Resp Care
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Patient-ventilator interaction is a key element in optimizing mechanical ventilation. The change from inspiration to expiration is a crucial point in the mechanically ventilated breath, and is termed "cycling." Patient-ventilator asynchrony may occur if the flow at which the ventilator cycles to exhalation does not coincide with the termination of neural inspiration. Ideally, the ventilator terminates inspiratory flow in synchrony with the patient's neural timing, but frequently the ventilator terminates inspiration either early or late. Most current mechanical ventilators include adjustable cycling features that, when used in conjunction with waveform graphics, can enhance patient-ventilator synchrony.
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Multicenter Study Controlled Clinical Trial
A low-sodium solution for airway care: results of a multicenter trial.
Normal saline is sometimes instilled into the endotracheal tube preparatory to airway suctioning, to assist in removing thick secretions. However, saline can damage the antimicrobial properties of airway secretions. We previously described a low-sodium physiologically based solution for airway care and reported a small (n = 60) randomized trial in neonates, which showed trends toward less ventilator-associated pneumonia (VAP) and less chronic lung disease with the new solution. We now report a multicenter trial of that solution. ⋯ The test solution significantly reduced the VAP and chronic lung disease rates.
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Meta Analysis
Role of noninvasive ventilation in acute lung injury/acute respiratory distress syndrome: a proportion meta-analysis.
The role of noninvasive ventilation (NIV) in the management of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is controversial. ⋯ Our results suggest an almost 50% NIV failure rate in patients with ALI/ARDS, so NIV should be cautiously used in patients with ALI/ARDS. There is a need for a uniform NIV protocol for patients with ALI/ARDS.
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Comparative Study
In-vitro comparison of 4 large-volume nebulizers in 8 hours of continuous nebulization.
Continuous albuterol nebulization has become the standard of care for patients with status asthmaticus. Predictable albuterol delivery is paramount for effective therapy. We compared the aerosol characteristics, solution output, and albuterol output of 4 brands of large-volume nebulizer. ⋯ The tested nebulizers had similar performance during the first 5 hours. The nebulizer solution might need to be replaced if treatment is planned for longer period. The Misty Finity and Hope nebulizers had a more consistent solution output.
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In-line administration of bronchodilators is widely used in pediatric patients receiving mechanical ventilation. We compared the amount of albuterol captured at the end of the endotracheal tube (ETT) with an intrapulmonary percussive ventilator (IPV) versus a Salter 8900 jet nebulizer placed in-line in a pediatric ventilator model, under various operating conditions. We hypothesized that the type of aerosol generator, tidal volume (V(T)), and position in the ventilator circuit would influence the albuterol delivery. ⋯ The IPV delivered less albuterol than the jet nebulizer when placed at the humidifier. IPV was equivalent to jet nebulizer when placed at the Y-piece. Doubling the V(T) did not increase aerosol delivery.