Resp Care
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Accidental hypothermia is defined as an unintentional decrease in core body temperature to below 35 degrees C. Hypothermia causes hundreds of deaths in the United States annually. Victims of accidental hypothermia present year-round and in all climates with a potentially confusing array of signs and symptoms, but increasing severity of hypothermia produces a predictable pattern of systemic organ dysfunction and associated clinical manifestations. ⋯ The paucity of randomized clinical trials with hypothermic patients precludes creation of evidence-based treatment guidelines, but a clinically sound management strategy, tailored to individual patient characteristics and institutional expertise and resources, can nonetheless be gleaned from the literature. This article reviews the epidemiology, pathophysiology, clinical presentation, and treatment of accidental hypothermia. Initial evaluation and stabilization, selection of a rewarming strategy, and criteria for withholding or withdrawing support are discussed.
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Comparative Study
Performance comparison of nebulizer designs: constant-output, breath-enhanced, and dosimetric.
Design differences among pneumatically powered, small-volume nebulizers affect drug disposition (percentage of the dose delivered to the patient, lost to deposition in the equipment, and lost via exhalation to ambient air) and thus affect drug availability and efficacy. ⋯ The nebulizers we tested differ significantly in overall drug disposition. The dosimetric AeroEclipse provided the largest inhaled drug mass and the lowest loss to ambient air, with the test conditions we used. method.
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Comparative Study
Laboratory evaluation of 4 brands of endotracheal tube cuff inflator.
Routine measurement of endotracheal tube (ETT) cuff pressure is a standard in respiratory care, and several devices are available for measuring ETT cuff pressure. Yet an informed choice in the buying process is hindered by the present paucity of unbiased, comparative data. ⋯ The 4 cuff inflators tested differ in bias and precision and none of the devices accurately measure cuff pressure. Cuff inflator manufacturers should design an accurate yet reasonably priced device to inflate ETT cuffs, and ideally that device should allow cuff-pressure checks without decreasing cuff pressure. In the meanwhile clinicians may opt to use my proposed cuff-pressure measurement technique, which minimizes the loss of cuff pressure during cuff-pressure checks and provides more accurate cuff-pressure measurements.
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Comparative Study
Characteristics of demand oxygen delivery systems: maximum output and setting recommendations.
Demand oxygen delivery systems (DODS) allot oxygen by interrupting the oxygen flow during exhalation, when it would mostly be wasted. Because DODS conserve oxygen by various methods, there are important performance differences between DODS. We studied certain performance factors that have not previously been carefully examined. ⋯ DODS settings were not equivalent to continuous-flow oxygen in a bench model assessment; with equivalent settings the DODS tended to deliver greater F(I)O(2) than did continuous-flow oxygen. The maximum output capacity differed markedly among the DODS, and the user should know the device's capacity. A volume-referenced setting system for DODS should be adopted that would allow more predictable oxygen prescription and delivery via DODS.