Chest
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Randomized Controlled Trial Clinical Trial
Effect of continuously nebulized ipratropium bromide plus albuterol on emergency department length of stay and hospital admission rates in patients with acute bronchospasm. A randomized, controlled trial.
To compare the outcome of patients with acute bronchospasm treated with continuously nebulized albuterol plus ipratropium bromide vs albuterol alone. ⋯ Although the direction of all three outcome measures favored combination therapy, there was no statistically significant difference between ED patients with acute bronchospasm receiving continuous albuterol plus ipratropium bromide and those receiving albuterol alone.
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Review Case Reports
Mycoplasma pneumoniae-associated bronchiolitis causing severe restrictive lung disease in adults: report of three cases and literature review.
To characterize adult Mycoplasma pneumoniae-induced bronchiolitis requiring hospitalization. ⋯ In adults, Mycoplasma-associated bronchiolitis without pneumonia is rarely reported, but in hospitalized patients, it may be more common than expected and may be associated with severe physiologic disturbances.
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Randomized Controlled Trial Clinical Trial
The unidirectional valve is the best method to determine maximal inspiratory pressure during weaning.
Although maximal inspiratory pressure (MIP) is used as an index of inspiratory muscular strength, there is no consensus on how to measure it. We compared, during weaning from mechanical ventilation, two methods of measurement to determine which shows the greater values (MIPbest) and is more reproducible. One method measured MIP when negative pressure was maintained for at least 1 s after a forceful expiration, and the other method measured MIP with a unidirectional expiratory valve (MIPuni). ⋯ Because MIPuni displayed the maximal values, it is the best method for estimating MIP in patients undergoing short-term mechanical ventilation. The reproducibility of consecutive measurements was similar between the methods, even after a short period of time.
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Modern low-pressure, high-volume cuffed tracheotomy tubes have been shown to decrease tracheal injury. However, injury still occurs in patients requiring prolonged mechanical ventilation and prevents weaning, delays decannulation, prolongs hospitalization, and may totally obstruct the airway. We describe 37 patients, including the first reported case of failure to wean due to tracheal obstruction. ⋯ Tracheal obstruction in patients requiring prolonged mechanical ventilation prevented weaning. Reestablishment of the airway with a longer tracheal tube or tracheal stent allowed most of the patients to be weaned.