Resp Care
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Randomized Controlled Trial
Different tracheotomy tube diameters influence diaphragmatic effort and indices of weanability in difficult to wean patients.
To determine the effects of different tracheotomy tube sizes on diaphragm effort and weanability indices. ⋯ In tracheotomized difficult to wean subjects the decrease of the tracheotomy tube size was associated with an increased PTP(di), f/V(T), and TT(di), that were otherwise normal, using a higher diameter. The in vitro study showed that the resistances increased similarly for tracheotomy tube and endotracheal tube, decreasing the diameter and increasing the flows.
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Blow-by, a common form of nebulizer therapy, in which the device is held away from a child's face, has been dismissed as ineffective because studies have demonstrated incremental aerosol drop-off with increasing distances from the face. Many of these studies do not take into account differences among nebulizer systems. Using common, commercially available nebulizer systems, we defined the interaction of system components (nebulizer type, face mask configuration, and compressor characteristics) on aerosol delivery with and without blow-by. ⋯ At 4 cm, the Pari system delivered more drug than Respironics at 0 cm, suggesting adequate therapy during blow-by for some systems. Our results indicate that pediatric aerosol delivery is a strong function of the nebulizer system as a whole, and not simply a function of blow-by distance from the face or nebulizer efficiency. In uncooperative children, blow-by can be an effective means of drug delivery with the appropriate nebulizer system.
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Multicenter Study Comparative Study
Comparison of 2 correction methods for absolute values of esophageal pressure in subjects with acute hypoxemic respiratory failure, mechanically ventilated in the ICU.
A recent trial showed that setting PEEP according to end-expiratory transpulmonary pressure (P(pl,ee)) in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) might improve patient outcome. P(pl,ee) was obtained by subtracting the absolute value of esophageal pressure (P(es)) from airway pressure an invariant value of 5 cm H(2)O. The goal of the present study was to compare 2 methods for correcting absolute P(es) values in terms of resulting P(pl,ee) and recommended PEEP. ⋯ Referring absolute P(es) values to Vr rather than to an invariant value would be better adapted to a patient's physiological background. Further studies are required to determine whether this correction method might improve patient outcome.