Chest
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Randomized Controlled Trial Clinical Trial
Reduced effect of inhaled beta 2-adrenergic agonists on lung mucociliary clearance in patients with cystic fibrosis.
It has been suggested that the defective cyclic AMP-dependent Cl- secretion and the increased Na+ absorption from airway epithelia in cystic fibrosis (CF) may lead to dehydrated secretions and impaired mucociliary clearance. Beta 2-adrenergic agonists are unable to stimulate the Cl- transport in the airways in CF while being able to do so in normal airways. Thus, we questioned whether the beta 2-adrenergic agonist, terbutaline, would improve mucociliary clearance in patients with CF as it does in healthy subjects. ⋯ We conclude that 1 mg of terbutaline did not improve mucociliary clearance significantly in the patients with CF. Also, the effect of terbutaline was much less than demonstrated earlier in healthy subjects. This is consistent with earlier findings of a lack of beta-adrenergic modulation of Cl- transport in CF. Thus, no rehydration of the dry mucus in CF is expected, and a possible beta 2-agonist-induced increase in ciliary beating would have only a minor effect on overall mucociliary clearance.
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Advances in cytokine biology and molecular biology have led to the development of novel immunologic approaches to the treatment of septic shock, ARDS, and MOF. These advances are necessary since improvements in supportive care clearly fall short of the hoped-for reductions in mortality associated with these disorders. As noted in this review, these new therapies are directed at three distinct levels of the inflammatory cascade: (1) the inciting event or insult (eg, endotoxin); (2) the mediators (eg, TNF, IL-1); and (3) the effector cells (eg, neutrophils). ⋯ That is, due to the complexity and redundancy of the inflammatory network, it is doubtful that a "magic bullet" will be found. However, it is also clear that advances in our understanding of the pathogenesis of ARDS, septic shock, and MOF at the molecular level have provided clinicians with powerful weapons with which to do battle. It remains to be seen which ones will work the best.
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Case Reports Comparative Study
Inverse ratio ventilation in ARDS. Improved oxygenation without autoPEEP.
Inverse ratio ventilation and related ventilatory modes (eg, pressure release ventilation) have been applied to patients with the adult respiratory distress syndrome (ARDS) with apparent beneficial effects on arterial oxyhemoglobin saturation. While several mechanisms of improved gas exchange have been postulated, many intensive care physicians believe that the development of occult PEEP (autoPEEP; intrinsic PEEP) leads to the observed rise in oxygen saturation. We report here our findings in a patient whose improved oxygenation on inverse ratio ventilation could not be attributed to autoPEEP.
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Two cases of airway foreign bodies involving the aspiration of component parts of commonly used respiratory therapy equipment are described. The first case demonstrated the accidental introduction of a washer from a closed catheter suction system into the airway of a patient. The second case involved the accidental introduction of a part of an intubating stylet into the lung. Improper use of this equipment can result in airway foreign bodies and potential respiratory compromise.