Resp Care
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Because of the severity of illness, the intensive care unit (ICU) is a setting where death is common. Approximately 20% of all deaths in the United States occur in ICUs. ⋯ This review also describes the development and evaluation of a new intervention for hospitals and individual ICUs: Integrating Palliative and Critical Care (IPACC). The goal of the IPACC intervention and this paper is to teach ICU clinicians basic palliative care skills and the language of palliative care, and to encourage all ICU clinicians to prioritize palliative care as one of the important things that we do in the ICU.
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Physicians often fail to use lung-protective ventilation (LPV) in patients with acute lung injury. ⋯ LPV, once initiated, is often discontinued. Uncertainty in the diagnosis of acute lung injury appears to be an important barrier to initiating and continuing LPV, whereas concerns regarding metabolic acidosis and clinical changes (hypoxemia improved) may prevent the initiation of LPV. Even when physicians believe they are using LPV, they may not be, which suggests that protocol-implementation failure is an important barrier to use of LPV.
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Handheld spirometers have several advantages over desktop spirometers, but worries persist regarding reproducibility and validity of data from handheld spirometers. We undertook an independent examination of the EasyOne handheld spirometer. ⋯ The EasyOne spirometer yielded generally reproducible results that were generally valid, compared to the values from the laboratory spirometer. The use of the EasyOne in clinical, occupational, and research settings seems justified.
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Though uncommon, right-to-left shunt through a patent foramen ovale with normal right-side pressure and with a normal interatrial pressure gradient has been reported. The speculated pathophysiology is attributed to directional blood flow streaming from the vena cava to the left atrium. ⋯ Five prior cases have documented hypoxemia secondary to a right-to-left shunt through a patent foramen ovale in the presence of an elevated right hemidiaphragm. This is the sixth documented case of right-to-left shunt through a patent foramen ovale in the presence of an elevated right hemidiaphragm with a similar presentation in which closure of the patent foramen ovale resulted in resolution of hypoxemia.
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Malnutrition might be expected to result in reduced maximum respiratory pressure and pulmonary function in cystic fibrosis (CF). ⋯ MEP and MIP had no significant relationship to nutritional status, clinical score, chest radiograph score, and pulmonary function.