Resp Care
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Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) cause substantial morbidity and mortality despite our improved understanding of lung injury, advancements in the application of lung-protective ventilation, and strategies to prevent ventilator-induced lung injury. Severe refractory hypoxemia may develop in a subset of patients with severe ARDS. ⋯ Each shows evidence for improving oxygenation, though each has associated risks, and no single therapy has proven superior in the management of severe hypoxemia. Importantly, increased survival with these strategies has not been clearly established.
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Artificial airway cuff pressure should be maintained within a narrow range. Excessive cuff pressure presents a risk of tracheal damage and stenosis. Insufficient cuff pressure adds the risk of secretion leak past the cuff, tidal-volume leakage, and accidental extubation. The available cuff-inflation devices do not address these problems. ⋯ The cuff-inflation device demonstrated possible improvements over available cuff-inflation devices and cuff-pressure-control methods.