Resp Care
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Post-traumatic pulmonary pseudocyst is an uncommon cavitary lesion of the lung, which generally develops after blunt chest trauma. We saw a 22-year-old man with chest trauma, hemopneumothorax, and hemoptysis, on the day he fell from an electrical pylon. Intubation in the emergency department was followed by 4 days of mechanical ventilation. ⋯ On hospital day 6 he developed pneumonia, which we treated with ceftazidime plus gentamycin. He was discharged on hospital day 20, and a month later the pseudocyst had resolved without complications. Diagnosis of post-traumatic pulmonary pseudocyst may require computed tomography, and some complicated cases may require surgery.
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Vocal cord dysfunction (VCD) is difficult to diagnose. Laryngoscopy while the patient is symptomatic is the accepted standard method to establish a diagnosis of VCD, but patient characteristics and spirometry values are thought to be useful for predicting VCD. We sought to identify clinical and spirometric variables that suggest VCD. ⋯ VCD remains difficult to predict with spirometry or flow-volume loops. If VCD is suspected, normal flow-volume loop patterns should not influence the decision to perform laryngoscopy.
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Practitioners often presume there is adequate humidification in the ventilator circuit if the Y-piece is at a specified temperature, but control of Y-piece temperature may be inadequate to ensure adequate humidification. ⋯ Maintaining temperature at one point in the inspiratory circuit (eg, Y-piece), does not ensure adequate water-vapor delivery. Other factors (humidification system, V (E), gradient setting) are critical. At a given temperature, humidification may be significantly higher or lower than expected.
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Positive-expiratory-pressure (PEP) therapy uses positive airway pressure generated by a either a fixed-orifice resistor or a threshold resistor. We hypothesized that tubing diameter and length, and the diameter of the PEP bottle's air-escape orifice would impact the PEP pressure delivered to the airway and determine whether the PEP bottle acts as a threshold resistor or a fixed-orifice resistor. ⋯ To obtain a threshold-resistor PEP bottle system (ie, the PEP pressure is generated only by the water-column pressure), the tubing must be > or = 8 mm inner diameter, and the air-escape orifice must be > or = 8 mm.