Resp Care
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Comparative Study
Comparison of measured versus predicted energy requirements in critically ill cancer patients.
Accurate determination of caloric requirements is essential to avoid feeding-associated complications in critically ill patients. ⋯ Underfeeding and overfeeding were common in our critically ill cancer patients when resting energy expenditure was estimated rather than measured. Indirect calorimetry is the method of choice for determining caloric need in critically ill cancer patients, but if indirect calorimetry is not available or feasible, the Harris-Benedict equation without added stress and activity factors is more accurate than the clinically estimated resting energy expenditure.
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Post-traumatic pulmonary pseudocyst is an uncommon cavitary lesion of the lung, which generally develops after blunt chest trauma. We saw a 22-year-old man with chest trauma, hemopneumothorax, and hemoptysis, on the day he fell from an electrical pylon. Intubation in the emergency department was followed by 4 days of mechanical ventilation. ⋯ On hospital day 6 he developed pneumonia, which we treated with ceftazidime plus gentamycin. He was discharged on hospital day 20, and a month later the pseudocyst had resolved without complications. Diagnosis of post-traumatic pulmonary pseudocyst may require computed tomography, and some complicated cases may require surgery.
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Vocal cord dysfunction (VCD) is difficult to diagnose. Laryngoscopy while the patient is symptomatic is the accepted standard method to establish a diagnosis of VCD, but patient characteristics and spirometry values are thought to be useful for predicting VCD. We sought to identify clinical and spirometric variables that suggest VCD. ⋯ VCD remains difficult to predict with spirometry or flow-volume loops. If VCD is suspected, normal flow-volume loop patterns should not influence the decision to perform laryngoscopy.
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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.
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Positive-expiratory-pressure (PEP) therapy uses positive airway pressure generated by a either a fixed-orifice resistor or a threshold resistor. We hypothesized that tubing diameter and length, and the diameter of the PEP bottle's air-escape orifice would impact the PEP pressure delivered to the airway and determine whether the PEP bottle acts as a threshold resistor or a fixed-orifice resistor. ⋯ To obtain a threshold-resistor PEP bottle system (ie, the PEP pressure is generated only by the water-column pressure), the tubing must be > or = 8 mm inner diameter, and the air-escape orifice must be > or = 8 mm.