Respiratory care : the official journal of the American Association for

Transcription

December 1992
Volume 37, Number 12
ISSN 009891 42-RECACP
A MONTHLY SCIENCE JOURNAL
YEAR— ESTABLISHED 1956
37TH
A New Look
Some
for
Open Forum '93—with
Pointers on Staying
'In
Fashion'
Does a Sigh Breath Improve
Oxygenation in the Intubated Patient
Receiving
CPAP?
Comparison
Clinical
of
Gentle-Haler
Actuator and Aerochamber Spacer for
Metered Dose Inhaler (MDI) Use by
Asthmatics
Classic Reprints
—A
Critical Carol:
Being an Essay on Anemia,
Suffocation, Starvation,
Forms
Manner
and Other
of Intensive Care, After the
of
Dickens
Annual Indexes
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'93
Numher
12
Slav ing 'In Fashit)n'
Texas
Improve Oxygenation
a Sigh Breath
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Comparison of Gentle-Haler Actuator and Aerocliamber Spacer tor MeDose Inhaler (MDI) Use by Asthmatics
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1414
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Forms
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R
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PFT Corner #47— -'What
1432
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An Unusual Cause
1437
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J Ward MEd RRT
MURDER MYSTERIES
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1445
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1440
A
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Being an Essay on Anemia. Suffocation. Starvation, and Other
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h\ Robert
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RESPIRATORY CARE
•
DECEMBER
"92 Vol 37
No
12
1393
—
Abstracts
Summaries of
Pertinent Artieles in Other Journals
and Reviews
Kditorials, Reports,
Occupational Kxposure
PA Band. N
helow
.
Hiigl
J
Nitrous Oxide: Not a I-au^hing Matter
tti
Med
1992:327: 1026. (Pertains lo Rowland
The Racial Disparity in Infant Mortality
N
Engl
Oxide— AS Rowland. DD Baird, CR
Weinberg. DL Shore. CM Shy, AJ
Wilco.x. N Engl J Med 1992:327:
Related Editorial:
Occupational Exposure
Oxide
—Not
Engl J
Med
Baird PA.
to
Nitrous
a luiughing Matter.
1
J
Med
(editorial)
N
992; 327: 1026.
BACKGROUND:
els
female
in
we found
controlling for covariates,
wotnen exposed
that
to high levels of
nitrous oxide were significantly less
women who were
than
fertile
exposed or exposed
re-
is
exposed
to lev-
of nitrous oxide similar to those
found
some
in
dental
Epi-
offices.
demiologic studies have suggested
un-
lower levels
to
of nitrous oxide. The effect was ev-
women
ident only in the 19
with 5 ov
more hours of exposure per week.
women were
These
confidence
Fertility
rats
only -Wî (95^1
23-74^^;
interval
to
p
<
women
conceive during each menstrual
CONCLUSIONS:
cycle.
exposure
to
may
ide
Occupational
high levels of nitrous ox-
woman's
adverselv affect a
becotne pregnant.
ability to
mixed anesthetic gases and impaired
We
investigated the effects
Clinical Determinants of the Ra-
Low
Disparity in Very
cial
of occupational exposure to nitrous
Weight—A Kempe. PH
oxide
the fertility of female dental
Barkan.
METHODS:
SL Gortmaker, et al.
Med 1992:327:969. Related
oti
assistants.
tionnaires
male dental
registered
to
7.000
by the California DepartAffairs. 69^^ re-
459 wotnen were
sponded.
to
fe-
assistants, ages 18 to 39.
ment of Consumer
mined
Screening ques-
were mailed
al:
WM
Davidson
SE
B Sachs.
N Engl J
Sappenfield.
EC
Jr.
The Racial Disparity
NEnglJ Med
tality.
Birth
Wise.
Editori-
Eurusliinia T.
in Infant
Mor-
1992:327:1022.
BACKGROUND:
Although the
risk
pregnant during the previous 4 years
of very low birth weight (< 1..500 g)
for reasons unrelated lo the failure of
is
and
')\'
'<
of these
wom-
en cotiiplcted Iclc|ihotic interviews.
information
Detailed
on exposure
tility
to nitrous
cycles
ception that the
become
1394
blacks as
among
high
as
whites
iti
among
the Utiiled
the clinical conditions asso-
was collected
ciated
with
oxide and
poorly explored.
without
women
pregnani).
more than twice
States,
fer-
(measured by the number of
menstrual
Jr.
T
Fii-
abstracted on
contra-
required to
RFSL'LTS: After
1980-1985 (687
SULTS:
We
this
disparity
born
ill
RE-
reviewed the medical
records of over 980^ of
weighing
remain
METHODS &
500-1.499
Boston
g
during
all
infants
1985 and 1986 (397 infants), and
in
two health
in
1984 and 1985 (215
districts in Mississippi
The
infants).
medical records of the infants" moth-
were also reviewed. These data
ers
were linked
to birth-certificate files.
During the study periods, there were
4M.1M6 live births in Boston. 16.232
in
St Louis,
and 16.332
sissippi districts.
very low
birth
infants as
The
the Mis-
in
relative risk of
weight
among
black
compared with white
in-
fants ranged frotn 2.3-3.2 in the three
The higher proportion of black
areas.
birth
weights
was
related
an elevated risk
in
their
mothers of tnajor conditions
as-
to
sociated with very low birth
w eight,
primarily
or
chorioatntiionitis
mature rupture of the amniotic
pre-
mem-
brane (associated with 38.0*^ of the
excess proportion
of black
infants
with very low birth weights [95'^
confidence interval 31.3-45.4%]);
id-
iopathic preterm labor (20.9'^f of the
|95'^f
confidence interval 16.0-
26.4%]); hypertensive disorders (12.3%
1951 confidence
hemorrhage
and
interval 8.6-16.6%]);
(9.8'(
[95% con-
fidence interval 5.5-13.5''?
j).
CON-
CLL'SIONS: The higher proportion
of black infants w ith verv low birth
weights
is
associated with a greater
frei|uency of
all
tnajor maternal con-
tliiions precipitating deliverv
who wcic
black wotnen. Reductions
the
parity
pcriixl
Louis
infants), in St
in
excess
deter-
be eligible. ha\ing become
birth cotiirol.
et al
infants with very low
an association between exposure to
fertility.
abstracted
— EC Davidson
Kempe
1992:327:1022. (Pertains to
0.003) as likely as unexposed
duced
(editorial)
et al
1.^94.)
Reduced Fertility among Women
Kmpioyed us Dental .Assistants Exposed to High Levels of Nitrous
993.
Note
I
rushima.
Pace
to
RESPIRATORY CARE
•
'iti
birth
among
in the dis-
weight between blacks
DECEMBER
"92 Vol 37
No
12
SURVANTA
beractant
intratracheal suspension
bovine pulmonary surfactant
berac
intral
suspensi
Stenle
Suspension
For Intratracheal
Administration Only -
NotForlnJTCtioo
DO NOT SHAKE
"
roMMiuom
From Ross LaboratoriesHelping Premature Babies Survive'
Please see adjacent column
B401/2980
© 1992 Ross Laboratories
for Brief
Summary of
prescribing information.
COLUfvlBUS. OMIO -3321
DwsKxi
ot
LITHO
Abbott Laboratories u
Circle 125
IN
USA
BRIEF
SUMMARY
insert lor
full
Please see package
prescribing information
SURVANTA'
(1040)
beractant
intratracheal suspertston
Sterile
Suspension For Intratracheal Use Only
INDICAHONS AND USAGE
SURVANTA
IS indicated for prevention and
treatment (rescue
ot Respiratory Distress
Syndrome (RDSl (hyaline membrane disease)
)
in
premature infants
SURVANTA
significantly
reduces the incidence o( RDS, mortality due to
air leak complications
RDS and
Prmnntion
In premature infants less than 1250 g birth
weight or with evidence of surfactant defi-
ciency, give
SURVANTA
as soon as possible,
preferably within 15 minutes of birth
ResaiB
To treat infants with
RDS confirmed by
x-ray
and requiring mechanical ventilation, give
SURVANTA as soon as possible, preferably by
8 hours
of
age
CONTRAINDICATIONS
None known
WARNINGS
SURVANTA
IS
intended for intratracheal use only
SURVANTA CAN RAPIDLY AFFECT OXYGENATION AND LUNG COMPLIANCE Thereuse should be restricted to a highly
supervised clinical setting with immediate
experienced with intubation, ventilator management, and general
care of premature infants Infants receiving
SURVANTA should be frequently monitored
with arterial or transcutaneous measurement
of systemic oxygen and carbon dioxide
fore, Its
availability of clinicians
DURING THE DOSING PROCEDURE,
TRANSIENT EPISODES OF BRADYCARDIA
AND DECREASED OXYGEN SATURATION
HAVE BEEN REPORTED U these occur, slop
the dosing procedure and initiate appropriate
measures
to alleviate the condition
bilization,
resume the dosing procedure.
After sta-
PRECAUTIONS
General
Rales and moist breath sounds can occur
transiently after administration Endotracheal
suctioning or other remedial action is not
necessary unless clear-cut signs of airway
obstruction are present
Increased probability o1 post-treatment
nosocomial sepsis
infants was observed
in
SURVANTA-treated
in
the controlled clinical
The increased
risk for sepsis
infants was not
associated with increased mortality among
these infants The causative organisms were
trials (Table 3)
among SURVANTA-treated
similar
m
was no
Significant difference
in
treated
and control infants There
between groups
the rate of post-treatment infections other
than sepsis
Use of SURVANTA in infants less than 6(X) g
birth weight or greater than 1750 g birth
weight has not been evaluated in controlled
There is no controlled experience with
use of SURVANTA in conjunction with experimental therapies for RDS (eg. high-frequency
ventilation or extracorporeal membrane
oxygenation)
No information is available on the effects of
doses other than 100 mg phospholipids ko,
more than four doses, dosing more frequently
than every 6 hours, or administration after
48 hours of age
trials
CarclnoBenesls. Mutagenesis,
Impairment
of Fertllltv
Reproduction studies m animals have not been
completed Mutagenicity studies were negative Carcinogenicity studies have not been
performed with SURVANTA
ADVERSE REACTIONS
The most commonly reported
adverse experiences were associated with the dosing procedure In the muttiple-dose controlled
clinical trials, transient bradycardia occurred
with 11 9% of doses Oxygen desaturation
occurred with 9 8% of doses
Other reactions during the dosing procedure occurred with fewer than 1% of doses
and included endotracheal tube reflux, pallor,
vasocohstriction, hypotension, endotracheal
tube blockage, hypertension, hypocarbia.
hypercarbia and apnea No deaths occurred
during the dosmq procedure, and all reactions resolved with symptomatic treatment
The occurrence of concurrent illnesses
common in premature infants was evaluated
in the controlled trials The rates in all controlled studies are in Table 3
TABLE 3
SIEMENS
Avoid Explosive Issues.
