Resp Care
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Comparative Study
The impact of imposed expiratory resistance in neonatal mechanical ventilation: a laboratory evaluation.
Small endotracheal tubes (ETTs) and neonatal ventilators can impact gas exchange, work of breathing, and lung-mechanics measurements in infants, by increasing the expiratory resistance (R(E)) to gas flow. ⋯ The major cause of R(E) appears to be the ventilator exhalation valve. Neonatal ventilators that use a set constant flow during inhalation and exhalation appear to have less R(E) than ventilators that use a variable bias flow during exhalation. Clinical studies are needed to determine whether the imposed R(E) of these ventilator designs impacts gas exchange, lung mechanics, or ventilator weaning.
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Comparative Study
Nail polish does not significantly affect pulse oximetry measurements in mildly hypoxic subjects.
The effect of nail polish on pulse oximetry measurements in non-hypoxic subjects has been studied extensively. Some studies found that nail polish decreased pulse-oximetry (S(pO(2))) values, whereas others found no effects from nail polish. ⋯ With the pulse oximeters and oximetry probes we tested, nail-polish had no significant effect on S(pO(2)) in mildly hypoxic healthy subjects.
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Editorial Comment
Recruitment maneuvers in acute lung injury: what do the data tell us?
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Comparative Study
Feasibility and potential cost/benefit of routine isoflurane sedation using an anesthetic-conserving device: a prospective observational study.
Inhaled sedation is efficient and easily controllable; in low concentrations it causes minimal changes in the patient and very little interference with hemodynamics. Awakening after inhaled sedation is quick and predictable. The major reason inhaled sedation has not become widely used in intensive care is that no commercially available administration device has been available. ⋯ Routine ICU isoflurane sedation with the AnaConDa is easily feasible, effective, safe, and has a relatively short awakening period. In some patients with sedation difficulties, this sedation method may significantly decrease sedation cost and enhance sedation efficacy.
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Review
Institutional review board consideration of chart reviews, case reports, and observational studies.
Though the need for human-subjects review is readily apparent to investigators when conducting a randomized clinical trial, that same requirement is often less obvious when considering activities such as chart reviews, observational studies, or even case reports. In some cases all that is needed is notification of the institutional review board, which might then exempt the research. ⋯ In all cases, including case reviews, quality-improvement projects, and chart reviews, the most cautious approach for the investigator is to discuss regulatory requirements with the institutional review board official to ensure compliance. I will review what constitutes human-subjects research and how investigators may access protected health information, and consider some examples of observational research.