Resp Care
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In-line administration of bronchodilators is widely used in pediatric patients receiving mechanical ventilation. We compared the amount of albuterol captured at the end of the endotracheal tube (ETT) with an intrapulmonary percussive ventilator (IPV) versus a Salter 8900 jet nebulizer placed in-line in a pediatric ventilator model, under various operating conditions. We hypothesized that the type of aerosol generator, tidal volume (V(T)), and position in the ventilator circuit would influence the albuterol delivery. ⋯ The IPV delivered less albuterol than the jet nebulizer when placed at the humidifier. IPV was equivalent to jet nebulizer when placed at the Y-piece. Doubling the V(T) did not increase aerosol delivery.
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As hospitals begin to implement electronic medical records, the inadequacies of legacy paper charting systems will become more evident. One area of particular concern for respiratory therapists is the charting of mechanical ventilator settings. ⋯ Of particular note is the complexity related to set airway pressures when using modes whose primary control variable is pressure (versus volume). We review the clinically relevant issues surrounding documentation of the patient-ventilator interactions related to airway pressure and provide suggestions for a standardized vocabulary.
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Multicenter Study Controlled Clinical Trial
A low-sodium solution for airway care: results of a multicenter trial.
Normal saline is sometimes instilled into the endotracheal tube preparatory to airway suctioning, to assist in removing thick secretions. However, saline can damage the antimicrobial properties of airway secretions. We previously described a low-sodium physiologically based solution for airway care and reported a small (n = 60) randomized trial in neonates, which showed trends toward less ventilator-associated pneumonia (VAP) and less chronic lung disease with the new solution. We now report a multicenter trial of that solution. ⋯ The test solution significantly reduced the VAP and chronic lung disease rates.
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Meta Analysis
Role of noninvasive ventilation in acute lung injury/acute respiratory distress syndrome: a proportion meta-analysis.
The role of noninvasive ventilation (NIV) in the management of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is controversial. ⋯ Our results suggest an almost 50% NIV failure rate in patients with ALI/ARDS, so NIV should be cautiously used in patients with ALI/ARDS. There is a need for a uniform NIV protocol for patients with ALI/ARDS.