Resp Care
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Comparative Study
Aerosol delivery of recombinant human DNase I: in vitro comparison of a vibrating-mesh nebulizer with a jet nebulizer.
Inhaled recombinant human DNase I (rhDNase) improves clearance of visco-elastic secretions in patients with cystic fibrosis. Because of their portability, newer-generation vibrating-mesh nebulizers offer greater convenience for the patient, but their efficiency in delivering rhDNase has not been determined. ⋯ The MicroAir could be employed as a portable nebulizer for rhDNase therapy in patients with cystic fibrosis.
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We used a high-flow nasal cannula with a patient who required a high fraction of inspired oxygen but could not tolerate a nasal or facial mask. We saw a 92-year-old woman with delirium and dementia in the intensive care unit for multi-lobar pneumonia with severe hypoxemia. Attempts to oxygenate the patient failed because she was unable to tolerate various facial and nasal masks. ⋯ She had previously clearly expressed a desire not to undergo intubation and mechanical ventilation. In a situation where the patient was agitated and unable to tolerate a mask, the high-flow cannula reduced her agitation and improved her dyspnea, oxygenation, tolerance of oxygen therapy, and comfort at the end of life. Oxygen via high-flow cannula may enhance quality of life by reducing hypoxemia in patients who are unable to tolerate a mask but need a high oxygen concentration.
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To determine if using an N95 filtering face-piece respirator concurrently with a loose-fitting powered air-purifying respirator (PAPR) offers additional protection to the wearer. ⋯ An N95 decreases the concentration of airborne particles inspired by the wearer of a PAPR.
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Studies have found that increasing the respiratory frequency during mechanical ventilation does not always improve alveolar minute ventilation and may cause air-trapping. ⋯ With these ventilators and pressure-control ventilation, alveolar minute ventilation can be optimized with higher-than-normal frequency and lower V(T) than is commonly used in patients with acute respiratory distress syndrome. We call this strategy mid-frequency ventilation.