Resp Care
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Inhaled nitric oxide (INO) has been shown to preferentially lower resistance in the pulmonary vasculature. The relative selectiveness of INO in accomplishing this effect makes it an attractive drug to administer as salvage therapy in patients with acute right ventricular failure secondary to pulmonary embolism. We describe 4 cases in which INO was used as a temporizing agent to decrease right ventricular after-load following massive near-fatal pulmonary embolism. All 4 patients survived to hospital discharge.
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Randomized Controlled Trial
Effect of slow expiration with glottis opened in lateral posture (ELTGOL) on mucus clearance in stable patients with chronic bronchitis.
Slow expiration with glottis opened in lateral posture (ELTGOL, l'expiration lente totale glotte ouverte en infralatéral) has been used in clinical practice to improve mucus clearance from peripheral airways. The purpose of this crossover study was to evaluate the effect of ELTGOL on mucus clearance of right and left lungs, especially of peripheral lung areas, in stable patients with chronic bronchitis. ⋯ ELTGOL was efficient in increasing peripheral airway clearance in dependent lung of patients with chronic bronchitis, most of them with mild to moderate COPD.
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In a subset of aspirin-tolerant asthmatics, administration of aspirin improves respiratory symptoms. We present a patient with chronic rhinosinusitis with nasal polyps who exhibited relief of nasal obstruction and nasal discharge and improvement in the sense of smell following oral administration of 150 mg of aspirin daily. Improvement in the patency of the nasal passages was documented by nasal endoscopy and magnetic resonance imaging. Improvement of olfactory function was documented by validated psychophysical olfactory testing and by means of olfactory event-related potentials.
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A mass-casualty respiratory failure event where patients exceed available ventilators has spurred several proposed solutions. One proposal is use of a single ventilator to support 4 patients. ⋯ Using a single ventilator to support 4 patients is an attractive concept; however, the V(T) cannot be controlled for each subject and V(T) disparity is proportional to the variability in compliance. Along with other practical limitations, these findings cannot support the use of this concept for mass-casualty respiratory failure.