Resp Care
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Two prostacyclins (prostaglandin E(1) and prostaglandin I(2)) are potent vasodilators. Aerosolized prostacyclins reduce pulmonary artery pressure, improve right heart function, and increase arterial oxygenation by improving ventilation/perfusion matching. This report describes aerosolized prostacyclins and compares them to inhaled nitric oxide. I review the types of inhalable prostacyclins and their indications, evidence of efficacy, delivery, and adverse effects.
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Despite advances in therapy, asthma continues to be the chronic condition most responsible for school absenteeism and pediatric hospitalizations. This is especially true for inner-city children. We operate an inner-city Pediatric Asthma Compliance and Technique (PACT) clinic in which physicians and respiratory therapists collaborate to improve metered-dose inhaler (MDI) technique and outcomes among asthmatic children. ⋯ In our PACT clinic asthmatic children showed sustained improvement in MDI technique, and some of the patients improved in pulmonary function and overall asthma severity score.
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Computer control of mechanical ventilators includes the operator-ventilator interface and the ventilator-patient interface. New ventilation modes represent the evolution of engineering control schemes. ⋯ The operator-ventilator interface has received little attention in the literature, despite the fact that there is a whole science of human-computer interaction. This report suggests a methodology for the study of ventilator interfaces.
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Computers were initially used in health care for billing and administrative functions. More recently computers have been used to present clinical information such as laboratory results and pharmacy orders. ⋯ This report considers the challenges of developing electronic-health-record systems and integrating them into useful computerized decision-support systems and presents a "pyramid of progress" concept that involves 5 steps: (1) to gather electronic health data into a standardized and coded format, (2) to validate the quality of that electronic health data, (3) to optimize presentation of electronic health data and explore computerized decision-support, (4) to develop and share computerized knowledge bases that are based on clinical evidence as well as consensus, and (5) to tailor and to implement the computerized strategies so that they fit into the workflow process of patient care. This report discusses 3 examples of successful computerized clinical decision-support (use of antibiotics, laboratory alerting, and ventilator management) and discusses strategies essential to making computerized clinical decision-support more widely available and useful.