Resp Care
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Fiberoptic bronchoscopy and lung biopsy are important diagnostic tools in patients with diffuse pulmonary infiltrates. However, these patients often have hypoxemic respiratory failure that makes this procedure hazardous. Noninvasive ventilation (NIV) has been shown to improve oxygenation in hypoxemic patients. ⋯ NIV-assisted bronchoscopic lung biopsy is a novel method for obtaining diagnosis in hypoxemic patients with diffuse lung infiltrates. However, this approach should be reserved for centers with extensive experience in NIV. More studies are required to define the utility of this approach.
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We present a patient with acute-onset dyspnea and unexplained severe hypoxemia. No signs of severe cardiopulmonary disease, pulmonary arterial hypertension, or pulmonary embolism were present. ⋯ The condition of the patient did not improve and he was referred for liver transplantation, which is the only treatment option with documented efficacy. The case highlights the importance of thinking outside the thorax when evaluating patients with dyspnea.
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Randomized Controlled Trial Comparative Study
Short-term effects of humidification devices on respiratory pattern and arterial blood gases during noninvasive ventilation.
The impact of humidification devices on ventilatory and arterial blood gases parameters during noninvasive ventilation (NIV) remains controversial. The aim of the study was to compare the short-term impact of heat and moisture exchangers (HMEs) and heated humidifiers (HHs) during NIV for either hypercapnic or hypoxemic acute respiratory failure. ⋯ Use of an HME decreased CO(2) elimination during NIV, despite increased minute ventilation, especially in hypercapnic subjects.
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Randomized Controlled Trial
CPAP has no effect on clearance, sputum properties, or expectorated volume in cystic fibrosis.
Positive expiratory pressure (PEP) is used for airway clearance in cystic fibrosis (CF) patients. Hypertonic saline (HTS) aerosol increases sputum expectoration volume and may improve respiratory secretion properties. CPAP may also be used to maintain airway patency and mobilize secretions. To evaluate if CPAP would increase the beneficial clearance effect of HTS in subjects with CF, we investigated the effects of CPAP alone and CPAP followed by HTS on sputum physical properties and expectoration volume in CF subjects. ⋯ CPAP alone had no effect on mucus clearance, sputum properties, or expectorated volume, and did not potentiate the effect of HTS alone in CF subjects.