Resp Care
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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.
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Seasonal variations in the incidence of pulmonary embolism (PE) have been reported. It has been suggested that changes in meteorological factors may explain this variation. Previous studies have provided inconsistent results, possibly as a result of a small number of observations, in some studies and confounding factors. ⋯ The results confirm the presence of seasonal variations in episodes of idiopathic PE and an association between decreased atmospheric pressure and increased temperature.
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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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The conflicts in Iraq and Afghanistan have seen the advancement of combat medicine. The nature of the conflicts, with troops located in remote areas and faced with explosive ordinance designed to focus massive injuries on dismounted personnel, have forced military medical personnel to adapt accordingly. There has been a rekindling of interest in the use of tourniquets to stop exsanguination from extremity wounds, as well as in the transfusion of fresh whole blood from walking blood banks. ⋯ The field of combat medicine has taken several concepts initially designed in civilian settings, such as temporary abdominal packing and vascular shunting, and adapted them to the military setting to provide state of the art trauma management to our troops in combat. In turn, developments in the resuscitation of the trauma patient, using increased blood and plasma products and less crystalloid, have been pioneered in conflict and transitioned to the civilian sector. Advancements made during the wars in Iraq and Afghanistan, as well as those still being developed, will shape the care of the injured patient, in both civilian and military settings, for the foreseeable future.