Respiratory care
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Comparative Study
"In vitro" evaluation of Heat and Moisture Exchangers designed for spontaneous breathing tracheostomized patients.
Heat and moisture exchangers (HMEs) are commonly used in chronically tracheostomized spontaneously breathing patients, to condition inhaled air, maintain lower airway function, and minimize the viscosity of secretions. Supplemental oxygen (O2) can be added to most HMEs designed for spontaneously breathing tracheostomized patients. We tested the efficiency of 7 HMEs designed for spontaneously breathing tracheostomized patients, in a normothermic model, at different minute ventilations (VE) and supplemental O2 flows. ⋯ The efficiency of HMEs in terms of temperature and absolute humidity is significantly affected by O2 supplementation and V(E).
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An athletic 21-year-old male was admitted to the surgical ICU after sustaining 2 stab wounds to his torso. He had an episode of left lung collapse early in his course, managed with suctioning and increased PEEP, to 15 cm H2O. ⋯ After premedication with glycopyrrolate, he was successfully extubated the following day, while his heart rate remained at his baseline of 50 beats/min. We review the physiologic mechanisms of bradycardia due to the removal of mechanical ventilation.
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Multicenter Study
High Resource Utilization Does Not Affect Mortality in Acute Respiratory Failure Patients Managed with Tracheostomy.
Tracheostomy practice in patients with acute respiratory failure (ARF) varies greatly among institutions. This variability has the potential to be reflected in the resources expended providing care. In various healthcare environments, increased resource expenditure has been associated with a favorable effect on outcome. ⋯ We were unable to demonstrate a positive relationship between resource expenditure and outcome in ARF patients managed with tracheostomy.
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Prolonged mechanical ventilation, longer hospital stay, and a lower rate of home discharge have been reported with patient-ventilator asynchrony in medical patients. Though commonly encountered, asynchrony is poorly defined within the traumatically injured population. ⋯ Ventilator asynchrony is common in trauma patients. It may be associated with SIMV with a set breathing frequency of ≥ 10 breaths/min, though not with longer mechanical ventilation, longer stay, or discharge disposition. (ClinicalTrials.gov NCT01049958).
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Case Reports
Gorham Syndrome with Post-operative Respiratory Failure and Requiring Prolonged Mechanical Ventilation.
Gorham syndrome is a rare disease that presents as progressive osteolysis, and may affect any part of the skeleton. The pathologic process involves the replacement of normal bone by aggressively expanding but non-neoplastic vascular tissue, resulting in massive osteolysis of the adjacent bone. If the spine and ribs are affected, the subsequent kyphosis and chest wall deformity may cause severe restrictive ventilatory impairment. ⋯ He underwent spinal surgery but could not be extubated after surgery. Postoperative left lower lung pneumonia and respiratory failure required prolonged mechanical ventilation. After a weaning program of pressure support ventilation and T-piece spontaneous breathing trials, he was successfully weaned from mechanical ventilation.