Resp Care
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Obstructive sleep apnea (OSA) increases the risk of central and obstructive apneas after anesthesia, but the vast majority of patients with OSA are undiagnosed preoperatively. Current guidelines promote the use of postoperative continuous positive airway pressure (CPAP) in patients with OSA. Owing to the complex postoperative requirements of these patients, respiratory therapists (RTs) could substantially improve these patients' clinical management in the immediate postoperative period. We describe a system that identifies patients with suspected or documented OSA and automatically alerts the perioperative RT. ⋯ As part of a hospital-wide postoperative policy, our automated OSA alert and perioperative RT system helped prevent sudden-onset acute respiratory compromise in postoperative patients with OSA or at risk of OSA.
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To improve the heat and humidification that can be achieved with a heat-and-moisture exchanger (HME), a hybrid active (ie, adds heat and water) HME, the Hygrovent Gold, was developed. We evaluated in vitro the performance of the Hygrovent Gold. ⋯ The passive Hygrovent Gold provided adequate heat and moisture in normothermia, but the active Hygrovent Gold provided the highest humidity, in both normothermia and hypothermia.
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Editorial Comment
Improved oxygenation and increased comfort: a great combination.
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Little is known about the alveolar dead-space fraction after the first week of acute respiratory distress syndrome (ARDS). We measured the dead-space fraction in the early phase (first week) and the intermediate phase (second week) of ARDS, and evaluated the association of dead-space fraction with mortality. ⋯ Increased alveolar dead-space fraction in the early and intermediate phases of ARDS is associated with a greater risk of death.
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End-tidal carbon dioxide (P(ETCO(2))) is a surrogate, noninvasive measurement of arterial carbon dioxide (P(aCO(2))), but the clinical applicability of P(ETCO(2)) in the intensive care unit remains unclear. Available research on the relationship between P(ETCO(2)) and P(aCO(2)) has not taken a detailed assessment of physiologic dead space into consideration. We hypothesized that P(ETCO(2)) would reliably predict P(aCO(2)) across all levels of physiologic dead space, provided that the expected P(ETCO(2))-P(aCO(2)) difference is considered. ⋯ There were strong correlations between P(ETCO(2)) and P(aCO(2)) in all the V(D)/V(T) ranges. The P(ETCO(2))-P(aCO(2)) difference increased predictably with increasing V(D)/V(T).