Resp Care
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We describe the combined use of inhaled nitric oxide and heliox (79% helium and 21% oxygen) as a rescue therapy for a critically ill infant with localized interstitial pulmonary emphysema and pulmonary hypertension. Conventional interventions were ineffective, not feasible, or unlikely to take effect in time, during this infant's acute critical illness. ⋯ The infant made a full recovery. To our knowledge this is the first case report of heliox and inhaled nitric oxide used simultaneously in localized interstitial pulmonary emphysema.
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Multicenter Study
Management of tracheostomy: a survey of Dutch intensive care units.
To determine tracheostomy-management practices in Dutch intensive care units (ICUs) and post-ICU step-down facilities. ⋯ There were large differences in tracheostomy management among Dutch ICUs. ICU and post-ICU tracheostomy-management guidelines are lacking and needed.
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We only need to look around us to see that we are in an epidemic of obesity and obesity-related medical problems. The obesity hypoventilation syndrome is a disorder in which an obese person with normal lungs chronically hypoventilates. Obesity impairs ventilatory mechanics, increases the work of breathing and carbon dioxide production, results in respiratory muscle dysfunction, and reduces ventilatory response to hypercapnia. ⋯ When noninvasive ventilation can be successfully introduced, hypoventilation can usually be corrected. Weight loss is the desirable long-term treatment for the obesity hypoventilation syndrome. This paper concisely overviews the physiologic factors that lead to the obesity hypoventilation syndrome and discusses therapies for it.
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Ventilator exhalation-valve performance during the expiratory phase has been studied in depth. An active exhalation valve uses servo-control technology that allows gas to be released from the exhalation valve during the inspiratory phase if the patient makes an expiratory effort. We conducted a bench study of active exhalation valve response to expiratory effort during the inspiratory phase. ⋯ There was a significant difference in exhalation resistance between the Evita XL and the other 3 ventilators with active exhalation valves. All 4 ventilators with active exhalation valves had lower exhalation resistance than the 7200ae.
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Comparative Study
Aerosol delivery of recombinant human DNase I: in vitro comparison of a vibrating-mesh nebulizer with a jet nebulizer.
Inhaled recombinant human DNase I (rhDNase) improves clearance of visco-elastic secretions in patients with cystic fibrosis. Because of their portability, newer-generation vibrating-mesh nebulizers offer greater convenience for the patient, but their efficiency in delivering rhDNase has not been determined. ⋯ The MicroAir could be employed as a portable nebulizer for rhDNase therapy in patients with cystic fibrosis.