Resp Care
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Tracheostomy tubes are used to administer positive-pressure ventilation, to provide a patent airway, to provide protection from aspiration, and to provide access to the lower respiratory tract for airway clearance. They are available in a variety of sizes and styles, from several manufacturers. The dimensions of tracheostomy tubes are given by their inner diameter, outer diameter, length, and curvature. ⋯ Others are designed with a port above the cuff that allows for subglottic aspiration of secretions. The tracheostomy button is used for stoma maintenance. It is important for clinicians caring for patients with a tracheostomy tube to understand the nuances of various tracheostomy tube designs and to select a tube that appropriately fits the patient.
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An increasing number of technology-dependent patients are sent home for long-term home-management of stable chronic illness. With a patient who is going to undergo tracheotomy, patient-education (for the patient and his/her caregivers) should begin early (before the tracheostomy, if possible), should be individualized to the patient, and should include basic airway anatomy, medical justification for the tracheostomy, tube description and operation, signs and symptoms of respiratory and upper-airway distress, signs and symptoms of aspiration, suctioning technique, tracheostomy tube-cleaning and maintenance, stoma-site assessment and cleaning, cardiopulmonary resuscitation, emergency decannulation and reinsertion procedures, tube-change procedure, equipment-and-supply use and ordering procedures, and financial issues. There should be a scheduled follow-up plan with the attending physician. A combination of process-validation, through additional research, and expert consensus may be needed to standardize the long-term care of patients who undergo tracheostomy.
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Comparative Study
The impact of closed endotracheal suctioning systems on mechanical ventilator performance.
Closed endotracheal suctioning during mechanical ventilation is increasingly used, but its impact on ventilator function has not been fully studied. ⋯ There are large differences between the ventilators evaluated (p < 0.001). Closed suctioning does not cause mechanical ventilator malfunction. Upon removal of the suction catheter, these ventilators resumed their pre-suctioning-procedure gas delivery within 2 breaths, and, during all the tested modes, all the ventilators maintained gas delivery. However, closed suctioning can decrease end-expiratory pressure during suctioning.
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Inhalation is a very old method of drug delivery, and in the 20th century it became a mainstay of respiratory care, known as aerosol therapy. Use of inhaled epinephrine for relief of asthma was reported as early as 1929, in England. An early version of a dry powder inhaler (DPI) was the Aerohalor, used to administer penicillin dust to treat respiratory infections. ⋯ Design and lung-deposition improvement of MDIs, DPIs, and nebulizers are exemplified by the new hydrofluoroalkane-propelled MDI formulation of beclomethasone, the metered-dose liquid-spray Respimat, and the DPI system of the Spiros. Differences among aerosol delivery devices create challenges to patient use and caregiver instruction. Potential improvements in aerosol delivery include better standardization of function and patient use, greater reliability, and reduction of drug loss.