Saturatie copd patient
Het is een test die vaak gebruikt wordt voor het monitoren van patiënten met chronische bronchitis of copd. Voor meer informatie verwijzen we naar onze saturatie faq.(het totale volume dat men kan uitblazen) en de verhouding tussen de 2:. Met de spirometer kan men patiënten met een longprobleem (zoals astma en copd) beter opvolgen, maar uiteraard zijn spirometers duurder dan piekstroommeters. Meer informatie over spirometrie. Saturatie faq, de arteriële zuurstofsaturatie is de weergave van het zuurstofgehalte in het bloed.
Astma patiënten hebben immers een sterk gedaalde piekstroom tijdens een astma aanval. Men is zich hier niet altijd van bewust en de balm peakflowmeter is dan aangewezen om een objectieve vaststelling van de piekstroom toe te laten. Hoe een peakflowmeter gebruiken? Voor het uitvoeren van een test met de peakflowmeter zet men het apparaat aan de mond en blaast men met alle kracht zo hard mogelijk uit in de piekstroommeter. Men dient minstens een seconde zo krachtig mogelijk uitblazen in de meter. Het resultaat kan afgelezen worden op de meetschaal op de zijkant van de piekstroommeter en wordt uitgedrukt in liter/minuut of liter/seconde. Deze waarden worden vergeleken met de normale waarden van de patiënt. Indien de waarde lager ligt dan normaal kunnen maatregelen genomen worden, zoals het innemen van de medicatie (de puffer ). Wat met de andere spirometriewaardes? Piekstroom is slechts én parameter van de uitgeblazen lucht.
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Wat is de piekstroom? Een debiet is de hoeveelheid vloeistof of gas die per tijdseenheid ergens door stroomt. De piekstroom of peak (expiratory) flow is het hoogste debiet dat men kan uitblazen en wordt gemeten ter hoogte van de mond. Peak flow wordt uitgedrukt in aantal liter per seconde of per minuut. Waarom de piekstroom meten? Men stelt vast dat bij mensen met een longprobleem, zoals astma uitslag of copd, de piekstroom gedaald. Vooral bij astma patiënten is het het middel bij uitstek om de ziekte op te volgen.
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Moreover, a multicentre study in European icus showed that a chronic respiratory disease is a strong predictor of withholding and withdrawing therapies inversely, for example, for the use of cardiopulmonary resuscitation. However, a great variability in the end-of-life practice was observed between countries. In a recent survey carried out in European respiratory intermediate care units, the prediction of a low probability of hospital survival or poor functional status following hospital discharge, as estimated by the attending physician, were the main reasons for withholding therapy. However, physicians are not always able to correctly predict the survival of a patient. A study comparing mortality at 180 days as predicted by clinicians for patients with an exacerbation of copd with the actual 180-day mortality found that clinicians are generally pessimistic about the survival prospects and have specific problems in identifying those with poor prognosis. Table 1 illustrates the main obstacles and common beliefs that may determine icu refusal in copd patients. All these problems are unique features in the acute setting and highlight a need to approach a clear discussion about decision making earlier and in a stable phase.
The patient with end-stage copd the presence of acute or chronic respiratory failure is often seen as a terminal phase of this disease. Ethical problems about the treatment of acute exacerbation of end-stage copd are increasingly topical, especially in respiratory units and the icu. It is well known, in fact, that once one of these patients is intubated several factors may lead to a poor prognosis. Age, respiratory muscle weakness, hypercapnia, hypoxia, malnutrition, treatment with corticosteroids or other agents, haemodynamic instability and activity limits due to respiratory disorders may, for example, lead to difficulties in the weaning process. A prospective, multicentre cohort study before the era of noninvasive ventilation (NIV) showed that patients with copd admitted to an icu for an acute exacerbation and who were aged 65 yrs had a mortality rate of 30, which doubled after 1 yr to. A more recent retrospective study aiming to evaluate the long-term survival of patients being treated with niv for the first time showed that survival at 1, 2 and 5 yrs was 72, 52 and 26, respectively.
The survival rate was also influenced by the need for readmission; those who required readmission had a 20 chance of survival at 5 yrs. Once these chronically ill patients have recovered from the most acute phase of their critical illness they ervaringen are still likely to require intensive nursing and/or physiotherapy for several weeks. Although several studies showed that either invasive ventilation 15 or niv 16 could be used to achieve an acceptable survival rate, we also know that once discharged, when this is feasible, most patients describe their quality of life as rather poor or poor after leaving. Indeed almost half of these patients die in hospital, most of them in the icu, which is probably the worst environment to spend the last few days of life, due to the lack of privacy and the restricted policy of visiting from the relatives. All this knowledge leads to the general perception that the outcome of copd patients requiring mechanical ventilation is poor, thus, negatively influencing the choice to admit a patient in icu.
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End-of-life care: is the care (comfort, supportive or symptom care) provided to a person in their final stages of life. The consensus Conference also highlighted the problem that many of the words used are imprecise or ambiguous,. Passive euthanasia and terminal weaning, and they may reflect specific religious orientations. For example, the termination of a continuous life-sustaining treatment, such as mechanical ventilation, is prohibited according to jewish law or Halacha (followed mainly by Orthodox Jews so that withdrawal is considered passive euthanasia. A similar view was recently expressed by the roman Catholic Church. The overall incidence of these practices in Europe is only partially known, but there are important differences between countries or regions, reflecting the absence of a common strategy even within the european Community.
