Resp Care
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Case Reports
Mediastinal teratoma with pulmonary involvement presenting as massive hemoptysis in 2 patients.
Massive hemoptysis is described in many disease processes. However, a mediastinal teratoma is rarely considered in a patient presenting with massive hemoptysis. ⋯ Flexible bronchoscopy can be diagnostic in cases of a mediastinal teratoma with involvement of the bronchial tree. We report 2 cases of hemoptysis caused by mediastinal teratoma with bronchial communication.
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The development of less expensive, smaller, and more reliable video cameras has revolutionized the design of laryngoscopes and the process of endotracheal intubation. The term video laryngoscopy defines a broad range of devices, distinct from fiberoptic bronchoscopes, in which a video camera is used in place of line-of-sight visualization to accomplish endotracheal intubation. ⋯ Each model of video laryngoscope has its own unique strengths, weaknesses, and best applications. For the purposes of this review, video laryngoscopes are grouped into 3 different designs: stylets, guide channels, and video modifications of the traditional (usually Macintosh) laryngoscope blades.
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To determine the impact of the 2005 American Heart Association cardiopulmonary resuscitation (CPR) guidelines, including use of an impedance threshold device (ITD), on survival after in-hospital cardiac arrest. ⋯ Implementation of improved ways to increase circulation during CPR increased the in-hospital discharge rate by 60%, compared to historical controls in 2 community hospitals. These data demonstrate that immediate care with improved means to circulate blood during CPR significantly reduces hospital mortality from inhospital sudden cardiac arrest.
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Ventilator-associated pneumonia (VAP) is a pervasive and expensive nosocomial infection that is largely related to instrumentation of the airway with an endotracheal tube (ETT), followed by microaspiration of contaminated secretions. VAP prevention will probably be most effective via a multifaceted approach, which includes meticulous attention to basic infection-control methods during patient care, proper patient positioning, oral hygiene, and removal of the ETT as soon as indicated. ⋯ Most importantly, cost-effectiveness data are lacking for modified ETTs designed to prevent VAP. It is critical that future studies of ETTs designed to prevent VAP be adequately powered to demonstrate efficacy on important patient outcomes and safety, in addition to cost-effectiveness.
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Tracheostomy tubes are placed for a variety of reasons, including failure to wean from mechanical ventilation, inability to protect the airway due to impaired mental status, inability to manage excessive secretions, and upper-airway obstruction. A tracheostomy tube is required in approximately 10% of patients receiving mechanical ventilation and allows the patient to move to a step-down unit or long-term care hospital. The presence of a tracheostomy tube in the trachea can cause complications, including tracheal stenosis, bleeding, infection, aspiration pneumonia, and fistula formation from the trachea to either the esophagus or the innominate artery. Final removal of the tracheostomy tube is an important step in the recovery from chronic critical illness and can usually be done once the indication for the tube placement has resolved.