Resp Care
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Intensive-care mechanical ventilators regularly enter the market, but the gas-delivery capabilities of many have never been assessed. ⋯ Most of the tested ventilators performed at an acceptable level during the majority of evaluations, but some ventilators performed inadequately during specific settings. Bedside clinical evaluation is needed.
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Adaptive support ventilation (ASV) facilitates ventilator liberation in postoperative patients in surgical intensive care units (ICU). Whether ASV has similar benefits in patients with acute respiratory failure is unclear. ⋯ Extubation readiness may not be recognized in a timely manner in at least 15% of patients recovering from respiratory failure. ASV helps to identify these patients and may improve their weaning outcomes.
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Hudson prongs (Hudson RCI, Teleflex Medical, Research Triangle Park, North Carolina) (a device to deliver nasal continuous positive airway pressure) are often secured with a "Velcro mustache" in neonatal intensive care units. We report 2 premature infants who required bag-and-mask ventilation while on Hudson prongs secured with a Velcro mustache. Effective ventilation was achieved only after removing the Velcro mustache.
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Randomized Controlled Trial
Evaluation of an alternative chest physiotherapy method in infants with respiratory syncytial virus bronchiolitis.
We proposed a new chest physiotherapy (CPT) secretion clearance method to treat respiratory syncytial virus bronchiolitis in infants. Our new CPT method consists of 15 prolonged slow expirations, then 5 provoked cough maneuvers. ⋯ Our new CPT method showed short-term benefits to some respiratory symptoms of bronchial obstruction in infants with acute respiratory syncytial virus bronchiolitis.
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Respiratory failure and acute respiratory distress syndrome secondary to H1N1 influenza infection is a source of substantial morbidity and mortality, having caused over 265,000 hospitalizations in the United States in 2009. During the H1N1 pandemic, up to 31% of the H1N1 patients required intensive care unit admission, and many were refractory to maximal conventional therapies. These most critically ill patients may require extracorporeal membrane oxygenation (ECMO) for survival. ⋯ This series suggests that ECMO is a viable treatment for refractory hypoxemia secondary to H1N1 influenza infection in both pediatric and adult patients.