Resp Care
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Chest radiography and computed tomography (CT) have a crucial role to play in the diagnosis and management of acute respiratory distress syndrome (ARDS). The identification of pulmonary opacification is a requirement for the definition of ARDS on the chest radiograph, while CT has a role to play, not only in the diagnosis of ARDS, but also in the identification of complications. This paper reviews the radiological appearances of ARDS that have been documented for some time, and also more recent research that has identified a role for CT in directing ventilation and in prognostication.
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Air-fluid levels within emphysematous lung bullae are a relatively uncommon occurrence in patients with preexisting bullous disease, and are not commonly reported. We report 2 cases of new onset air-fluid levels in patients with underlying bullous disease with substantially different clinical presentations but with clinical improvement after medical therapy only.
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Choke points and airway wall structure in expiratory central airway collapse are poorly defined. Computed tomography, white light bronchoscopy, endobronchial ultrasound, vibration response imaging, spirometry, impulse oscillometry, negative expiratory pressure, and intraluminal catheter airway pressure measurements were used in a patient with cough, dyspnea, and recurrent pulmonary infections. Computed tomography and white light bronchoscopy identified dynamic collapse of the trachea and mainstem bronchi, consistent with severe crescent tracheobronchomalacia. ⋯ After Y-stent insertion, the choke point migrated distally. Imaging studies revealed improved airway dynamics, airway patency, and ventilatory function. Novel imaging and physiologic assessments could be used to localize choke points and airway wall structure in tracheobronchomalacia.
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Pierre-Robin syndrome (PRS) is often associated with difficulty in endotracheal intubation. We present the use of percutaneous dilational tracheotomy (PDT) for airway management of a newborn with PRS and a glossopharyngeal web. A 2-day-old term newborn with PRS and severe obstructive dyspnea was evaluated by the anesthesiology team for airway management. ⋯ Using 5 French, 7 French, 9 French, and 11 French central venous catheter kit dilators, staged tracheotomy stoma dilation was performed. By inserting a size 3.0 tracheotomy cannula, PDT was successfully completed in this newborn. This case describes the successful use of PDT for emergency airway management of a newborn with PRS and glossopharyngeal web.
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For the busy clinician, educator, or manager, it is becoming an increasing challenge to filter the literature to what is relevant to one's practice and then update one's practice based on the current evidence. The purpose of this paper is to review the recent literature related to long-term oxygen therapy, pulmonary rehabilitation, airway management, acute lung injury and acute respiratory distress syndrome, respiratory care education, and respiratory care management. These topics were chosen and reviewed in a manner that is most likely to have interest to the readers of Respiratory Care.