Resp Care
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Comparative Study
Survey of aerosol delivery techniques to spontaneously breathing tracheostomized children.
Therapeutic inhaled aerosols are often delivered to spontaneously breathing tracheostomized children. Although aerosol delivery can be affected by several factors, no recommendations for device/drug formulation choice are available. We hypothesized that practice modalities will vary among different institutions. ⋯ A wide variation in practice of delivering aerosols to spontaneously breathing tracheostomized children was noted. In-vivo and in-vitro studies are needed to support clinical recommendations.
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To investigate the predictive value of the maximal inspiratory pressure obtained by a digital vacuometer using a unidirectional valve (P(ImaxUV)) as to weaning outcome, and to compare its performance with the respiratory drive using airway occlusion pressure at 0.1 second (P(0.1)), and P(0.1)/P(ImaxUV). ⋯ Every studied index had only a modest performance regarding prediction of weaning outcome. Of note, P(ImaxUV) values obtained by digital technology using a unidirectional valve performed better than historically reported using a conventional techniques, surpassing P(0.1) and P(0.1)/P(ImaxUV) in this regard.
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Technological advances have increased ventilator mode complexity and risk of operator error. ⋯ Dual targeting during VC allows increased V(T), compared to set-point, but not as much as PS.
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Adjunctive aerosolized antibiotics (AAA) have been recommended in the setting of Gram-negative ventilator-associated pneumonia (VAP), but little is known about their influence on clinical outcomes. ⋯ Patients with PA and AB VAP may experience favorable survival when treated with AAA, despite greater severity of illness and a greater incidence of multidrug-resistant infection. Large randomized trials are needed to further explore this therapy.
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Case Reports
Tidal volume variability during airway pressure release ventilation: case summary and theoretical analysis.
Airway pressure-release ventilation (APRV) is used in the management of patients with severe or refractory respiratory failure. In addition to reversal of inspiratory-expiratory ratios, this pressure control mode also allows unrestricted spontaneous breathing. The spontaneous tidal volume (V(T)), as well as the V(T) resulting from transition between the high and low airway pressures, is uncontrolled. ⋯ This case report suggests caution when using these modes, and that end-inspiratory lung volumes and V(T) should be limited to avoid lung injury. The important point of this case study and model analysis is that the application of APRV is more complex than it appears to be. It requires a lot more knowledge and skill than may be apparent from descriptions in the literature.