Resp Care
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Randomized Controlled Trial
Adoption of lower tidal volume ventilation improves with feedback and education.
To determine whether feedback and education improve adoption of lung-protective mechanical ventilation (ie, with lower tidal volume [V(T)]). ⋯ Adoption of a lower-V(T) ventilation strategy in patients with acute lung injury or acute respiratory distress syndrome is far from complete in the Netherlands. Adoption of a lower-V(T) strategy improves after feedback and education.
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To derive a clinical prediction rule that uses bedside clinical variables to predict extubation failure (reintubation within 48 h) after a successful spontaneous breathing trial. ⋯ With our clinical prediction rule that incorporates an assessment of mental status, endotracheal secretions, and pre-extubation P(aCO(2)), clinicians can predict who will fail extubation despite a successful spontaneous breathing trial.
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One device that has been proposed to address the need for emergency ventilation is the Vortran Automatic Resuscitator. ⋯ The Vortran Automatic Resuscitator showed an automatic increase in frequency and decrease in V(T) that resulted in inappropriate levels of minute alveolar ventilation over a range of compliance and resistance values expected in paralyzed patients ventilated for respiratory failure. The variable performance under changing load, along with the lack of alarms, should prompt caution in using the Vortran Automatic Resuscitator for emergency ventilatory support in situations where the patient cannot be constantly monitored by trained and experienced operators.
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The diffusing capacity of the lungs for carbon monoxide (D(LCO)) is commonly measured during pulmonary function testing (PFT). Although adjustment of the measured D(LCO) for an elevated baseline carboxyhemoglobin level is recommended, carboxyhemoglobin is not routinely measured, which may reduce the accuracy of D(LCO) measurements. We sought to assess the utility of routine carboxyhemoglobin measurement and subsequent D(LCO) correction in patients referred for PFT. ⋯ The noninvasive measurement of carboxyhemoglobin is easy to perform during PFT. When precise measurement of D(LCO) is important, noninvasive measurement of carboxyhemoglobin may be of value. If routine S(pCO) measurement is considered, the highest yield is among current smokers.
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Noninvasive positive-pressure ventilation (NPPV) unloads respiratory muscles. Spontaneous-breathing ventilation modes require patient effort to trigger the ventilator, whereas controlled modes potentially economize on patient triggering effort and thus achieve more complete respiratory muscle rest. Data on controlled NPPV have not been published to date. We hypothesize that controlled ventilation is feasible in patients with hypercapnic chronic obstructive pulmonary disease. ⋯ Controlled NPPV is feasible in patients with hypercapnic chronic obstructive pulmonary disease. We observed improved blood gas values, lung function, and inspiratory muscle strength.