Respiratory care
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For the busy clinician, educator, or manager, it is becoming an increasing challenge to filter the literature to what is relevant to one's practice and then update one's practice based on the current evidence. The purpose of this paper is to review the recent literature related to invasive mechanical ventilation, noninvasive ventilation, and cystic fibrosis. These topics were chosen and reviewed in a manner that is most likely to have interest to the readers of Respiratory Care.
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The majority of foreign-body aspirations are seen in children. In adults, neurological dysfunction, trauma, alcohol abuse, or psychological disorders can lead to aspiration, but normal adults can also suffer foreign body aspiration. ⋯ Bronchoscopic removal of the foreign body is necessary, and flexible bronchoscopy is effective in the diagnosis and removal. We saw a patient with COPD who aspirated a plastic cigarette filter while using his bronchodilator inhaler.
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Electrical impedance tomography measures changes in lung impedance, which are mainly related to changes in lung volume. We used electrical impedance tomography to investigate the effects of high-flow nasal cannula (HFNC) and body position on global and regional end-expiratory lung impedance variation (ΔEELI). ⋯ HFNC increased global EELI in our population, regardless of body position, suggesting an increase in functional residual capacity. Prone positioning was related to a more homogeneous distribution of ΔEELI, while in supine position ΔEELI was higher in the ventral lung regions.
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Even though it is not a common practice, an external filter to the expiratory limb of the breathing circuit may protect the expiratory valve from water saturation in case of nebulization, or from the environment in case of lung infection with multi-drug-resistant micro-organisms or H1N1 influenza. ⋯ In BTPS condition, volume error differed substantially across ICU ventilators for VT delivery, with further significant changes occurring after addition of a filter at the distal expiratory limb.
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Patients with do-not-intubate (DNI) status and respiratory failure are commonly treated with noninvasive ventilation (NIV). High-flow nasal cannula (HFNC) therapy supplies a high flow of heated and humidified oxygen that may provide an effective alternative to NIV. We assessed the efficacy of HFNC in DNI patients with hypoxemic respiratory distress. ⋯ HFNC can provide adequate oxygenation for many patients with hypoxemic respiratory failure and may be an alternative to NIV for DNI patients.