The effects of real-time waveform analysis software on patient ventilator synchronization during pressure support ventilation: a randomized crossover physiological study.

Background: Patient-ventilator asynchrony commonly occurs during pressure support ventilation (PSV). IntelliSync + software (Hamilton Medical AG, Bonaduz, Switzerland) is a new ventilation technology that continuously analyzes ventilator waveforms to detect the beginning and end of patient inspiration in real time. This study aimed to evaluate the physiological effect of IntelliSync + software on inspiratory trigger delay time, delta airway (P) and esophageal (P) pressure drop during the trigger phase, airway occlusion pressure at 0.

High-Flow Oxygen Therapy in Tracheostomized Subjects With Prolonged Mechanical Ventilation: A Randomized Crossover Physiologic Study.

Background: High-flow oxygen therapy via tracheostomy (HFT) can be used in tracheostomized patients during ventilator disconnection. The physiologic effects of this technique are unknown. We hypothesized that HFT would reduce inspiratory effort and improve breathing pattern compared to conventional oxygen therapy via T-tube.

Ultrasound Evaluation of Diaphragm Force Reserve in Patients with Chronic Obstructive Pulmonary Disease.

Diaphragm function is a key determinant of dyspnea in chronic obstructive pulmonary disease (COPD); however, it is rarely assessed in clinical practice. Lung hyperinflation can also impair diaphragm function. Ultrasound can assess the activity, function, and force reserve of the diaphragm.

Effects of high-flow nasal cannula and non-invasive ventilation on inspiratory effort in hypercapnic patients with chronic obstructive pulmonary disease: a preliminary study.

Background: Non-invasive ventilation (NIV) is preferred as the initial ventilatory support to treat acute hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease (COPD). High-flow nasal cannula (HFNC) may be an alternative method; however, the effects of HFNC in hypercapnic COPD are not well known. This preliminary study aimed at assessing the physiologic effects of HFNC at different flow rates in hypercapnic COPD and to compare it with NIV.

Incidence and Risk Factors of Hypoxemia During Interventional Rigid Bronchoscopy Under Spontaneous-assisted Ventilation.

Background: Interventional rigid bronchoscopy for tracheobronchial stenosis can be performed under total intravenous anesthesia and spontaneous-assisted ventilation. Intraoperative hypoxemia can occur during this procedure, but the incidence and risk factors have not yet been determined.

Methods: Medical records of patients who underwent rigid bronchoscopy for the treatment of tracheobronchial stenosis under total intravenous anesthesia and spontaneous-assisted ventilation during the study period from January 2011 to December 2012 were retrospectively reviewed.

Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department.

Background: Acute dyspnea and hypoxemia are 2 of the most common problems in the emergency room. Oxygen therapy is an essential supportive treatment to correct these issues. In this study, we investigated the physiologic effects of high-flow nasal oxygen cannula (HFNC) compared with conventional oxygen therapy (COT) in subjects with acute dyspnea and hypoxemia in the emergency room.

Lung cancer staging now and in the future.

For a long time lung cancer was associated with a fatalistic approach by healthcare professionals. In recent years, advances in imaging, improved diagnostic techniques and more effective treatment modalities are reasons for optimism. Accurate lung cancer staging is vitally important because treatment options and prognosis differ significantly by stage.

Respiratory muscle strength explained by age and weight in female and male.

Objective: To determine the relationship between respiratory muscle strength and age, sex, height and weight.

Material And Method: Maximal inspiratory mouth pressure (MIP) and maximal expiratory mouth pressure (MEP) were assessed in 249 subjects aged 30-70 years using a mouth pressure meter MIP was performed 10 times at residual volume, whereas MEP was performed 12 times at total lung capacity. Pearson's correlation was used to assess the association between respiratory muscle strength and characteristics data.

High-flow nasal cannula versus conventional oxygen therapy after endotracheal extubation: a randomized crossover physiologic study.

Objective: Compare the short-term benefit of high-flow nasal cannula (HFNC) with non-rebreathing mask in terms of change in dyspnea, physiologic variables, and patient comfort in subjects after endotracheal extubation.

Methods: A randomized crossover study was conducted in a 10-bed respiratory care unit in a university hospital. Seventeen mechanically ventilated subjects were randomized after extubation to either Protocol A (applied HFNC for 30 min, followed by non-rebreathing mask for another 30 min) or Protocol B (applied non-rebreathing mask for 30 min, followed by HFNC for another 30 min).

High dose rate endobronchial brachytherapy (HDR-EB) in recurrent benign complex tracheobronchial stenosis: experience in two cases.

Unlabelled: Benign complex tracheobronchial stenosis (BCTS) is a tracheobronchial stenosis that is longer than 1 cm or has more than one site of stenotic area. The most common etiology of the stenosis is endobronchial tuberculosis. BCTS causes challenge in diagnosis and management because of nonspecific presentation and usually precluded surgical treatment.

Experience of percutaneous dilatational tracheostomy by using Grigg's technique in Siriraj Hospital.

Background: Percutaneous dilatational tracheostomy (PDT) was increasingly performed after the commercial kit was available in 1985. Several studies showed that PDT was equivalent to surgical tracheostomy considering perioperative and long-term complications and PDT was more cost-effective and provide greater feasibility in terms of bedside capacity and nonsurgical operation.