Although you might take issue
with our graphic depletion, we feel
It's necessary to make our point:
No other
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(PRVC) and Volume Support
The preset volumes you've
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delivered at the lowest possible
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All
exclusive features available
with the Servo Ventilator
and
adult patients alike.
We live and
Siemens
breathe patient care.
offers this
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technology exclusively Because
Siemens Medical Systems,
we go
Patient
to great lengths to provide
(VS) ventilation.
you with the very best
The Servo
care. For
matically
300 autoobserves changes In
Ventilator
lung /thorax mechanics, breath by
breath,
and adjusts the
pressure
level
inspiratory
accordingly
300 are
applicable to neonatal, pediatric,
more
In ventilator
Information, a
10 Constitution
Avenue
Piscataway NJ 08855
personal demonstration or a free
full color poster contact your local
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Inc.
Care Systems Division
technology
in
caring liands.
ABSTRACTS
and whites are not
from any single
likely
result
to
clinical intervention
from comprehensive pre-
but. rather,
\enti\ e strategies.
A
Prospective Investi};ation of Pul-
Women and
monary Embolism
in
Men — DA
\iV
ML
Quinn.
JH
Tenrin.
KA
asoulis.
Thrall.
McKusick.
women using oral
who were suspected
The specimens were examined
der (even young
oles.
contraceptives)
without know ledge of the exposures
having
of
and
emboli
pulmonary
were enrolled
in the
vestigation of
Pulmonary Embolism
Prospective In-
Diagnosis study had a smaller
fre-
o\'
the
subject
particular
Turin.
in
For 283 (71%) of the subjects
Italy.
the preservation of the bronchial epi-
thelium was satisfactory for patho-
quency of pulmonary embolism than
logical
Thompson.
men
among them (73%)
C.\ Athan-
pulmonary embolism were the same
could be arranged with their next of
women and men, except
women using oral contraceptives
that
kin, focusing
had
the deceased and
et al.
JAMA
1992:268:1689.
of that age. The risk factors for
tor
and
examination,
206
for
interview
an
on smoking habits of
spouses, as
their
an increased risk of pulmonary em-
well
OBJECTIVE: The aim of this study
was to compare, in women and men
bolism following surgery. Although
viewers were not aware of the results
suspected of pulmonary embolism,
preliminary
the frequency, risk factors, diagnosis,
nary embolism
and presentation of pulmonary em-
pulmonary
bolism as well as the accuracy of the
needed for accurate diagnosis.
ventilation/perfusion scan
as a diagnostic tool.
V/Q
scan was a useful tool
evaluation
for
women,
these
in
in the
pulmo-
was
angiogram
a
often
a prospective
and Passive Smoking and
.\ctive
Pathological
Indicators
Lung
of
an Autopsy Study
Cancer Risk
of Pulmonary Embolism Diagnosis)
— D Trichopoulos. F Mollo. L Tom-
V/Q
accuracy of the
scan compared with pulmonary angi-
SETTING: 6
ograms.
tertiary
med-
examinations.
pathological
the
inter-
MAIN OUTCOME MEASURE:
Spec-
imens were examined for basal
squamous
hyperplasia,
meta-
(in
mem-
and
atypia.
cell
cell
cell
branous bronchioles and bronchiolo-
study (the Prospective Investigation
to establish the
of
plasia,
(V/Q scan)
DESIGN: Data
were collected during
the
The
as other variables.
atis,
E
in
L Delsedime, X Za-
Agapitos,
vitsanos.
et
JAMA
al.
1992;268:
aheolar airways) mucous
plasia,
may
ie.
meta-
cell
pathological entities that
be lung cancer risk indicators or
epithelial, possibly precancerous, le-
sions (EPPL).
The gland and
wall
thicknesses were also measured and
1697.
their
OBJECTIVE: The
ratio
calculated (Reid
Index).
PARTICIPANTS:
tween involuntary smoking and lung
RESULTS: In comparison with nonsmokers, EPPL \alues were significantly higher among current smok-
pulmonary em-
cancer has been supported h> most
ers
was made
for a V/Q scan or pulmonary angiogram (496 women and 406 men).
RESULTS: Women 50 years old and
epidemiologic studies, but a number
so,
been excluded. Few autopsy-based
women
under had a decreased frequency of
studies have explored the role of ac-
than to nonsmokers.
pulmonary embolism compared with
tive
smoking and other exposures in
lung carcinogenesis, and none has
data neither occupation nor residence
Massachusetts. Mich-
ical centers in
igan, Connecticut. Pennsylvania, and
North
Carolina.
Patients suspected of
bolism for
men
whom
a request
(16% vs 32%), but
was no difference in patients
over 50 years old (Breslow-Day test,
p < 0.01 ). Risk factors for pulmonary
of that age
there
embolism, the usefulness of the V/Q
scan, and
different
I
women and men.
women was not
in
be-
of authors and interest groups claim
that
the possibility of bias has not
been previously done
role
to
examine
of passive smoking.
such
undertaken
study
in
an
We
DESIGN:
as-
age or older, of both genders,
who
had died within 4 hours fiom a cause
of pulmonary embolism, except
other than
had
using oral contraceptives
undergone
surgery
who
within
.3
respiratory or cancer in
Athens or the surrounding
each person
at
area.
least 7 tissue
For
blocks
months; 4 of 5 (80%) had emboli
were taken from the main and lobar
compared with 4 of 28 (14%) age-
bronchi and
matched surgical patients not using
estrogens
SION:
1
398
(p
Women
<
0.01).
CONCLU-
50 vears old and un-
the
at
least
5 blocks from
parenchyma, including an aver-
age of about 20 smaller cartilaginous
bronchi
and
In
this
of
set
was associated with EPPL. but
this
of residential history with exposure
sociated with an increased frequency
women
smokers rather
to
have
Es-
in
married
could be due to the poor correlation
autopsy-based
Athens. Greece.
and higher, but not significantly
among former smokers. Furthermore. EPPL values were significantly
higher among deceased nonsmoking
the
Lung specimens were taken at autopsy from 400 persons 35 years of
-year mortality were not
for
trogen use
association
membranous bronchi-
and the lack of ade-
to air pollution
quate
of
standardization
contem-
porary Greek occupations. The Reid
was higher among smokers
Index
and former smokers
v\ith
in
comparison
anmng
nonsmokers.
with mainly urban residence
subjects
in
com-
parison with those with mainly rural
residence,
women
and among nonsmoking
in
com-
to
non-
these
dif-
married to smokers
parison with those married
smokers,
but
ferences was
none
statisticallN significant.
CONCLUSION:
RESPIRATORY CARE
•
ol
These
DECEMBER
results
'92 Vol 37
pro-
No
12
.
HE BEAR* 1000
VENTILATOR.
REDEFINING
THE SHAPE OF
.
Bear
k
Bear Medical Systems, Inc.
2085 Rustin Avenue
Riverside, CA 92507
Phone 800-232-7633 909-788-2460
FAX
909-351-4881
TLX
676346
BEARMED RVSD
Breathing new life
into ventilation.
Circle 86
BEAR'
is
a registered trademark
Bear Medical Systems, Inc.
©1992 Bear Medical Systems,
(
BEAKJOOO
V
Inc.
FROM PATIENT
E
I-l
I
I
L
A
•
O
R
^
ABSTRACTS
vide support to the body of evidence
smoking
linking passive
to lung can-
even though they are based on a
cer,
Hospital
hospitals.
over
quality
persists
nonteaching
small
but
time,
hospitals narrowed the gap with bet-
study methodologically different from
ter
those that have pre\iously examined
and 1986.
this association.
ferent
between
hospitals
quality
1981
CONCLUSIONS: The
measures led
to consistent
dif-
Care— EB Keeler. LV RuKL Kahn, D Draper, ER
of
ity
benstein,
MJ McGinty,
Harrison,
JAMA
et al.
1992:268:1709.
and hospital characteristics. Thus,
ity
information
\alid
about
Apparatus
for the
Control of
Breathing Patterns during Aerosol
Inhalation
SD
develop
ways
to
use
such
mation
improve
care.
to
be useful.
need
We
to
infor-
quality of
care measured by explicit criteria, im-
and
review,
plicit
outcomes
at different
DESIGN:
pitals.
sickness-adjusted
types of hos-
Further analysis of
and
Treatment,
Diagnosis,
Pre-
PR
Anderson.
Phipps.
Gonda.
I
Med
Aerosol
J
computerized breathing
circuii lor
monitoring, recording and controll-
vention of Pulmonary Kmholisni:
ing acrt)sol inhalation patterns
Report of the WHO/International
scribed.
Society
and Federation of Cardi-
ology Task Force
— SZ
Goldhaber,
the
WHO/ISFC
1992;
5(3): 155.
A
OBJECTIVE: To compare
re-
changing physician practice would
hospital
quality can be obtained.
Finally,
search into effective techniques for
and
plausible relationships between qual-
Hospital Characteristics and Qual-
venous thrombosis and pulmonary
embolism prophylaxis.
A
de-
is
target pattern, using sine
functions derived from previous re-
cording of breathing,
is
displayed on
data retrospectively abstracted from
M
medical records to evaluate the
ef-
Task Force on Pulmonary Embolism.
ducibility of tidal breathing patterns
on
JAMA
of 9
of
fects
payment
prospective
quality of care for hospitalized
SETTING:
icare patients.
in 5 states
along
A
were sampled
with
Hospitals
admissions
manv dimensions. PATIENTS:
of
total
elderly
14.()()8
of the following
1
."i
patients
diseases:
congestive heart failure, acute
myo-
pneumonia, stroke,
cardial infarction,
for
1992:268:1727.
