Resp Care
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Comparative Study
Echocardiography, 6-minute walk distance, and distance-saturation product as predictors of pulmonary arterial hypertension in idiopathic pulmonary fibrosis.
Pulmonary arterial hypertension (PAH) is frequently seen in patients with idiopathic pulmonary fibrosis (IPF). We sought to examine the performance of echocardiography, 6-min walk test (6MWT) distance, distance-saturation product (DSP), and pulse oximetry (SpO2) in detecting underlying PAH in IPF. ⋯ Right-ventricle systolic pressure measured by echocardiography, by 6MWT distance, by DSP, or by SpO2 performs poorly in detecting PAH in IPF. Measured by right heart catheterization, right-ventricle systolic pressure performs better to predict PAH in IPF.
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We report a complication of the novel H1N1 influenza A viral infection not yet described during this 2007-2009 pandemic. Pulmonary hemorrhage is a known complication of influenza pneumonia, including well documented reports from previous pandemics. A 57-year-old African American female presented with fevers, progressive shortness of breath, and cough. ⋯ Our case highlights one of the more feared complications that may have been more common in prior outbreaks, such as the 1918 "Spanish Flu." Autopsy studies from the 1918 influenza pandemic found severe tracheobronchitis (oftentimes hemorrhagic), septal edema, necrotizing bronchiolitis, alveolitis, and extensive hemorrhage, as opposed to the more benign laryngitis and tracheobronchitis that is commonplace in other influenza infections. Similar pathology appearances, including pulmonary hemorrhage, have also been described in H5N1 outbreaks in China and Thailand. It is crucial for pandemic preparedness planning that additional careful and complete autopsy study of this present pandemic influenza infection be performed and reported to answer questions regarding the natural history, pathology, and pathogenesis of this novel H1N1 influenza.
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Editorial Comment
Spontaneous breathing trials: should we use automatic tube compensation?
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Randomized Controlled Trial Comparative Study
Comparison between automatic tube compensation and continuous positive airway pressure during spontaneous breathing trials.
Various methods to perform spontaneous breathing trials (SBTs) exist, but no one method has been shown to be superior. Automatic tube compensation (ATC) is a new and potentially advantageous ventilation mode to use during SBT. We compared ATC to continuous positive airway pressure (CPAP) during SBTs, to determine their efficacy in identifying patients ready to be liberated from mechanical ventilation. ⋯ When applied as part of a respiratory-therapist-driven weaning protocol in a general intensive-care population, SBTs with ATC were safe but did not hasten liberation from mechanical ventilation, when compared to CPAP.
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Comparative Study
Effects of imposed resistance on tidal volume with 5 neonatal nasal continuous positive airway pressure systems.
Neonates with respiratory distress syndrome are often treated with nasal continuous positive airway pressure (CPAP). Nasal CPAP methods include electronic feedback control, underwater seal, flow opposition, and flow opposition with fluidic flow reversal on expiration. Few studies have compared those modes, and the results have been contradictory. ⋯ The differences in these nasal CPAP systems correlate with the differences in unassisted V(T) due to loading effects. The ventilator imposed the least load, and the AirLife nasal CPAP system imposed the most.