Resp Care
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Uncertainties exist regarding the value of the air leak test or use of steroids for preventing post-extubation stridor and extubation failure in children. ⋯ The majority of surveyed pediatric critical care fellowship program directors rely on the air leak test and use corticosteroids to prevent post-extubation stridor and extubation failure. At an air leak of >or= 30 cm H(2)O most of the surveyed physicians would delay extubation and initiate glucocorticosteroids.
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Ventilators possess an anti-asphyxia valve that allows spontaneous breathing of ambient air during ventilator failure. This study examined the imposed work of breathing and pressure-time product of 8 critical care and 9 portable ventilators, using a laboratory simulation of spontaneous breathing during ventilator failure. ⋯ Spontaneous breathing during ventilator failure may impose work approximating the physiologic work of breathing. This imposed work may prevent effective breathing through the anti-asphyxia valve during mechanical ventilator failure due to electrical failure. These results reinforce the need to properly monitor mechanically ventilated patients and to have in place sufficient back-up power supplies and a method of manual ventilation.
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The last 50 years have witnessed major progress in our understanding of the underlying nature of chronic obstructive pulmonary disease (COPD) and approaches to care. During the last 10 years, however, there has been an explosive expansion of knowledge related to this disorder. Large-scale epidemiologic studies show that COPD is the fourth leading cause of death in the United States and will be the fifth leading health burden worldwide by the year 2020. ⋯ Unfortunately, most clinicians fail to perform spirometric screening of at-risk individuals, so most patients first present with COPD during a sudden exacerbation of the disease. Worldwide interest is emerging in promoting earlier diagnosis and finding new pharmacologic interventions to halt the progression of airway and parenchymal damage. In this review, evidence is presented that we are on the upward limb of an exponential curve of progress in managing COPD, which will produce major advances in our ability to recognize and treat this disorder in its earliest stages.
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In contrast to outpatient, laboratory testing, which is performed by a small, dedicated group of pulmonary function technologists, inpatient, bedside spirometry at the Cleveland Clinic Hospital is performed less frequently and by a larger group of respiratory therapists with broader responsibilities. A 1998 audit of bedside spirometry tests at our hospital showed that American Thoracic Society acceptability and reproducibility criteria were infrequently met (15% of instances). ⋯ A quality improvement program for bedside spirometry testing that emphasizes training and routine feedback on test quality can enhance the quality of inpatient spirometry testing.