Respiratory care clinics of North America
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Respir Care Clin N Am · Dec 2004
Review Comparative StudyThe role of bronchoscopy in the management of lung transplant recipients.
Bronchoscopy is an integral piece in the complex multidisciplinary approach to the care of lung transplant recipients. Although the use of surveillance bronchoscopies is controversial, bronchoscopy undoubtedly provides valuable information in patients with respiratory symptoms or functional decline. ⋯ The objectives of the research should be to increase the yield of bronchoscopy, improve its safety, and decrease procedure-related discomfort. Only randomized, multicenter clinical trials with full commitment from lung transplant centers can accomplish these goals.
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Respir Care Clin N Am · Dec 2004
Review Comparative StudySurgical considerations in lung transplantation: transplant operation and early postoperative management.
During the last 20 years improvements in perioperative care have led to improved outcomes for lung transplant recipients. Although uncommon, technical complications can be the source of significant morbidity and mortality. Infections and ischemia-reperfusion injury continue to have the greatest impact on short-term outcomes of lung transplant recipients, and research into the prevention and treatment of these two entities will be necessary to improve these patients' outcomes significantly.
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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.