Respiratory care clinics of North America
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An in-depth examination of ventilators currently marketed for the pediatric population and the technology associated with each is provided with this article. Also included is a discussion of an "ideal pediatric ventilator" and its application to the pediatric intensive care patient. Triggering, cycling, and limiting variability, costs, and special features currently available are detailed.
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High-frequency oscillatory ventilation (HFOV) offers the potential to maintain adequate gas exchange without imposing the large pressure swings and tidal volumes associated with ventilatory-induced lung injury. This article reviews the studies evaluating the use of HFOV to treat pediatric respiratory failure, discusses the complications associated with HFOV, and details an approach to the practical application of HFOV in the non-neonatal pediatric population.
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Respiratory considerations in aeromedically evacuated patients are the cornerstone of safe, successful transport. Maintenance of the ABCs and ongoing resuscitation including pulmonary/ventilator stabilization and management en route are paramount. All of these goals are predicated on a well-developed understanding of hypobaric pulmonary physiology and hypobaric effects on medical devices, a solid grasp of the inherent limits of an aeromedical environment, and the resolute accomplishment of both initial and follow-up team member training.
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Combined flail chest and pulmonary contusion is a frequent problem in patients with blunt multisystem trauma admitted to the intensive care unit. These patients are at high risk for pneumonia and adult respiratory distress syndrome, which adds substantially to their morbidity and mortality rates. This article discusses the epidemiology and pathophysiology of this condition and the role of the respiratory care practitioner in the optimal management of these critically injured patients.
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Ventilatory support during cardiopulmonary resuscitation can be accomplished with an array of methods and devices. These run the gamut from expired air resuscitation, including mouth-to-mouth and mouth-to-mask, to the use of ventilators including ventilator-to-mask and ventilator-to-artificial airway techniques. Appropriate application of these techniques depends on the clinical situation, rescuer training, and availability of equipment. This article discusses the proposed standards of emergency ventilatory support, the advantages and disadvantages of the techniques and devices used, and current controversies surrounding this topic.