Respiratory care clinics of North America
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Respir Care Clin N Am · Sep 2004
ReviewThe "best" tidal volume for managing acute lung injury/acute respiratory distress syndrome.
An inappropriate tidal volume setting can overstretch and injure the lung. Maximal stretch, tidal stretch, frequency of stretch, and rate of stretch are all implicated in such injury. ⋯ Clinical trials have shown that limiting maximal and tidal stretch improves outcomes, even if gas exchange is partially compromised. Current strategies should focus on limiting tidal and maximal stretch as much as possible.
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Respir Care Clin N Am · Sep 2004
ReviewTherapy for ventilator-associated pneumonia: what works, what doesn't.
Ventilator-associated pneumonia is a common cause of morbidity and mortality in critically ill patients. Inappropriate initial antimicrobial therapy is associated with poor outcome. An initial aggressive strategy using broad-spectrum antibiotics based on the local distribution of pathogens, patient risk factors, and antimicrobial characteristics; followed by focused therapy based on microbiologic studies, will help minimize the chance of inappropriate therapy and the emergence of resistance.
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Respir Care Clin N Am · Sep 2004
ReviewForehead oximetry in critically ill patients: the case for a new monitoring site.
Pulse oximetry is a ubiquitous monitor in anesthesia and critical care and is often considered the fifth vital sign. Under conditions of normal perfusion and temperature, the finger probe is the most common and effective sensor. ⋯ Another site and sensor are necessary to monitor these patients effectively. This article describes the search for this site, the choice of the forehead, and preliminary data regarding the use of this sensor site.
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Respir Care Clin N Am · Sep 2004
ReviewSetting the positive expiratory-end pressure-FIO2 in acute lung injury/acute respiratory distress syndrome.
Airspace collapse is a hallmark of parenchymal lung injury. Strategies to reopen and maintain patency of these regions offer three advantages: improved gas exchange, less ventilator-induced lung injury, and improved lung compliance. Elevations in intrathoracic pressure to achieve these goals, however, may overdistend healthier lung regions and compromise cardiac function. ⋯ Mechanical approaches to achieve this balance are clinically difficult to do. Thus gas exchange algorithms with modest PaO2 goals are commonly used today. Recruitment maneuvers and long inspiratory time strategies may be useful adjuncts.
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Respir Care Clin N Am · Sep 2004
ReviewEmergency airway management in orbit: an evidence-based review of possibilities.
It is likely that the first responder to a medical emergency in space will be a nonphysician. Terrestrial experience has shown that even under optimal conditions experienced clinicians can have difficulty establishing an airway. Establishing and maintaining a patent airway is essential to ensuring a successful outcome from cardiopulmonary resuscitation or respiratory failure secondary to trauma or acute illness. ⋯ For minimally trained care providers the airway will also be the first route of administration of resuscitative pharmacologic agents. It is therefore of paramount importance that the method for securing and airway permit a successful outcome when used by nonphysician crewmembers during medical emergencies in space. This article evaluates airway management in the microgravity environment and applies to both the International Space Station and the Space Shuttle, whether operating independently or docked.