Chest
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The National Board for Respiratory Care credentials general respiratory therapists and therapists specializing in pulmonary function testing, neonatal/pediatrics, sleep, and adult critical care. A sponsor of the NBRC requested a new specialty certification program. The request came with the intent to serve a candidate population from multidisciplinary backgrounds (eg, nurse, nurse practitioner, physician assistant) in addition to respiratory therapists. ⋯ A second survey was simultaneously distributed to those directly working in the pulmonary disease educator role; 3,095 responded. Results from both surveys, including the limitations, were summarized for the NBRC, which decided against continued development of the program. A pulmonary disease educator certification program was subjectively desirable and feasible; however, there did not objectively seem to be enough potential candidates to support the program.
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Single-night disease misclassification of OSA due to night-to-night variability may contribute to inconsistent findings in OSA trials. ⋯ Multinight monitoring of OSA allows for better estimates of hypertension risk and potentially other adverse health outcomes associated with OSA. These findings have important implications for clinical care and OSA trial design.
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Previous studies have inconsistently reported associations between refractory ceramic fibers (RCFs) or mineral wool fibers (MWFs) and the presence of pleural plaques. All these studies were based on chest radiographs, known to be associated with a poor sensitivity for the diagnosis of pleural plaques. ⋯ This study suggests the existence of a significant association between exposure to RCFs and MWFs and the presence of pleural plaques in a large population previously exposed to asbestos and screened by using CT scans.
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Case Reports
37-Year-Old Tracheostomized Woman With Overdistended Tracheostomy Cuff and Difficulty Ventilating.
A 37-year-old woman with a medical history of myasthenia gravis resulting in progressive respiratory failure requiring continuous mechanical ventilation via tracheostomy, as well as multiple cardiac arrests leading to severe anoxic brain injury, was brought to the hospital from a nursing home because of difficulties with ventilation and oxygenation. On presentation to the ED, the patient was found to be agitated and tachypneic on a ventilator, generating low tidal volumes despite elevated peak airway pressures. ⋯ More recently, staff has noted intermittent loss of tidal volumes, temporarily responding to overinflation of tracheostomy cuff. Additionally, the tracheostomy tube was exchanged for an extra-long tracheostomy tube to improve tidal volumes; however, the problem persisted, prompting the current presentation.