Resp Care
-
Review Meta Analysis
Higher PEEP in patients with acute lung injury: a systematic review and meta-analysis.
Studies of ventilation strategies that included higher PEEP in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) have yielded conflicting results. ⋯ In 4 recent studies that used volume-limited or pressure-limited ventilation in ALI/ARDS patients, higher PEEP was not associated with significantly different short-term mortality or barotrauma. This study does not support the routine use of higher PEEP in patients with ALI/ARDS.
-
Comparative Study
Population-based study on the prevalence of spirometric obstructive pattern in Porto, Portugal.
The diagnosis of obstructive lung disease (OLD) based on clinical grounds is challenging. There have been no population-based COPD studies that collected pulmonary function data in Portugal, a country in transition between phases 2 and 3 of the smoking epidemic. ⋯ The prevalence of spirometric obstructive pattern was high. Considering Portugal's position in the smoking epidemic, together with the aging of the population, we can expect an increase in the prevalence of OLD in older people and in women. Our results confirm the limited validity of self-reported OLD in epidemiological studies.
-
Case Reports
Use of non-partitioned ventilator tubing results in dead-space ventilation hypercarbia.
We present a case of severe postoperative hypercarbia in a patient with severe COPD. Hypercarbia and respiratory acidosis continued to increase despite maximal ventilation, bronchodilator therapy, sedation, and paralysis. ⋯ The ventilator's self-test function failed to detect the error. We changed to a partitioned-lumen circuit, with much less ventilation dead space, and the hypercarbia resolved immediately.