Chest
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Comparative Study
Human and financial costs of noninvasive mechanical ventilation in patients affected by COPD and acute respiratory failure.
It has been suggested that noninvasive mechanical ventilation (NIMV) may be a time-consuming procedure for medical and paramedical personnel. We carried out a prospective trial in 10 consecutive COPD patients aimed at assessing the human and economic resources needed to ventilate patients by NIMV and we compared these with those needed by a group of six patients receiving invasive mechanical ventilation (InMV). ⋯ We conclude that in the first 48 h of ventilation, daily NIMV is neither more expensive nor time-consuming and staff demanding than InMV. After the first few days of ventilation, NIMV was significantly less time-consuming than InMV, for MDs and Ns, so that medical and paramedical time expenditure seems not to be a major problem during NIMV.
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Increasing evidence indicates that routine preoperative diagnostic spirometry (pulmonary function tests [PFTs]) before elective abdominal surgery does not predict individual risk of postoperative pulmonary complications and is overutilized. This economic evaluation estimates potential savings from reduced use of preoperative PFTs. ⋯ Reduced use of PFTs before elective abdominal surgery could generate substantial savings. Current evidence indicates reduced use would not compromise patients' outcomes.
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To determine the usefulness of routinely inserting a hollow airway exchange catheter (jet stylet) prior to tracheal extubation of adult patients with risk factors for difficult tracheal intubation. ⋯ The No. 11 CAEC is a useful and effective tool for giving patients a trial of extubation. Administration of oxygen through the CAEC diminishes the potential for hypoxia while maintaining the ability to reintubate the trachea, especially when reintubation might prove challenging. Previous data suggest that the CAEC is rigid enough to facilitate tracheal reintubation in adults; this was confirmed in the three patients in our study who required tracheal reintubation. The risk of aspiration, barotrauma, or other airway trauma during prolonged placement of the CAEC appears to be low (zero incidence in 40 patients in this study), and use of the No. 11 CAEC appeared to be safe. Since oxygen can be delivered through the CAEC, it may provide a means to safely evaluate an airway during a trial of extubation, ie, a reversible extubation. Finally, oxygen administration through the CAEC may obviate the need for facemask or nasal cannula following tracheal extubation.
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To highlight the incidence of subglottic stenosis (SGS) as a complication of surgery for congenital heart disease and the role of single-stage laryngotracheoplasty in treating this complication. ⋯ SGS can complicate surgery for congenital heart disease in children. Single-stage LTR is an effective treatment modality for this problem.