Resp Care
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Comparative Study
The impact of endotracheal suctioning on gas exchange and hemodynamics during lung-protective ventilation in acute respiratory distress syndrome.
To evaluate the respiratory and hemodynamic effects of open suctioning (OS) versus closed suctioning (CS) during pressure-control (PC) and volume-control (VC) ventilation, using a lung-protective ventilation strategy in an animal model of acute respiratory distress syndrome (ARDS). ⋯ PaO2/FIO2) was better maintained during CS with both VC and PC modes during lung-protective ventilation for ARDS, as compared with OS, and shunt fraction post-suctioning changed least with PC.
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Dexmedetomidine is a selective alpha-2 adrenergic receptor agonist that exhibits sedative, analgesic, anxiolytic, and sympatholytic effects without respiratory-drive depression. We prospectively evaluated the use of dexmedetomidine to facilitate the withdrawal of mechanical ventilation and extubation in 5 trauma/surgical intensive-care-unit patients who had failed previous weaning attempts due to agitation and hyperdynamic cardiopulmonary response. ⋯ Dexmedetomidine appears to maintain adequate sedation without hemodynamic instability or respiratory-drive depression, and thus may facilitate extubation in agitated difficult-to-wean patients; it therefore deserves further investigation toward this novel use.
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Although poorly understood, idiopathic pulmonary fibrosis is the most common of the idiopathic interstitial lung diseases. Its etiology is unknown, but how this fibrotic process develops in the lung has been studied over the last 60 years. It is a relatively rare disease, afflicting those 50-70 years of age, slightly more common among men than women, without racial predilection. ⋯ No definitive medical treatment is available, although most patients are given trials of corticosteroids, alone or in combination with cytotoxic agents. On average, patients survive 2-4 years after diagnosis. Lung transplantation has been the only therapy shown to improve survival of those with idiopathic pulmonary fibrosis.
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Lung transplantation is now performed in patients with end-stage pulmonary parenchymal or vascular lung disease. The process of evaluating a patient for transplantation, managing the patient during the peri-operative period, and caring for the patient following transplantation is complex. ⋯ This article reviews the indications for, expected outcomes of, and management of complications that can develop following lung transplantation. Respiratory therapists play an instrumental role in assisting in the management of this group of patients in the pretransplant and post-transplant periods, and in their long-term management.
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Acute brain injury, in the form of trauma, stroke, or spontaneous hemorrhage, occurs commonly and in all age groups. Although the management of these conditions differs considerably, certain physiologic principles are shared by all and are useful in guiding the management of the most severely injured patients. This article reviews basic cerebral physiology and describes the links between physiology and management principles, emphasizing subjects relevant to the respiratory management of patients with acute brain injury.