Diaphragmatic dysfunction after open heart surgery: treatment with a rocking bed

Article Abstract:

The diaphragm is a muscle used during breathing and the phrenic nerve is involved in controlling the muscles of the diaphragm. In coronary artery bypass surgery healthy vessels are grafted to replace diseased segments of coronary arteries which are no longer able to provide the heart muscle with adequate blood and oxygen. The internal mammary artery, which provides blood to the area near the diaphragm, can be used as a coronary bypass graft. Of 1,225 patients having coronary artery bypass surgery, 13 patients experienced a decline in diaphragm function after surgery. The internal mammary artery was used as a graft in 11 of these patients. During the bypass procedure damage to the phrenic nerve has been related to the surgical use of cardiac hypothermia, or decreasing the temperature of the heart. Phrenic nerve damage may also be caused by using the internal mammary artery as a graft and/or by decreasing the blood supply to the phrenic nerve. Patients with diaphragm dysfunction can be put on mechanically assisted breathing devices until the phrenic nerve heals and the diaphragm can function normally. A rocking bed, which rotates 60 degrees up and down (head to foot), has been used in the past to treat diaphragm dysfunction in patients with polio; the rhythmic motion passively moves the diaphragm muscle during breathing. The rocking bed was employed for the cardiac surgery patients to support ventilation and avoid prolonged use of mechanical ventilation devices, which can be restrictive. The phrenic nerve healed within 4 to 27 months after coronary bypass surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Injuries, Complications and side effects, Physiological aspects, Hypothermia, Coronary artery bypass, Ventilators, Ventilators (Medical equipment), Diaphragm, Diaphragm (Anatomy), Internal mammary artery implantation, Cervical plexus

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Regional deposition of aerosolized pentamidine: effects of body position and breathing pattern

Article Abstract:

Pneumocystis carinii pneumonia (PCP) is the most common of the opportunistic infections that threaten AIDS patients. PCP bacteria are predominantly in the alveoli, the very small terminal lung buds where inspired oxygen is transferred to blood. PCP is prevented and treated by aerosolized pentamidine, and the effectiveness of pentamidine is likely related to the uniform delivery of the drug to lung alveoli. Relapses of PCP have occurred in upper lung lobes, probably due to poor drug delivery. The distribution of pentamidine aerosol was studied in 16 patients with AIDS in relation to four body positions during treatment. Thirteen patients completed the study. Aerosol penetration was studied after patients inhaled pentamidine with slow, deep breaths while sitting, resting in a supine position (on the back), and sitting with a tight abdominal binder. The fourth method entailed sitting and inhaling the medication with shallow breaths. Aerosol distribution was more uniform when the patients used a supine position; the upper lobes were remarkably better perfused with pentamidine. Inhalation while supine was well tolerated and was not associated with increased complications. The apparent benefit from this positioning should be verified by further clinical studies of PCP relapse. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration, Pneumocystis carinii, Pentamidine isethionate, Pentamidine

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Aerosolized prostacyclin and iloprost in severe pulmonary hypertension

Article Abstract:

Spraying prostacyclin or iloprost into the lungs of patients with primary pulmonary hypertension may help improve oxygenation and circulation through the lungs. In primary pulmonary hypertension, constriction of blood vessels in the lungs eventually leads to heart failure. Iloprost is a more chemically stable variety of prostacyclin, a drug that dilates blood vessels. Researchers evaluated the response to oxygen, inhaled nitric oxide, intravenous prostacyclin, prostacyclin spray, and iloprost spray in six patients with severe pulmonary hypertension. Oxygen improved blood oxygenation but did not improve circulation. Nitric oxide decreased blood vessel resistance in the lungs but only briefly. Prostacyclin and iloprost spray acted similarly to intravenous prostacyclin in that they decreased resistance to blood circulation through the lungs, but in addition, the sprays increased blood oxygenation. The effects of prostacyclin spray lasted 10 to 30 minutes while iloprost lasted one to two hours.

Pulmonary hypertension, Prostacyclin

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