Resp Care
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We have previously demonstrated aerosol delivery during conventional and high frequency oscillatory (HFOV) ventilation using magnetic resonance imaging (MRI) in piglets. There are no reports on aerosol delivery during high frequency jet ventilation (HFJV). ⋯ This is the first report of effective aerosol delivery in a neonatal HFJV circuit. Future studies are needed for more accurate quantification of aerosol deposition.
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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.
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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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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.
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Tuberculosis (TB) remains an important public health problem worldwide, as its residual lesions result in functional and quality of life impairments. Few studies have investigated multiple-drug-resistant pulmonary TB (MDR-TB), and the literature regarding the functional parameters of this group of patients is scarce. Functional characterization may point to the need for post-treatment intervention measures that optimize the quality of life in patients with MDR-TB. Thus, this study sought to analyze the respiratory function, functional capacity, and quality of life of patients who were treated for MDR pulmonary TB. ⋯ In conclusion MDR-TB cured subjects exhibit impaired respiratory function and a mildly reduced functional capacity and quality of life, suggesting that a portion of these patients may require a pulmonary rehabilitation approach.