Respiratory care
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Randomized Controlled Trial
Noninvasive ventilation coupled with nebulization during asthma crises: a randomized controlled trial.
Despite the clinical improvements attributed to noninvasive ventilation (NIV) during asthma crises, and the well established effects of nebulization, there are few studies on the effects of these interventions together. We hypothesized that nebulization coupled to NIV should raise radio-aerosol pulmonary deposition in asthmatics. The aims of this study were to assess the effects of coupling β-agonist nebulization and NIV during asthma exacerbations on radio-aerosol pulmonary deposition, using scintigraphy and cardiopulmonary parameters, to correlate pulmonary function with radio-aerosol deposition index, radio-aerosol penetration index, and pulmonary clearance. ⋯ Coupling nebulization and NIV during asthma exacerbation did not improve radio-aerosol pulmonary deposition, but we observed clinical improvement of pulmonary function in these subjects. (ClinicalTrials.gov registration NCT01012050).
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Definite diagnosis of transudative or exudative pleural fluids often presents a diagnostic dilemma. The aim of this study was to evaluate whether amino-terminal brain natriuretic peptide (NT-proBNP) levels in pleural fluid has a diagnostic value for discriminating heart-failure-related pleural effusions from non-heart-failure effusions. ⋯ Pleural fluid NT-proBNP measurement in the routine diagnostic panel may be useful in differentiation of heart-failure-related pleural effusions and exudative pleural fluids with reasonable accuracy, especially in heart-failure patients treated with diuretics.
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Practice Guideline
AARC Clinical Practice Guideline. Surfactant replacement therapy: 2013.
We searched the MEDLINE, CINAHL, and Cochrane Library databases for English-language randomized controlled trials, systematic reviews, and articles investigating surfactant replacement therapy published between January 1990 and July 2012. By inspection of titles, references having no relevance to the clinical practice guideline were eliminated. The update of this clinical practice guideline is based on 253 clinical trials and systematic reviews, and 12 articles investigating surfactant replacement therapy. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation scoring system: 1: Administration of surfactant replacement therapy is strongly recommended in a clinical setting where properly trained personnel and equipment for intubation and resuscitation are readily available. 2: Prophylactic surfactant administration is recommended for neonatal respiratory distress syndrome (RDS) in which surfactant deficiency is suspected. 3: Rescue or therapeutic administration of surfactant after the initiation of mechanical ventilation in infants with clinically confirmed RDS is strongly recommended. 4: A multiple surfactant dose strategy is recommended over a single dose strategy. 5: Natural exogenous surfactant preparations are recommended over laboratory derived synthetic suspensions at this time. 6: We suggest that aerosolized delivery of surfactant not be utilized at this time.
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We report the case of an adult patient with idiopathic pneumonia syndrome following allogeneic hematopoietic stem cell transplantation, which was successfully managed with venovenous extracorporeal membrane oxygenation (ECMO) and immunosuppressive therapy. A 30-year-old man with precursor B cell acute lymphocytic leukemia had received chemotherapy 10 years previously, with complete remission. He underwent allogeneic hematopoietic stem cell transplantation 4 months prior to enrollment, owing to leukemia relapse. ⋯ He subsequently developed acute hypercapnic and hypoxic respiratory failure that was unresponsive to conventional medical therapy. He was successfully managed with venovenous ECMO for 19 days, with complete resolution of his respiratory symptoms. Thus, judicious use of ECMO as a bridge before steroid and other conventional therapy take effect in patients with isolated respiratory failure appears justified.