Resp Care
-
We present a case of unilateral airflow obstruction during forced exhalations. The patient presented with episodic dyspnea and wheezing, particularly when he lay in the right lateral decubitus position. ⋯ Following a right pneumonectomy, total lung capacity was markedly reduced; interestingly, however, spirometry was essentially unchanged. This case is an elegant illustration of the effects of respiratory maneuvers and body position on airway caliber.
-
Clinical Trial
Noninvasive nocturnal ventilatory support in advanced lung disease from cystic fibrosis.
Respiratory failure is the most common cause of death among people with cystic fibrosis (CF). The role of noninvasive positive-pressure ventilation (NPPV) in severe but stable lung disease from CF has not been adequately determined. We therefore sought to determine the tolerability and efficacy of NPPV in people with advanced lung disease from CF. ⋯ NPPV is well tolerated by most patients with CF and severe lung disease and may be a useful bridge to support CF patients awaiting lung transplantation. However, despite subjective improvement, standard objective measures did not improve and cannot explain the reduced symptoms reported by these patients.
-
Arterial blood gas (ABG) values are a necessary diagnostic measurement in the management of critically ill neonates. We hypothesized that a fiberoptic intravascular blood gas sensor, adapted for use through an umbilical artery catheter, would produce blood gas results with clinically acceptable bias and precision, in comparison to laboratory values, but with no blood loss. ⋯ The Neotrend device was accurate and reliable in the neonatal setting, allowing blood gas assessment with no iatrogenic blood loss. Catheter placement in high position may increase the likelihood of successful sensor placement and sensor duration of function.
-
Uncertainties exist regarding the value of the air leak test or use of steroids for preventing post-extubation stridor and extubation failure in children. ⋯ The majority of surveyed pediatric critical care fellowship program directors rely on the air leak test and use corticosteroids to prevent post-extubation stridor and extubation failure. At an air leak of >or= 30 cm H(2)O most of the surveyed physicians would delay extubation and initiate glucocorticosteroids.
-
Ventilators possess an anti-asphyxia valve that allows spontaneous breathing of ambient air during ventilator failure. This study examined the imposed work of breathing and pressure-time product of 8 critical care and 9 portable ventilators, using a laboratory simulation of spontaneous breathing during ventilator failure. ⋯ Spontaneous breathing during ventilator failure may impose work approximating the physiologic work of breathing. This imposed work may prevent effective breathing through the anti-asphyxia valve during mechanical ventilator failure due to electrical failure. These results reinforce the need to properly monitor mechanically ventilated patients and to have in place sufficient back-up power supplies and a method of manual ventilation.