Material And Method: The data of patients who were performed PDT at Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital were retrospectively reviewed since March 2007 to December 2011.

Impact of endobroncial ultrasound guided transbrocnhial needle aspiration on clinical practice guideline.

Objective: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA) is performed by using special bronchoscope which has an ultrasound probe at its tip that could demonstrate lymph node outside the airway and allow for real time observation of transbronchial needle aspiration. The sensitivity and specificity of EBUS TBNA are high in many studies. However because of the high expense and special training required, the impact of this method on clinical practice guidelines (CPG) needs to be further evaluated.

Amyloidosis and respiratory tract involvement: report of two cases.

Amyloidosis is a group of diseases in which amyloid deposit in the extracellular space in an abnormal insoluble fibrillar form. The most important amyloid precursors are immunoglobulin light chain (AL) and serum amyloid-associated protein (AA). Amyloidosis can manifest as localized or systemic disease and respiratory system is one of the target organs that can be involved by amyloid.

The efficacy of Jackson drain in the application to be a tunnel pleural catheter (TPC) in the management of malignant pleural effusion.

Background: Malignant pleural effusion (MPE) is a common clinical problem in patients with advanced cancer and portends a poor prognosis, which means survival of less than six months. In June 1997, the US-FDA approved an indwelling TPC with a one-way drainage valve to be used in the management of MPE. Although popularity of this TPC has increased over the past few years, the experience with this device remains limited in Thai patients.

The endobronchial ultrasound-guided transbronchial lung biopsy in peripheral pulmonary lesions.

Background: Peripheral pulmonary lesions are technically challenging with conventional bronchoscopy in obtaining tissue diagnosis. The recently developed small-caliber ultrasonographic probe can be introduced via the working channel of a flexible bronchoscope to localize peripheral pulmonary lesions (PPLs) prior to transbronchial lung biopsy (TBLB). The endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) is a new diagnostic method for the diagnosis of pulmonary lesions in our center.

Impact of bronchoalveolar lavage galactomannan on the outcome of patients at risk for invasive pulmonary aspergillosis.

Background: Invasive pulmonary aspergillosis (IPA) is an important cause of morbidity and mortality among immunocompromised patients especially in neutropenic and patients treated with immunosuppressive drugs. New diagnostic tools have been developed to improve treatment and outcome. Compared with serum galactomannan, bronchoalveolar lavage galactomannan (BAL GM) detection has higher sensitivity (81% vs.

Is cytology necessary in diagnosis of mediastinal mass?

Background: Mediastinal mass is an uncommon abnormality found in clinical practices of respiratory physicians. The diagnosis of a mediastinal mass arises from a clinical suspicion, and more commonly, by a check-up chest x-ray. Definite diagnosis is necessary because the managements are different in various etiologies of the masses.

Outcome of medical thoracoscopy.

Background: Medical thoracoscopy is a common procedure for pulmonologists working in Europe but is still unpopular in South East Asia with few medical centers in Thailand performing this procedure. We report our outcome of medical thoracoscopy based upon 10 years experience.

Material And Method: Medical thoracoscopy was first performed in our unit in 1998.

Medical thoracoscopy: experiences in Siriraj Hospital.

Objective: Medical thoracosopy is the investigational and therapeutic procedure for many kinds of pleural diseases. One of its indications is for the diagnosis of undetermined pleural effusion. We report our experience in using medical thoracoscopy in investigating undiagnosed pleural effusion.

Comparison of telomerase activity between malignant and tuberculous pleural effusions.

Objective: To determine if telomerase activity can differentiate malignant from tuberculous pleural effusions.

Design: Telomerase activity in malignant and tuberculous pleural effusions was measured in a blinded manner using a PCR-based telomeric repeat amplification protocol (TRAP) assay.

Material And Method: Fifty-two patients with lymphocytic exudative pleural effusions were identified on thoracocentasis over a period of 18 months.

Prevalence of bronchial hyperresponsiveness and asthma in the adult population in Thailand.

Objectives: We conducted a nationwide cross-sectional survey of respiratory health in adults aged 20 to 44 years during 2001 to 2002 to determine the prevalence of bronchial hyperresponsiveness (BHR) and asthma in the adult Thai population.

Design: Subjects were selected by a multistage stratified random sampling. The stratification was done on geographic area, age group, and sex.

Tranexamic acid in patients with hemoptysis.

Unlabelled: Hemoptysis is a common respiratory symptom leading to admission to hospital. The main management of hemoptysis depends on treating the underlying cause. The use of tranexamic acid is recommended by many doctors without much information available.

Laser bronchoscopy: experience at Siriraj Hospital.

Laser bronchoscopy is a major procedure employed in intervention bronchoscopy. From August 1998 to August 2000, 20 patients with endobronchial lesions were treated by this procedure in the Respiratory and Tuberculosis Division of the Department of Internal Medicine, Siriraj Hospital. Of 16 malignant lesion, a good response was obtained in 78 per cent (7 out of 9) of lesions in the proximal right main bronchus with failure to open any of the 3 completely obstructed lesions at the left distal bronchus.