Resp Care
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Ventriculopleural shunts are uncommonly used for the treatment of normal pressure hydrocephalus in adults. Pleural effusion has been reported to complicate the course of these ventriculopleural shunts in children. The pleural effusion should typically resemble the cerebrospinal fluid unless frankly infected. ⋯ We discuss the possible mechanisms in the development of the effusion. It is important to be aware of this unlikely complication of an uncommon procedure. Recognizing the origin of the pleural effusion can help in instituting close follow-up and early referral for revision of the ventriculopleural shunt.
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Spirometric testing is one of the oldest clinical tests still in use today. It is a straightforward test that has the patient maximally exhale from total lung capacity. The key measurements are the forced expiratory volume in the first second (FEV(1)) and the maximum exhaled volume (vital capacity [VC]). ⋯ Using this measurement can diagnose the presence and severity of airway obstruction. This can be used to guide therapies and predict outcomes. Using spirometry to screen for obstructive lung disease, however, can be problematic, and the effect of screening on outcomes has yet to be demonstrated.
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Extracorporeal membrane oxygenation, a form of artificial circulatory support, continues to evolve beyond its well-established neonatal applications. It is often the most aggressive aspect of treatment algorithms in the management of severe respiratory and cardiac failure. While its use is relatively infrequent and executed in a small number of centers, it remains an important supportive measure while organ function is preserved and restored. Refinements in equipment and techniques continue to develop; patient-selection has changed, in adults and children, and cardiac applications have gained prominence.
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Randomized Controlled Trial Comparative Study
Comparison of optimal positive end-expiratory pressure and recruitment maneuvers during lung-protective mechanical ventilation in patients with acute lung injury/acute respiratory distress syndrome.
In patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), the use of alveolar-recruitment maneuvers to improve oxygenation is controversial. There is lack of standardization and lack of clinical studies to compare various recruitment maneuvers. Recruitment maneuvers are closely linked to the selection of positive end-expiratory pressure (PEEP), which is also a subject of debate. ⋯ Sighs superimposed on lung-protective mechanical ventilation with optimal PEEP improved oxygenation and static compliance in patients with early ALI/ARDS.
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New features of mechanical ventilators are frequently introduced, including new modes, monitoring techniques, and triggering techniques. But new rarely translates into any measureable improvement in outcome. We describe 4 new techniques and attempt to define what is a new invention versus what is innovative-a technique that significantly improves a measurable variable. We describe and review the literature on automated weaning, automated measurement of functional residual capacity, neural triggering, and novel displays of respiratory mechanics.