Resp Care
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Performance of Flutter® (Axcan Scandipharm Inc, Birmingham, AL), Acapella® (Smiths Medicals Inc, Rockland, MA) and Quake® (Thayer Medical, Tucson, AZ) were compared at similar frequencies and amplitudes of oscillations at nine angles of the device in clearing simulated mucus inside a tracheal model (trachea) oriented at three angles with or without simulated constrictions in airway upstream of trachea. ⋯ Mucus clearance can be significantly enhanced by coughing through oscillating positive expiratory devices that generate high amplitude oscillations at moderate frequencies, increasing frontal depths of mucus facing airflow and slightly increasing resistance to airflow in airways in COPD patients.
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Inhaled nitric oxide (INO) has been shown to preferentially lower resistance in the pulmonary vasculature. The relative selectiveness of INO in accomplishing this effect makes it an attractive drug to administer as salvage therapy in patients with acute right ventricular failure secondary to pulmonary embolism. We describe 4 cases in which INO was used as a temporizing agent to decrease right ventricular after-load following massive near-fatal pulmonary embolism. All 4 patients survived to hospital discharge.
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Case Reports
Continuous noninvasive ventilation delivered by a novel total face mask: a case series report.
Noninvasive ventilation (NIV) has been widely used to decrease the complications associated with tracheal intubation in mechanically ventilated patients. However, nasal ulcerations may occur when conventional masks are used for continuous ventilation. ⋯ The total face mask was very well tolerated by all the patients, and permitted safe and efficient continuous NIV for several days until the acute respiratory failure episode resolved. None of the patients required endotracheal intubation during the acute episode.
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The bedside chest x-ray (CXR) is an indispensible diagnostic tool for monitoring seriously ill patients in the intensive care unit. The CXR often reveals abnormalities that may not be detected clinically. ⋯ The interpretation of the bedside CXRs is often challenging, and requires extensive radiologic experience to avoid misinterpretation of the wide spectrum of pleural and pulmonary disease. The clinical information is of substantial value for the interpretation of the frequently nonspecific findings.