Resp Care
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Airway pressure release ventilation (APRV) is inverse ratio, pressure controlled, intermittent mandatory ventilation with unrestricted spontaneous breathing. It is based on the principle of open lung approach. It has many purported advantages over conventional ventilation, including alveolar recruitment, improved oxygenation, preservation of spontaneous breathing, improved hemodynamics, and potential lung-protective effects. ⋯ Also, they should be familiar with the differences between APRV, biphasic positive airway pressure (BIPAP), and other conventional and nonconventional modes of ventilation. There is no solid proof that APRV improves mortality; however, there are ongoing studies that may reveal further information about this mode of ventilation. This paper reviews the different methods proposed for APRV settings, and summarizes the different studies comparing APRV and BIPAP, and the potential benefits and pitfalls for APRV.
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Randomized Controlled Trial Comparative Study
A randomized trial of conventional chest physical therapy versus high frequency chest wall compressions in intubated and non-intubated adults.
Conventional chest physical therapy (CCPT), applied by therapists using cupped hands to perform percussion, is commonly used in hospitalized adults. However, increased work load demands and occupational health concerns (eg, carpal tunnel syndrome) limit the overall utilization of this therapy. Therefore, we conducted a study to compare the overall effectiveness of CCPT to high-frequency chest wall compressions (HFCWC) applied via a vibratory vest. ⋯ This study was inadequately powered for the primary outcome of interest and hence we cannot make recommendations on the preferential use of HFCWC or CCPT for intubated and non-intubated adult patients. HFCWC was associated with statistically better comfort scores. (ClinicalTrials.gov registration NCT00717873.).
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Case Reports
Hidden diagnosis of Tuberculous pleurisy masked by concomitant Pseudomonas oryzihabitans bacteremia.
The clinical presentations of tuberculous pleurisy are usually nonspecific and have an insidious course, thus resulting in diagnostic challenges. Pseudomonas oryzihabitans is a nonfermenting, oxidase-negative, catalase-positive, Gram-negative bacillus that has rarely been encountered as a human pathogen. ⋯ Tuberculous pleurisy was finally diagnosed by histopathologic and microbiologic studies. He recovered after a 2-week antibiotic course and 6-month antituberculosis treatment.
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Randomized Controlled Trial Multicenter Study
Preventive use of noninvasive ventilation after extubation: a prospective, multicenter randomized controlled trial.
The effectiveness of noninvasive ventilation (NIV) after extubation in preventing post-extubation respiratory failure is still controversial. ⋯ Preventive use of NIV after extubation in patients who passed spontaneous breathing trial did not show benefits in decreasing extubation failure rate or the mortality rate.
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Review Case Reports
Congenital pulmonary airway malformation: a case report and review of the literature.
Congenital parenchymal lung malformations have an estimated incidence at 1:25,000-1:35,000 births. We present a case of this rare congenital abnormality in a 38 year-old male, review the current literature with discussion of proposed causes, malignant potential, and management strategies. A 38-year-old white male presented with a 4-day history of chronic stable hemoptysis. ⋯ Defects in thyroid transcription factor 1 have also been proposed. With the increasing use and image resolution of ultrasound in modern obstetric practice, congenital pulmonary airway malformations rarely go undetected into adulthood. Management remains controversial; however, most authors agree with early surgical excision.