Thorax
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Randomized Controlled Trial Clinical Trial
Aerosol kinetics and bronchodilator efficacy during continuous positive airway pressure delivered by face mask.
Rates of fresh gas flow (FGF) commonly used when continuous positive airway pressure (CPAP) is delivered by face mask theoretically reduce the delivery and availability of therapeutic aerosols. As it may be hazardous for patients with acute respiratory failure to interrupt mask CPAP, the effects of CPAP on aerosol kinetics and bronchodilator efficacy were investigated. ⋯ Despite a reduction in aerosol presented to the proximal airway, the bronchodilator response to inhaled beta 2 agonists in stable asthmatic subjects was not affected when CPAP was delivered by face mask. Despite a high rate of FGF, nebulised beta 2 agonists are effective when administered in conjunction with CPAP delivered by face mask.
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Although one would predict that surfactant replacement therapy would be effective in acute respiratory distress syndrome (ARDS), a recent large trial proved unsuccessful, possibly reflecting the nature of the surfactant used. Given the importance of the unique proteins in the action of surfactant, these would seem vital components of any exogenous surfactant. ⋯ Advanced cases might undergo bronchoscopic focal lavage to remove plasma proteins and inflammatory mediators prior to focal instillation of surfactant to areas of greatest need. Ventilation regimens might be adjusted both to minimise trauma and to conserve endogenous surfactant.