Year : 2012 | Volume
: 135 | Issue : 2 | Page : 260--261
Applied technologies in pulmonary medicine
LRS Institute of TB & Respiratory Diseases, Sri Aurobindo Marg, New Delhi 110 030, India
LRS Institute of TB & Respiratory Diseases, Sri Aurobindo Marg, New Delhi 110 030
|How to cite this article:|
Behera D. Applied technologies in pulmonary medicine.Indian J Med Res 2012;135:260-261
|How to cite this URL:|
Behera D. Applied technologies in pulmonary medicine. Indian J Med Res [serial online] 2012 [cited 2019 Nov 17 ];135:260-261
Available from: http://www.ijmr.org.in/text.asp?2012/135/2/260/94223
Applied technologies in pulmonary medicine , A.M. Esquinas, editor (S. Karger, Basel, Switzerland) 2011. 256 pages. Price: US$ 152/CHF 129c
This book is a compilation of the selected articles highlighting the application of technological advances in the diagnosis, monitoring and treatment of patients with lung diseases. It provides an insight into not only the currently applied technologies in pulmonary management but also the potential application of the advancements in future.
The book commences with the newer modes of mechanical ventilation providing options of automatic ventilation control that can reduce errors associated with the treatment. One such option is Proportional Assist Ventilation (PAV), in which the ventilator measures the patient's ongoing volume and rate of flow of inspiratory gas and applies additional pressure support in proportion to the patient's own inspiratory effort. Another option is Neurally Adjusted Ventilatory Assist (NAVA), in which the patient's respiratory neural drive to the diaphragm (Edi) is detected by electrodes mounted on a nasogastric tube positioned at the lower oesophagus. The technology is used to eliminate the noise and to amplify the signal. The absence of signal indicates central apnoea or suppression of spontaneous breathing activity. While both PAV and NAVA require the patients to be spontaneously breathing, another mode called Adaptive Support Ventilation (ASV) can be used for passive as well as active patients. All modes have been shown to improve the synchrony between the patient and the ventilator, which could expedite weaning. Further, NAVA, using a neural trigger, is not affected by leaks for obtaining synchrony. Smart care is yet another signal that provides automated support during weaning. The use of innovative options is likely to have a significant impact on the quality of critical care in future.
Reduction of Positive End-expiratory Pressure (PEEP) is well known to improve the cardiac output in cases of hypovolemic shock. Contrarily, the application of Negative End-expiratory Pressure (NEEP) to increase the blood flow in haemorrhagic shock could be a promising concept.
Another potential application of technology is the development of a non-contact sensing modality such as Thermal Infrared Imaging (TIRI) during polysomnography. It can sense thermal information at a distance (contact-free). Once validated, it could be used in place of the thermal sensor or the nasal pressure-airflow monitoring devices routinely used to measure apnoeas, hypopnoeas and Respiratory Effort Related Arousals (RERAs) during the sleep studies. This would not only improve patients' comfort but also obtain a representative sample of the subject's usual sleep. Initial results with TIRI have been encouraging in adults. The technique also has the potential to make a significant impact in paediatric polysomnography, where it is difficult to maintain the oro-nasal sensor in place.
Cardiopulmonary resuscitation (CPR) with the Boussignac System, which administers passive oxygenation, has been shown to give higher survival rate than chest compression combined with classic ventilation. The technology would simplify the procedure of CPR.
The section on inhalation therapy compares the vibrating mesh nebulisers with the jet and the ultrasonic nebulisers. The former are advantageous due to their higher efficiency for drug delivery to the respiratory tract, an effective aerosolisation of solutions, a minimal residual volume of medication left in the device (cost-economic effect) and a breath-actuated aerosol delivery. This section also discusses novel devices for enhanced pulmonary drug delivery as well as the inhalation of biomolecules for systemic treatment including that of insulin inhalation for diabetes treatment.
Development of Endobronchial Ultrasound (EBUS) is an example of the application of technological advancement for diagnosis of pulmonary problems. The Radial EBUS facilitates airway wall assessment, TBNA of paratracheal lymph nodes and biopsies of peripheral lung lesions, while the Linear EBUS-TBNA improves diagnostic yield compared to conventional 'blind' TBNA of mediastinal and hilar lymph node stations, as well as, peribronchial tumours. EBUS clearly has the potential to identify lymphadenopathy that has been missed on computed tomography. The chapter highlights the advanced features of EBUS which has revolutionized the bronchoscopy today.
The surgical section discusses the clinical benefits (chiefly reduction of pain and shorter hospital stay) offered by Video-assisted Thoracic Surgery (VATS) in comparison to the conventional open approach. The carriage of a Minimally Invasive Thoracic Surgery (MITS) with robotic assistance, a uniportal VATS through a single incision as compared to the standard three-port VATS and awake VATS pulmonary resections are the recent additions. Another advancement, the Intra-operative Magnetic Resonance Imaging (iMRI) technology, could be beneficial, but would require the availability of magnetic resonance (MR) safe and compatible equipment in the operating room. At the same time, the anaesthetist needs to be aware of ensuring the patient's safety during the procedure.
Hyperbaric oxygen therapy is described as a promising treatment as a bridge to transplantation, keeping the donated organs viable until the harvesting procedure takes place for potential brain-dead donors. Mini-hyperbaric oxygen chambers may help to provide the hyperbaric treatment of the isolated donor organ. These may be easier to use and of relatively low cost.
Recent advances in technology make it possible to reach patients in their homes through e-health or telemedicine. The telemedicine assistance programmes are effective in preventing hospitalizations, urgent general practitioner calls, and may be cost-effective in severe chronic respiratory failure patients needing home oxygen therapy and/ or mechanical ventilation.
The subsequent sections of the book discuss the application of technology in monitoring of the patient. While capnography provides a numeric and graphic wave display of end-tidal carbon dioxide with each breath and can reduce the need for frequent arterial blood gas sampling, the intra-abdominal pressure monitoring can give a useful idea about intra-abdominal hypertension, as well as, abdominal compartment syndrome which can have a significant impact on the respiratory function of the critically ill patients.
The role of chest X-ray-imaging, lung ultrasound and chest CT scan is well known in the localization of pleural effusion and thoracocentesis. The section on air pollution discusses the health effects and the oxidative stress caused by air pollutants. It also mentions various non-invasive techniques of respiratory assessments like lung function testing, sputum induction, detection of nitric oxide in exhaled air, examination of exhaled breath condensate and nasal lavage and saccharin transit time test.
Apart from the technological advancements being applied in the treatment of lung diseases, the book describes the relevant aspects of health care associated pneumonia, ventilator associated pneumonia, lung cancer and pulmonary rehabilitation highlighting critical issues of management. Early mobilization and complete recovery before discharge is stressed. The role of exogenous surfactant in respiratory distress syndrome is also discussed elaborately.
The salient features the book include the precise selection of the topics of current interest to a pulmonologist/critical care physician, the evidence-based scientific content and the recommendations/ conclusions at the end of the chapters. The controversial aspects of a subject have also been dealt with conviction to present a clear view to the readers. The content is well supported with references. The readers are likely to find the book very informative.