Respiratory care
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Comparative Study
Calculation of physiologic dead space: comparison of ventilator volumetric capnography to measurements by metabolic analyzer and volumetric CO2 monitor.
Calculation of physiologic dead space (dead space divided by tidal volume [VD/VT]) using the Enghoff modification of the Bohr equation requires measurement of the partial pressure of mean expired CO2 (PĒCO2) by exhaled gas collection and analysis, use of a metabolic analyzer, or use of a volumetric CO2 monitor. The Dräger XL ventilator is equipped with integrated volumetric CO2 monitoring and calculates minute CO2 production (VCO2). We calculated PĒCO2 and VD/VT from ventilator derived volumetric CO2 measurements of VCO2 and compared them to metabolic analyzer and volumetric CO2 monitor measurements. ⋯ PĒCO2, and therefore VD/VT, can be accurately calculated directly from the Dräger XL ventilator volumetric capnography measurements without use of a metabolic analyzer or volumetric CO2 monitor.
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In patients with COPD, chronic anemia is known as an unfavorable prognostic factor. Whether the association between hemoglobin (Hb) levels and long-term survival is restricted to anemia or extends to higher Hb levels has not yet been systematically assessed. ⋯ In subjects with COPD and chronic respiratory failure undergoing treatment with noninvasive ventilation and LTOT, high Hb levels are associated with better long-term survival. The optimal cutoff level for prediction was above the established threshold defining anemia. Thus, predicting survival only on the basis of anemia does not fully utilize the prognostic potential of Hb values in COPD.
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Manual ventilation in the delivery room is provided with devices such as self-inflating bags (SIBs), flow-inflating bags, and T-piece resuscitators. ⋯ Although some manikin studies favor T-piece for providing reliable and consistent pressures, our experience did not indicate significant differences in effectiveness of resuscitation between the T-piece and SIB in preterm resuscitations.
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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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Case Reports
Bilateral micronodular pulmonary infiltrate: is it important to make a histological diagnosis?
Pulmonary alveolar microlithiasis is a rare disease characterized by the deposition of calcium phosphate within the alveoli. We report the case of a 20-year-old man with a 6-week history of cough and shortness of breath on exertion. ⋯ High-resolution computed tomography revealed bilateral diffuse fine nodular shadowing involving the mid zones, with sparing of the apices. The patient underwent a transbronchial lung biopsy, which confirmed the diagnosis of pulmonary alveolar microlithiasis.