PubMed · 8197385
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
P Carroll. 1994. Safe suctioning prn.. https://pubmed.ncbi.nlm.nih.gov/8197385/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
Dyspnea is a common symptom and, in most cases, can be effectively managed in the office by the family physician. The differential diagnosis is composed of four general categories: cardiac, pulmonary, mixed cardiac or pulmonary, and noncardiac or nonpulmonary. Most cases of dyspnea are due to cardiac or pulmonary disease, which is readily identified with a careful history and physical examination. Chest radiographs, electrocardiograph and screening spirometry are easily performed diagnostic tests that can provide valuable information. In selected cases where the test results are inconclusive or require clarification, complete pulmonary function testing, arterial blood gas measurement, echocardiography and standard exercise treadmill testing or complete cardiopulmonary exercise testing may be useful. A consultation with a pulmonologist or cardiologist may be helpful to guide the selection and interpretation of second-line testing.
OBJECTIVE: Whether a chest radiograph should be performed routinely in all infants after extubation, or selectively only in those with clinical deterioration, is a controversy in neonatal unit practice. This study tested the hypothesis that most cases of post-extubation radiological deterioration in the lungs could be detected by clinical assessment. METHODS: A chest radiograph was performed at 8 h post-extubation in 100 episodes of extubation in 85 newborn infants ventilated for a variety of lung diseases. Each infant was assessed at the same time by a neonatologist blinded to the radiological findings, to determine whether a chest radiograph would have been requested based on clinical judgement. The infants were continuously monitored for their respiratory and oxygenation status before and after extubation. RESULTS: Compared to the pre-extubation chest radiographs, 23 of the 100 post-extubation chest radiographs showed either deterioration of the pre-existing lung pathologies or appearance of significant new pathologies. The clinicians' assessment failed to detect most of the deterioration, with a sensitivity of only 21.7%. Systematic analysis of the infants' clinical parameters showed that the development of significant intercostal/subcostal retraction, and an increase in inspired oxygen concentration by > or = 7% after extubation, were the best predictors of post-extubation radiological deterioration (sensitivity 82.6%, specificity 62.3%, positive predictive value 39.6%, and negative predictive value 92.3%). Serial blood gas in contrast had little predictive value. CONCLUSION: We conclude that most cases of radiological deterioration of the lungs after extubation are clinically predictable, provided the correct clinical criteria are used.
A survey performed in 100 CPAP users indicated that irritation of the face, a painful nose and nasal obstruction were among the most frequently mentioned complaints in chronic CPAP users. In 132 normocapnic SAS patients a significant improvement of PaO2 was shown, with a decrease of the alveolo-arterial oxygen difference. This improved gas exchange was parallelled by a significant increase in the FRC and TLC. Maybe a modulation in force of the respiratory muscles may be involved. These data were more pronounced in obstructive sleep apnea than in central sleep apnea. In 50 chronic CPAP users we could show a lower AHI immediately after CPAP withdrawal after a previous prolonged treatment. These findings may support the insufflation theory as a mechanism of action of CPAP. Traditionally, mechanical splinting of the upper airway has been considered as the dominant mechanism of action. Other mechanisms like changes in regulation of breathing and decrease of the pharyngeal edema may be involved as well.