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Related Concept Videos

Respiratory Volumes01:15

Respiratory Volumes

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Respiratory volumes are crucial metrics, meticulously measured to quantify the air exchanged in and out of the lungs during various phases of the breathing cycle. These precise measurements are vital for assessing lung function, diagnosing respiratory conditions, and monitoring overall respiratory health. Each parameter provides specific insights into the mechanics of breathing and the functional capacity of the lungs.
Tidal Volume (TV) Tidal volume (TV) is the air inhaled or exhaled in a...
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External and Internal Respiration01:24

External and Internal Respiration

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External respiration occurs in the lungs, and it is the first step in the journey of oxygen inside the body. When we inhale, oxygen enters our lungs and diffuses across the thin alveolar membrane. The alveoli are tiny, air-filled sacs that provide a vast surface area for gas exchange. Oxygen in the alveoli has a higher partial pressure (105 mmHg) than in the adjacent pulmonary capillaries (40 mmHg), establishing a pressure gradient. As a result, oxygen molecules move from the alveoli into the...
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Pulmonary Ventilation: Inhalation01:24

Pulmonary Ventilation: Inhalation

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Pulmonary ventilation is a vital process that ensures the exchange of oxygen and carbon dioxide in the lungs. It refers to the movement of air into and out of the lungs, enabling the body to obtain oxygen and remove waste carbon dioxide. In this article, we will explore the intricacies of pulmonary ventilation, including its underlying principles, mechanisms, and the interplay of pressures within the respiratory system.
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Breathing01:05

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The process of breathing, inhaling and exhaling, involves the coordinated movement of the chest wall, the lungs, and the muscles that move them. Two muscle groups with important roles in breathing are the diaphragm, located directly below the lungs, and the intercostal muscles, which lie between the ribs. When the diaphragm contracts, it moves downward, increasing the volume of the thoracic cavity and creating more room for the lungs to expand. When the intercostal muscles contract, the ribs...
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Respiratory Volumes and Capacities I01:26

Respiratory Volumes and Capacities I

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Assessing the respiratory rate and rhythm for a complete minute is crucial for evaluating the breathing pattern. Even a minor increase in the patient's average respiratory rate, by as little as three to five breaths per minute, is an early and vital indicator of respiratory distress. Patients with a respiratory rate exceeding twenty-four breaths per minute require close monitoring to determine the physiological alterations. This careful observation is essential for prompt recognition and...
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Pneumothorax-II01:27

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Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
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Lung volume reduction surgery for diffuse emphysema.

Joseph Em van Agteren1, Kristin V Carson, Leong Ung Tiong

  • 1Basil Hetzel Institute for Translational Health Research, Woodville, Australia.

The Cochrane Database of Systematic Reviews
|October 15, 2016
PubMed
Summary
This summary is machine-generated.

Lung volume reduction surgery (LVRS) improves long-term outcomes for severe emphysema patients, but carries short-term risks. Selected patients, particularly those with upper lobe-predominant disease and low exercise capacity, benefit most from this lung volume reduction surgery.

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Area of Science:

  • Pulmonary Medicine
  • Thoracic Surgery
  • Respiratory Disease Research

Background:

  • Lung volume reduction surgery (LVRS) was reintroduced to treat severe diffuse emphysema, aiming to improve lung elasticity and patient function.
  • This treatment, while potentially improving quality of life, involves significant costs, morbidity, and mortality risks.
  • An updated review is necessary after a decade to reassess the evidence on LVRS effectiveness and safety.

Purpose of the Study:

  • To evaluate the effectiveness of LVRS compared to standard non-surgical therapy for severe diffuse emphysema.
  • To identify patient subgroups benefiting from LVRS, contraindications, surgical approaches, and cost-effectiveness.
  • To determine postoperative complications, morbidity, and mortality associated with LVRS.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) identified through the Cochrane Airways Group COPD register and clinical trials registers up to April 2016.
  • Inclusion criteria focused on RCTs assessing LVRS safety and efficacy in diffuse emphysema, excluding giant or bullous emphysema.
  • Data extraction and meta-analysis were performed by two independent reviewers using RevMan 5 software.

Main Results:

  • Eleven RCTs (1760 participants) met criteria; evidence quality ranged from low to moderate.
  • LVRS showed higher short-term mortality but favored long-term mortality compared to standard care.
  • Improvements in quality of life and exercise capacity were observed with LVRS, despite increased adverse events like air leaks and pulmonary/cardiovascular morbidity.

Conclusions:

  • LVRS is an effective treatment for selected severe emphysema patients, particularly those with upper lobe-predominant disease and low exercise capacity, improving health status and lung function.
  • The procedure is associated with increased risks of early mortality and adverse events.
  • While LVRS increases quality-adjusted life-years (QALYs), it remains a relatively costly intervention.