HIV/AIDS News & Information

All of the vital capacities (VCs) of the patients were measured in both sitting and supine positions. Any patients for whom food aspiration was suspected had methylene blue tests. Two patients with positive methylene blue tests had high positioned tracheosto­mies and were converted to noninvasive alternatives of ventilatory support without long-term cuff deflation. Two other patients had tracheoesophageal fistulas that were repaired before further atten­tion could be paid to their tracheostomy tubes.

Continue Reading »

One hundred four long-term ventilator-dependent patients with neuromuscular respirator) insufficiency were referred for pulmo­nary rehabilitation. Seventy-eight of these patients were dependent on TIPPV with inflated cuffs at referral. The other 26 patients were converted to TIPPV after varying periods of time receiving nonin­vasive methods of assisted ventilation. The 104 patients presented with the following diagnoses: traumatic high level quadriplegia in 38 patients, postpolio in 22 patients, Duchenne muscular dystrophy in 19 patients, non-Duchenne myopathies in 14 patients, polymyo­sitis in three patients, amyotrophic lateral sclerosis in three patients, Charcot-Marie-Tooth disease in two patients and kyphoscoliosis, multiple sclerosis, and cervical myelopathy in one patient each.

Continue Reading »

Patients with traumatic quadriplegia or progressive neuromuscular conditions may require long-term ventilatory support that is most frequently managed by intubation and subsequent tracheostomy and tra­cheostomy intermittent positive pressure ventilation (TIPPV) with an inflated cuff. Patients are often unnecessarily maintained with an inflated cuff longer than necessary. Although cuff deflation and transition to the use of cuffless tracheostomy tubes have been described during ventilator weaning of patients with paralytic respiratory insufficiency, weaning from TIPPV is not always possible. There is often no effort made to optimize the tracheostomy tube diameter and the delivered volumes to permit cuff deflation or removal and there appear to be no guidelines in the literature to facilitate this.

Continue Reading »

Continue Reading »

All measurements in the present study showed excellent reproducibility, and deviation for each device under the same conditions was within 3 percent of the coefficient of variance. Standard deviation was very small and for all experimental conditions all values were statistically significant except comparison for different pressure-monitoring sites of Vapoi-Phase.

Thedl(-)

Figure 3 shows dl( —) for each device for four different inspiratory flow rates and Paw monitoring at three different sites. All devices exhibited the largest dl( —) when the pressure monitoring was done at PI. The dl( —) was smallest when the pressure was mon­itored at P2 under inspiratory flow rates of 30 and 60 L/min and all humidifiers had little effect on dl( —). Under a high inspiratory flow rate, dl( —)P3 of the HWB systems was less than dl( —)P2. The reason for this phenomenon was not clear. As the inspiratory flow rate increased, dl(-), especially dl( —)P1, of all devices increased. The cascade humidifier exhibited the largest dl( — )P1 at any inspiratory flow rate. Vapor- Phase (Inspiron) represented almost no resistance to gas flow and its dl( —) was zero. When Paw was monitored at P3, dl( —) for HME was greater than that of HWB.

Continue Reading »

Endotracheal intubation results in a bypass of the natural warming and humidifying process through the nasopharynx, and a humidifying device is therefore necessary during respiratory tract manage­ment. Although FDA guidelines place some require­ments on the flow-resistance characteristics of humid­ifiers at continuous flow rates, there have been few reports investigating the flow-impedance characteris­tics of humidifiers under dynamic conditions and the changes in respiratory work load due to humidifiers. In the present study, we calculated the amount of AWL imposed by different types of humidifying de­vices and evaluated their flow-impedance character­istics. In addition to this, we examined the ventilator factors which affect the values of AWL.

Continue Reading »