Med-
to represent
Medicare
national
the
Morpurgo,
To
assess the state of the art of ve-
this
heart-related professions, the
(WHO)
Health Organization
World
and the
International Society and Federation
(ISFC) conxened a
of Cardiology
task
force
in
Geneva, Switzerland.
(iii)
for 2
these diseases in 297 hospitals in 2
oral presentations.
time periods, 1981 to 1982 and
I98.'5
sequently prepared by the task force
er
OUTCOME MEASURES:
members, who contributed sections
than
to
1986.
by
Each subject breathed
minutes using each method on
The breath-b\ -breath
was found to be similar
for all methods. The day-to-day variation was greatest for the "no control" method with the exception of
inspiratory pause (P,). The inspir-
position papers and presented brief
was sub-
met-
target,
)
variability
Members of
report
target, (ii) a
\olume (Vi
separate days.
randomly sampled from those with
A
repro-
the full control provided
system.
or hip fracture. These patients were
the task force prepared
no
(i)
tidal
and
medical
the
The
normal volunteers was com-
ronome and
and other
for
screen.
pared using
nous thrombosis and pulmonary embolism
computer
the
atory tlowrate (F,) and P, had a great-
using
variation
the
full
the
control.
metronome
The Vt and
Explicit criteria, implicit review, and
in their
mortality within 30 days of admis-
of the report occurred both during
well
sion adjusted for sickness at admis-
the task force meeting itself in
methods. This system provides better
sion.
RESULTS:
ings
for
using explicit
types
are
rat-
similar
implicit
criteria,
outcomes
and
view,
Quality of care
hospital
adjusted
re-
for
sickness at admission. Quality differ-
between
ences
were
types
of
hospitals
large, with the lowest
timated
to
have
four
group
points higher mortality than
teaching hospitals
tients with
in a
average mortality of 16%.
teaching, larger, and
than
1400
major
cohort of pa-
Quality varies from state to
pitals
es-
percentage
but
more urban hos-
have better quality
nonteaching.
state,
small,
in
general
and
rural
areas of expertise. Revisions
Ge-
breathing
were
frequency
controlled
using
equally
two
these
neva and during the ensuing months.
control with an easy to follow target
The
was approved by the
WHO-ISFC Task Force on Pulmonary Embolism Steering Committee.
More quantitative information is
display of the subject's own. or pre-
needed on the frequency of venous
(Jas
thrombosis and pulmonary embolism
Vsthniatic
in
final report
hospitalized
medical patients as
well as in outpatients
at
high
risk.
set,
inhalation pattern.
Transcutaneous and
Monitoring
Children
.Arterial
Svniptoms
—
I)
Older
in
Holmgren, R
Blood
Acute
during
Sixt. Pe-
diau Pulmonol 1992:14:80.
Population studies should focus cm
incidence,
survival,
complications
the world
w
in
and
different
long-term
parts
of
The
relationship
taneous and
between
arterial
transcu-
blood gases was
respect to gender and
investigated in 14 children with asth-
race. Further educational efforts are
matic symptoms, aged 7-15 years,
needed
heforcand
ith
lo increase
awareness about
after the inhalation
RESPIRATORY CARE • DECEMBER
"92 Vol 37
of
sal-
No
12
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Copyright
GEM
IS
©
1992,
MaMmckrodt Sensor
a registered
Systems,
Inc.
trademdrk of MaMintkrodt Sensor Systems,
Circle 140
Sensor Systems
Inc.
MSS151C
D
1
ABSTRACTS
butamol. The degree of bronchial ob-
was assessed by forced ex-
struction
piratory
and
\olume
maximum
259r of
FVC
one second (FEV|)
expiratory flow
remained
On
(MEF:5).
in
to
average
(range
2.6-0
kPa)
transcutaneous
(range 0-1.5
corresponding
0.01).
The
trans-
the
1.3
kPa
lower and
the
was 0.6
kPa
Pco:
kPa) higher than the
values
arterial
(p
<
difference between arteri-
and transcutaneous P02 was the
same over the whole range of values
al
studied (7.3-14 kPa). After the inhalation of salbutamol. the relationship
between transcutaneous and
blood
gases
was
not
G
in
(p
<
0.05). indicating a
common
on transcutaneous blood gases was
investigated
mo-2.5
toms.
clude that the
tween
We
and
children (aged
asthmatic
one
was
symp-
salbutamol
a
mean
1
in-
increase in
transcutaneous Po: (tcPo:) of 0.5 kPa
(p
<
0.01); after a second dose given
30 minutes
was
1.2
crease in
mean
later, the
increase
kPa (p < 0.001). The intcPo: after only one dose of
was
salbutamol
significantly
cor-
No
such
<
0.01).
arterial
blood gases, even after the inhalation
based on a desired percent
hemoglobin saturation (S02)
was observed
after
two
livered
(BW
salbutamol
±
GA
g;
26 ±
1
wk;
8 d) receiving oxy-
hood were studThe desired range of So; from
gen-air mixtures by
ied.
92
to
969f with a target
\
alue of
95%
was determined by pulse oximetry
and maintained with adjustment of
Fio: using three
modes:
(
1
)
standard
oxygen delivery evaluated
intervals;
salbutamol
have beneficial effects
in
(2)
at
20 minmanual
bedside
control with Fio: manipulation e\ery
in
2 to 5 minutes;
inha-
a negative correlation
tomatic period (p < 0.05).
that
860 ± 80
infants
dysplasia
after a sec-
to the duration of the current
clude
14
neonate.
the
study age 41
symp-
We
con-
inhalations
young
chil-
dren with acute asthmatic symptoms,
and (3) adapti\e con-
with on-line adjustment of F102
trol
showed
to
bronchopulmonary
with
ute
ond dose. The overall increase
tcPo:
con-
(Fic);).
neonatal intensive care protocol with
de-
clo.se relationship be-
transcutaneous
2.^
with
After
lations
the peripheral airways.
in
yrs)
halation there
nominator, probably the conditions
in
gen
was achieved by on-line bedside control of the oxygen concentration de-
effect of salbutamol inhalations
related to age (p
MEF25
Adapti\e adjustment of inspired oxy-
The
arterial
transcutaneous
in
R
Engstrom.
I
Wennergren. Pediatr
arterial
significantly
Pq: correlated to changes
G
Pulmonol 1992; 14:75.
correlation
changed. Changes
Bjure,
J
Sten.
when
be expelled
cutaneous P02 (tcPo:) was
Holmgren,
Sixt.
according to a specifically designed
adaptive program. Each study period
was of 40-minute
duration. Sq: val-
within a steady 94-969^ range
ues
was achieved
for 54^^
of the time
w,ith
standard protocol, compared to
even below the age of 18 mo. pro-
6Wc
(p
for monitoring acute bronchial ob-
vided that an adequate dose reaches
control
struction and for evaluating the ef-
the lung and preferably at an early
adaptise control. In addition, fluctua-
fects of treatment in children of dif-
stage of obstruction.
tions
of a beta: agonist, indicates that the
transcutaneous technique can be used
were
ferent ages.
Adaptive Control of Inspired Oxy-
Transcutaneous Blood Gas Monitoring
during Salbutamol Inhalations in ^'oung Children with
Acute
1402
Asthmatic
Symptoms
—
gen Delivery to the Neonate
Bhutani. JC Taube.
MJ
— VK
Antunes.
M
in
<
0.01) with bedside manual
and 81**
<
0.01)
with
S02 values and o\ershoots
less
control
(p
apparent
with
adaptive
of oxygen delivery.
These
data describe adaptive Fic- control as
an efficient alternati\e technique for
Delivoria-Papadopoulos. Pediatr Pul-
achieving a stable desired range of
monol 1992:14:110.
oxygenation
RESPIRATORY CARE
•
in
neonates.
DECEMBER
"92 Vol 37
No
12
I
Just
Up to 60 Watts of Heater Wire
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Flat Control Buttons. Help prevent
accidental readjustment and
provide easy visibility and cleaning.
Standby Mode. Up to 20 minutes
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Exclusive Standard IBM PC
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remote monitoring and data
Calibrated Chamber Control.
Provides precise delivery of
humidity from chamber.
retrieval
Dedicated LED Alarm Display.
Alerts user to specific problem
Chamber Set Low Light.
and
Warns
simplifies troubleshooting.
if
the humidifier
is
set too low according to
ANSI/ISO standards.
:**.<SP:Mrfi
The New Fi^
Do
Water.
lykel IVIR730
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fverytliing Else For You.
The MR730. And a
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The Fisher & Paykel MR730
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not only is the MR730 easy to use, it's easy to acquire.
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And
more information or a personal demonstration, contact
Baxter Healthcare Corporation, Pharmaseal Division,
27200 North Tourney Road, Valencia, California 91355.
For
Telephone 1.800.321.3832.
©Copyright 1992, Baxter Healthcare Corporation.
All rights
reserved.
Circle 90
Can LeadI
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lodert
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It
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you an understanding of nicotine and
chemistry of the brain,
how
it
how
it
can be measured
bodily fluids, and the value of using self-tests to determim
addiction
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This IISP also teaches the importance of
nicotine replacement and
how
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can be enhanced with behavioral
counseling. Item SCI, $10 (60 pages)
Prepare Yourself for the Role oi
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Bedside Counseling of the Hospitalized Smoker
is
an Individual Independent Stud)
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inpatients. Hospitalization presents a
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to assist patients to
smoking.
This IISP helps you understand the role of the bedside nicotine-dependence
e'^sô/fl^&n/
how
counselor and
to assess the inpatient smoker.
You
will
be able to help
patients cope with nicotine withdrawal, increase motivation for
and be able
cessation,
to
permanent
understand factors contributing to smoking relapse.
Item SC2, $10 (80 pages)
of
t^
u/
d ay
Please send me: lj Nicotine Dependency Evaluation and Treatment (SCI)
Bedside Counseling of the Hospitalized Smoker (SC2)
^
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I
I
each, phis $3.75 shipping
Payment enclosed
D
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TX
75229. (214) 243-2272, Fax (214) 484-6010.
qu
—
—
Editorials
A New Look for Open Forl m '93
Some Pointers on Sta)ing 'In Fashion'
witli
What's the most
common
reaction of re\iewers and
Preparing an abstract
Forum each year? "Gee. the abstracts get better e\ery year." And. we agree
better,
more timely, more relevant and more numerous!
