Resp Care
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A partial sitting position has been reported to increase functional residual capacity (FRC) in lean subjects, whereas FRC does not change with position in the morbidly obese. The effects of positioning in the subgroup of overweight and mildly to moderately obese subjects have not been examined. We hypothesized that a change in FRC may be related to adipose tissue distribution. ⋯ Standard position changes purported to increase FRC are ineffective in the overweight and mildly to moderately obese, a subpopulation represented by almost 67% of Americans. Bedside caregivers may need to modify current practices when the clinical goal is to improve resting lung volumes in sedentary patients.
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Endotracheal suctioning is required but can have adverse effects, and could affect cardiorespiratory variables that are used to predict whether the patient is ready for extubation. ⋯ Post-suctioning changes in the measured variables persisted longer in these spontaneously breathing patients weaning from mechanical ventilation than in patients who are sedated and paralyzed. The effects of suctioning on cardiopulmonary function should be considered in practice and during the design of future studies on weaning and extubation prediction variables.
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Postoperative pneumonia continues to be a leading cause of mortality and morbidity after thoracic surgery. High-frequency chest-wall compression (HFCWC) is an established therapeutic adjunct for patients with chronic pulmonary disorders that impair bronchopulmonary secretion clearance. We studied the feasibility of applying HFCWC following thoracic surgery. ⋯ HFCWC is a safe, well-tolerated adjunct after thoracic surgery. The observation of hemodynamic stability is especially important, considering that the patients were studied in the early postoperative period, during epidural analgesia.
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Noninvasive ventilation (NIV) successfully treats primary respiratory failure in chronic obstructive pulmonary disease (COPD), acute pulmonary edema, and, in some patients, hypoxemic respiratory failure. Increasingly clinicians have applied NIV in an effort to shorten the duration of mechanical ventilation by facilitating weaning and preventing or treating post-extubation respiratory failure. ⋯ NIV appeared to be ineffective in heterogeneous patient populations in some randomized trials that enrolled relatively few patients with COPD, and a case-control study found that NIV decreased the need for reintubation in this group. Therefore, as with primary therapy, NIV should be considered for patients with COPD and post-extubation respiratory distress.