Respiratory care
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Pulmonary gas exchange abnormalities and refractory hypoxemia cause myriad difficulties in patients with chronic liver disease. In addition to intrinsic cardiopulmonary diseases and hepatopulmonary syndrome, some unusual pathophysiological mechanisms in patients with portosystemic collaterals might contribute to hypoxemia. ⋯ There has been no such report in the published literature. This case highlights the importance of keeping direct portopulmonary venous anastomosis in the differential diagnosis of oxygen-refractory hypoxemia and recurrent hepatic encephalopathy in patients with cirrhosis in the appropriate clinical context.
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Several new generation neonatal ventilators that incorporate conventional as well as high frequency ventilation (HFOV) have appeared on the market. Most of them offer the possibility to use HFOV in a volume-targeted mode, despite absence of any preclinical data. With a bench test, we evaluated the performances of 4 new neonatal HFOV devices and compared them to the SensorMedics HFOV device. ⋯ These new generation neonatal ventilators were able to deliver adequate V(T) under pre-term infant, but not term infant respiratory system conditions. The clinical relevance of these findings will need to be determined by further studies.
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Randomized Controlled Trial Multicenter Study
Oxygenation With a Single Portable Pulse-Dose Oxygen-Conserving Device and Combined Stationary and Portable Oxygen Delivery Devices in Subjects With COPD.
Portable oxygen devices simplify and facilitate patient therapy. This study was designed to compare S(pO2) and patient satisfaction with a portable oxygen concentrator or a combined system consisting of a fixed device with continuous-flow oxygen dispensation and a portable device with pulse dispensation for ambulation. ⋯ Subjects preferred using a single portable oxygenation system both at home and during ambulation. Portable systems alone, however, did not supply the same levels of oxygenation as the combination of fixed and portable systems. Before the widespread adoption of portable systems as a single device, additional studies are needed to determine best-practice protocols for adjustment of daytime and nighttime oxygenation settings. (ClinicalTrials.gov registration NCT02079753).