Chest
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To evaluate the effects of fiberoptic bronchoscopy (FOB) on delivered volumes and pressures during mechanical ventilation, utilizing a lung model. ⋯ Extreme care must be taken when bronchoscopy is performed on a patient receiving mechanical ventilation. Extremely low VT and significant auto-PEEP may develop unless flow, respiratory rate, mode, and ETT size are carefully selected. The PC mode delivered more volume than did the CMV mode. When performing FOB during mechanical ventilation, the inside diameter of the ETT should be > or = 2.0-mm larger than the outside diameter of the bronchoscope to maintain volume delivery and minimize the development of auto-PEEP.
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Comparative Study
Predisposing factors for nosocomial pneumonia in patients receiving mechanical ventilation and requiring tracheotomy.
To assess the incidence of nosocomial pneumonia (NP) after tracheotomy in an ICU population and to determine NP risk factors during the ICU stay, particularly on the day of tracheotomy. ⋯ Our results could suggest that tracheotomy should be delayed in mechanically ventilated patients with bronchial colonization and hyperthermia, when sedation cannot be discontinued after the procedure, to prevent occurrence of early NP.
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Comparative Study
Correlation of changes in quality of life after lung volume reduction surgery with changes in lung function, exercise, and gas exchange.
To evaluate correlations between improvement in quality of life (QOL) in patients with severe COPD before and after they undergo lung volume reduction surgery (LVRS) with changes in pulmonary function tests, gas exchange, exercise performance, and alterations in medical management. ⋯ There is an association between an improvement in QOL and reduced hyperinflation after LVRS. Reduced hyperinflation may lead to more efficient work of breathing during exercise and, therefore, to an increased ability to perform daily activities. Changes in QOL scores correlate best with behaviorally based variables that directly affect the patient's well-being, such as systemic steroid administration.