Chest
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To determine the usefulness of routinely inserting a hollow airway exchange catheter (jet stylet) prior to tracheal extubation of adult patients with risk factors for difficult tracheal intubation. ⋯ The No. 11 CAEC is a useful and effective tool for giving patients a trial of extubation. Administration of oxygen through the CAEC diminishes the potential for hypoxia while maintaining the ability to reintubate the trachea, especially when reintubation might prove challenging. Previous data suggest that the CAEC is rigid enough to facilitate tracheal reintubation in adults; this was confirmed in the three patients in our study who required tracheal reintubation. The risk of aspiration, barotrauma, or other airway trauma during prolonged placement of the CAEC appears to be low (zero incidence in 40 patients in this study), and use of the No. 11 CAEC appeared to be safe. Since oxygen can be delivered through the CAEC, it may provide a means to safely evaluate an airway during a trial of extubation, ie, a reversible extubation. Finally, oxygen administration through the CAEC may obviate the need for facemask or nasal cannula following tracheal extubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative physiologic effects of noninvasive assist-control and pressure support ventilation in acute hypercapnic respiratory failure.
To compare the effects of noninvasive assist-control ventilation (ACV) and pressure support ventilation (PSV) by nasal mask on respiratory physiologic parameters and comfort in acute hypercapnic respiratory failure (AHRF). ⋯ During NIV for AHRF using settings adapted to patient's clinical tolerance and mask air leaks, both ACV and PSV mode provide respiratory muscle rest and similarly improve breathing pattern and gas exchange. However, these physiologic effects are achieved with a lower inspiratory workload but at the expense of a higher respiratory discomfort with ACV than with PSV mode.
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Randomized Controlled Trial Comparative Study Clinical Trial
Ultrasonic nebulization of albuterol is no more effective than jet nebulization for the treatment of acute asthma in children.
Nebulizer systems used to generate therapeutic aerosols vary in their ability to deliver medication to the airway. In a recent study in 17 adults with stable asthma, albuterol given using an ultrasonic nebulizer (UN) appeared to produce greater bronchodilatation than the same dose of albuterol given by a jet nebulizer (JN). The purpose of this study was to determine if the UN used in that study would produce a better bronchodilator response in children with acute asthma than the JN system that has been in use at Cardinal Glennon Children's Hospital. ⋯ For the treatment of acute exacerbations of asthma in children, there is no greater bronchodilator response when albuterol is administered by a UN than by a JN.
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Lactic acidosis previously has been reported during treatment of asthma with beta-2 agonists. However, this metabolic disturbance never had any clinical consequence. We report a case of a patient with asthma in whom beta-2 agonist administration increased dyspnea by metabolic acidosis due to a sharp increase in lactate levels (hyperlactatemia) and led to inappropriate intensification of bronchodilator therapy.