Resp Care
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The profession of respiratory care is founded on rigorous scientific research, which in turn depends on rigorous training in research methods. Only a small part of that training is from written and audiovisual materials; the most important aspects of becoming a respiratory researcher are learned from. Becoming a thoroughly-involved respiratory care professional, then a researcher, and then a mentor is challenging but rich with the rewards of contributing to the advancement of science and, thereby, to the care and comfort of our patients. ⋯ In addition to planning and using your time wisely, you must learn what are realistic expectations about how long a project will take, when to ask for help, and when to stop because you have reached your physical or mental limit and you need to rest and devote some time to your nutrition and recreation. The sixth aspect is : having achieved the basic skills and gained a fair amount of experience, your efficiency improves and you begin to achieve more in a day; you begin to start mentoring others; you can confidently and quickly handle multiple projects; if you don't know the answers you know where to find them; you are seen as an authority and people ask you for consultations and presentations and to participate in committees. The final aspect is, meaning that your practice of respiratory care reaches a level at which you meet challenges for which you feel you have no response in memory and yet you succeed.
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Case Reports
Successful treatment of acute chest syndrome with high-frequency oscillatory ventilation in pediatric patients.
Severe acute chest syndrome afflicts patients with sickle cell disease and can cause hypoxemia refractory to conventional treatments. Obstructive mucus plugging and the development of acute respiratory distress syndrome may underlie the pathophysiology of refractory hypoxemia in acute chest syndrome. ⋯ We report the first successful HFOV management of pediatric patients suffering from severe acute chest syndrome and hypoxic respiratory failure. These cases suggest that HFOV should be strongly considered for patients with severe acute chest syndrome that is refractory to conventional mechanical ventilation.
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Portable pressure ventilators, or bi-level ventilators, do not typically have an oxygen control, and thus supplemental oxygen is usually administered by adding it into the mask or the circuit. We conducted this study to test the hypothesis that delivered oxygen concentration using this configuration is affected by the choice of leak port, oxygen injection site, and ventilator settings. ⋯ Delivered oxygen concentration during BiPAP is a complex interaction between the leak port type, the site of oxygen injection, the ventilator settings, and the oxygen flow. Because of this, it is important to continuously measure arterial oxygen saturation via pulse oximetry with patients in acute respiratory failure who are receiving noninvasive ventilation from a bi-level ventilator.
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Comparative Study
Aspiration of dead space in the management of chronic obstructive pulmonary disease patients with respiratory failure.
Carbon dioxide clearance can be improved by reducing respiratory dead space or by increasing the clearance of carbon-dioxide-laden expiratory gas from the dead space. Aspiration of dead space (ASPIDS) improves carbon dioxide clearance by suctioning out (during expiration) the carbon-dioxide-rich expiratory gas while replacing the suctioned-out gas with oxygenated gas. We hypothesized that ASPIDS would allow lower tidal volume and thus reduce exposure to potentially injurious airway pressures. ⋯ ASPIDS is a simple adjunct to mechanical ventilation that can decrease P(aCO(2)) during conventional mechanical ventilation and permissive hypercapnia.
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Case Reports
Severe acute respiratory distress syndrome in a child with malaria: favorable response to prone positioning.
We present the case of a 4-year-old boy with malaria who developed acute respiratory distress syndrome with severe hypoxemia refractory to mechanical ventilation and inhaled nitric oxide. Placing the patient in prone position immediately and persistently improved oxygenation: the ratio of P(aO(2)) to fraction of inspired oxygen rose from 47 to 180 mm Hg and the oxygenation index decreased from 40 to 11. The patient survived, with no respiratory sequelae.