Respiratory care
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Lung recruitment maneuvers are frequently used in the treatment of children with lung injury. Here we describe a pilot study to compare the acute effects of 2 commonly used lung recruitment maneuvers on lung volume, gas exchange, and hemodynamic profiles in children with acute lung injury. ⋯ SRS is effective in opening the lung in children with early acute lung injury, and is hemodynamically well tolerated. However, attention must be paid to PaCO2 during the SRS. Even minutes following lung recruitment, lungs may derecruit when PEEP is lowered beyond the closing pressure.
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To describe the self-expanding endobronchial occluder, as utilized in bronchoscopic lung volume reduction, with a 36 month follow-up procedure. ⋯ This preliminary study demonstrates early significant improvements in pulmonary function, 6-min walk distance, dyspnea score, BODE index, and quality of life after placement of the self-expanding endobronchial occluder in bronchoscopic lung volume reduction. Its placement also proved both easy and safe. However, the initial improvements were maintained long-term for only a minority of subjects.
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Different filtering devices are used during mechanical ventilation to avoid dysfunction of flow and pressure transducers or for airborne microorganisms containment. Water condensates, resulting from the use of humidifiers, but also residual nebulization particles may have a major influence on expiratory limb resistance. ⋯ Expiratory limb filtration is likely to induce several major adverse events. Expiratory filter resistance increase is due mainly to the humidification circuit type, rather than to nebulization. If filtration is mandatory while using an unheated circuit, a dedicated filter should be used for ≤ 24 hours, or a heated HEPA for a longer duration.
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The role of transforming growth factor β1 (TGF-β1) and tumor necrosis factor α (TNF-α) in asthma is unclear. The aim of this study was to assess the relationships among polymorphisms, clinical phenotypes, and the serum levels of TGF-β1 and TNF-α. ⋯ The genetic polymorphisms of TGF-β1 and TNF-α are associated with asthma. TGF-β1 modulates atopy. Both TGF-β1 and TNF-α modulate clinical severity and airway obstruction, in an additive manner.