Respiratory care clinics of North America
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Crape states that in relation to the results of spirometry in the Lung Health Study that perhaps the most important message is that pulmonary function technologists need continuous monitoring and feedback to maintain optimum performance. Technologist education is an essential component of producing valid test results.
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The measurement of co uptake (VCO and DLCO) from alveolar gas is a unique way to noninvasively assess pulmonary vascular function, specifically the functional volume of the pulmonary capillary bed. Proper interpretation of results, however, needs to account for inherent assumptions regarding co distribution and timing procedures. Moreover, reasonable airway mechanics, lung volumes, and patient cooperation are required for accurate measurements. Potential clinical utility may be increased if measurements are made in different positions or under exercise conditions.
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The use of early tracheostomy in the multiply injured trauma patient has many advantages both in terms of patient management and reduction of morbidity associated with prolonged translaryngeal intubation. Tracheostomy (percutaneous or open technique) has been associated with very low risk of mortality and comparable morbidity to prolonged endotracheal intubation. ⋯ A delay in converting translaryngeal intubation to tracheostomy had been associated with longer ICU stays; conversely, early tracheostomy has been associated with a reduction in ICU stays, incidence of hospital-acquired pneumonias, mechanically ventilated days, and length of hospital stay. Thus, the benefits of early tracheostomy are improved care for patients in the trauma or critical care setting and reduced hospital and patient costs.
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Respir Care Clin N Am · Mar 1997
ReviewTo everything turn, turn, turn.... An overview of continuous lateral rotational therapy.
Continuous lateral rotational therapy can be a significant adjunct in the care of the critically ill patient. CLRT has a great impact on both patient outcomes as well as cost containment in the care of the critically ill. These systems should be used with clear guidelines to determine when CLRT is indicated, its therapeutic benefit, and when to discontinue the therapy. Much research is needed to validate efficacy of particular systems, cost-effectiveness, and necessary frequency and degree of rotation to attain optimal clinical benefits.
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The selection of pharmacologic agents for the sedation and paralysis of critically ill patients should be based on clinical and pharmacoeconomic trials in this patient population. There is a need for the design and evaluation of cost-effective regimens, especially with the continued development and release of newer agents. Additionally, clinicians must continue to be sensitive to the monitoring techniques of sedation and paralysis to ensure maximal clinical benefit while minimizing the adverse effect profile of pharmacologic agents.