Resp Care
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We have modified the circuits of pressure-preset and volume-preset ventilators to permit the administration of ribavirin to mechanically ventilated infants suffering from respiratory syncytial virus. The modifications isolate the ventilator itself and permit continuous aerosolization for as long as seven days without ventilator malfunction from the effects of crystallized medication. Excessive spilling of ribavirin into the environment is also avoided. Each institution must devise its own experimental protocols and gain permission from its own committee on human experimentation and from the parent/guardian of the patient before administering such treatment.
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In patients with permanent tracheostomies, the clinician can encounter difficulty in creating a satisfactory seal between the patient and pulmonary function testing (PFT) equipment. We have developed a simple apparatus and procedure for effecting a tight seal during testing. ⋯ This equipment is simple, inexpensive, and readily available. Further, it permits pulmonary function testing whether or not a tracheostomy tube is in place, an advantage if variable extrathoracic upper airway obstruction is a consideration. If the patient has a cuffed tracheostomy tube in place, the PFT equipment can be connected directly to the tube. We have found that this apparatus and technique are well tolerated and that test results are reproducible.
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Comparative Study
Contamination of a multiple-use suction catheter in a closed-circuit system compared to contamination of a disposable, single-use suction catheter.
Multiple-use (M-U) closed-system endotracheal suction catheters are effective in preventing arterial oxygen desaturation in patients on positive end-expiratory pressure (PEEP) and may lessen the frequency of bradycardia and hypotension in unstable patients who are prone to these complications of suctioning. However, because M-U catheters remain attached to the ventilator circuit and are reintroduced repeatedly into the patient's airway over 24 hours or longer, they could become heavily contaminated with pathogens. We hypothesized a risk of autocontamination to the patient by re-inoculation of the respiratory tract with organisms that flourished on the M-U catheter while it was isolated from the patient's immune defenses or antibiotic therapy. ⋯ Fourteen different pathogens or potential pathogens were recovered, in numbers of 2 x 10(1) to 2 x 10(7)colony-forming units. The greatest number of colonies was most often recovered from the sputum specimen, and statistical analysis showed no differences in rate or magnitude of contamination between M-U and S-U catheters.(ABSTRACT TRUNCATED AT 250 WORDS)
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The hand-held computer (HHC) allows computer technology to be brought inexpensively to the patient's bedside. In this paper we describe HHC applications software that interprets oxygenation, ventilation, and acid-base status--and also provides a differential diagnosis and makes suggestions for therapy. ⋯ Computerized arterial blood gas interpretation is especially helpful to students and others who infrequently interpret arterial blood gases. The software described here has been enthusiastically accepted by emergency department personnel in our institution.
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Management of the patient receiving long-term ventilator care is facing many changes, among them new alternatives in placement outside hospitals. These include the home and two new options--the skilled nursing facility and the residential care facility. Government and insurance carriers are now more willing to pay for these alternatives to hospitalization. ⋯ The skilled nursing facility (SNF) has been in the past an unsafe alternative placement; however, some SNFs are developing special units for ventilator-dependent patients that will make a placement to these facilities safe and practical. Residential care facilities, developed as a model program in California, can care for small numbers of ventilator-dependent persons in a homelike setting. These new placement alternatives will make it possible for virtually all medically stable, ventilator-dependent patients to live away from the hospital.