The growing number of submitted and accepted asbtracts is forcing us to re\amp our sNstem. So. what are
we going to do? Limit the number of abstracts accepted?
obser\ers to the Open
—
—
No
judged on
No
its
No arbitrary
own merit. No
quotas.
limitations.
ranking.
No
Each
\alid.
it.)
We're simply going
form
in
which they
are submitted
—
a
new look
Submitted abstracts must adhere closely
—no opportunity
spelled
words or
after
clarify
We
the
me
for our
to say all of that in that little space
convoluted sentences or add
stract writing as
Let's
paring the abstract
—
little
more care
that
your study planning and execution
trouble saying everything in that
in pre-
egraphic style
to assure completeness, accuracy,
—
Pa02. FI02.
ABG. ARDS. &,
—
your grandchildren. There
permanent as an error
Read
in t)pe.
(1
is
should know
.As
but
reviewed and
if
by the early deadline (March
7c).
identifying
Abbreviate any
(eg,
it
second-
always, the editorial office stands ready to help
we
can't help
much
10 minutes before the final
deadline. Call or write or fax, but
do
before the early deadline (March
19). So.
it
early
!)
the 1993 Call for Abstracts carefully. Follow
stracts received
first
hand smoke simulator [SHSS]). Pare! Pare! Pare!
nothing so
the instructions to the letter. Rules ha\e changed!
having
still
Adopt a teland the's. Use
space.
out with the a's, an's,
(eg,
for
little
standard abbreviations and symbols without explanation
to specifications.
recurring phrase after
you save
new look and
Ab-
—
preferably
conform
Pat Brougher
19) will be
and resubmission by the
RespiratoriDallas,
•
DECEMBER
'92 Vol 37
No
RRT
Editor
final deadline (June 1).
RESPIRATORY CARE
to the
stay in fashion.
unacceptable for any reason returned to
the author for possible revision
What
reviewer's desk.
at the
study planning.
it is
assume
the spelling checker of your
that
provided on the
ha\e been crisp and complete, but you are
It
Use the dictionary or
word processing program
even if you think evervthing is OK. Ask the nearest
English major to check grammar and syntax. After all.
you don't want spelling errors in the November issue
and adherence
if differ-
would you ha\e to know to be conxinced? Don't even
start to work until you ha\e clearly in mind what the
study question is and how you will answer it. 1 suspect
that the problem with abstract writing is not so much ab-
missing data.
a
could be an-
Think abstract from the day you plan
your study. Put yourself
to specifica-
as a potential author?
that the study question
exist, that there
abstract blank?"
submission to correct mis-
What does this mean to you
means that you need to exercise
and
was
must make clear the study question
was no bias in subject selection,
that the reported differences were or were not statistically significant and clinically important. The conclusions
must be consistent with the study question and methodology and supported by the results.
I hear you saying "Just exactly how
do you expect
November issue and the Annual Meeting Program.
Well, how do you stay in fashion, and what does this
mean in terms of abstract acceptance and publication?
tions
abstract
subjects were involved to detect differences
ences
to adopt the ap-
in
—
so much
What do re-
a challenge
essential?
is
swered, that the method was appropriate, that enough
abstract
photograph and publish accepted abstracts
will
The
(or hypothesis)
comparisons.
proach that many other journals and societies use.
always
vinced, to be persuaded that the study or evaluation
an abstract meets the criteria for ac-
If
ceptance, accept
is
What
viewers look for? The reviewer (reader) needs to be con-
way! (The Association and the Journal's philosophy
has always been:
is
to say, so little space.
12
C^re
Texas
140.^5
—
1993 Call for Abstracts
Respiratory Care
The American Association
for Respirator,'
Care and
its sci-
Open Forum
•
Abstract Format and Typing Instructions
ence journal. Rkspiratory Caki:. invite submission of brief
abstracts will be reviewed, and selected authors
be invited
v\ ill
Open Foru.m during the ."XARC Annual
Meeting in Nashville. Tennessee, December 1-14. 1993. Accepted abstracts will be published in the November 1993 issue
to present papers at the
1
of Rhspiratorv Care. Membership
in the
AARC
not nec-
is
Accepted abstracts
The
abstracts related to any aspect of cardiorespiratory care.
should be the
stract
will be photographed. First line of ab-
title in all
plain content. Follow
capital letters. Title should ex-
with names of
title
name. Type or electronically print the abstract single .spaced
the space provided
on the abstract blank.
couraged but must be accompanied by
Specifications— READ
will be
CAREFULLY!
masked (blinded)
paragraph. Data
may repon
an original study, (2) the evaluation of a method or device, or (3) a case or case series.
Topics may be aspects of adult acute care, continuing care/ reabstract
(
figures
)
1
lotted.
cardiopulmonary
perinatology/pediatrics,
sonnel and health-care delivery.
at a local
The
tech-
management of
nology, health occupations education, or
presented previously
abstract
or regional
— but
not national
invited to present a paper at the
OPEN FoRliM.
Give
specific information.
Do
Make
and conclu-
not write such general
.
en-
is
Identifiers
the abstract
all
one
be submitted in table form and simple
A
abstract form.
clear photocopy of the abstract
A
new or infrequently used abbreviation
should be preceded by the spelled-out term the
a
by
Therefore, the
abstract must provide all important data, findings,
hard copy
is
it
first
spelling,
(3)
explained.
grammar,
conformance
Check
facts,
first
may be
used. .\n\ recurring phrase or expression
in
abstract will be the only evidence
for review.
a
in
letter
form may be used. Standard abbreviations may be employed
without explanation.
which the reviewers can decide whether the author should be
sions.
one
the abstract. Provide all author information requested in right
if
The
may
per-
may ha\e been
meeting and should not have been published previously
national journal.
Insert only
may he included provided they fit within the space alNo figures, illustrations, or tables are to be attached to
column of
habilitation,
authors (including
space between sentences. Text submission on diskette
essary for participation.
An
all
and location. Underline presenter's
credentials), institution(s).
time
it
is
abbreviated
the abstract for (I) errors in
and figures:
of language:
(2) clarity
to these specifications, .^n abstract not pre-
may not be reviewed. Questions about abmay be telephoned to the editorial staff of
Respiratory Care at (214) 243-2272.
pared as requested
stract preparation
statements as "Results will be presented" or "Significance will
be discussed."
Deadlines
Essential Content Elements
The mandatory
thors
An
original study abstract musl include
(
I
)
Introduction: state-
ment of research problem, question, or hypothesis:
Method:
(2)
description of research design and conduct in sufficient detail
judgment of
to periTiit
validity; (3) Results: statement of re-
search findings with quantitative data and statistical analysis;
(4) Conclusions: interpretation of the
meaning of the
nu'thod/dcvice evaluation abstract must include
duction: identification of the
method or device and
results.
(
1
its
function; (2) Method: description of the evaluation
ficient detail to
permit judgment of
its
Final Deadline
is
June 7 (postmark). Au-
be notified of acceptance or rejection by letter
— to be mailed by August
15.
Authors
mit abstracts early. .Abstracts received by
may choose
March
to sub-
19 will be re-
viewed and the authors notified by April 24. Rejected abstracts
will
be accompanied by a written critique
that
should
in
many
cases enable authors to revise their abstracts and resubmit
them by
the final deadline (June 7).
Intro-
)
intended
in
Mailing Instructions
suf-
objectivity and validity:
(3) Results: findings of the evaluation; (4) Experience:
mary of
A
only
will
sum-
the author's practical experience or a notation of lack
Mail (Do not fax!) 2 clear copies of the coinpleted abstract
form and a stamped,
self- addressed
postcard (for notice of re-
ceipt) to:
of experience: (5) Conclusions: interpretation of the evaluation
and experience. Cost comparisons should be included where
possible and appropriate.
A
case report abstract must report a
Respiratory Care Open Forum
1
case that
is
uncommon
1030 Abies Lane
or of exceptional teaching/learning val-
Dallas
ue and must include:
(
1
)
case
summary and
(2) significance
case. Content should reflect results of literature review.
TX 75229-4593
of
The
author(s) should have been actively involved in the case and a
case-managing physician must be a co-author or must approve
the report.
1406
"92 Vol 37
No
12
1993 Respir\tory C\re
Abstract
Open Forum
Form
1.
Title
must be
thors"
2.
in all
names and
Follow
title
uppercase
text in
(capital) letters, au-
upper and lowercase.
with nil atithors' names including cre-
dentials (underline presenter's name), institution,
and location.
4.
Do
Do
5.
All text, tables, and figures must
3.
not justify
(ie,
leave 'ragged' right margin).
not use type size less than 9 points.
fit
into the rec-
tangle shown.
6.
Submit 2 clear copies. This form may be photocopied
7.
if
For more
multiple abstracts are to be submitted.
details, see
accompanying examples and
editorial.
Presenter's
Name &
Credentials
Presenter's Mailing Address
CO
o
E
Presenter's Voice
Phone
&
Fax
C\J
C\J
Corresponding Author's
Name &
Credentials
Corresponding Author's Voice Phone
Mail original
&
1
&
Fax
photocopy
to:
Respiratory Care Open Forum
11030 Abies Lane
Dallas
Early deadline
in
March
TX
75229
19.
1993
iahstract received)
Final deadline
is
June
7,
1993
(abstract postmarked)
8.1
cm
or 3.2"
'92 Vol 37
No
12
1407
Respir.\torv
C\re Open Forum
Sample Abstracts
EVALUATION OF DISTAL AIRWAY PRESSURE
SUPPORT VENTILATION (DAPSV)— Toshimichi
MP
Konyukov MD. Jun Takezawa
Toshiro Hotta RRT. Toshio
Yasuhiro
Shimada
MD. Nagoya UniverFukuoka RRT.
Takahashi
.
