Resp Care
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This was an evaluation of intra-individual variation of the cuff-leak test (ΔCLT) immediately post-intubation and pre-extubation, as a predictor of post-extubation stridor. ⋯ The intra-individual variation of CLT immediately post-intubation and pre-extubation does not improve the accuracy of a standard pre-extubation CLT to predict post-extubation stridor. Moreover, the standard pre-extubation CLT did not appear in our study to be an ideal test to detect post-extubation stridor. Larger studies should be performed before generalizing these preliminary results.
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Blow-by, a common form of nebulizer therapy, in which the device is held away from a child's face, has been dismissed as ineffective because studies have demonstrated incremental aerosol drop-off with increasing distances from the face. Many of these studies do not take into account differences among nebulizer systems. Using common, commercially available nebulizer systems, we defined the interaction of system components (nebulizer type, face mask configuration, and compressor characteristics) on aerosol delivery with and without blow-by. ⋯ At 4 cm, the Pari system delivered more drug than Respironics at 0 cm, suggesting adequate therapy during blow-by for some systems. Our results indicate that pediatric aerosol delivery is a strong function of the nebulizer system as a whole, and not simply a function of blow-by distance from the face or nebulizer efficiency. In uncooperative children, blow-by can be an effective means of drug delivery with the appropriate nebulizer system.
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Case Reports
Prolonged high-frequency oscillatory ventilation in tubercular multifocal cystic lung disease.
Multifocal cystic lung disease in infants is most commonly congenital, and is managed surgically with perioperative mechanical ventilation. Multifocal cystic lung disease in infants may be due to tuberculosis. We report a young infant with tubercular multifocal cystic lung disease and respiratory failure. ⋯ Subsequent chest imaging showed progression to multifocal cystic lung disease. The ventilation mode was changed to high-frequency oscillatory ventilation (HFOV) due to persistent CO(2) retention in the presence of cystic lung disease. The cystic lung disease reversed with antitubercular treatment and prolonged HFOV with slow wean.