Resp Care
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Open-circuit mouthpiece ventilation (MPV) is a form of noninvasive ventilation that can be used to provide portable daytime ventilatory support for neuromuscular patients with chronic respiratory failure. MPV has been reported to reduce the risk of respiratory infection due to tracheostomy, and to improve cough and voice function and patient quality of life. Despite these potential benefits, mouthpiece ventilation is not widely used. This may be due in part to the fact that little information is available as to which ventilators can support this application. ⋯ Six of the 8 ventilators supported MPV: Respironics Lifecare PLV-100 and PLV Continuum, Mallinckrodt Achieva PSO2, Pulmonetics LTV800, Newport HT50, and Uni-Vent Eagle 754.
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Randomized Controlled Trial Comparative Study
Positive expiratory pressure changes aerosol distribution in patients with cystic fibrosis.
We hypothesized that aerosol distribution in the lungs of patients with cystic fibrosis changes with positive expiratory pressure (PEP). ⋯ These results indicate that less aerosol is deposited in the lungs of patients with cystic fibrosis when the Pari LC Plus nebulizer is used with the Pari PEP device, as described in these experiments. Nevertheless, aerosol administration with this nebulizer and PEP device also results in a proportional redistribution of aerosol to the peripheral airways, compared to nebulization without the PEP device. The clinical relevance of this subtle redistribution of aerosol in cystic fibrosis patients will probably depend on the drug administered and disease severity.
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Randomized Controlled Trial
Effects of expiratory rib-cage compression on oxygenation, ventilation, and airway-secretion removal in patients receiving mechanical ventilation.
Expiratory rib-cage compression, a chest physiotherapy technique, is well known as the "squeezing" technique in Japan. ⋯ This study suggests that rib-cage compression prior to endotracheal suctioning does not improve airway-secretion removal, oxygenation, or ventilation after endotracheal suctioning in this unselected population of mechanically ventilated patients.
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Comparative Study
Comparison of an oxygen-powered flow-limited resuscitator to manual ventilation with an adult 1,000-mL self-inflating bag.
Positive-pressure ventilation of patients with unprotected airways during cardiopulmonary resuscitation can cause gastric dilation. ⋯ Our study found no significant difference between the Oxylator and BVM when comparing tidal volume delivered to lungs and stomach during ventilation of a simulated unconscious nonintubated patient. More research on BVM use and the Oxylator should be done to validate the American Heart Association's guideline recommendations for ventilating unconscious patients with unprotected airways. Research on gastric dilation during cardiopulmonary resuscitation needs to be done with bench models using manikins that simulate chest excursion, bidirectional airway flow, lung impedance, and gastric compliance.