Resp Care
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Review
Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant.
Nasal continuous positive airway pressure (CPAP) is a noninvasive form of respiratory assistance that has been used to support spontaneously breathing infants with lung disease for nearly 40 years. Following reports that mechanical ventilation contributes to pulmonary growth arrest and the development of chronic lung disease, there is a renewed interest in using CPAP as the prevailing method for supporting newborn infants. Animal and human research has shown that CPAP is less injurious to the lungs than is mechanical ventilation. ⋯ It is also unclear whether different strategies or devices used to maintain CPAP play a role in improving outcomes in infants. Nasal CPAP technology has evolved over the last 10 years, and bench and clinical research has evaluated differences in physiologic effects related to these new devices. Ultimately, clinicians' abilities to perceive changes in the pathophysiologic conditions of infants receiving CPAP and the quality of airway care provided are likely to be the most influential factors in determining patient outcomes.
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Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary bypass adapted for long-term use. Blood is drained from the patient, pumped through an artificial lung or membrane where gas exchange is augmented, and then re-infused back to the patient. ECMO provides support for the neonate with severe respiratory failure so that potentially deleterious ventilator settings can be minimized and the disease process given time to resolve. Survival rates and long-term neurodevelopmental outcomes in newborns supported with ECMO for hypoxemic respiratory failure remain favorable, although the use of ECMO has decreased in the most recent decade because of the availability of alternative treatment options.
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Randomized Controlled Trial Multicenter Study
Feasibility study of noninvasive ventilation with helium-oxygen gas flow for chronic obstructive pulmonary disease during exercise.
Individually, noninvasive ventilation (NIV) and helium-oxygen gas mixtures (heliox) diminish ventilatory workload and improve exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). NIV in combination with heliox may have additive effects on exercise tolerance in severe COPD. ⋯ The adjunctive use of NIV with heliox during exercise proved both safe and tolerable in patients with severe COPD. The lack of demonstrable efficacy to any of the treatment arms relative to placebo (P = .09) may be the result of the small sample size (ie, type 2 error)-a conclusion emphasized by the large standard deviations and differences in treatment group variances in exercise duration alone.