Chest wall disorders

Chronic obstructive airwav disease Chest wall disorders... 

Restrictive disorders Chest wall disorders Kyphoscoliosis Thoracoplasty Fibrothorax... 

Annane D, Chevrolet JC, Chevret S, et al. Nocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders. Cochrane Database Syst Rev 2000 (2) CD001941. 

Goldstein RS, Brooks D, Davis L. Sleep in patients with neuromuscular and chest wall disorders. In McNicholas WT, Phillipson EA eds. Breathing Disorders in Sleep. London WB Saunders,... 

Impaired lung motion due to pleural effusion or pneumothorax Adult respiratory distress syndrome Chest wall diseases and chest wall deformities Neurological disorders affecting the muscles of respiration... 

Hypercapnic respiratory failure is due to failure of the ventilatory pump caused by acute (drug overdose, acute neuromuscular diseases) or chronic (chest wall abnormalities, chronic neuromuscular diseases) disorders. It is characterized by alveolar hypoventilation, which leads to hypercapnia with coexistent, usually mild, hypoxemia. The central drive may be globally reduced with the fall in Pa02 resulting from the increase in alveolar CO2. More commonly, the drive remains high, but the mechanical load on the respiratory systan is too great or the capacity of the muscles too low to ensure efficient CO2 elimination (Fig. 1). 

Shneerson JM, Simonds AK. Noninvasive ventilation for chest wall and neuromuscular disorders. Eur Respir J 2002 20 480-487. 

A large number of conditions can result in chronic ventilatory failure and patients with these conditions may benefit from home ventilation. Typically, patients with restrictive disorders have decreased compliance of the chest wall, resulting from a thoracic cage deformity or from respiratory muscle involvement (1). In patients with severe obstructive pulmonary disorders, respiratory muscle fatigue and alveolar hypoventilation, especially during sleep, are thought to contribute to respiratory failure (2,3) (Table 1). 

Sancho J, Servera E, Diaz J, et al. Comparison of peak cough flows measured by pneumotachograph and a portable peak flow meter. Am J Phys Med Rehabil 2004 83(8) 608-612. Schneerson JM, Simonds AK. Noninvasive ventilation for chest wall and neuromuscular disorders. Eur Respir J 2(X)2 2(X2) 480-487. 

During the 1970s, more patients with respiratory failure due to neuromuscular disorders and chest wall deformities received long-term ventilatory assistance at home, either via tracheostomy or body ventilators, which provided effective nocturnal noninvasive ventilation (NIV) (5,6). In the 1970s, the development of home respiratory therapy companies improved support for home mechanical ventilation (HMV). Respiratory therapists could now set up ventilatory equipment, educate the patient and caregivers about using the equipment, and be available to deal with problems. 

Figure 3 Percentage of users in each disease category by country. The symbol represents lung/ airways (COPD, cystic fibrosis, bronchiectasis, pulmonary fibrosis, and pediatric diseases) , chest wall deformities (kyphoscoliosis, old TB, OHS, surgical resection) and , neuromuscular disorders (muscular dystrophy, motor neuron disease, post-polio kyphoscoliosis, central hypoventilation, spinal cord damage, and phrenic nerve palsy). Abbreviations COPD, chronic obstructive pulmonary disease TB, tuberculosis OHS, obesity hypoventilation syndrome. Source From Ref. 15.

A 47-year-old man with chest pain and a myeloproliferative disorder had a CT scan of the abdomen with contrast enhancement (the type of contrast medium was not stated) (67). He had no significant past medical history or history of allergy. During a later CT scan of the abdomen infusion of 60 ml of the non-ionic monomer iohexol (iodine 300 mg/ml) caused a sudden cardiac arrest. Resuscitation was ineffective and postmortem examination showed intramural acute and old organizing infarctions in the entire left ventricular wall. 

Asthma is a chronic inflammation disorder of the airways that make the bronchial tubes swell and narrow, producing wheezing, chest tightness, breathlessness, and coughing symptoms. Airway narrowing in asthma is caused by inflammation, bronchospasm, and bronchial hyperactivity. Asthma does not affect the alveoli and is reversible spontaneously and by drug treatment. Asthma is fully reversible and thus is different from COPD and emphysema, which are accompanied by destruction of alveolar walls and are irreversible. 

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