Resp Care
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Randomized Controlled Trial
Effects of expiratory rib-cage compression on oxygenation, ventilation, and airway-secretion removal in patients receiving mechanical ventilation.
Expiratory rib-cage compression, a chest physiotherapy technique, is well known as the "squeezing" technique in Japan. ⋯ This study suggests that rib-cage compression prior to endotracheal suctioning does not improve airway-secretion removal, oxygenation, or ventilation after endotracheal suctioning in this unselected population of mechanically ventilated patients.
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Comparative Study
Comparison of an oxygen-powered flow-limited resuscitator to manual ventilation with an adult 1,000-mL self-inflating bag.
Positive-pressure ventilation of patients with unprotected airways during cardiopulmonary resuscitation can cause gastric dilation. ⋯ Our study found no significant difference between the Oxylator and BVM when comparing tidal volume delivered to lungs and stomach during ventilation of a simulated unconscious nonintubated patient. More research on BVM use and the Oxylator should be done to validate the American Heart Association's guideline recommendations for ventilating unconscious patients with unprotected airways. Research on gastric dilation during cardiopulmonary resuscitation needs to be done with bench models using manikins that simulate chest excursion, bidirectional airway flow, lung impedance, and gastric compliance.
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Patient education is a critical factor in the use and misuse of medication inhalers. Inhalers represent advanced technology that is considered so easy to use that many patients and clinicians do not receive adequate training in their use. ⋯ Reimbursement and teaching strategies to improve patient education could substantially reduce these wasted resources. Problems with inhaler use, the cost of inhalers, and myths associated with inhalers are reviewed, with recommendations for strategies and techniques to better educate patients in inhaler use.
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Review Comparative Study
Comparing clinical features of the nebulizer, metered-dose inhaler, and dry powder inhaler.
Topically inhaled bronchodilators and corticosteroids are the mainstay of treatment for asthma and chronic obstructive pulmonary disease. These medications are delivered via jet or ultrasonic nebulizer, metered-dose inhaler (MDI), or dry powder inhaler (DPI). While the number of devices may be confusing to patients and clinicians, each device has distinct advantages and disadvantages. ⋯ There is a high rate of errors in device use with all these devices, especially the MDI. In choosing a drug/device combination for a patient, the clinician must take into account several factors, including the cognitive and physical ability of the patient, ease of use, convenience, costs, and patient preferences. Clinicians should also have a rudimentary understanding of aerosol principles in order to be able to teach appropriate use of aerosol devices to their patients.