Yurii
MD. Naoto Kuwayama MD,
sity Hospital,
Use of
distal
Nagoya, Japan.
airway pressure (Pdaw). instead of Pa^- as
new mode of me-
triggering and target pressure allows a
chanical ventilation called distal airway pressure support
ventilation
(DAPSV). Our study sought
to validate this
mode. Method: A spring-loaded bellov\ s-iype lung model was used to simulate spontaneous breathing. Diaphragm bellows was connected to jet-How generator to
generate inspiratory efforts. Cl and Ccw were 0.06 and
RR was
0.12 L/cm H:0. respectively.
I:E 1:1. Puritan-Bennett
7200a
20 breaths/min,
ventilator
was put
&
in
CPAP mode at PS level of 10 cm H:0. ETT (ID 6.0,
7.0. & 8.0 mm) with embedded lumen in side wall was
interposed between lung model & enlilator. Pressure
\
monitoring
line
of ventilator was disconnected from ex-
piratory limb and attached to pressure monitoring line of
ETT. Expiratory (Exp) delay
(Insp Pawp>- peak
Exp Palv
time, peak inspiratory
(Pavlp), and peak
Exp
Paw
Ppl
(Pplp) were measured. Results: Pressure supporting time
exceeded inspiration phase
minated
in
DAPSV. At
higher Pau to attain
sult,
set
a
in
PSV
but prematurely ter-
matched Vt.
DAPSV
support level of Piia«
inspiratory negative deflection
•
showed
As a re-
& expiratory over-
shooting of Ppl was minimized by D.'XPSV. This ten-
dency
is
aggravated u hen smaller
Conclusion: Although
DAPSV
for improving synchrony than
criteria
ETTs
are used.
has a greater potential
PSV. flow-termination
should be reduced to < 5 L/min for better pa-
tient-ventilator synchrony.
Oridnal Contributions
Does a Sigh Breath hiiprove Ox\'genation
hitiibated Patient Recei\ing
in the
CPAP?
MMSc RRT, M Chi istint- Stock MD,
Eugenia Tarras MMSc RRT, and Susan Hancock MMSc RRT
D
Ricliiud
BACKCROrND:
Bruce
In thf spontaneously breathing patient, tracheal intubation with
ambient end-expiratory pressure decreases functional residual capacity, resulting
in
diminished arterial oxygenation and lung compliance. The sigh breath, a posi-
tive-pressure breath with a volume of 10 to 15 ml,/kg applied interniittentlv. has
An appropriate
known to pre\ent or
been used to decrease atelectasis and prevent arterial hvpoxemia.
level of
CPAP
overcome
PEEP
or
loss of
FRC.
provided to the intubated patient
We
is
sought to determine whether intermittent sigh breaths
v»ould further increase oxygenation and, thus, provide any advantage to intubated
patients maintained on
care unit
who
CPAP. METHODS:
Thirty adults in the surgical intensive
who
required tracheal intubation but
did not require ventilatory
support received two modes of support in random sequence
CPAP
with a single sigh breath/minute
oxygenation were assessed at the end of 3 hours of
CPAP
or 12 hours of
and 12 hours of
CPAP + S
the anticipated duration of intubation. Data
RESULTS:
dependently.
Levels of
— CPAP
alone or
ICPAP + S). Hemodynamics and
CPAP
CPAP and
(in
3 hours of
arterial
CPAP
-i-
S
random order) depending on
from the two groups were analyzed inand Fio: were similar during both
modes of therapy. Hemodynamics and gas exchange did not differ significantly
when the patients recei>ed one mode of therapy or the other. CONCLUSIONS:
Neither
CPAP
nor
CPAP-hS provided an advantage with respect to gas exchange
A sigh breath carries some inherent risk of barotrauma
or hemodynamic function.
and may increase the
cost
and sophistication of care.
spontaneously breathing patients receiving
CPAP
A
sigh breath
is
unneeded for
augmenting
for the purpose of
arterial oxygenation. (Re^pir Cure 1942;37; 1409- 1413.)
Introduction
and
genation
compliance
lung
deteriorate.'"-^
to
Raising end-expiratoiy airway pressure, either w
Tracheal
intubation
diminishes
functional
(FRC) and may cause
sidual capacity
arterial
re-
positive end-expiratory pressure
oxy-
tinuous positive airway pressure (CPAP).
treatment of choice for restoring the
Mr
Bruce,
tant,
and
Critical
who
Ms
that
died June 30. 1991, was a Physician's Assis-
Tarras and
Ms Hancock
is
pulmonary
patients with severe
Atlanta, Georgia.
relatively fixed tidal
Presented, in part,
at
the
Annual Meeting of
Society of Anesthesiologists, October
1
1,
California, and during the Respir.^tory
the
the
piratory Care.
Reprints;
thesiology.
M
November
Christine
Emory
Road NE. Atlanta
Care Open Forlm
Stock
MD,
•
advocated
inflating"
or "sigh"
livered
the
of
use
Department
of
breaths
(
larger
L'i-20
to prevent or reverse atelectasis
iinprove arterial oxygenation
Anes-
when
'92 Vol 37
No
they were
and
em-
ployed with conventional mechanical ventilation
1364 Clifton
and ambient expiratory airway
DECEMBER
"hyper-
mL/kg) de-
every 5-10 minutes. These sigh breaths
were thought
30322.
RESPIRATORY CARE
cHnicians
at
for Res-
1988. Orlando. Florida.
University Hospital. B339,
GA
American
CPAP, many
hypoxemia were ventilated at
volumes and fixed rates. Some
1988. San Francisco.
Annual Meeting of the American Association
decreases
defects. In the eariy
could simply and effectively deliver
Associate Professor of Anesthesiology,
Emory University School of Medicine,
the
1960s, prior to the de\elopment of systems that
vices and Anesthesiology. Grady Memorial Hospital, Atlanta,
Or Stock
FRC
is
intubation and for aineliorating the
effects of restrictive
are Physician Assistants,
Care Medicine. Departments of Respiratory Care Ser-
Georgia.
accompany
ith
(PEEP) or con-
12
pressure.'*''
Fre-
1409
SIGH BREATHS DURING CPAP
quently, arterial
tilatory
in the
this
51^
CPAP. The
study was to determine whether
administering a single,
oxygenation
arterial
by CPAP.
that afforded
Fig. 1.
ume
Continuous flow
CPAP
system with volume ven-
FGF
= fresh gas flow; R = reservoir bag; VV = volventilator; H = humidifier; PT = patient; TRV = uni-
tilator.
Methods
FGF
^ÎSlf
mechanical breath
large
each minute would enhance
beyond
TRV
absence of ven-
can be reversed with
failure
purpose of
hypoxemia
directional threshold resistor valve.
This study was approved by the
sity
Human
Subjects
Emory Univer-
Review Committee. Written,
informed consent was obtained from
from
all
was unable
their next of kin if the patient
The
first
who
30 adults
care
in the surgical intensive
required trachea! intubation, but
who
did
not require ventilatory support, were included. Pa-
one of two categories: those
for whom tracheal extubation was anticipated within 6 hours (6-hour group), and those who would remain tracheally intubated for at least 24 hours (24hour group). CPAP alone was compared to CPAP
tients
were assigned
to
(MABP), and
air and
oxygen through a circuit with a compliant 5-L reservoir bag in the inspiratory limb, and a threshold
continuous flow (40-60 L/min) of blended
resistor valve in the expiratory
positive pressure (Fig.
1).
mode
inter-
of a volume
ventilator provided a single breath/minute with a
dal
volume of 12
in addition to
to 15
ti-
niL/kg of ideal body weight
CPAP. Sigh
breaths were not syn-
chronized to the patient's spontaneous breaths. All
patients received both
tients
served as their
modes of
own
therapy, so that pa-
controls. Patients
assigned randomly to receive either
CPAP-I-S
initially. In the
lar-to-arterial
CPAP
Student's
and
after 12 hours
therapy and again after 12 hours of the
Data from the two patient groups
were analyzed independently. The level of CPAP
and the fraction of inspired oxygen (Fio;) were
alternate therapy.
kept constant during both
t
test
probability that they occurted by chance
less
Results
modes of
Twenty-two
patients
were studied
group, and 8 patients were studied
therapy. Pa-
in the
in the
6-hour
24-hour
group. Patients" ages ranged from 22 to 92 years:
the
mean ages of
the 6-hour
group and 24-hour
group were 40 years and 56 years, respectively.
Twelve of the 22 patients originally were intubated
to prevent piilimtnary aspiration, to pre\cnt
remainder
required
pulmonary
tilatory support
intubation
to
airway
toilet.
provide
The
ven-
and had been subsequently weaned
from mechanical
For both the 6-hour
\entilation.
and 24-hour groups, the levels of
w ere indistinguishable w hen
CPAP
and Fio:
CPAP alone w as com-
pared to CPAP-fS. Although one positive-pressure
breath/minute must increase
mean airway
pressure,
the difference in mean airway pressure when
CPAP and CP.AP-(-S were compared was not clin-
mode
differences
1410
was
than50'r (p<0.05).
ically significant (Tables
of therapy.
cal-
two modes of therapy were statistically differDifferences were considered significant if the
were administered sedatives and analgesics
by the usual standard of care and w ithout regard to
tients
|P(A-a)02].
detemiined whether results from
alone or
therapy,
first
24-hour group, data were collected
first
the alveo-
and the physiologic shunt fraction (Qs/Qi) were
culated from standard formulae.
obstruction, or to facilitate
again after 3 hours of the alternate therapy. In the
of the
also.
were
6-hour group, data were
gathered after 3 hours of the
pulmo-
limb to establish
For CPAP-i-S, the
mittent mandatory ventilation
blood pressure
patients had
The PaO:/Fio; ratio,
oxygen tension difference
were collected
ent.
delivered with a high
arterial
When
analy-
cardiac output, and intrathoracic vascular pressures
the
CPAP was
mean
heart rate.
pH
agement, mixed-venous oxyhemoglobin saturation,
minute (CPAP-i-S). The same circuit provided both
support.
blood gas and
nary artery catheters as part of their medical man-
with a single positive-pressure breath, or sigh, each
modes of
arterial
respiratory rate,
sis,
to
give consent.
unit
Data included
patients or
1
&
2).
