Respiratory care
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Review Case Reports
Successful epoprostenol withdrawal in pulmonary arterial hypertension: case report and literature review.
Pulmonary arterial hypertension is a rare and devastating disease characterized by vascular proliferation and remodeling. Epoprostenol, the drug counterpart of the eicosanoid prostacyclin, produced by the vascular endothelial cells, is the drug of choice for this disease. Its capacity to act rapidly and to significantly improve survival prospects in severe pulmonary hypertension patients has been supported by a wealth of evidence. ⋯ The availability of newer and less invasive drug therapies for pulmonary arterial hypertension led physicians to withdraw epoprostenol in carefully selected patients. We report a case of successful intravenous epoprostenol interruption in a patient with idiopathic disease. A literature review on epoprostenol withdrawal in pulmonary hypertension in adult patients is also provided.
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Comparative Study
Noninvasive CPAP with face mask: comparison among new air-entrainment masks and the Boussignac valve.
The performances of 2 noninvasive CPAP systems (high flow and low flow air-entrainment masks) were compared to the Boussignac valve in 3 different scenarios. ⋯ High-flow air-entrainment mask showed the best performance in human subjects. During high flow demand, the Boussignac valve delivered lower than expected F(IO(2)) and showed higher dynamic hyper-pressurization than the air-entrainment masks.
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Comparative Study
Mechanical behaviors of Flutter VRP1, Shaker, and Acapella devices.
Flutter VRP1, Shaker, and Acapella are devices that combine positive expiratory pressure (PEP) and oscillations. ⋯ The Flutter VRP1 and Shaker devices had a similar performance to that of Acapella in many aspects, except for PEP.
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Severe tracheomalacia (STM) is being increasingly recognized as a cause for respiratory failure in the ICU. The diagnosis is often overlooked, as chest radiography appears normal, and the role of invasive diagnostic testing for this diagnosis is not well described in the ICU setting. The prevalence and risk factors for STM are not known, and computed tomography (CT) based diagnostic criteria for ventilated patients are not well studied. ⋯ STM was associated with prolonged ICU stay. A distal tracheal antero-posterior diameter < 7 mm on a non-intubated CT chest was suggestive of STM that required a confirmatory bronchoscopy. Gastroesophageal reflux disease and obesity were potential risk factors.
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Observational Study
Tracheostomy tube change before day 7 is associated with earlier use of speaking valve and earlier oral intake.
Presence of a tracheostomy tube often decreases the patient's ability to communicate and to tolerate oral intake. The initial tracheostomy tube change is often recommended between day 7 and 14 post insertion. Local guidelines permit tracheostomy tube change 5 days after insertion. ⋯ Tracheostomy tube change before day 7 is associated with earlier ability to tolerate speaking valve and oral intake. In this series, early tracheostomy tube change was not associated with an increased rate of complications.