Respiratory care clinics of North America
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Respir Care Clin N Am · Dec 1998
ReviewAcute respiratory distress syndrome. Patient position and motion strategies.
A review of the literature since 1974 indicates that, although there is no consensus as to the mechanism, positioning strategies in patients with ARDS improve PaO2 and may diminish lung parenchymal damage. The effect of these maneuvers on patient outcomes is uncertain. There is no uniform algorithm for the application of these techniques; however, there is sufficient evidence cited in the referenced articles to support the use and early application of the techniques to improve oxygenation.
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The increased understanding of the pathophysiology of acute lung injury that has been achieved over the last decade has led to several new pharmacologic approaches for the prevention and management of ARDS. Based on in vitro information and animal models, many of these strategies are quite compelling. Nevertheless, to date, no specific pharmacologic approach for the prevention or treatment of ARDS has been validated conclusively in clinical trials. Active basic and clinical investigations are continuing, and it is hoped that these will lead to new therapies that can be applied by the clinician in the management of future ARDS patients.
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Respir Care Clin N Am · Sep 1998
ReviewMechanical ventilation of the patient with chronic obstructive pulmonary disease.
Mechanical ventilation of the patient with COPD is a balance between avoiding overdistension, auto-PEEP, providing adequate gas exchange, and allowing patient-ventilator synchrony. Figure 13 shows an approach that the authors have found helpful to achieve these goals.
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Humidification devices and techniques can expose the airway mucosa to a wide range of gas temperatures and humidities, some of which are excessive and may cause injury. Humidified gas is a carrier of both water and energy. The volume of water in the gas stream depends on whether the water is in a molecular form (vapor), particulate form (aerosol), or bulk form (liquid). ⋯ Humidifiers, however, do not measure the gas temperature at the patient airway but only at the circuit wye. To compensate for any cooling of the gas as it passes from the wye to the patient the gas temperature at the wye must be set higher than core temperature. To safely avoid the risk that this higher temperature may accidentally reach the patient and cause an injury, the average gas temperature at the wye should restricted to less than 43 degrees
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In summary, current data indicate that body temperature cannot be controlled efficiently by changing inspired gas temperature. Inspired gas temperature should therefore be maintained at 32 degrees C to 34 degrees C for intubated patients and other efforts should be made to optimize body temperature.