Respiratory care
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The incidence of pneumothoraces with automated cardiopulmonary resuscitation (CPR) is unknown. Herein, we present 4 cases of pneumothoraces occurring in the setting of automated mechanical CPR (AM-CPR) in a 2-month period since incorporating mechanical devices into our resuscitation program. Two of the cases were in-hospital cardiac arrests, whereas the other 2 were out-of-hospital cardiac arrests. ⋯ Two of the cases presented with obstructive lung disease, whereas the other 2 had underlying malignancy. Suboptimal positioning and failure to secure the included shoulder straps could have led to migration of the piston over the ribs. Further study is needed to determine the incidence of complications for all FDA-approved AM-CPR devices compared with manual chest compressions.
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Mechanical insufflation-exsufflation (MI-E) is increasingly used in the home management of children with neuromuscular disease. Research to date has focused on the effect of MI-E on physical health. The aim of this study was to qualitatively investigate the impact of home MI-E on the child and family's lifestyle. ⋯ Although involving a small number of subjects, this study demonstrated a mixture of opposing impacts of home MI-E on lifestyle, both enabling and disabling, which need to be considered when introducing home MI-E. The positive impacts included greater ability to manage the child's health, including avoidance of hospital admissions. Negative impacts were greatest for those parents who were sole operators of the device, including a frequently disrupted lifestyle.
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Observational Study
Effect of Weight Loss on Postural Changes in Pulmonary Function in Obese Subjects: A Longitudinal Study.
Postural changes are known to affect normal lung volumes. A reduction in sitting to supine functional residual capacity (FRC) is well-described in non-obese subjects adopting a supine position. However, postural changes in lung volumes in the obese require further exploration. We aimed to longitudinally address the effects of weight loss on postural changes in lung volumes and pulmonary function in obese subjects. We tested the hypothesis that supine reduction in FRC would be absent in morbid obesity and recovered upon weight loss. ⋯ Although postural change in FRC is absent when the morbidly obese adopt a supine position, supine reduction in FRC can be recovered following gastroplasty-induced weight loss, despite residual mild to moderate obesity. This also shows that mild to moderate obesity may affect supine FRC more than morbid obesity. (ClinicalTrials.gov registration NCT02207192.).
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This study was conducted to compare the efficiency of jet nebulizers, vibrating mesh nebulizers, and pressurized metered-dose inhalers (pMDI) during assisted and unassisted administration techniques using a simulated spontaneously breathing pediatric model with a tracheostomy tube (TT). ⋯ In this in vitro pediatric breathing model with a TT, the pMDI delivered the highest IM%, whereas the vibrating mesh nebulizer delivered the highest IM. The jet nebulizer was the least efficient device. Delivery efficiency was similar with unassisted and assisted administration techniques.
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Human granulocytic anaplasmosis is a tick-borne bacterial disease caused by Anaplasma phagocytophilum. ARDS is a very rare presentation of human anaplasmosis. ⋯ In our case, despite early initiation of empiric antibiotics, the clinical course of our patient continued to deteriorate but responded dramatically upon addition of steroids. Clinicians should be vigilant about the presentation, diagnostic workup, and treatment of human granulocytic anaplasmosis.