For example, in 2002, in the netherlands, the euthanasia act legalised euthanasia in a patient who is suffering unbearably with no prospect of improvement if all the due care criteria are fulfilled. Euthanasia is used most often in the netherlands for patients with malignant disease. However, euthanasia was also performed in a patient with end-stage chronic obstructive pulmonary disease (copd) 5 to end his or her life in dignity after having received every type of curative and palliative care available. Indeed our societies are increasingly multicultural and multiracial, with a diversity of religious beliefs, whereas deficiencies in end-of-life care tend to be more pronounced in ethnic minority populations. Recognising this pluralism is, therefore, fundamental to the provision of high- quality end-of-life care. Of interest, 15 of icu patients retain decision making capacity so it is impossible to discuss the decision with them, while rarely the patient's family are involved in the decision and when this is the case the relatives rate the communication with hospital staff. Concerning the problem of patients affected by chronic pulmonary disorders, the 2008 National copd audit identified that only 13 of units provide information to severe copd patients when they are stable and 25 of patients with oxygen dependence have discussed care with medical staff. So, it was apparent that copd patients typically receive little information, but information is essential for people making choices about their care. At last it was obvious that it was inappropriate to discuss these issues during exacerbation, but this is typically when such discussions occur.
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Decreasing inspiratory oxygen fraction to 21, extubation, turning off the ventilator and suspending the vasopressors). Terminal sedation: pain and symptom treatment with the possible side-effect of shortening life. Euthanasia: from the Greek words eu and thanatos meaning good death. It means that a doctor is intentionally laserontharing killing a person who is suffering unbearably and hopelessly at the latter's voluntary, explicit, repeated, well-considered and informed request. Physician-assisted suicide: means that a doctor is intentionally helping/assisting/co-operating in the suicide of a person who is suffering unbearably and hopelessly at the latter's voluntary, explicit, repeated, well-considered and informed request. These acts do not include withholding or withdrawing treatments although these may occur prior to physician-assisted lichaam suicide. Cardiopulmonary resuscitation failure: defined as death despite the use of a ventilator or cardiac massage. Brain death: documented cessation of cerebral function and meeting the criteria for brain death. Palliative care: any interventions aimed to prevent and relieve suffering by controlling symptoms and providing other support to patients and families in order to maintain and improve their quality of living during all stages of chronic life-threatening (or terminal) illness.
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Number of publications in peer-reviewed journals in the field of end-of-life care in a) adults with all diseases, and b) adults with chronic obstructive pulmonary disease. The definitions of end-of-life decisions, during the period at the end of life, potentially important decisions are needed. However, the correct definition of each possible intervention is extremely important and often a matter of debate among clinicians, bio-ethicists, religious figures and politicians. The following definitions are taken from the International Consensus Conference on challenges in end-of-life care in the icu published in 2004. Withholding: a planned decision not to introduce therapies that filorga are otherwise warranted (. Intubation, renal replacement therapy, increased doses of vasopressor infusions, surgery, transfusion, nutrition and hydration). Withdrawal: discontinuation of treatments that have been started (.
The patients clinicas eligible for palliative care are those complaining of breathlessness, pain, fatigue and depression, which in some studies accounted for a prevalence much higher than. Among comfort measures for palliation, oxygen is frequently prescribed even when the criteria for long-term home oxygen therapy are not met; however, when compared with air, no benefits on dyspnoea have been found. The only drug with a proven effect on dyspnoea is morphine, but not when it is delivered with a nebuliser. Finally, noninvasive ventilation may be used only as a comfort measure for palliation to maximise comfort by minimising adverse effects. In Europe, attention to end-of-life care in the hospital setting, especially in the intensive care unit (icu has only increased in the last decade. A medline search, conducted by the authors of this review in December 2011, found that more than 1,000 articles related to end-of-life care were published between 20 ( fig. 1 compared with only 336 published before 2001. These studies were mainly published in North America, even though in more recent years the problem of end-of-life care has also gained a lot of attention in Europe and the rest of the world. Unfortunately, very few studies were performed in patients affected by chronic respiratory diseases, both in the phase of clinical stability or during an acute exacerbation of their diseases.
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Annalisa carlucci, aldo guerrieri, stefano nava. European Respiratory review 2012 21: 347-354; doi:.1183/09059180.00001512. Abstract, the presence of acute or chronic respiratory failure is often seen as a terminal phase of chronic obstructive pulmonary disease. A great variability in end-of-life practice is observed in these patients mainly because physicians are not always able to correctly predict survival. There is a need for a clear discussion about decision making earlier than when acute respiratory failure ensues. Indeed, a perceived poor quality of life does acide not necessarily correlate with a clear willingness to refuse invasive or noninvasive mechanical ventilation. It has been suggested to start palliative care earlier, together with curative and restorative care, when there is an increased intensity of symptoms.