Resp Care
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Editorial Comparative Study
New technologies for lighter portable oxygen systems.
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The airway mucosa responds to infection and inflammation in a variety of ways. This response often includes surface mucous (goblet) cell and submucosal gland hyperplasia and hypertrophy, with mucus hypersecretion. Products of inflammation, including neutrophil-derived deoxyribonucleic acid (DNA) and filamentous actin (F-actin), effete cells, bacteria, and cell debris, all contribute to mucus purulence and, when this mucus is expectorated it is called sputum. ⋯ Mucoregulatory agents reduce the volume of airway mucus secretion and appear to be especially effective in hypersecretory states such as bronchorrhea, diffuse panbronchiolitis, and some forms of asthma. Mucoregulatory agents include anti-inflammatory agents (indomethacin, glucocorticosteroids), anticholinergic agents, and some macrolide antibiotics. Classifying mucoactive agents should help us to develop and evaluate new types of therapy and to better direct therapy toward the patients who are most likely to benefit.
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We present a case of unilateral airflow obstruction during forced exhalations. The patient presented with episodic dyspnea and wheezing, particularly when he lay in the right lateral decubitus position. ⋯ Following a right pneumonectomy, total lung capacity was markedly reduced; interestingly, however, spirometry was essentially unchanged. This case is an elegant illustration of the effects of respiratory maneuvers and body position on airway caliber.
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Clinical Trial
Noninvasive nocturnal ventilatory support in advanced lung disease from cystic fibrosis.
Respiratory failure is the most common cause of death among people with cystic fibrosis (CF). The role of noninvasive positive-pressure ventilation (NPPV) in severe but stable lung disease from CF has not been adequately determined. We therefore sought to determine the tolerability and efficacy of NPPV in people with advanced lung disease from CF. ⋯ NPPV is well tolerated by most patients with CF and severe lung disease and may be a useful bridge to support CF patients awaiting lung transplantation. However, despite subjective improvement, standard objective measures did not improve and cannot explain the reduced symptoms reported by these patients.
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Arterial blood gas (ABG) values are a necessary diagnostic measurement in the management of critically ill neonates. We hypothesized that a fiberoptic intravascular blood gas sensor, adapted for use through an umbilical artery catheter, would produce blood gas results with clinically acceptable bias and precision, in comparison to laboratory values, but with no blood loss. ⋯ The Neotrend device was accurate and reliable in the neonatal setting, allowing blood gas assessment with no iatrogenic blood loss. Catheter placement in high position may increase the likelihood of successful sensor placement and sensor duration of function.