Resp Care
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A tracheostomy tube decreases the ability of the patient to communicate effectively. The ability to speak provides an important improvement in the quality of life for a patient with a tracheostomy. ⋯ Speech can be facilitated in patients with a tracheostomy tube who are breathing spontaneously by use of a talking tracheostomy tube, by using a cuff-down technique with finger occlusion of the proximal tracheostomy tube, and with the use of a cuff-down technique with a speaking valve. Teamwork between the patient and the patient care team (respiratory therapist, speech-language pathologist, nurse, and physician) can result in effective restoration of speech in many patients with a long-term tracheostomy.
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The respiratory therapist plays an integral role in tracheostomy tube decannulation. Removal of the tracheostomy tube should be considered only if the original upper-airway obstruction is resolved, if airway secretions are controlled, and if mechanical ventilation is no longer needed. ⋯ Tracheostomy decannulation requires caution, particularly following a prolonged period of tracheostomy use. The tracheostomy tube decannulation process is well suited for therapist-implemented protocols.
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Comparative Study Clinical Trial
Accuracy of physiologic dead space measurements in patients with acute respiratory distress syndrome using volumetric capnography: comparison with the metabolic monitor method.
Volumetric capnography is an alternative method of measuring expired carbon dioxide partial pressure (P(eCO2)) and physiologic dead-space-to-tidal-volume ratio (V(D)/V(T)) during mechanical ventilation. In this method, P(eCO2) is measured at the Y-adapter of the ventilator circuit, thus eliminating the effects of compression volume contamination and the need to apply a correction factor. We investigated the accuracy of volumetric capnography in measuring V(D)/V(T), compared to both uncorrected and corrected measurements, using a metabolic monitor in patients with acute respiratory distress syndrome (ARDS). ⋯ Volumetric capnography measurements of V(D)/V(T) in mechanically-ventilated patients with ARDS are as accurate as those obtained by metabolic monitor technique. .
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Comparative Study
A laboratory evaluation of 2 mechanical ventilators in the presence of helium-oxygen mixtures.
Helium-oxygen (heliox) mixtures are being used more frequently with mechanical ventilators. Newer ventilators continue to be developed that have not yet been evaluated for safety and efficacy of heliox delivery. We studied the performance of 2 previously untested ventilators (Servo-i and Inspiration) during heliox administration. ⋯ Both Ventilators cycled consistently with heliox mixtures. In most cases, actual delivered V(T) can be reliably calculated if the F(IO2) and the set V(T) or the measured exhaled V(T) is known. With the Servo-i, at high helium concentrations the exhaled V(T) measurement was unreliable and caused a high-priority alarm condition that couldn't be disabled. A supplemental oxygen analyzer is not necessary with either device for heliox applications.