Chronic respiratory disease
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Tracheostomy is the most common surgical procedure performed on critically ill patients. For those who survive their critical illnesses but remain ventilator-dependent, tracheostomy provides patients with a secure airway that frees the mouth for oral nutrition, enhances verbalized speech, and promotes generalized comfort. Avoiding complications from tracheostomy requires a skilled multi-disciplinary approach to ensure that the benefits outweigh the risks of the procedure.
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The diagnosis and management of SVV remains one of the most challenging clinical scenarios encountered by a clinician. Careful attention to detail and a thorough knowledge of the specific disorders, their therapies, and complications thereof is required to optimally care for these patients. The recent completion of a number of randomized, controlled, multicenter clinical trials has greatly improved our knowledge base and ability to care for vasculitis patient. The next decade holds even more promise.
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Patients with cystic fibrosis (CF) are susceptible to chronic respiratory infection with a number of bacterial pathogens. The Burkholderia cepacia complex bacteria are problematic CF pathogens because (i) they are very resistant to antibiotics, making respiratory infection difficult to treat and eradicate; (ii) infection with these bacteria is associated with high mortality in CF; (iii) they may spread from one CF patient to another, leading to considerable problems for both patients and carers; and (iv) B. cepacia complex bacteria are difficult to identify and nine new species have now been found to constitute isolates originally identified as 'B. cepacia' based on their phenotypic properties. ⋯ Several virulence factors have been defined for B. cenocepacia (the dominant CF pathogen within the complex); however, knowledge of the disease mechanisms employed by other B. cepacia complex species is limited. The recent determination of the complete genome sequences for several of the B. cepacia complex species should greatly enhance our ability to study these problematic CF pathogens.
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Manual lung hyperinflation (MHI) can enhance secretion clearance, improve total lung/thorax compliance and assist in the resolution of acute atelectasis. To enhance secretion clearance in the intubated patient, the evidence highlights the need to maximize expiratory flow. Chronic pulmonary diseases such as chronic obstructive pulmonary disease (COPD) have often been cited as potential precautions and/or contra-indications to the use of manual lung hyperinflation (MHI). ⋯ MHI may also increase right ventricular after load through raised intrathoracic pressures with lung hyperinflation, and may therefore impair right ventricular function in patients with evidence of cor pulmonale. There is the potential for beneficial effects from MHI in the intubated COPD patient group (i.e., secretion clearance), but further research is required, especially on the effect of MHI on inspiratory and expiratory flow rate profiles in this patient group. The more controlled delivery of lung hyperinflation through the use of the mechanical ventilator may be a more optimal means of providing lung hyperinflation and should be further investigated.