Respiratory care
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Organizational factors associated with adoption and use of respiratory care protocols have received little attention. This study examines patterns of protocol use and features of a hospital and providers that are associated with respiratory care protocol use. ⋯ The study extends prior research by clarifying features of hospitals and providers associated with use of respiratory care protocols. Validation in future hypothesis-testing samples will further advance this knowledge.
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Oxidative stress and inflammatory responses are thought to be involved in the pathogenesis of ARDS, which is one of the most serious complications of orthotopic liver transplantation (OLT). The collection of exhaled breath condensate (EBC) is a noninvasive method for obtaining clinical samples from the lungs. However, the changes of mediators of inflammation and oxidative stress in EBC remain unclear. Therefore, the aim of this study was to investigate the changes of mediators in EBC from OLT subjects and the relations between these mediators and ARDS. ⋯ EBC analysis is a noninvasive method for detecting mediators of inflammation and oxidative stress from the lungs. This method could be used to predict the higher incidence of ARDS induced by OLT.
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Previous studies have shown that lung recruitment maneuvers are important means of treating ARDS. Although computed tomography (CT) scans and pressure-volume curves are the most common ways to evaluate lung recruitment, there are still many disadvantages. Not only do the scans have to take place in a CT room, but the patient is exposed to large doses of radiation through the multiple scans necessary to define the optimal PEEP. ⋯ Bedside ultrasound is a faster and more convenient imaging method because it reduces the need for patient transport compared with CT scan and requires no muscle relaxation. This case supports that ultrasound may become an alternative imaging tool to guide and evaluate alveolar recruitment in patients with ARDS. Additionally, we have also included a brief review of lung recruitment evaluation by ultrasound to supplement this case study.