Resp Care
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Limited data are available to describe the CPAP effects that can be expected when using high flow with a traditional nasal cannula. ⋯ Clinically important pressures were not generated by high flows with a standard nasal cannula. The differences in spontaneous V(T) across all flows were negligible.
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Safety attitude surveys have been widely conducted in various disciplines, but not among respiratory therapists (RTs), to assess clinician's awareness of patient safety. We conducted a nationwide survey in Taiwan to assess RTs' safety attitudes in several hospital settings. ⋯ Taiwanese RTs had low positive attitudes about the surveyed 6 safety domains in their hospitals. High work load, management of RTs under other professions, and lack of protocol use probably contribute to their low opinions about the patient safety situation and low job satisfaction.
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Case Reports
Portable pulse-dose oxygen concentrators should not be used with noninvasive ventilation.
An increasing number of patients, mainly COPD and overlap-syndrome patients, simultaneously use home oxygen therapy and noninvasive ventilation (NIV) at night. Usually the oxygen source is a stationary concentrator. We report a patient who, without a medical recommendation, was using a portable oxygen concentrator during nocturnal NIV. ⋯ We tested ventilator inspiratory pressures of 10, 14, and 18 cm H(2)O, and expiratory pressures of 4 and 6 cm H(2)O. The portable oxygen concentrator did not detect the patient's inspiratory effort or deliver the required oxygen flow at any of the tested settings. We recommended that the patient not use the portable oxygen concentrator during nocturnal NIV.
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Chylothorax is suspected when milky white turbid fluid is obtained from thoracocentesis. Conservative management usually involves intercostal tube drainage, dietary restriction, and total parenteral nutrition. ⋯ We describe a young woman with idiopathic chylothorax who failed conservative therapy but refused surgery. We instilled intrapleural streptokinase, which improved her condition.
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Low-tidal-volume ventilation reduces mortality in patients with ARDS, but there are often challenges in implementing lung-protective ventilation, such as acidosis from hypercapnia. In a patient with severe ARDS we achieved adequate ventilation with a very low tidal volume (4 mL/kg ideal body weight) by inducing mild hypothermia (body temperature 35-36°C).