Resp Care
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Electrical activity of the diaphragm (E(di)) has been proposed as a parameter to evaluate respiratory function. Normative values of electrical activity of the diaphragm in full-term neonates are not known. This is a small case series to establish preliminary values of E(di) in term neonates and to determine how these values vary while awake and asleep and during feeding states. ⋯ These are the first preliminary values for E(di) in neonates. Higher E(di) peak while awake may reflect larger tidal volume to meet increased metabolic requirements when awake and active. Post-prandial lower E(di) peak and higher respiratory rate may indicate compensation for decreased tidal volume from increased intra-abdominal pressure. These data may be useful in identifying respiratory pathology in neonates and monitoring progression toward respiratory health.
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The involvement of pleura in patients with allergic bronchopulmonary aspergillosis (ABPA) is uncommon. In most reported cases the involvement of the pleura is presumed to be due to ABPA per se, due to the observed response to corticosteroids. We report a case of histopathologically proven tubercular pleural effusion in a patient with ABPA at the time of initial diagnosis. This case highlights the importance of intensive evaluation of an exudative pleural effusion in settings where pleural effusion due to the primary underlying disease is uncommon or rare.
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Previous studies have often investigated the association of obstructive sleep apnea (OSA) with cardiovascular morbidity and mortality, but the possibility of reverse causation has not been clearly defined. ⋯ Patients with any of the cardiovascular-related diseases are at a higher risk of having moderate to severe OSA without significant increase in daytime sleepiness. Therefore, we suggest that patients with any of the cardiovascular-related diseases should be screened for OSA, even if they are asymptomatic.
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ARDS remains a lethal complication after major lung resections. The reported mortality ranges from 50% to 100%, with increased incidence and mortality rates in pneumonectomy patients. The pathogenesis of early ARDS is still not fully understood, and the majority of patients will require mechanical ventilation. ⋯ NIV is a technique of augmenting alveolar ventilation delivered by face mask, without introducing an endotracheal tube. NIV may reduce the need for endotracheal mechanical ventilation and improve clinical outcome in patients with acute respiratory failure after lung resection, avoiding complications related to intubation. We present a case of early ARDS following left-sided pneumonectomy, where bi-level positive airway pressure ventilation prompted a successful outcome.
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In home mechanical ventilation (HMV), the mask is a key factor for patient comfort and therapeutic adherence. There is no evidence on the best strategy for choosing the mask in HMV. ⋯ Patient choice is an effective criterion for selecting the interface in HMV treatment.