Respiratory care clinics of North America
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The rationale for using the most appropriate equipment to administer oxygen and medical gas mixtures is presented. The emphasis is placed on delivering an appropriate FiO2 for the patient's pathophysiology. ⋯ The research that supports the use of one device over another is discussed when available. The advantages of high-flow fixed performance equipment are contrasted with low-flow variable performance devices.
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Respir Care Clin N Am · Dec 2000
ReviewOther modalities of oxygen therapy: hyperbaric oxygen, nitric oxide, and ECMO.
Novel therapies for the next decade include hyperbaric oxygen, nitric oxide, and extracorporeal membrane oxygenation. Hyperbaric oxygen delivers oxygen at a pressure greater than one atmosphere and has been used in diseases ranging from decompression sickness to carbon monoxide poisoning. Inhaled nitric oxide, a potent vasodilator, has been used in the acute respiratory distress syndrome and for the diagnosis and treatment of pulmonary hypertension. Extracorporeal membrane oxygenation (ECMO) has been used to provide cardiopulmonary bypass support, particularly in the pediatric and neonatal population.
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Liquid ventilation (LV) is an exciting, up-and-coming technique presently under investigation for the treatment of acute respiratory distress syndrome (ARDS) and infantile respiratory distress syndrome (IRDS). Two different methods of LV, total liquid ventilation (TLV) and partial liquid ventilation (PLV), are described in this article using a liquid called perflubon. This type of therapy has been shown to positively affect the physiologic derangements seen in ARDS and IRDS cases, and may have additional benefits, including anti-inflammatory properties and synergistic characteristics with other known and experimental therapies.
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It has become increasingly clear that a lung protective ventilatory strategy during adult respiratory distress syndrome/acute lung injury has a positive effect on outcome. Lung recruitment is a major component of this strategy. High-pressure recruitment maneuvers and prone positioning can open the lung; however, once the lung is opened, it must be kept open with appropriate levels of positive end-expiratory pressure. For both of these techniques to be effective, they must be used early in the course of adult respiratory distress syndrome/acute lung injury.
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This article reviews the complex physiology of oxygen transport in the fetus and neonate, and how it differs from the older pediatric patient and adult. The common causes of respiratory distress unique to the neonatal and pediatric populations are reviewed in detail, including a brief discussion regarding the different modes of mechanical ventilation used in neonates. The increased susceptibility of infants to the toxic effects of oxygen is reviewed.