Respiratory care
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Review
An Introduction to the Clinical Application and Interpretation of Electrical Impedance Tomography.
Electrical impedance tomography is no longer a new technology, but its clinical use at the bedside is still in its primary stage. Global research has drastically increased since its commercial availability, and this has slowly begun to make its way into routine clinical bedside use in some areas of the world. This paper will provide the bedside clinician an introduction to the technology, how it is used, and the most common applications found in the literature.
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Multicenter Study
Flexible Bronchoscopy in Pediatric Venovenous Extracorporeal Membrane Oxygenation.
Pediatric patients with ARDS will on occasion need venovenous extracorporeal membrane oxygenation (VV-ECMO) for organ support. As these patients recover, they may benefit from lung recruitment maneuvers including flexible bronchoscopy (FB). The objective of this study was to assess the clinical course of patients who underwent FB while on VV-ECMO for ARDS. ⋯ FB can be performed on patients while anticoagulated on VV-ECMO with a low incidence of complications. FB may be beneficial especially when performed early in the course of VV-ECMO.
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Contemplating the future should be grounded in history. The rise of post-polio ICUs was inextricably related to mechanical ventilation. Critically ill patients who developed acute respiratory failure often had "congestive atelectasis" (ie, a term used to describe ARDS prior to 1967). ⋯ Therefore, it is imperative we understand the long-crooked path needed to reach the era of protective ventilation in order to avoid similar mistakes moving forward. The emerging era is as difficult to fathom as our current practices and technologies were to those practicing 60 years ago. This review explores the history of mechanical ventilation in treating ARDS, describes current protective ventilation strategies, and speculates how ARDS management might look 20 years from now.
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Electronic cigarettes (e-cigarettes) and hookah smoking have gained tremendous popularity over the past decade. With the constantly evolving e-cigarette market and potential impact of the COVID-19 pandemic on users of these tobacco products, research is needed to assess the prevalence and safety of these devices as well as potential public health implications and cessation tools. For this year in review, PubMed was searched from January 2021-December 14, 2021, for articles related to e-cigarettes, vaping-related lung injury, and hookah smoking. ⋯ Hookah smoking has remained stable across the past several years and remains a primarily social activity among youth. New e-cigarette devices are constantly emerging, resulting in an increased demand to understand the safety of these devices. Additionally, hookah smoking continues to be a concerning public health issue with the increase in hookah bars and venues coupled with lack of policy regulations for hookah smoking.
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Although quality control standards are recommended to ensure accurate test results, the coefficient of variation for the FVC and FEV1 biologic quality control (BioQC) is not specified. The primary aim of this study was to evaluate variations in spirometry BioQCs in a large and diverse cohort of individuals to determine an acceptable standard for the coefficient of variation. ⋯ Interlab biologic control variation values of < 4% for FVC and FEV1 are achievable; however, individual labs should strive to attain lower values. Acceptable coefficients of variation can be achieved within 28 d.