Resp Care
-
The application of noninvasive ventilation (NIV) to treat acute respiratory failure has increased tremendously both inside and outside the intensive care unit. The choice of ventilator is crucial for success of NIV in the acute setting, because poor tolerance and excessive air leaks are significantly correlated with NIV failure. ⋯ A wide range of ventilators of different complexity have been introduced into clinical practice to noninvasively support patients in acute respiratory failure, but the numerous commercially available ventilators (bi-level, intermediate, and intensive care unit ventilators) have substantial differences that can influence patient comfort, patient-ventilator interaction, and, thus, the chance of NIV clinical success. This report examines the most relevant aspects of the historical evolution, the equipment, and the acute-respiratory-failure clinical application of NIV ventilators.
-
Controlled Clinical Trial
Hypercapnia test as a predictor of success in spontaneous breathing trials and extubation.
The ventilatory capacity of the respiratory neuromuscular system can be studied with the hypercapnia test. ⋯ The SBT/extubation-failure patients had less response to the hypercapnia test than did the SBT/extubation-success patients, and the hypercapnia test was not useful in predicting SBT or extubation success.
-
Controlled Clinical Trial
Transcutaneous carbon dioxide pressure monitoring in a specialized weaning unit.
To evaluate transcutaneously measured P(CO(2)) (P(tcCO(2))) values during ventilator weaning and during bronchoscopies on ventilated patients, and to compare P(tcCO(2)) values to P(aCO(2)) values from arterial blood analysis and end-tidal P(CO(2)) (P(ETCO(2))) values from capnography. ⋯ Monitoring P(tcCO(2)) is very helpful in assessing and managing patients undergoing SBTs, during the first night off the ventilator, and during bronchoscopy on ventilated patients. P(tcCO(2)) more closely matches P(aCO(2)) than does P(ETCO(2)).
-
We report the characteristics of a centralized spirometry quality-control program developed for a population-based survey of the prevalence of chronic obstructive pulmonary disease in 5 cities: São Paulo, Brazil; México City, México; Montevideo, Uruguay; Santiago, Chile; and Caracas, Venezuela (the Latin American Project for the Investigation of Obstructive Lung Diseases [PLATINO]). ⋯ Standardization of equipment, training, and supervision of spirometry is essential in a multinational spirometry survey. Centralized quality control can be done via e-mail with good reliability and low cost.