Managing common neonatal respiratory conditions during transport.

As neonatal care in the tertiary setting advances, neonatal transport teams are challenged with incorporating these innovations into their work environment. One of the largest areas of advancement over the last decade involves respiratory support and management. Many major respiratory treatments and the equipment required have been adapted for transport, whereas others are not yet feasible. This article reviews the history of respiratory management during neonatal transport and discusses current methodologies and innovations in transport respiratory management.

Chronic obstructive pulmonary disease: clinical signs and infections.

Chronic obstructive pulmonary disease (COPD) is a pathological condition that involves excessive production of mucus, chronic cough and inflammatory changes leading to airway limitation. The most common cause of COPD is cigarette smoking. COPD can be categorized into either chronic bronchitis or emphysema; both conditions can be differentiated by age and the production of copious, tenacious sputum. Patients with COPD are susceptible to pulmonary infections of bacterial or viral origin. Nurses should be aware of the subtle differences in conditions and the usefulness of antibiotics in the treatment of acute bacterial exacerbations of chronic bronchitis.

The nursing of a patient following lung volume reduction surgery.

Lung volume reduction surgery (LVRS) is an experimental surgical procedure that aims to alleviate the symptoms of breathlessness for patients with end-stage chronic emphysema. Emphysema (from the Greek for 'puff up') is a progressive chronic obstructive pulmonary disease (COPD) and risk factors include smoking and chronic infections. The disease causes the alveoli of the lung to over-expand and lose their elasticity (Schedel and Connolly, 1999). Advanced emphysema causes severe dyspnoea that significantly reduces the patient's quality of life.

Nursing care of the thoracoscopic lung volume reduction patient.

BACKGROUND: Several methods to surgically enhance pulmonary function and improve the quality of life in patients with bullous emphysema are currently being evaluated. One of these methods, lung volume reduction, is performed in patients with bullous emphysema that can no longer be well managed with medical therapy. OBJECTIVES: The focus of this article is to review bullectomy via unilateral thoracoscopy with an endoscopic stapler in the management of end-stage pulmonary emphysema, and to discuss nursing care of these patients. METHODS: An experimental study was used, including review of the literature and analysis of clinical experience using chi-square and t test analyses of pre- and postoperative variables. RESULTS: At 3-month follow-up there were significant improvements in forced expiratory volume in 1 second, forced vital capacity, minute volume ventilation, partial pressure of oxygen, residual volume, and 6-minute walk when pre- and postoperative parameters were compared. Operative mortality was 4%, with the most common complication being prolonged air leak, occurring in 30% of patients studied. CONCLUSIONS: There is now consistent preliminary information to support the concept that lung volume reduction improves pulmonary function and quality of life in a significant percentage of patients.

Perceived uncertainty, physical symptoms, and negative mood in hospitalized patients with chronic obstructive pulmonary disease.

OBJECTIVE: To determine whether perceived uncertainty and physical symptoms were related to negative mood in hospitalized patients with chronic bronchitis and/or emphysema. DESIGN: Descriptive correlational. SETTING: Five large teaching hospitals in a city in central Canada. SUBJECTS: The sample consisted of 15 men and 11 women ranging in age from 53 to 86 years. INSTRUMENTS: Mishel Uncertainty in Illness Scale; Somatic Scale of the Bronchitis Emphysema Symptom Checklist; and Tension, Depression and Anger Subscales of the Profile of Mood States. RESULTS: Only the variable of physical symptoms contributed to the negative mood of the subjects with chronic obstructive pulmonary disease, explaining 21% of the variance (p < 0.02). Of the four symptom categories measured (fatigue, dyspnea, congestion, and peripheral-sensory disturbance), only fatigue was a significant predictor (p < 0.006) of negative mood, accounting for 28% of the variance. CONCLUSION: Negative mood is evidence of impaired coping. The finding that fatigue contributed to negative mood provides support for the theoretic prediction that low energy interferes with an individual's ability to cope with a stressful situation.

Lung volume reduction surgery for emphysema.