In the 6-hour group, there were no significant
in
hemodvnamic
RESPIRATORY CARE
•
\alues. PaO:, PaO:/
DECEMBER
"92 Vol 37
No
12
—
lo
CPAP
Qs/Qt when
Fio:. P(A-a)0;. aiid
compared
CPAP + S
(Table
CPAP
alone was
CPAP
Table
Effects
1.
of
CPAP
CPAP
and
namics and Oxygenation
S (Table
-I-
perienced
1).
+ Sigh on Hemody-
a
trend
Patients
toward
in
was
group ex-
this
lower
S. but the difference
-I-
MABP
during
not clinically sig-
nificant.
22 Intubated Patients
in
Studied for 6 Hours
Discussion
CPAP+S
CPAP
Variable
2).
Our
patients received positive-pressure breaths
Fio:*
22
0.34(0.06)t
0.36(0.09)
0.39
CPAP(cmH:Ol
22
6.0(4.9)
7.5(4.7)
0.31
taneous breaths. Because the frequency of positive-
HR (beats/min)
MABP(mmHg)
22
104(16)
101(18)
0.19
pressure breaths
22
94(12)
97(15)
0.47
ventilation,
CVP(mmHg)
22
10(6)
11(5)
0.55
were abnormally large
that
breaths
relative to their spon-
was low and added
to
little
minute
we chose to call these additional
"sighs." Awake man at rest normally sighs
approximately 3 times each hour." Spontaneously
PAOP(mmHg)
8
12(4)
11(5)
CO.
8
6.0(2.2)
6.0(1.8)
Pa02/Fio: (torr)
22
278(88)
303(113)
0.42
detection of any effect that might be present
P(.A-a)0: (torr)
22
104(56)
113(52)
0.58
without markedly altering the spontaneous breath-
0.25(0.09)
0.19(0.08)
0.18
0.66
isoflurane-anesthetized
breathing
(L/min)
Q^Q.
8
=
*Fio2
HR
CVP
=
fraction of inspired O:;
mean
arterial
pressure;
CO. =
blood pressure;
PAOP = mean
pulmonary
cardiac output; P(.A-a)02
tension difference; Qs/(i
=
=
heart rate:
= mean
1.0
MABP
ing pattern
=
2.
Effects of
at the
high-
sigh/minute, or 60 sighs/hour.
Methods of delivering sigh breaths vary considerably. Branson and Campbell recently (1992) reviewed techniques of sigh delivery.^ Sigh breaths
ute ventilation:
artery occlusion pressure;
alveolar-to-arterial o.xygen
physiologic shunt fraction.
fValues are mean (SD).
Table
— we delivered sigh breaths
To allow
frequency that did not add significantly to min-
est
venous
central
breathe
adults
deeply approximately 6 times each hour.^
1
can be pressure-limited'*'*'" or volume-limited, and
CPAP
CPAP
and
namics and O.xygenation
in
may
+ Sigh on Hemody-
involve a sustained or prolonged inflation.'" If
a sigh breath were to improve arterial oxygenation,
8 Patients Studied for 24
the
Hours
improvement would most
due
likely be
to re-
cruitment of collapsed alveoli.
CPAP+S
CPAP
Variable
0.33 (0.04 )t
Fio:*
Laver and co-workers"
0.33(0.03)
al'-
1.0
in
humans showed
cm H2O
5.5(2.1)
6.0
HR (beats/min)
110(14)
108(10)
0.75
MABP (mm
112(15)
100(12)
0.10
efit
7(5)
9(5)
0.44
collapse in
CO.
(L/min)
40
recruit alveo-
and improve oxygenation
ARDS. Novak
et al's'"
in subjects
ARDS
with severe
patients did not ben-
6.3(0.5)
7.0(3.5)
0.58
277(72)
299(81)
0.57
CPAP
104(50)
P(A-a)0; (torr)
would
from a similar protocol. The degree of alveolar
ARDS patients is much more severe
than in our patients who required < 7 cm HÔ
Hg)
Pa02/Fi02 (torr)
that hyperinflations to
ef
0.62
(1.8)
li
CVP (mm
dogs and Scholten
lasting 15-30 seconds
CPAP(cmH;0)
Hg)
in
100(52)
to
maintain adequate arterial oxygenation
with Fio: < 0.35. Further, Gattinoni
0.88
et al's"*
ARDS
patients did not require sustained hyperinflation to
0.12(0.07)
*FiO:
mean
=
fraction of inspired O:;
arterial pressure;
C.O.= cardiac output;
CVP
= mean
P(A-â)0:
tension difference; (Js'Qt
=
HR
=
0.14(0.01)
= heart
central
rate;
0.44
MABP
improve
=
oxygen
and
atelectasis,
physiologic shunt fraction.
Similarly, the 24-hour group experienced
no
when CPAP alone was compared
'92 Vol 37
CPAP
not to einploy sustained
hemodynamic
alone, either in patients
12
mL/kg every 60 seconds
offered no advantage in arterial oxy-
genation or in
to
No
sigh breath of 12-15
during
sig-
differences in measures of arterial oxy-
we chose
or prolonged hyperinflation.
A
genation
CO:
re-
removal.
Thus, for our patients with mild alveolar collapse
tValues are mean (SD).
nificant
oxygenation while his patients
ceived \eno-venous extracorporeal
venous pressure;
alveolar-to-arterial
arterial
who
effect
over
received each
CPAP
mode
141
who
for 3-hour periods or in patients
mode
received each
12 hours. These data are distinct from
for
those of Bendixen and co-workers'*^^
who demon-
breathing population a sigh breath/minute does not
enhance
at lea.st
oxygenation and
arterial
cm H.O CPAP
5
unnecessary
is
if
applied.
is
using a sigh-breath technique. However, circum-
The administration of CP.-XP alone may have adin other respects. The peak and mean airway pressures associated u ith CPAP alone are nec-
stances under which these patients were treated dif-
essarily
fered from our patients" circumstances. Bendixen
though we believe that the difference
strated
that
oxygenation could
arterial
mented and physiologic shunt
et
al's
pressures of 15 to 20
20
to
ceive
PEEP
or
by
cm H:0
In contrast,
received
at least
5
pressure during quiet, spontaneous \entilation will
re-
our patients were
cm HÔ CPAP.
cumstances under which
Bendixen
et al's
edly and
may
a sigh breath
Thus, the
was used
cir-
for
and for our patients differed mark-
explain
why
al-
air-
with peak
not anesthetized; they breathed spontaneously, and
all
lower than those during CPAP-t-S.
with \entilatory
25 breaths/minute, and did not
CPAP.
vantages
in mean airway pressure is not clinically important. However,
when CPAP is administered alone, the peak airway
were anesthetized, received con-
patients
rates of
aug-
fraction reduced
trolled, pressure-limited ventilation
way
be
CPAP
be the
barotrauma
level and. thus, the risk of
should be low\ Our study involved too few patients
to
CPAP
assess the risk of barotrauma. Finally.
without sigh breaths can be administered less expensi\ely because a mechanical ventilator
is
un-
necessary.
two
the results of the
Conclusions
studies differ.
Patients receiving apneic oxygenation during ex-
CO2
tracoiporeal
removal
gradually
become
hypoxemic if airway pressure remains
ambient." However, if two pressure-limited, posiincreasingly
tive-pressure
breaths are delivered each
minute,
then arterial oxygenation improves significantly.^
Similarly, application of
modest
CPAP
levels of
A
single
positive-pressure breath each minute
does not augment
arterial
hemodynamics
the
in
Because the application of sigh
barotrauma and
tribute to
therapy, the use of
Patients in these studies were paralyzed and were
CPAP
at
ambient expiratory airway pressure.
-I-
may
CPAP
cm HÔ CPAP.
breaths may con-
increase the cost of
alone
S for the support of
alter
spontaneously
intubated,
breathing patient receiving 5-10
also will result in improved arterial oxygenation.
maintained
oxygenation or
is
preferable to
oxygenation
arterial
in
the intubated, spontaneously breathing patient.
Their response to non-sustained sigh breaths with-
PEEP/CPAP was similar to that of Bendixen et
al's patients who received mechanical ventilation,
ACKNOWLEDGMENTS
out
PEEP, and sustained sigh breaths.
Grim and co-workers'" used positi\e-pressure
Wc
lli.ink
Ms
Ester
determined inspiratory capacity. They demonstrat1.
that
in
isotlurane-anesthetized
patients,
three
in-
may be
related to the
2.
to
60/hour
did
in
not
patients with
improve
oxy-
Care
4.
who
sis.
nation Irom sigh breaths had received ambient ex5.
port.
1412
Our
data suggest that
m
the spontaneously
young pa-
in
("rit
Care
Med
Med
positive
L.A.
Pulmonary
effect.s
of venti-
cardiopulmonary bypass. Crit
1976:4:295-300.
in
surgical
.1.
l.aver
MB.
Impaired
patients during general anes-
thesia with controlled ventilation: a concept of atelecta-
derived enhanced arterial oxyge-
piratory airway pressure and full \eiililatory sup-
use
levels in adult patients
lov\
Bendixen HH. Hedle\\Vhyte
oxygenation
genation.
Patients
its
airways. .Arch Surg 1980:1 l.s:S24-S28.
Downs. JB. Mitchell
latory pattern following
modest
arterial
PF.F.P;
normal Uniys.
Venus B. Copiozo GB. Jacobs HK. Continuous
v,ilh artificial
low
sigh frequency. For our patients, increasing the fre-
alveolar collapse
McVslan TC.
airway pressure: Ihe use of
3.
quency of sighs
.IF,
with appareiulv
I979;7:14-!y
fluence arterial oxygenation. Lack of benefit from a
sigh breath in that study
Iâinniann
tients
positive-pressure sigh breaths delivered at the be-
ginning and end of a 2-hour anesthetic did not
tor ihe
REFERENCES
breaths with xolumes equal to the patient's pre-
ed
Laurence and Ms Dianne Byrd
preparalicni of ihe manus(.ripl.
N
Engl
J
Med
Egbert LD. Laver
1963:269:991
MB. Bendixen
1111
liiicrmiiteiu
deep
breaths and compliance during anesthesia in man. .An-
esthesiology 1963:24;57.
'92 Vol
.^7
No
12
6.
McCutcheon FH. Atmospheric rcspiRilion and the complex cycles in mammalian breathing mechanisms. J Cell
10.
