Respiratory care
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Multicenter Study
Why do patients with interstitial lung diseases fail in the ICU? a 2-center cohort study.
Admitting patients with interstitial lung disease (ILD) to the ICU is controversial, due to their associated high mortality when they require invasive mechanical ventilation. We aimed to determine the risk factors for mortality in ILD patients requiring ICU support due to acute respiratory failure. ⋯ Because of higher mortality, physicians should consider invasive ventilation cautiously in the ICU management of ILD patients with acute respiratory failure. NIV may be an option in less severely ill patients with APACHE II score < 20.
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Comparative Study
Comparing the effects of rise time and inspiratory cycling criteria on 6 different mechanical ventilators.
Inspiratory rise time and cycling criteria are important settings in pressure support ventilation. The purpose of this study was to investigate the impact of minimum and maximum rise time and inspiratory cycling criteria settings on 6 new generation ventilators. Our hypothesis was there would be a difference in the exhaled tidal volume, inspiratory time, and peak flow among 6 different ventilators, based, on change in rise time and cycling criteria. ⋯ Significant differences in exhaled tidal volume, inspiratory time, and peak flow were observed by adjusting rise time and cycling criteria. This research demonstrates that during pressure support ventilation strategy, adjustments in rise time and/or cycling criteria can produce changes in inspiratory parameters. Obviously, this finding has important implications for practitioners who utilize a similar pressure support strategy when conducting a ventilator wean. Additionally, this study outlines major differences among ventilator manufacturers when considering inspiratory rise time and cycling criteria.
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Lung transplant patients commonly undergo transbronchial biopsy to evaluate for rejection. Post-biopsy radiographs are used to exclude pneumothorax, one of the most common major complications. We report a lung transplant patient who developed a pneumothorax 5 months after transbronchial biopsy, with multiple intervening chest computed tomograms documenting that the pneumothorax developed from the biopsy site. This case illustrates that in transplant patients transbronchial biopsy can evolve to pneumothorax several months later, despite normal post-biopsy radiographs.
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Oxygen has been widely used for COPD patients because long-term oxygen therapy can improve survival duration of COPD patients with severe hypoxemia. The typical oxygen delivery methods used for long-term oxygen therapy are continuous flow oxygen (CFO) and demand oxygen delivery (DOD). Currently, DOD is preferred to CFO in oxygen conserving devices because waste of oxygen is substantial in CFO. However, DOD causes discomfort to patients since it abruptly supplies high-flow oxygen during inhalation only. ⋯ In conclusion, SDOD might provide more comfortable oxygen delivery by reducing DI, and conserves oxygen while offering an equivalent Fio2.
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The influence of percutaneous tracheostomy on ventilator-dependence and clinical outcomes has been investigated in a number of studies. However, except for the variations during the procedure, the impact of tracheostomy on gas exchange has been scarcely explored. We investigated the effect of tracheostomy on respiratory function in a cohort of ICU patients. ⋯ Percutaneous tracheostomy did not worsen gas exchange in a cohort of ICU patients. In hypoxemic patients, tracheostomy appeared to improve oxygenation and ventilation.