Resp Care
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To determine the frequency of, and barriers to, use of noninvasive ventilation (NIV) for adult patients with acute asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF) in academic emergency departments (EDs). ⋯ Consistent with available evidence, NIV use is more common in the ED for acute COPD and CHF than for acute asthma. Barriers to greater use of NIV in the ED include physician familiarity, availability of RT and equipment in the ED, and time required for NIV. For acute asthma, uncertainty about therapeutic benefits remains a challenge.
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Children with double aortic arch most often present in infancy. This report presents 3 patients in whom the diagnosis of double aortic arch was not revealed until later in childhood. They were all given a misdiagnosis of asthma, but abnormalities detected on the flow-volume curve led to the true diagnosis.
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A practitioner questioned whether moisture that collected in the ventilator circuit and spacer affected the delivery of aerosol from a pressurized metered-dose inhaler (pMDI). An in vitro model was used to quantify the impact of accumulated humidity in a pMDI spacer and ventilator over time. ⋯ Aerosol delivery from a pMDI with spacer during mechanical ventilation was greater with a dry spacer and unchanged for the first hour after initiating heated humidification. Turning off the heated humidifier did not increase drug delivered.
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Editorial Comment
Innovation in pulmonary rehabilitation: experimenting with a hybrid.
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Resource planning is essential for successful transport of the mechanically ventilated patient. Mechanically ventilated patients require adequate oxygen supplies to ensure transport is completed without incident. The LTV-1000 portable ventilator utilizes a program to calculate oxygen cylinder duration, based on cylinder size, fraction of inspired oxygen (F(IO(2))), and current minute ventilation. We evaluated the accuracy of the cylinder-duration algorithm in a laboratory setting. ⋯ Actual cylinder duration averaged 12% longer than the cylinder duration estimated by the algorithm of the LTV-1000. One explanation is that the E cylinders may contain more liters of oxygen than indicated by the sticker on the side of the tank. Additionally, the bias flow during expiration is affected by inspiratory-expiratory ratio and respiratory rate. Clinicians should be aware of these differences when planning for patient transport.