Lomefloxacin has been shown to produce high and sustained concentrations in serum and bronchial mucosa after once-daily administration. This study was designed to assess whether a dose response ...exists for 400 mg lomefloxacin given once daily or twice daily for 10 days in the treatment of acute bacterial exacerbations of chronic bronchitis of gram-negative etiology. A total of 100 adult patients with acute exacerbations of chronic bronchitis were enrolled at 10 study sites in Germany. Patients with confirmed bacterial pathogens in the baseline sputum culture (once-daily group n = 49, twice-daily group n = 47) were eligible for analysis of bacteriologic and clinical efficacy. The eradication rates for the most frequently isolated baseline pathogens, Haemophilus influenzae, Pseudomonas aeruginosa, and Klebsiella pneumoniae, were at least 75% for both treatment regimens. Overall, once-daily treatment eradicated baseline pathogens in 42 of 49 (85.7%) patients, while twice-daily treatment eradicated pathogens in 43 of 47 (91.5%). This difference was not statistically significant (p = 0.226). Clinically, 47 of 49 (95.9%) patients in the once-daily group and 46 of 47 (97.9%) in the twice-daily group were cured or improved (p = 0.307). Both regimens were well tolerated; there were no differences in the incidence (six patients in each group), types, or severity of adverse events, nor was there clinical evidence of theophylline interaction. The results of this study demonstrate that once-daily treatment with 400 mg lomefloxacin is as effective as twice-daily dosing with 400 mg in patients with acute bacterial exacerbations of chronic bronchitis.
To study in anemic patients with chronic obstructive pulmonary disease (COPD) whether blood transfusion reduces minute ventilation and work of breathing (WOB).
We prospectively evaluated the minute ...ventilation and WOB in 20 anemic adults (hemoglobin of <11 g/dL). Ten patients had severe COPD and ten patients were without lung disease. Measurements were made before and after receiving red blood cell transfusion; post-transfusion measurements were made 24 to 36 hrs after the last transfusion.
The study was performed in the intensive care unit of a tertiary referral center for home mechanical ventilation and for patients considered difficult to wean from mechanical ventilation.
Twenty clinically stable patients (12 female, eight male) with chronic anemia were studied. Ten patients with COPD (mean forced expiratory volume in 1 sec: 0.55+/-0.1 SD L) were compared with ten patients without lung disease. All participants had adequate renal and left ventricular function.
Patients received 1 unit of packed red blood cells for each g/dL that their hemoglobin value was less than an arbitrarily defined target value of 11.0 to 12.0 g/dL. Each unit was transfused over 2 hrs and < or =3 units in total was given.
Esophageal pressure was measured from a catheter which was positioned in the middle of the esophagus. Flow was measured using a pneumotachygraph connected to a mouthpiece while a nose clip closed the nostrils during the measurements. From these data, respiratory rate, minute ventilation, and inspiratory resistive WOB were computed. Arterial blood gas values, oxygen saturation, hemoglobin, and hematocrit were also measured, and oxygen content was calculated before and 24 to 36 hrs after transfusion. In patients with COPD, hemoglobin increased from 9.8+/-0.8 to 12.3+/-1.1 g/dL due to a mean transfusion of 2.2+/-0.4 (SD) units of red blood cells. There was a reduction in the mean minute ventilation from 9.9+/-1.0 to 8.2+/-1.2 L/min (p < .0001); correspondingly, WOB decreased from 1.03+/-0.24 to 0.85+/-0.21 WOB/L (p< .0001). The capillary P(CO2) increased from 38.1+/-6.0 to 40.7+/-6.8 torr (5.1+/-0.8 to 5.8+/-0.9 kPa) (p < .05). Similarly, capillary P(O2) changed from 56.9+/-8.9 to 52.8+/-7.0 torr (7.6+/-1.2 to 7.0+/-0.9 kPa) (p < .05). In anemic patients without lung disease, minute ventilation, WOB, and the capillary blood gas values did not change after increase of the hemoglobin by a similar degree.
We conclude that red blood cell transfusion in anemic patients with COPD leads to a significant reduction of both the minute ventilation and the WOB. In these patients, transfusion may be associated with unloading of the respiratory muscles, but it may also result in mild hypoventilation.
