Resp Care
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Comparative Study
Comparison of Alpha 200 and CoughAssist as intermittent positive pressure breathing devices: a bench study.
Intermittent positive pressure breathing (IPPB) is used in non-intubated patients to increase lung volume and to enhance coughing. Alpha 200 (Salvia Lifetec, Kronberg, Germany) is a specific IPPB device. CoughAssist (Respironics France, Carquefou, France) is a mechanical insufflator-exsufflator used to remove secretions in patients with inefficient cough. Both can also be used for intubated or tracheotomized patients. We assessed the impact of various artificial airways on the ability of the Alpha 200 and CoughAssist to generate insufflated volume. ⋯ This bench study has shown that in the presence of artificial airways the value of the insufflated volume generated by the CoughAssist device was significantly lower than that generated by the Alpha 200 device.
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While the etiologies of solitary pulmonary nodules (SPNs) in immunocompetent patients are well established, common etiology, diagnostic techniques, and guidelines to assess SPNs in patients infected with human immunodeficiency virus (HIV) have not been established. ⋯ Etiologies of SPN in HIV-infected patients are varied and difficult to diagnose. In our study, SPN was attributable to infectious etiology in 50% of cases. Sputum analysis was of no diagnostic value. Biopsy is necessary for definitive diagnosis and treatment.
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We report an 18-year-old ice skater with acute lymphoblast leukemia. She developed Staphylococcus epidermidis bacteremia, severe sepsis, septic shock, and ARDS following chemotherapy-induced severe bone marrow failure. She was successfully treated with extraordinary life support measures, which included extracorporeal membrane oxygenation, double lumen lung ventilation for management of hemoptysis, and lung assist membrane ventilation. After 57 days of ICU treatment and a year of rehabilitation, the patient has fully regained her functional status, is now finishing high school, and is ice skating again.
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Previous research reporting factors influencing aerosol delivery in intubated patients has been largely focused on the endotracheal tube (ETT) during mechanical ventilation, with little comparative analysis of effect of types of artificial airways and their interfaces on aerosol delivery during spontaneous breathing. The purpose of this study was to compare aerosol delivery via tracheostomy tube (TT) and ETT, using interfaces such as T-piece, tracheostomy collar, and manual resuscitation bag. ⋯ In this adult model of spontaneous ventilation, aerosol therapy through ETT was less efficient than TT, while the manual resuscitation bag was more efficient than T-piece or tracheostomy collar.
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Oxygen therapy is an important therapeutic resource for patients with hypoxemia. When changing oxygen flow meters, we have observed that sometimes, even with the same oxygen flow setting as before, a different S(pO(2)) is obtained. ⋯ The flow meters tested showed good precision and poor accuracy.