Pulmonary angiography is required only occasionally.
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When combined with objective studies of the venous system, the ventilation-perfusion lung scan provides a guide to management in the great majority of patients. In the absence of deep vein thrombosis, the low-probability scan identifies a patient population not requiring anticoagulation. Treatment trials and clinical follow-up studies have shown that although the V/Q scan is not always predictive of angiogram results, it is a reliable predictor of patient outcome. Several studies have shown that some emboli found on angiography are clinically benign and, in the absence of persistent thrombosis of the lower extremities, do not require anticoagulation. The goal of V/Q scanning is not detection of pulmonary emboli per se, but rather the identification of patients at a high or low risk for future embolic events if they are not anticoagulated. These data suggest that the lung scan is a better predictor of patient outcome than has been previously appreciated. number of non-diagnostic examinations (65) with V/P scan and the probabilistic interpretation criteria were confusing to the clinicians (Gray et al., 1993 The PIOPED Investigators, 1990). Major prospective studies recently have made available objective data for formulation and evaluation of diagnostic and therapeutic strategies. Some physicians recommend diagnostic approaches in which the lung scan plays a relatively minor role, and angiography is required for many patients. OSTI.GOV Journal Article: Studies on diagnostic usefulness of ventilation/perfusion scintiphotography using xenon isotope for cardiovascular and pulmonary diseases. Ventilation-perfusion (VQ) scintigraphy is known to miss some emboli found on pulmonary angiography. Sheffield The European Respiratory Society.Diagnosis and management of the patient with pulmonary embolism remains a vexing clinical problem. , (2015) European Respiratory Society Practical Handbook: NIV.
Diagnostic ventilation cenon update#
, (2012) ‘Non-invasive Ventilation in Motor Neurone Disease: an update of current UK practice’ Journal of Neurology, Neurosurgery and Psychiatry 83: 371 -376 Simonds, A. Clinical guideline NICE (2016) Motor Neurone Disease: assessment and management O’Neill, C. August 18 (5 -6): 388 -396 NICE (2010) Motor Neurone Disease: non-invasive ventilation. , et al (2017) Advance Care Planning for patients with ALS fronto-temporal Degen. ‘Existential concerns for people with MND: who is listening to their needs, priorities and preferences? BJOT 79 (6) 391 -393 Levi. BMJ supportive and Palliative Care 4: 43 -39 Harris, D. ‘Issues for Palliative Medicine doctors surrounding the withdrawal of NIV at the request of a patient with MND: a scoping study’.
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, (2015) ‘Withdrawal of assisted ventilation at the Request of a Patient with Motor Neurone Disease’. Lancet Neurology 5: 140 -7 British Thoracic Society Standards of Care Committee (2002) BTS Guideline: Non-invasive ventilation in acute respiratory failure. , (2006) 'Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial'. Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders 3: 145 -149 Bourke, S. , (2002) ‘Non-invasive ventilation in motor neuron disease: current UK practice'. Palliative Medicine 27(6) 516 -52 Bourke, S. (2013) ‘The use of NIV at end of life in patients with MND’. References BBC Inside the Ethics Committee (2011). Non-invasive mechanical ventilation for diagnostic bronchoscopy using a new face mask: an observational feasibility study Intensive Care Med.