Physiol! 953;4 1:29 1-303.
7.
thesia in
8.
in arterial
I..
improve gas exchange
with
Grim PS. Freund PR. Cheney FW.
ous sighs
Novak RA. Shumaker
riodic hyperinflations
Effect of spontane-
oxygenation during isotlurane anes-
hypoxemic
respiratory
failure?
11.
humans. .Ancsth Analg 1987;66:839-842.
Laver
MB. Morgan
J.
Bendi.xen
\olume. compliance, and
arterial
Branson RD, Campbell RS. Sighs: wasted breath or
controlled ventilation.
12.
1992:37:462-468,634.
Gattinoni L,
Kolobow
Samaja M. White D.
T.
et
al.
removal
intubated patients.
Low-frequency positive-
(LFPPV-ECC02R): an experimental
13.
study.
Care
J
HH. Radford
Med
El'.
Lung
oxygen tension during
Appl Physiol 1964:19:725-733.
Kolobow
Ann Surg
in
intubated and non-
1985:51:330-335.
T. Gattinoni L, Tomlin.son
TA.
Control of breathing using an extracorporeal
Anesth Anale 1978:37:470-477.
Crit
pe-
in patients
Scholten DJ. Novak RA. Snyder JV. Directed manual
recruitment of collapsed lung
Tomlinson T. lapichino G,
pressure ventilation with extracorporeal carbon dioxide
MR. Do
1987:1.3:1081-108.'^.
breath of fresh air? (Kittredge's Comer). Respir Care
9.
Snyder JV. Pinsky
Pierce JE.
membrane
lung. Anesthesiology 1977:46:138-144.
92 Vol 37
No
12
1413
Comparison of Gentle-Haler Actuator and
Aerochaniber Spacer for Metered Dose Inhaler (MDI)
Use by Asthmatics
Clinical
MD,
Bradley E Chipps
Gordon
BACKGROUND:
A Wong MD.
Peter F
Naumann
and Otto
PA-C,
G Raabe PhD
Aerochamhcr haw
Spatinj; devicts such as the
hceii
shown
lo
improve delivery of medication from MDIs in patients \»ho could not use proper
technique with an MDI alone, but the Aerochaniber ma\ be inconvenient lo carry
&
use because of
its
responses usin(> a standard
We
treated
31)
We
bulkiness.
matics usinf; a new, smaller
therefore
compared
responses of asth-
clinical
MDI actuator ((Jentle-Halerl with no spacer to their
MDI actuator & spacer (Aerochaniber). MKTHODS:
asthmatic patients in 2 sessions with the beta-a!>onisl albuterol using
the above-mentioned devices. Both devices were utilized in each treatment session,
with one deli>erin^ albuterol
&
the other generating a placebt). During the second
session on a different day. the albuterol
On
the two devices.
&
FEF25-75. blood pressure.
treatment
&
at 15
&
placebo were reversed with respect to
each study day. phvsiologic measurements of FE\
30 minutes
&
1, 2. 3. 4. 5.
&
6 hours. Analvsis
were used to compare the ratio of physiologic responses
delivered with the two devices. RESULTS: Both devices were equall>
dent's
/
test
& V\C. No
eliciting desirable increases in FEV'i, FF^F25.75.
differences
(5%
F\ C.
I
to albuterol
effective in
statistically significant
significance level) in effectiveness of the albuterol were associated
A
with the use of either de\ice.
duction
i.
& after
of variance & Stu-
pulse were obtained at pretreatment (baseline
in diastolic
very small (<
l'"e)
but statistically significant re-
blood pressure (3 of 8 time points)
&
systolic pressure (1 of 8
time points) was associated with the use of the Gentle-Haler.
nificant differences in pulse rate
cause the (ientle-Haler de>ice
is
No
statistically sig-
were associated with use of the two devices. Besmall & compact, its use was preferred by 22 of
the 30 patients surveyed. (Respir Care 1992:37:1414-142:.)
way
Introduction
disease.'
The aerosol
acts quickly
and
directly,
uith fewer side effects than have been reported
The
by metered dose
betai agonists delivered
(MDIs) have been shown
halers
to
v\
ith
other routes of administration.-^^ Optimal de-
in-
be very ef-
fective in the treatment of chronic ohstructi\'e air-
lower airways
li\cry to the
is
important for maxi-
mal benefit.' Studies have shown
centage of patients surveyed do
tcchnic|tic
Dr Chipps
is
a private practiiiiiimci
diseases in Sacramento, California.
assistant
sician's
Wong
associated
&
allergic
Mr Naumann
is
a phy-
Dr Chipps's
practice.
Or
the
MDI.'*''
halation techniques arc u.scd with
14%
use
iioi
When
proper
optimal
MDI
in-
spacers. 9-
of inhaled medication actually reaches the
lower airway.'-*
President of Vortran Medical Technology Inc. Sac-
is
ramento. Dr Raabe
is
Professor. Department of Biochemistry.
Nutrition. Pharmacology.
Medicine.
gineering.
Chipps
with
pulmonary
ui
with
that a large per-
&
&
&
Toxicology, School of Veterinar>'
Department of Civil and Environmental En-
University
Dr Raahc
of California.
Davis.
California.
Dr
are consultants to Vortran Medical Tech-
Spacing devices such as the Aerochaniber* have
been shown
to
impio\c dcli\cr\ of drugs
lower respiratory
MDI
actuators.'
been found
tract
'^
to the
when used with conventional
Different styles of spacers have
The
to give similar desirable results.''
nology, manufacturer of Cieiulo-Haler.
Aerochaniber
Reprints:
ramento
1414
Gordon A Wong MD. 3941
CA
9.5819.
J
St. Suite
#354. Sac-
is
relatively large
and bulky, so
ma\ be incoincnicnt to use and carry.
.A
ator, llic (iciillc-Halcf. 'does not require a
RESPIRATORS CARE • DECEMBER
new
it
is
actu-
spacer but
"92 Vol 37
No
12
2
.
CLINICAL COMPARISON OF ACTUATOR
produces an
low \elocity and
aerost)! with
paction that
is
comparable
to that
little
im-
produced with
spacers. In this study, treatments with albuterol sul-
were compared using the Gentle-Haler and the
Aerochamber in a randomized double-blind fashion
in 30 patients with asthma, a lung disease charfate
variety of stimuli.'"
The purpose of
the study
Aerochamber spacer
bronchodilator,
26% from one
FEV, by 15%
or
more
after
one changed baseline values by
was unable to learn or coordinate spirometry. Those enrolled subjects with FEV, < 80% but > 70% of normal values were classified as mild cases (n = 12),
session to the next, and one
to a
was
<
to contrast the relative effectiveness of the standard
actuator used with the
did not improve their
FEV, 60%-70% of normal were considered moderate cases (n = 12), and those with FEV|
acterized by mostly reversible airway obstruction,
airway inflammation, and airway sensitivity
& SPACER
to the
those with
60%
=
of
were
normal
classified
severe
as
The characteristics of this study group
(n
summarized in Table 1
6).'-
are
Gentle-Haler actuator used without a spacer.
Subject Preparation
Subjects
&
Methods
Criteria for establishment of study procedures
followed the guidelines of Chai
Subject Selection
were asymptomatic
Eligible for the study
were private-practice pa-
tients
who
sent:
were not pregnant or nursing: had no
enrolled voluntarily; gave informed consignif-
the
study.
Coffee,
for
1
week
et
al.'"*
Patients
prior to the start of
beta agonists,
steroids,
anti-
cholinergic agents, cromolyn, and antihistamines
were withheld
for 12 hours before testing.
Theo-
icant medical condition such as hypertension, heart
phylline preparations were withheld for 24 hours.
disease, convulsive disorder, renal disease, hyper-
Those who had used inhaled
thyroidism, or diabetes mellitus: had no
sensitivity
to
known
sympathomimetic amines: and had
steroids
more than
1
hours prior to the study sessions are noted in Table
1.
mild to severe reversible airway obstruction, with
an FEV| <
S0%
of predicted normal values and
with at least a \57c increase in
FEV, over
after three inhalations of albuterol sulfate using a
standard
MDI
actuator.'" "
Of 37
Description of Devices
baseline
patients original-
30 (19 males), aged 9 to 45 years
(mean. 22 y) met these criteria. Of the seven who
were excluded from the study, two did not return
ly considered.
Standard
fate
canisters
were
obtained with albuterol sul-
They were outfitted as
an Aerochamber spacer
identical.
propriate with either
apat-
tached to a standard actuator or a Gentle-Haler ac-
for the
second session, one had hypertension, two
Table
Gentle-Haler/Aerochamber Comparison Study: Summary of Patients
1.
MDls were
and placebo. The physical appearances of the
tuator in place of the standard actuator.
Both of
CLINICAL COMPARISON OF ACTUATOR & SPACER
these devices are intended to facilitate delivery of
respirable aerosol to the patients. Figure
shows
1
MDI. The Gentle-Haler
paction of the normal
about the same size as a standard actuator
cm
is
(its
out-
canister).
The
two devices, demonstrating the appearance of
the aerosols as discharged. There were no obvious
principle
differences in the appearance of the aerosols.
sipation of a high-velocity discharge by directing
the
extends 6
let
MDI
the
from the center of a
upon which
this
device works
the dis-
is
output through a miniature vortex cham-
ber connected to the canister outlet tube and
lowing linnted
al-
entrainment on demand. Ac-
air
cording to the manufacturer, larger, poorly inhaled
particles are
remo\ed from
the aerosol in the vor-
tex.
Because of
their
removal of larger
particles,
both
of these devices discharge smaller medication dos-
ages of aerosol per actuation than are discharged by
As
a standard actuator.
part of this stud\
mass
the
.
outputs of these two devices and a standard actuator \\ere
measured gra\ imetrically by using a vacto draw the total aerosol output from 10
uum pump
actuations with canisters of albuterol sulfate onto a
preweighed membrane
on
filter
and weighing the
filter
microbalance after collection. Although the
a
drug was not chemically assayed, the aerosol mass
provided a relative measure of
MDI
discharge. In
three repeated sets of measurements, the standard
actuator delivered a
mean (SD) of 98.2
(0.8) jUg/
actuation, the Gentle-Haler delivered 46.9 (3.4) /jg/
actuation,
Fig. 1.
used
The Gentle-Haler and Aerochamber MDI devices
in this
Aerochamber delivered 53.3
and the
(1.1) pg/actuation.
