Resp Care
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Randomized Controlled Trial Clinical Trial
A comparison of the therapeutic effectiveness of and preference for postural drainage and percussion, intrapulmonary percussive ventilation, and high-frequency chest wall compression in hospitalized cystic fibrosis patients.
Cystic fibrosis (CF) patients have abnormally viscid bronchial secretions that cause airway obstruction, inflammation, and infection that leads to lung damage. To enhance airway clearance and reduce airway obstruction, daily bronchopulmonary hygiene therapy is considered essential. ⋯ HFCWC and IPV are at least as effective as vigorous, professionally administered PD&P for hospitalized CF patients, and the 3 modalities were equally acceptable to them. A hospitalized CF patient should try each therapy and choose his or her preferred modality.
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Automatic tube compensation (ATC), a new ventilation mode that compensates for the work of breathing imposed by endotracheal tube resistance, recently became commercially available. ⋯ ATC with a Nellcor Puritan Bennett 840 ventilator provided inspiratory ventilatory support corresponding to PS of
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Current American Thoracic Society and American Association for Respiratory Care guidelines for the delivery of aerosol agents such as methacholine chloride (MC) for bronchoprovocation testing require the use of pneumatic jet nebulizers that have well-defined droplet size and mass output. A recently developed disposable, breath-actuated nebulizer (AeroEclipse) may offer bronchoprovocation testers an alternative to existing devices. ⋯ Although the bronchoprovocation test procedure had to be slightly modified from the guidelines to accommodate the operation of the AeroEclipse's breath-actuation feature, our measurements indicate that a predictable dose of MC, within the useful range for bronchoprovocation testing, can be delivered to an adult patient breathing tidally. The green indicator on the AeroEclipse could be used to coach the patient to inhale for a specific period, thereby controlling MC delivery per breathing cycle.
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Assess a prototype inspiratory impedance threshold valve (ITV) designed to enhance vital organ circulation during standard and active compression/decompression cardiopulmonary resuscitation (CPR). ⋯ The prototype ITV passed all performance testing recommended by international guidelines and functioned effectively as intended for use. The animal study results, when combined with recent clinical data, suggest that an ITV inspiratory cracking pressure of 12 cm H(2)O should be sufficient to decrease intrathoracic pressure during the decompression phase of standard CPR. Clinical studies are now underway.