Respiratory care
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Depression in Japanese patients with chronic obstructive pulmonary disease: a cross-sectional study.
Some investigations have revealed an association between depression and physical measurements of COPD patients in North America and Europe, but few related studies have been performed in Asia. ⋯ Physical parameters were associated with depression in our Japanese COPD out-patients.
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Comparative Study Observational Study
Disparity between mainstream and sidestream end-tidal carbon dioxide values and arterial carbon dioxide levels.
Measuring and monitoring end-tidal carbon dioxide (PETCO2) is an important aspect of caring for critically ill patients. The 2 methods used for PETCO2 measurement are the mainstream and sidestream methods. ⋯ PETCO2 values obtained by mainstream and sidestream methods were found to be significantly lower than the PaCO2 values. There was essentially no agreement between the measurements obtained by 2 different methods and the PaCO2 values.
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User-friendly scores to assess knowledge of guidelines for prevention of ventilator-associated pneumonia (VAP) are scarce and have mainly evaluated nurses, but not students or physicians. Gaps between knowledge and actual clinical practice have not been sufficiently analyzed. We assessed knowledge of and adherence to guidelines for prevention of VAP among physicians, nurses, and students in adult ICUs. ⋯ A simple, easy-to-complete questionnaire enabled us to rapidly evaluate personal knowledge and reported clinical practice in prevention of VAP in large teaching institutions. These scores will be used as baseline figures to assess the impact of educational and intervention campaigns.
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Case Reports
Pneumothorax caused by aggressive use of an incentive spirometer in a patient with emphysema.
A 68-year-old man presented to the emergency department with a small pneumothorax following aggressive use of an incentive spirometer. The patient had a baseline chest radiograph consistent with emphysema. He was initially treated with oxygen in the emergency department, with resolution of his symptoms. ⋯ Inspiratory resistive breathing can cause large negative swings in intrathoracic pressure, which may result in mechanical stress of lung tissue. This is the first report of a secondary pneumothorax associated with use of an incentive spirometer. Patients with bullous emphysema should be counseled to avoid frequent high intensity maneuvers with an incentive spirometer if the potential benefits of the procedure are marginal.
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Current literature has been inconsistent in demonstrating that minimizing the duration of mechanical ventilation in very-low-birth-weight (VLBW) newborns reduces lung damage. ⋯ A combined BnCPAP strategy may contribute to a reduction of BPD, after adjusting for concurrent treatments.