Resp Care
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Randomized Controlled Trial
Recruitment maneuver in prevention of hypoxia during percutaneous dilational tracheostomy: randomized trial.
Percutaneous dilational tracheostomy (PDT) can potentially lead to hypoxia and alveolar derecruitment. The aim of this prospective study was to evaluate the efficacy of performing a recruitment maneuver (RM) before tracheostomy, in order to improve oxygenation. ⋯ Our study suggests that application of RM before PDT could be useful to avoid hypoxemia following such procedure, by reducing fall in P(aO(2)) and preventing the decrease in oxygenation values below baseline at 6 hours.
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Fiberoptic bronchoscopy and lung biopsy are important diagnostic tools in patients with diffuse pulmonary infiltrates. However, these patients often have hypoxemic respiratory failure that makes this procedure hazardous. Noninvasive ventilation (NIV) has been shown to improve oxygenation in hypoxemic patients. ⋯ NIV-assisted bronchoscopic lung biopsy is a novel method for obtaining diagnosis in hypoxemic patients with diffuse lung infiltrates. However, this approach should be reserved for centers with extensive experience in NIV. More studies are required to define the utility of this approach.
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We present a patient with acute-onset dyspnea and unexplained severe hypoxemia. No signs of severe cardiopulmonary disease, pulmonary arterial hypertension, or pulmonary embolism were present. ⋯ The condition of the patient did not improve and he was referred for liver transplantation, which is the only treatment option with documented efficacy. The case highlights the importance of thinking outside the thorax when evaluating patients with dyspnea.
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Comparative Study
Comparison of cardiopulmonary responses during 2 incremental step tests in subjects with COPD.
It is well established that the work rate increment size affects the duration of test and physiological responses to exercise during cycling in patients with COPD. However, this has never been tested for incremental step tests. ⋯ The slower the work rate increment during step test, the higher the exercise tolerance. Regardless of the work rate increment, cardiopulmonary stress and exertion effort at peak exercise were equivalent between tests.
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When obtaining an arterial blood sample via percutaneous puncture, there is a risk of accidentally obtaining venous blood. Conventional methods of confirming arterial blood at the bedside, such as blood color and pulsatile return, can be misleading in patients with low blood pressure or hypoxemia. ⋯ Our results were consistent with a laboratory study showing a significant difference between arterial and venous filling times and a negative correlation between mean arterial pressure and sampler filling time, but our times in adult subjects were longer. Respiratory therapists may find arterial sampler filling time as a useful indicator of successful arterial puncture at the bedside.