Chest
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Comparative Study
Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques.
Pulmonary complications are major causes of morbidity and mortality for patients with severe expiratory muscle weakness. The purpose of this study was to compare peak cough expiratory flows (PCEFs) during unassisted and assisted coughing and review the long-term use of mechanical insufflation-exsufflation (MI-E) for 46 neuromuscular ventilator users. These individuals used noninvasive methods of ventilatory support for a mean of 21.1 h/d for 17.3 +/- 15.5 years. ⋯ Each PCEF was significantly greater than the preceding, respectively (p < 0.01). We conclude that manually assisted coughing and MI-E are effective and safe methods for facilitating airway secretion clearance for neuromuscular ventilator users who would otherwise be managed by endotracheal suctioning. Severely decreased MIC, but not necessarily vital capacity, is an indication for tracheostomy.
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Bronchoalveolar lavage (BAL) has been proposed as a useful procedure for bacteriologic diagnosis of lower respiratory tract infection in mechanically ventilated patients. To determine the cardiopulmonary effects of this procedure and to identify the patients at risk of poor tolerance, 30 critically ill ventilated patients suspected of having pneumonia were studied. Hemodynamic and gas exchange parameters were continuously recorded using an arterial catheter, a Swan-Ganz catheter with SvO2 display, and a pulse oximeter. ⋯ Two hours after the end of BAL, PaO2 values were still 20 percent lower than pre-BAL values in 40 percent of the patients. We conclude that BAL can be performed safely in most critically ill ventilated patients who have stable hemodynamic and ventilatory parameters. However, none of the recorded parameters allows identification of the patients at risk of poor tolerance of the procedure.
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To assess cardiovascular effects and the oxygenation status of mechanically ventilated patients undergoing protected specimen brushing (PSB) and bronchoalveolar lavage (BAL) under fiberoptic bronchoscopy (FOB). ⋯ We conclude that PSB and BAL under FOB are well tolerated in critically ill, mechanically ventilated patients with hemodynamic disturbances requiring inotropic or vasopressor agents (or both); however, a modest impairment in arterial oxygenation was observed after the end of the FOB procedure.