in consultation with the medical team. Decisions of such import are emotionally stressful and are often a source of disagreement. Failure to resolve such disagreements may create conflict that compromises patient care, engenders guilt among family members, and creates dissatisfaction for health care professionals. However, the potential for strained communications is mitigated if clinicians provide timely clinical and prognostic information and support the patient and family with aggressive symptom control, a comfortable setting, and continuous psychosocial support. Effective communication includes sharing the burden of decision making with family members. This shift from individual responsibility to patient-focused consensus often permits the family to understand, perhaps reluctantly and with great sadness, that intensive caring may involve letting go of life-sustaining interventions.
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ranking = 0.125
keywords = capacity
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3/5. Right ventricular infarction during a lung lobectomy in a patient with chronic obstructive pulmonary disease: report of a case.

    A 63-year-old man with a low forced expiratory volume in 1 s underwent a wedge resection for peripheral lung cancer; however, it relapsed in the residual lobe. We decided that a lobectomy was feasible after further examinations focusing on gas exchange. During the lobectomy right ventricle myocardial infarction occurred, possibly due to coronary spasm, and it was successfully treated with intra-aortic balloon pumping. The patient has been doing well without relapse for 7 years. Our findings indicate that some patients with low spirometry data may therefore be candidates for a lobectomy.
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ranking = 27.423708071571
keywords = forced expiratory volume, expiratory volume, volume
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4/5. gastrectomy performed with noninvasive positive pressure ventilation for a patient with severe chronic obstructive pulmonary disease: report of a case.

    We report the case of a patient with severe chronic obstructive pulmonary disease (COPD) for whom gastrectomy was successfully performed with the use of noninvasive positive pressure ventilation (NPPV). A 63-year-old man who had been suffering from chronic pulmonary emphysema for 12 years and receiving home oxygen therapy (HOT) for 9 years was diagnosed with gastric carcinoma. The patient required supplemental oxygen via nasal cannulae even at rest, and had labored breathing through pursed lips after a short conversation. The forced expiratory volume in 1 s was 400 ml. He underwent conventional gastrectomy under general anesthesia, and was extubated 90 min after surgery and given NPPV support. He was successfully weaned from NPPV on postoperative day (POD) 10 and discharged from our hospital on POD 28. Noninvasive positive pressure ventilation is useful for the perioperative management of patients with severe COPD and for extending the possibilities of surgery for patients on HOT.
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ranking = 27.423708071571
keywords = forced expiratory volume, expiratory volume, volume
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5/5. Non-invasive ventilation corrects alveolar hypoventilation during spinal anesthesia.

    PURPOSE: To document and explain the beneficial effects of non-invasive ventilation in correcting hypoxemia and hypoventilation in severe chronic obstructive pulmonary disease, during spinal anesthesia in the lithotomy position. CLINICAL FEATURES: A morbidly obese patient with severe chronic obstructive pulmonary disease underwent prostate surgery in the lithotomy position under spinal anesthesia. Hypoxemia was encountered during surgery, and a profound decrease of forced vital capacity associated with alveolar hypoventilation and ventilation/perfusion mismatching were observed. In the operating room, an M-mode sonographic study of the right diaphragm was performed, which confirmed that after spinal anesthesia and assuming the lithotomy position, there was a large decrease (-30%) in diaphragmatic excursion. Hypoxemia and alveolar hypoventilation were successfully treated with non-invasive positive pressure ventilation. CONCLUSIONS: Intraoperative application of non-invasive positive pressure ventilation improved diaphragmatic excursion and overall respiratory function, and reduced clinical discomfort in this patient.
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ranking = 18.866498670239
keywords = forced vital capacity, vital capacity, capacity
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