Resp Care
-
With the recent increased use of noninvasive ventilation, the prognoses of children with neuromuscular disease has improved significantly. However, children with muscle weakness remain at risk for recurrent respiratory infection and atelectasis. ⋯ This is the first case report of HFCWO for secretion clearance in a severely weak child with type 1 spinal muscular atrophy. In a patient with neuromuscular disease and severe respiratory infection and compromise, HFCWO can be used safely in combination with conventional secretion-clearance physiotherapy.
-
We previously reported a new management variable, work rate, defined as work load due per hour, based on cumulative standard treatment times. We found that work rates were unachievable (ie, exceeded 1 hour of scheduled work per hour of available labor) for 75% of scheduled due times, despite presumed achievable average work load. ⋯ Our studies to date suggest that: basing assignments on average work load leads to periods of unachievable work rate, resulting in missed treatments and staff dissatisfaction. We have only limited ability to reduce peaks in work rate, but staggering treatment times is effective. Fair assignment of work should differentiate scheduled from unscheduled work.
-
Comparative Study
Comparison of the lower confidence limit to the fixed-percentage method for assessing airway obstruction in routine clinical practice.
Although the statistically derived lower limit of normal (LLN) for the ratio of FEV(1) to FVC is considered superior to a fixed cutoff value (such as 0.70) for diagnosing airway obstruction, the fixed-cutoff method continues to be used and advocated. ⋯ The negative age-dependence of FEV(1)/FVC results in over-diagnosis of airway obstruction in middle-aged and elderly men, and under-diagnosis in young men, with the fixed-percentage method. Airway obstruction should be assessed with the LLN of FEV(1)/FVC, with the LLN derived from appropriate reference equations.
-
Portable ventilators continue to decrease in size while increasing in performance. We bench-tested the triggering, battery duration, and tidal volume (V(T)) of 7 portable ventilators: LTV 1000, LTV 1200, Puritan Bennett 540, Trilogy, Vela, iVent 101, and HT50. ⋯ There was wide variability in battery duration and triggering sensitivity. Five of the ventilators performed adequately in V(T) delivery across several settings. The combination of high respiratory rate and low V(T) presented problems for 2 of the ventilators.
-
Case Reports
Surgical resection and liposomal amphotericin B to treat cavitary pulmonary zygomycosis in a patient with diabetes.
We describe a 24-year-old man with type 1 diabetes mellitus and a cavitary lesion in the right upper lobe, caused by a zygomycete. Surgical resection plus liposomal amphotericin B therapy was successful. We discuss predisposing condition, clinical findings, diagnosis, and treatment of pulmonary zygomycosis.