Respiratory care
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Currently, no clinical or animal studies have been performed to establish the relationship between airway humidification and mechanical ventilation-induced lung inflammatory responses. Therefore, an animal model was established to better define this relationship. ⋯ Pathology and reduced inflammation observed in animals treated at 40°C was similar to that observed in the control animals, suggesting that appropriate humidification reduced inflammatory responses elicited as a consequence of mechanical ventilation, in addition to reducing damage to the cilia and reducing water loss in the airway.
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Randomized Controlled Trial Comparative Study
A Randomized Controlled Trial of 2 Inhalation Methods When Using a Pressurized Metered Dose Inhaler With Valved Holding Chamber.
Information on the comparative efficacy of single deep breathing versus tidal breathing for inhaled asthma medications is limited, although such information can be of much use for the treatment of patients suffering from asthma. The objective of the present study was to compare the relative difference in improvement in peak expiratory flow (PEF) with single maximal inhalation with breath-holding versus 5 tidal breaths during inhalation of salbutamol from a pressurized metered dose inhaler (pMDI) with valved holding chamber (VHC) in children 5-15 y of age with asthma. ⋯ Single maximal inhalation with a breath-hold technique is not superior to tidal breathing for improvement in PEF following salbutamol inhalation. Either method may be used in children between 5 and 15 y of age. (India's Clinical Trials Registry CTRI/2013/04/003559.).
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Mask ventilation is lifesaving, especially in cases of difficult intubation. Many publications have offered distinct techniques for optimizing mask ventilation. ⋯ We divide difficult mask ventilation into 3 broad categories based on etiology: inadequate mask seal, increased airway resistance, and decreased respiratory compliance. Published strategies for overcoming difficulty are presented and organized by etiology.
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Comparative Study
CPAP Devices for Emergency Prehospital Use: A Bench Study.
CPAP is frequently used in prehospital and emergency settings. An air-flow output minimum of 60 L/min and a constant positive pressure are 2 important features for a successful CPAP device. Unlike hospital CPAP devices, which require electricity, CPAP devices for ambulance use need only an oxygen source to function. The aim of the study was to evaluate and compare on a bench model the performance of 3 orofacial mask devices (Ventumask, EasyVent, and Boussignac CPAP system) and 2 helmets (Ventukit and EVE Coulisse) used to apply CPAP in the prehospital setting. ⋯ Air-flow output, pressure applied, FIO2 delivered, device oxygen consumption, and ability to maintain air flow at 60 L/min differed significantly among the CPAP devices tested. Only the EasyVent and EVE Coulisse achieved the required minimum level of air-flow output needed to ensure an effective therapy under all CPAP conditions.
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In our institution's pediatric emergency department, adherence to evidence-based asthma guidelines was noted to be suboptimal for patients with asthma exacerbations. We hypothesized that an evidence-based asthma protocol would improve time to treatment and adherence to National Institutes of Health guidelines for patients presenting to the emergency department with status asthmaticus. ⋯ An asthma protocol resulted in improved adherence to National Institutes of Health guidelines in children with status asthmaticus and improved efficiency in the administration of rescue bronchodilator and systemic corticosteroid therapy.