Resp Care
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Randomized Controlled Trial Comparative Study
Influence of 4 interfaces in the assessment of maximal respiratory pressures.
The measurement of maximal respiratory pressure (MRP) is a procedure widely used in clinical practice to evaluate respiratory muscle strength through the maximal inspiratory pressure (P(Imax)) and maximal expiratory pressure (P(Emax)). Its clinical applications include diagnostic procedures and evaluating responses to interventions. However, there is great variability in the equipment and measurement procedures. Understanding the impacts of the characteristics of different interfaces can augment the repeatability of this method and help to establish widely applicable predictive equations. The aim of this study was to evaluate the influence of 4 different interfaces on a subject's capacity to generate MRP and the impact of these interfaces on the repeatability of these measurements. ⋯ P(Imax) and P(Emax) values seem not to be influenced by the different interfaces studied, suggesting that patient comfort and availability of interfaces can be considered.
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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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Hypersensitivity pneumonitis is an immunologic reaction to an inhaled antigen, with a wide spectrum of clinical presentations. The most common manifestations are fever, cough, and dyspnea. We describe a case of hypersensitivity pneumonitis with marked alveolar lymphocytosis; the patient presented with respiratory failure and shock requiring mechanical ventilation and vasopressive agents. We hypothesized that immune mediators implicated in the pathogenesis of hypersensitivity pneumonitis were responsible for the transient shock observed in this patient.
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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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Case Reports
Continuous noninvasive ventilation delivered by a novel total face mask: a case series report.
Noninvasive ventilation (NIV) has been widely used to decrease the complications associated with tracheal intubation in mechanically ventilated patients. However, nasal ulcerations may occur when conventional masks are used for continuous ventilation. ⋯ The total face mask was very well tolerated by all the patients, and permitted safe and efficient continuous NIV for several days until the acute respiratory failure episode resolved. None of the patients required endotracheal intubation during the acute episode.