Resp Care
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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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We used a high-flow nasal cannula with a patient who required a high fraction of inspired oxygen but could not tolerate a nasal or facial mask. We saw a 92-year-old woman with delirium and dementia in the intensive care unit for multi-lobar pneumonia with severe hypoxemia. Attempts to oxygenate the patient failed because she was unable to tolerate various facial and nasal masks. ⋯ She had previously clearly expressed a desire not to undergo intubation and mechanical ventilation. In a situation where the patient was agitated and unable to tolerate a mask, the high-flow cannula reduced her agitation and improved her dyspnea, oxygenation, tolerance of oxygen therapy, and comfort at the end of life. Oxygen via high-flow cannula may enhance quality of life by reducing hypoxemia in patients who are unable to tolerate a mask but need a high oxygen concentration.
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To determine if using an N95 filtering face-piece respirator concurrently with a loose-fitting powered air-purifying respirator (PAPR) offers additional protection to the wearer. ⋯ An N95 decreases the concentration of airborne particles inspired by the wearer of a PAPR.
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Tiotropium is used in maintenance treatment of chronic obstructive pulmonary disease (COPD), but there are no guidelines on when to start tiotropium following an exacerbation. ⋯ Early addition of maintenance-treatment tiotropium to a respiratory-therapist-directed bronchodilator protocol for patients hospitalized for COPD exacerbation reduced costs and produced no safety concerns.