Resp Care
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Mediastinal and hilar lymph node evaluation with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is being performed with increasing frequency. Original reports described performance under general anesthesia. Patient satisfaction is an important determinant of whether EBUS-TBNA may be performed under conscious sedation. ⋯ EBUS-TBNA may safely be performed under conscious intravenous sedation and is associated with very high patient satisfaction.
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Case Reports
A case of pneumomediastinum in a patient with acute respiratory distress syndrome on pressure support ventilation.
During mechanical ventilation for acute respiratory distress syndrome, tidal volume (V(T)) must be reduced. Once switched to pressure-support ventilation, there is a risk that uncontrolled large V(T) may be delivered. A 63-year-old man with community-acquired pneumonia required tracheal intubation and mechanical ventilation, with a V(T) of 6 mL/kg predicted body weight, PEEP of 10 cm H2O, a respiratory rate of 30 breaths/min, and F(IO2) of 0.60. ⋯ V(T) received over the previous 3 days had averaged 14 mL/kg predicted body weight. The patient was put back onto volume-controlled mode, and 2 days later there were no air leaks. In pressure-support ventilation, V(T) must be closely monitored to ensure lung-protective mechanical ventilation.