Resp Care
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To describe survival outcomes with noninvasive ventilation (NIV) for full ventilatory support, and a mechanically assisted cough and oximetry protocol in a series of patients with Duchenne muscular dystrophy. ⋯ Continuous NIV along with mechanically assisted cough and oximetry as needed can prolong life and obviate tracheotomy in patients with Duchenne muscular dystrophy. Unweanable patients can be decannulated and extubated to NIV plus mechanically assisted cough.
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Review
Optimizing the respiratory pump: harnessing inspiratory resistance to treat systemic hypotension.
We review the physiology and affects of inspiration through a low level of added resistance for the treatment of hypotension. Recent animal and clinical studies demonstrated that one of the body's natural response mechanisms to hypotension is to harness the respiratory pump to increase circulation. That finding is consistent with observations, in the 1960s, about the effect of lowering intrathoracic pressure on key physiological and hemodynamic variables. ⋯ While breathing has traditionally been thought primarily to provide gas exchange, studies of the mechanisms involved in animals and humans provide the physiological underpinnings for "the other side of breathing": to increase circulation to the heart and brain, especially in the setting of physiological stress. The existing results support the use of the intrathoracic pump to treat clinical conditions associated with hypotension, including orthostatic hypotension, hypotension during and after hemodialysis, hemorrhagic shock, heat stroke, septic shock, and cardiac arrest. Harnessing these fundamental mechanisms that control cardiopulmonary physiology provides new opportunities for respiratory therapists and others who have traditionally focused on ventilation to also help treat serious and often life-threatening circulatory disorders.
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The Boussignac continuous positive airway pressure (CPAP) device effectively treats acute pulmonary edema, but data on airway pressure with the Boussignac CPAP system are sparse. ⋯ With CPAP, pressure changes are considered to be associated with increased work of breathing. The device's pneumatic performance is adequate during normal breathing with low air flow, but during forced breathing (high air flow) it did not maintain stable airway pressure, which could increase the work of breathing and cause respiratory fatigue. Thus, the Boussignac CPAP system might be less suitable for a patient breathing at a higher frequency.
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Comparative Study
Nebulized hypertonic saline via positive expiratory pressure versus via jet nebulizer in patients with severe cystic fibrosis.
Nebulized hypertonic saline is a highly effective therapy for patients with cystic fibrosis (CF), yet 10% of patients are intolerant of hypertonic saline administered via jet nebulizer. Positive expiratory pressure (PEP) nebulizers splint open the airways and offers a more controlled rate of nebulization. ⋯ Hypertonic saline via PEP nebulizer benefits CF patients who do not tolerate hypertonic saline via jet nebulizer.
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Randomized Controlled Trial
Remifentanil improves breathing pattern and reduces inspiratory workload in tachypneic patients.
Properly titrated opiates decrease respiratory rate but do not affect tidal volume or induce respiratory acidosis. ⋯ Remifentanil improved respiratory pattern and decreased inspiratory muscles effort in patients with tachypnea or rapid shallow breathing, but did not affect oxygenation or sedation. Though the acid-base balance did not show clinically relevant changes on average, we cannot exclude the possibility that remifentanil might prolong weaning in hypercapnic patients. (Clinical-Trials.gov registration NCT00665119.)