Resp Care
-
Randomized Controlled Trial
CPAP has no effect on clearance, sputum properties, or expectorated volume in cystic fibrosis.
Positive expiratory pressure (PEP) is used for airway clearance in cystic fibrosis (CF) patients. Hypertonic saline (HTS) aerosol increases sputum expectoration volume and may improve respiratory secretion properties. CPAP may also be used to maintain airway patency and mobilize secretions. To evaluate if CPAP would increase the beneficial clearance effect of HTS in subjects with CF, we investigated the effects of CPAP alone and CPAP followed by HTS on sputum physical properties and expectoration volume in CF subjects. ⋯ CPAP alone had no effect on mucus clearance, sputum properties, or expectorated volume, and did not potentiate the effect of HTS alone in CF subjects.
-
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.
-
Comparative Study
Influence of nebulizer type with different pediatric aerosol masks on drug deposition in a model of a spontaneously breathing small child.
The performance of nebulizers varies with the design type as well as the breathing patterns of various age groups. The present study quantified aerosol delivery using spontaneously breathing parameters of a small child (2-4 years) by a lung simulator to determine the influence of nebulizer type, actuation mechanisms, and pediatric aerosol masks. ⋯ In this model using ventilatory parameters associated with a 2-4-year-old child, breath-actuated nebulization was not as effective as continuous nebulization. Aerosol mask design can impact inhaled drug dose across the range of nebulizers tested.
-
High-frequency oscillatory ventilation (HFOV) has been utilized as a rescue oxygenation therapy in adults with ARDS over the last decade. The HFOV oscillating piston can generate negative pressure during the exhalation cycle, which has been termed active exhalation. We hypothesized that this characteristic of HFOV entrains CO(2) into the inspiratory limb of the circuit and increases the total dead space. The purpose of this study was to determine if retrograde CO(2) entrainment occurs and how it is altered by HFOV parameter settings. ⋯ Retrograde CO(2) entrainment occurs during HFOV use and can be manipulated with the ventilator settings. This phenomenon may have clinical implications on the development or persistence of hypercapnia.
-
Case Reports
Dexmedetomidine for sedation in the parturient with respiratory failure requiring noninvasive ventilation.
Dexmedetomidine is a selective alpha-2 receptor agonist that possesses both sedative and analgesic properties, with minimal respiratory depression. We report the successful administration of dexmedetomidine on a 16-year-old primigravida woman that allowed the patient to tolerate application of bi-level positive airway pressure ventilation in treatment of acute hypoxemic respiratory failure.