Resp Care
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Review
Systematic review of the biology and medical management of respiratory syncytial virus infection.
Respiratory syncytial virus, the leading cause of serious upper and lower respiratory tract infection in infants and children, accounts for 125,000 hospitalizations and 450 deaths annually in the United States. It also may predispose to development of asthma later in life. Annual epidemics occur from November to April, and virtually all infants are infected by age 2. ⋯ The cost of the prophylactic antibody treatment is high; it is cost-effective for only the highest risk patients. Development of a vaccine remains far in the future. Application of evidence-based clinical practice guidelines is making both out-patient and in-patient therapy as effective and economical as possible.
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Respiratory distress syndrome is the most common respiratory disorder in preterm infants. Over the last decade, because of improvements in neonatal care and increased use of antenatal steroids and surfactant replacement therapy, mortality from respiratory distress syndrome has dropped substantially. ⋯ To obtain best results, a multidisciplinary approach is crucial. This review discusses surfactant replacement therapy and some of the current strategies in ventilatory management of preterm infants with respiratory distress syndrome.
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Comparative Study
Performance comparison of two oscillating positive expiratory pressure devices: Acapella versus Flutter.
Oscillatory positive expiratory pressure (PEP) with the Flutter device facilitates secretion removal. In the Flutter a steel ball vibrates inside a cone, causing air flow vibration. A new device, the Acapella, uses a counterweighted plug and magnet to create air flow oscillation. The Acapella comes in 2 models: one for patients with expiratory flow > or = 15 L/min and one for < or = 15 L/min. We hypothesized that the Acapella and Flutter would produce similar mean PEP, oscillatory pressure amplitude, and frequency over a clinically relevant range of flows. ⋯ Acapella and Flutter have similar performance characteristics. Acapella's performance is not gravity-dependent (ie, dependent on device orientation) and may be easier to use for some patients, particularly at low expiratory flows.
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Missed bronchodilator medication treatments in respiratory therapy: frequency and underlying causes.
In the context of increasing attention to medical errors, missed therapies have become a subject of focus both for optimizing clinical care and for assuring appropriate institutional performance during external review by accrediting bodies. Because the issue of missed treatments in respiratory therapy has received little attention to date, we undertook to describe the frequency and causes of missed respiratory therapy bronchodilator medication treatments at the Cleveland Clinic Hospital. ⋯ Overall, the frequency of missed bronchodilator treatments was relatively low in this series. The next steps include developing strategies to lower the frequency of missed treatments, so as to optimize the allocation of respiratory therapy services, and studying the clinical consequences of missed therapies.
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Comparative Study
A comparison of the OxyArm oxygen delivery device and standard nasal cannulae in chronic obstructive pulmonary disease patients.
Compare the performance of the OxyArm to that of nasal cannulae in the delivery of supplemental oxygen to patients with chronic obstructive pulmonary disease. ⋯ The OxyArm maintained stable S(pO2) over the range of oxygen flows studied and at levels equivalent to those maintained by nasal cannulae in 9 of the 10 subjects. The OxyArm does not contact the face and may be ideal for patients on long-term home oxygen therapy.