Respiratory care
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Endobronchial chondromas are rare benign tumors. They may be part of the Carney triad; however, isolated endobronchial chondromas can occur in the larynx, trachea, and bronchi. We report a case of an endobronchial chondroma in a 61-y-old man with an incidental 5-mm endobronchial polypoid lesion at the proximal left main bronchus that was later found to be an endobronchial chondroma. ⋯ We reviewed a total of 23 cases of isolated endobronchial chondromas reported in the medical literature. Despite their rarity, endobronchial chondromas should be considered in the differential diagnosis of endobronchial tumors. Prompt recognition and resection of endobronchial chondromas is important to prevent airway obstruction and its associated complications.
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Respiratory muscle strength (RMS) is a determinant of vital capacity, and its decline can lead to inadequate ventilation and deficiency in the elimination of secretions from the airways. Studies analyzing RMS in older adults with Parkinson's disease (PD) and Alzheimer's disease (AD) remain scarce, making the analysis of this variable still very uncertain. The aim of this study was to analyze the RMS of older adults diagnosed with PD and AD, in relation to healthy control peers. ⋯ The control of the anthropometric and cirtometric variables of the subjects indicates that RMS is affected by the aging process, and its decline increases in neurodegenerative conditions. This fact represents a serious risk for the development of atelectasis and other pneumo-functional complications, which must be considered in proposing of future therapies.
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During invasive mechanical ventilation, secretions accumulate in the subglottic space; consequently, there is a risk of aspiration of these secretions into the airway during cuff deflation and extubation. To minimize this risk, 2 extubation methods are used. The first consists of introducing a suction catheter into the endotracheal tube (ETT) and the trachea. After initiating suctioning, the cuff is deflated and the ETT is removed together with the suction catheter. The second technique involves applying positive pressure to the ETT using a resuscitation bag. Once the manual breath is delivered, the ETT cuff is deflated and the ETT is removed without suction. The aim of this laboratory study is to determine the existence and magnitude of differences in leak volume during cuff deflation and extubation using various combinations of positive pressure with or without endotracheal suctioning. ⋯ Endotracheal suctioning during cuff deflation and extubation produced greater leakage. Application of CPAP 15, PSV 15/10, and PSV 20/5 resulted in the lowest leak values, with the best results being obtained with the use of PSV 15/10 and PSV 20/5.
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Following unsuccessful treatment with noninvasive ventilation (NIV), patients requiring subsequent placement on invasive mechanical ventilation have a high mortality rate. Invasive mechanical ventilation is particularly problematic in patients with acute respiratory failure due to bronchiectasis exacerbation, as it is associated with a mortality rate of 19-35% and prolonged ICU stay. Here, we describe the successful management of a patient with exacerbated non-cystic fibrosis bronchiectasis using a pump-assisted venovenous system for extracorporeal CO2 removal (ProLUNG system) as an alternative to endotracheal intubation following NIV failure. The extracorporeal CO2 removal system proved to be safe and efficacious in this case study, and further studies focusing on its use in these types of cases seem warranted.
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Transitioning from an associate degree to a baccalaureate degree for respiratory therapists has been suggested as a new entry-level educational standard. One potential risk for this change is that it may limit the diversity of potential applicants for entry-level education. A diverse workforce is important to achieve the goal of reducing healthcare disparities. This study evaluated characteristics of therapists who completed associate and baccalaureate degree entry-level education. ⋯ Current entry-level associate and baccalaureate degree graduates have similar gender and race proportions. This finding challenges concerns that an entry-level baccalaureate degree would decrease the diversity of the respiratory therapist workforce.