The development of a new group of drugs (polypeptides) have recently increased the interest of alternative administration to the enteral route because of its proteolytic activity and the catabolism ...of the "first-pass effect." Aside from the "needle," the administration in the respiratory tract via aerosol is the method with the best efficiency. But several problems prohibited its spreading: (1) the accuracy and the reproducibility of the inhaled dose (range ca. 1:4); (2) the small amount of inhaled drug in relation to the dose in the aerosol delivery system (range ca. 1%-10%); (3) the fear of allergic reactions of the respiratory system; (4) the variability of the drug transport into the systemic circulation. New approaches and data raise hopes in reducing the problems: (1) aerosol delivery systems with defined particle spectrum and storage systems; slow vital capacity inhaling maneuver; (2) delivery systems that nebulizes nearly the total amount of drug; (3) all studies with the inhalation application of insulin, heparin, ergotamin, ribavirin, aminoglycosides, and "cigarette smoke" do not reveal any relevant allergic reaction; (4) many studies were performed in the last 10 years on the influence of substances and especially of diseases on the transport of molecules through the respiratory tract. Only a few of them are relevant (exogen allergic alveolitis, active sarcoidosis, active smoking). Aerosols for (exogen allergic alveolitis, active sarcoidosis, active smoking). Aerosols for systemic drug treatment seems to be a gained alternative to the "syringe."
This article presents a model for persistent, location-independent references intended for linking resources on the Internet as well as documents which are only available on a local system. A part of ...the proposed model has already been implemented in an application for writing digital commentaries, named Assistant for Philological Explorations (APE). The technical details of this implementation related to persistent linking are described and a few prospects for its future development are outlined.
Noninvasive positive-pressure ventilation (NPPV) unloads respiratory muscles. Spontaneous-breathing ventilation modes require patient effort to trigger the ventilator, whereas controlled modes ...potentially economize on patient triggering effort and thus achieve more complete respiratory muscle rest. Data on controlled NPPV have not been published to date. We hypothesize that controlled ventilation is feasible in patients with hypercapnic chronic obstructive pulmonary disease.
We measured blood gas values, respiratory muscle strength, spontaneous breathing pattern, and lung function before and after a 3-month period of NPPV in 305 patients (213 male, mean +/- SD age 61.3 +/- 8.6 y). The subjects used a controlled NPPV mode when they could tolerate it.
Ninety-one percent of the patients were able to adapt to a controlled NPPV mode. In those patients, daytime P(CO(2)) decreased from 56.7 +/- 7.5 mm Hg to 47.5 +/- 6.6 mm Hg (p < 0.001) and P(O(2)) increased from 49.2 +/- 8.8 mm Hg to 56.2 +/- 8.5 mm Hg (p < 0.001). Their mean maximum inspiratory pressure increased from 42.3 +/- 16.9 cm H(2)O to 48.4 +/- 18.0 cm H(2)O (p < 0.001). Their mean vital capacity increased from 1.89 +/- 0.62 L to 1.99 +/- 0.67 L (p = 0.004). And their spontaneous breathing pattern became less rapid and shallow.
Controlled NPPV is feasible in patients with hypercapnic chronic obstructive pulmonary disease. We observed improved blood gas values, lung function, and inspiratory muscle strength.
Apnea and hypopnea during sleep are often viewed as different expressions of the same sleep-related breathing disorder. In our point of view, both symptoms are two different entities which can occur ...in the same patient. We discuss the hypothesis that sleep apnea is a disorder associated with recurrent arousals and chronic activation of the sympathetic nervous system, leading to daytime sleepiness and disturbances in the autonomic system. Hypoventilation results from reduced alveolar ventilation and is associated with hypercapnia. In rare cases it is caused by genuine disorders of the breathing center, like Odine's curse. In most cases, hypoventilation is secondary to an underlying disease and a strategy of the body, to avoid respiratory muscle failure. Treatment trials of hypoventilation of the respiratory muscles by stimulating the breathing center failed to be beneficial. However, unloading treatment with long-term oxygen and/or home mechanical ventilation improves arterial blood gases, physical activity and prognosis.
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