Resp Care
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The importance of office spirometry has been strongly advocated in the pulmonary community, but whether its importance is recognized and accepted by primary care physicians is less well established. ⋯ The general knowledge and use of office spirometry in the primary care community is poor, but can be improved, at least in the short-term, by a simple educational workshop.
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Albuterol delivered during noninvasive positive-pressure ventilation is affected by use of a nebulizer or metered-dose inhaler (MDI) and whether the leak port is in the hose or the mask. ⋯ Albuterol delivery with noninvasive positive-pressure ventilation was affected by the type of aerosol delivery device, by the location of the leak port, and by actuating the MDI at the proper time in the respiratory cycle.
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The endotracheal tube (ETT) cuff-leak test (CLT) has been proposed as a relatively simple, noninvasive method for detecting the presence of laryngeal edema prior to tracheal extubation. ⋯ Failing the CLT was not an accurate predictor of PES and should not be used as an indication for either delaying extubation or initiating other specific therapy. Female patients, those whose ratio of ETT size to laryngeal diameter was > 45%, and patients intubated for > 6 d were more likely to develop PES.
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Open-circuit mouthpiece ventilation (MPV) is a form of noninvasive ventilation that can be used to provide portable daytime ventilatory support for neuromuscular patients with chronic respiratory failure. MPV has been reported to reduce the risk of respiratory infection due to tracheostomy, and to improve cough and voice function and patient quality of life. Despite these potential benefits, mouthpiece ventilation is not widely used. This may be due in part to the fact that little information is available as to which ventilators can support this application. ⋯ Six of the 8 ventilators supported MPV: Respironics Lifecare PLV-100 and PLV Continuum, Mallinckrodt Achieva PSO2, Pulmonetics LTV800, Newport HT50, and Uni-Vent Eagle 754.
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Randomized Controlled Trial Comparative Study
Positive expiratory pressure changes aerosol distribution in patients with cystic fibrosis.
We hypothesized that aerosol distribution in the lungs of patients with cystic fibrosis changes with positive expiratory pressure (PEP). ⋯ These results indicate that less aerosol is deposited in the lungs of patients with cystic fibrosis when the Pari LC Plus nebulizer is used with the Pari PEP device, as described in these experiments. Nevertheless, aerosol administration with this nebulizer and PEP device also results in a proportional redistribution of aerosol to the peripheral airways, compared to nebulization without the PEP device. The clinical relevance of this subtle redistribution of aerosol in cystic fibrosis patients will probably depend on the drug administered and disease severity.