Resp Care
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The physiologic changes that occur in ventilation during sleep contribute to nocturnal oxygen desaturation in those with lung disease. Nocturnal supplemental oxygen is often used as therapy, although convincing data exist only for those who are hypoxemic both during sleep and wake. ⋯ Because of its prevalence, obstructive sleep apnea may commonly overlap with lung disease in many patients and have important consequences. Patients with overlap syndromes may be good candidates for noninvasive ventilation during sleep.
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The management of patients with traumatic brain injury has evolved in the last several years, due to the introduction of new, invasive monitoring devices. The ability to monitor parameters other than measurements related to pressures has generated substantial interest. Brain tissue oxygenation monitoring has been consistently shown to provide prognostic information, as indicated by poor prognosis associated with low brain tissue oxygen values. ⋯ Retrospective studies suggest benefit, while prospective studies have shown a higher intensity of therapeutic interventions with no outcome differences. Data from high quality randomized trials are necessary to determine if brain-oxygenation-guided therapy is beneficial. An oxygen challenge (transient increase in F(IO(2)) to 0.6 up to 1.0) to assess the responsiveness of the monitoring and ascertain the presence of technical malfunction is an accepted practice.
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While pressurized oxygen in tank form, as well as oxygen concentrators, are ubiquitous in civilian healthcare in developed countries for medical use, there are a number of settings where use of these oxygen delivery platforms is problematic. These settings include but are not limited to combat casualty care and healthcare provided in extreme rural environments in undeveloped countries. ⋯ This paper provides a brief overview of the previous and current attempts to utilize chemical oxygen production strategies to enhance systemic oxygenation. While promising, the routine use of chemically produced oxygen continues to pose significant engineering and physiologic challenges.
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Oxygen is necessary for all aerobic life, and nothing is more important in respiratory care than its proper understanding, assessment, and administration. By the early 1970s P(aO(2)) had become the gold standard for clinically assessing oxygenation in the body. Since the 1980s the measurement of arterial oxygen saturation by pulse oximetry has also been increasingly used as an adjunct to (but not a replacement for) P(aO(2)). ⋯ In addition, the original goals of "normalizing" arterial oxygenation with high tidal volumes and lung-distending pressures have required modification as appreciation for ventilator-related lung injury has emerged. High concentrations of inspired oxygen may play a role in such injury, but aggressive measures to reduce them in order to avoid oxygen toxicity-which dominated ventilator management in previous decades-have been tempered in the present era of lung-protective ventilation. Although some additions and modifications have emerged, much of what we understand today about oxygen in respiratory care is owed to the pioneering work of Thomas L Petty more than 40 years ago.