Respiratory care
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The respiratory therapist has had integrated adjuncts to improve mucus clearance for decades. However, there is a lack of literature describing the impact of these interventions on specific patient populations, resulting in an inability to make recommendations about the use of devices and techniques. The purpose of this article is to review recent literature regarding airway clearance therapies in a manner that is most likely to have interest to the readers of Respiratory Care.
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Review
Alveolar Recruitment Maneuvers Under General Anesthesia: A Systematic Review of the Literature.
The sigh is a normal homeostatic reflex that maintains lung compliance and decreases atelectasis. General anesthesia abolishes the sigh reflex with rapid onset of atelectasis in 100% of patients. Studies show a strong correlation between atelectasis and postoperative pulmonary complications, raising health-care costs. Alveolar recruitment maneuvers recruit collapsed alveoli, increase gas exchange, and improve arterial oxygenation. There is no consensus in the literature about the benefits of alveolar recruitment maneuvers. A systematic review is necessary to delineate their usefulness. ⋯ Alveolar recruitment maneuvers followed by PEEP should be instituted after induction of general anesthesia, routinely during maintenance, and in the presence of a falling SpO2 whenever feasible. They allow the anesthesia provider to reduce the FIO2 while maintaining a higher SpO2 , limiting the masking of shunts. Utilization of alveolar recruitment maneuvers may reduce postoperative pulmonary complications and improve patient outcomes.
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Dendriform pulmonary ossification is a rare condition often diagnosed by either surgery or postmortem examination. We report a 43-y-old man with a history of nonproductive cough for 1 y. His physical examination was unremarkable. ⋯ We reviewed a total of 42 cases of dendriform pulmonary ossification reported in the medical literature: most of these cases were diagnosed by autopsy. Despite its rarity, dendriform pulmonary ossification should be considered in the differential diagnosis of diffuse lung disease. Bronchoscopy with transbronchial biopsies must be considered as a potential diagnostic procedure.
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Mechanical ventilation is an important and ever-evolving component of everyday critical care. Clinicians can struggle to keep up with current literature and descriptions of advancement in a way that they can apply these changes to their bedside patient care. This article serves as a review of important recent findings related to invasive mechanical ventilation and describes their relevance to bedside critical care.