This article summarizes the care of patients undergoing bilateral lung volume reduction surgery as a treatment for end-stage emphysema. Surgical removal of emphysematous tissue allows for a reconfiguration of the chest wall and diaphragm, improving pulmonary mechanics. This results in reduced air trapping and improved gas exchange. It is important for nurses caring for these patients to be knowledgeable in the postoperative care of thoracic surgical patients and to have an understanding of the pathophysiology of emphysema, the medical management, and, in particular, the relationship between dyspnea and anxiety. Strategies to assist with airway clearance, control pain, prevent and alleviate dyspnea, reduce and treat anxiety, and ensure nutrition need to be incorporated into the postoperative plan of nursing care.

Bilateral lung volume reduction surgery for treatment of emphysema.

Patients suffering from chronic pulmonary emphysema can benefit from a new surgical technique that offers them relief from chronic dyspnea and declining quality of life. Bilateral lung volume reduction surgery (LVRS) involves an innovative surgical stapling technique for removing emphysematous lung tissue. To prevent persistent air leaks, surgeons use bovine pericardium strips to reinforce surgical staple lines created during bilateral LVRS. Perioperative nurses should understand the disease process of chronic pulmonary emphysema, bilateral LVRS techniques, and possible postoperative complications to provide quality nursing care for patients undergoing LVRS procedures.

Surgical treatment of emphysema using bovine pericardium strips.

Chronic pulmonary emphysema (CPE) damages lung tissue, causing it to lose elasticity and no longer exchange oxygen and carbon dioxide efficiently. In the past, lung transplantation was the only surgical treatment for CPE. Lung volume reduction surgery (LVRS) using bovine pericardium strips is a surgical approach that removes emphysematous lung tissue, allows healthy lung tissue to reexpand, and improves the functioning of the intercostal muscles and diaphragm. Surgical stapling devices buttressed with strips of bovine pericardium are used in LVRS procedures to reduce air leaks along staple lines. Patients with CPE who have undergone LVRS procedures using bovine pericardium strips have experienced a dramatic increase in their ability to exchange air, allowing them to have more normal lifestyles.

Bilateral lung volume reduction surgery.

A new surgical approach, bilateral lung volume reduction surgery (LVRS), offers hope for select patients with chronic pulmonary emphysema (CPE). Bilateral LVRS procedures involve excision of emphysematous alveoli, which results in a 20% to 30% reduction in the volume of each lung. The goal of LVRS is to improve the respiratory mechanics of patients with CPE by reexpanding functional lung tissue compressed by overdistended emphysematous alveoli, restoring diaphragmatic mobility, and improving the bellows function of the chest wall structures. Patients undergoing bilateral LVRS procedures experience relief from chronic dyspnea and may note improved pulmonary functions and better quality of life.

A surgical approach for patients with endstage emphysema.

For patients with emphysema who experience deteriorating lung function and concomitant comorbidity, there has been little to offer apart from best supportive care and more recently pulmonary rehabilitation. The early promise of lung transplantation for these patients has failed to materialize--a shortage of donors has meant that younger patients are more likely to receive donor lungs. A renewed interest in lung volume reduction surgery (LVRS) appears to offer hope for selected patients. This article looks at the history of LVRS and illustrates its benefits with a case study. However, if LVRS is a clinically significant approach to the treatment of emphysemic patients, then it requires careful clinical trials so that its benefits and costs can be fully evaluated.

Supportive and palliative care for patients with COPD.

Chronic obstructive pulmonary disease (COPD) is the most common respiratory disorder in the UK (Shee, 2001). In 1999, the number of people who died of COPD was equal to the number who died of lung cancer (Hill and Muers, 2000). Patients' knowledge of the high level of morbidity of this disease has a large impact on their social, psychological and economic status (Addington-Hall et al, 1998). Patients with COPD, unlike those with lung cancer, may go from crisis to crisis, requiring many hospital admissions, and are more likely to die in hospital after an acute admission (Edmonds et al, 2001).

Lung volume reduction with video assisted thoracic surgery.

This article aims to describe lung volume reduction (LVR) and some aspects of perioperative care. LVR is a surgical treatment for emphysema. An understanding of the operation and the patient's pre-existing medical condition is important for skilled and appropriate care, particularly in anaesthetic and recovery rooms.