Resp Care
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Bacteria infect the respiratory tract early in the course of cystic fibrosis disease, often fail to be eradicated, and together with an aggressive host inflammatory response, are thought to be key players in the irreversible airway damage from which most patients ultimately die. Although incompletely understood, certain aspects of the cystic fibrosis airway itself appear to favor the development of chronic modes of survival, in particular biofilm formation; this and the development of antibiotic resistance following exposure to multiple antibiotic courses lead to chronic, persistent infection. ⋯ Future work should aim to develop clinically applicable methods to identify these and to determine which have the potential to impact pulmonary health. We outline the basic tenets of infection control and treatment.
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Comparative Study
Detection of upper airway obstruction with spirometry results and the flow-volume loop: a comparison of quantitative and visual inspection criteria.
There are important gaps in our understanding of the epidemiology and diagnosis of upper-airway obstruction. ⋯ The prevalence of reported upper-airway obstruction was 7.5%. The quantitative criteria showed low sensitivity for detecting upper-airway obstruction but exceeded that of visual criteria. The aggregate criterion increased the sensitivity to 69.4%, which suggests the need for additional criteria to help predict upper-airway obstruction.
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Practice Guideline
Cystic fibrosis pulmonary guidelines: airway clearance therapies.
Cystic fibrosis (CF) is a genetic disease characterized by dehydration of airway surface liquid and impaired mucociliary clearance. As a result, there is difficulty clearing pathogens from the lung, and patients experience chronic pulmonary infections and inflammation. Clearance of airway secretions has been a primary therapy for those with CF, and a variety of airway clearance therapies (ACTs) have been developed. ⋯ The committee recommends airway clearance be performed on a regular basis in all patients. There are no ACTs demonstrated to be superior to others, so the prescription of ACTs should be individualized. Aerobic exercise is recommended as an adjunctive therapy for airway clearance and for its additional benefits to overall health.
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Practitioners often presume there is adequate humidification in the ventilator circuit if the Y-piece is at a specified temperature, but control of Y-piece temperature may be inadequate to ensure adequate humidification. ⋯ Maintaining temperature at one point in the inspiratory circuit (eg, Y-piece), does not ensure adequate water-vapor delivery. Other factors (humidification system, V (E), gradient setting) are critical. At a given temperature, humidification may be significantly higher or lower than expected.