Hence, the quantity of
was
two devices being compared
similar for the
aero.sols
in
this study.
showing the aerosols generated with
study,
these devices: the Aerochamber mouthpiece and one-
way
valve were removed to simulate the open position
Study Design
during patient use.
Each of
The Aerochamber
spacer (volume,
MDI
consists of a
15.7-cm-iong
145 cm^) attached to a standard
the study patients attended
two sessions
on different days, during which he or she received
both albuterol sulfate and a placebo via
MDIs
using
the outlet.
both the Aerochamber and Gentle-Haler. but with
This extension serves the purpose of providing a
drug and placebo switched between sessions. The
volume
dis-
placebo used was from the canister of a Schering
stabilize prior to being
Demonstration Inhaler containing no active ingred-
actuator and valved (one-way)
in
which
the
higli-\ciocity
down and
charge can slow
at
aerosol
inhaled by the patient via a mouthpiece. Larger particles are lost in this
chamber by
settling.
The
re-
sulting aerosol stream exhibits reduced impaction
deposition
halation
in the
oropharyngeal region during
compared
in-
to that of the standard actuator
ients.
The study was designed
sion, although in
The Gentle-Haler
be
double-
each session only one canister had
the albuterol and the other had the placebo.
The
normal canister markings were rcmo\cd and they
were color-coded
alone.-
to
blinded, and both devices were used in each ses-
that neither clinician
si)
niu pa-
is
designed to eliminate the
knew which had the active drug. The combination of device and color-coded canister was
high-N'clocitv discharge
and associated aerosol im-
randoml\ selected on. the
use with
1416
MDls
that
is
a
new. special actuator tor
tient
RESPIRATORY CARE
•
first
visit
DECEMBER
and purposely
"92 Vol 37
No
12
reversed for the second
cei\ed the albuterol
each patient
visit. Tiiiis.
at
each
re-
once from the
visit,
Gentle-Haler and once from the Aerochamber.
Each
patient
was given
three puffs
& SPACER
comparisons of the potential
Statistical
differ-
ences between the two de\ices were performed
with logarithmically transformed data adjusted to
from both the
placebo canister and the one with drug during each
=
ba.seline at lime
the
of
ratio
before treatment to evaluate
The logarithmic
responses.
trans-
study day, with different devices attached to the
formation was chosen to
two
of the ratios of responses with the two devices be-
canisters. After proper shaking of the inhaler,
the mouthpiece
was placed
patient slowly inhaled
pacity
when
mouth and
in the
the
from functional residual ca-
the inhaler
was
was a
actuated. There
10-second breath-hold and 3-minute wait before
the next inhalation.
The baseline FEV, values on
each of the two treatment days were within
15%
facilitate the
comparison
cause this comparison was the main purpose of
A
study.
ratio
this
of 1.0 between responses indicates
two devices, and the
sig-
nificance of differences in this response ratio
was
identical responses for the
The
tested.
of responses
ratio
at
time =
is
thus ad-
of
justed to equal exactly 1.0 so that baseline differ-
Measurements
of FEV|, FVC, FEF25-73. blood pressure, and pulse
were obtained before treatment and 15 minutes. 30
minutes, and 1, 2, 3, 4, 5, and 6 hours after treatment. Respiratory data were recorded w ith a Cybermedic CM-555 pulmonary function apparatus,
which has been shown to be both reliable and accurate (volume errors < 1.8%).'^ Blood pressure
and pulse were measured manually.
During the course of the study. 16 patients
whose pulmonary function deteriorated to pretreatment levels were released from the study so
ences do not interfere with the analysis. Two-tailed
the value obtained at the initial visit.
that supportive therapy
monary function
could be administered. Pul-
data recorded
at that
reported and v\ere utilized only
if
other session were available at that
treatment.
The incidence,
severity,
point were
data from the
same time
post-
and duration of
Student's
formed
tests
t
with
95%
confidence were per-
measurements of
and diastolic blood
to evaluate the ratio of
FEV,, FEF25-75. FVC,
systolic
pressure, and pulse rate.'^
The
patients
were surveyed as
to
whether they
preferred either of the two devices over the other.
Results
Both devices were equally
effecti\'e in eliciting
FEV,, FEF25-7?. and FVC in
These data are summarized in Figures
desirable increases in
the patients.
and
2, 3,
4.
The
ANOVA
results of the
to devices, session
with respect
number, time, and interactions
with the two devices were nearly identical, with
statistically
insignificant
values
p
ranging
from
any adverse reaction such as tachycardia, palpitations,
EKG
changes.
CNS
tremors. ner\ousness.
dizziness, cough, or throat irritation
were
to
be
re-
corded.
Data Analysis
Statistical analyses
\ia
computer with
of the data were performed
SAS/STAT
statistical software.
Repeated-measures analysis of variance
was used
(ANOVA)
compare the observed quantitative rethe 30 patients using the GentleHaler or Aerochamber to deliver albuterol.'"' The
ANOVA considered order (order of use of the two
devices by a patient in successive visits), time following use of the MDI devices during which measurements were made, session (first or second visit),
and interactions: session x order, time x order, sessponses
to
among
sion X time, and session x time x order. Statistical
significance
was assumed
at the
59c level.
"92
Vol 37 No 12
Time
Fig.
2.
tained
Comparison
witfi
(h)
(
of FEVi oband Aerochamber (•)
response
of the time
the Gentie-Haler
)
MDI devices, shown as mean values with standard error
(SEM) bars: the average values of measurements obtained with
both devices are connected with straight
lines.
1417
Time
Fig.
3.
(h)
Comparison of the FEF25.75 obtained with the
and Aerochamber (•) IVIDI devices,
Gentle-Haler
(
)
shown as mean values with standard error (SEIVI) bars;
the average values of measurements obtained with both
devices are connected with straight
lines.
points)
was associated with
Haler (Table
2).
This effect
the use of the Gentleis
unexplained.
tistically significant differences in
No
sta-
pulse rate were
associated with use of the two devices. Overall, the
statistical
the
analysis
showed equal effectiveness of
Aerochamber and Gentle-Haler
in eliciting the
therapeutic response. All patients tolerated the use
of both devices.
No
adverse side effects were de-
tected during the testing.
Of
the
30
because of
Time
patients.
its
22 preferred the Gentle-Haler
ease of use and size.
(h)
Discussion
Fig. 7.
Ratio of
FVC
obtained with the Gentle-Haler and
Aerochamber MDI devices (corrected
to baseline before
showing geometric means with 95°o confidence intervals; a ratio of unity indicates identical values.
Although spacers have been shown
treatment),
Table
2.
Gentle-Haler/Aerochamber Comparison Study:
Variable
Statistical
to be effec-
tive in providing optimal therapeutic effectiveness
Analysis*
of aerosols
many
in
patients,
broad use has not
been made popular because they are
large and incon\enient to use.
relati\el\
The Aerochamber
spacer was selected for this study because its 145cm' volume is much smaller than that of the Inspirease spacer (volume, 700 cm'), making it easier
to use. The Gentle-Haler is a new actuator that per-
forms similarly
and easy
to a spacer but is small,
to use. Its si/e
is
metered dose inhaler actuators.
this
compact,
similar to those of other
We
believed that
if
device could perform equally as well as spac-
ers, its utilization
compact
size.
It
would be desirable because of its
works differently from the usual
metered dose inhaler
in that the
aerosol
is
gener-
& SPACER
(FRC) improved deposition 2035%. Others ha\e found that maximal responses to
bronchodilators were obtained when inhalation was
started from either RV or FRC."*-" Slow inspiratory tlowrates (10-30 L/min) have been shown by
Pedersen-' to augment improvement in FEV, when
compared to rates of 60-120 L/min. This is supresidual capacity
ported by the study of Tobin et
al,--
using their res-
ervoir aerosol delivery system with \ibrating reed,
when
tlowrates
inspirator}
exceeded
L/min.
18
Breath-holding of 10 seconds" duration after
halation of
MDI
tuation e\ery
minutes have often yielded
\o 3
1
creased bronchodilation.-'
ated by a vortex transducer that generates a low-
in-
and temporal spacing of drug acin-
-''
For the young, the elderly, and those unable to
velocity aerosol cloud rather than a fast-moving
coordinate the actuation and inhalation of MDIs,
aerosol spray.
spacing devices have been developed. The various
this
double-blind comparison study. 22 pa-
tients out
of 30 preferred the Gentle-Haler because
In
of
ease of use and size.
its
Both devices were
producing
bronchodilation
equally
effective
when
by pulmonary function parameters. No
reactions were noted, and all patients
in
spacing de\ ices
from the
MDIs
hold or slow
all
down
the aerosol
more
so that patients can
does not depend on precise actuation/inhalation co-
tested
adverse
showed acceptable improvement with the use of either delivery system. The use of other medications
with the Gentle-Haler
treatment
may
ordination.
MDIs with and w ithout spacshowed no impro\ement o\er MDIs alone in
patients having good actuation/inhalation coorStudies comparing
ers
also be effective in the
acute airtlow obstruction and in de-
o\'
dination. In children
ordination
livery of steroids, the Gentle-Haler's effectiveness
should be comparable
However,
all
ill,
that
of current spacers.
were able
the number of patients
was small and they were not
so further e\aluation will be necessary.
Metered dose inhalers (MDIs) ha\e been used
extensively
to
deliver
beta^
agonists,
anticholi-
cromolyn sodium, and corticosteroids to
patients with asthma.'
MDIs combine portability
with rapid and reliable delivery of medications for
many patients. However, it has been reported that
up to 50% of the patients may not properly use the
MDIs."*- Medical personnel may also incorrectly
use MDIs.'* This may lead to ineffecti\e or erratic
nergics,
''
is
and adult patients
difficult for actuation
ui
be extremely helpful
in
producing optimal bron-
chodilation,-*-^-^ In the emergency room, the use of
MDIs with spacing devices has been shown to be
as effective as the use of nebulizers in the treatment
asthma.'*'*' '*
of acute obstructive
Not imly
The use of spacers
is
that
It
spacers decrease throat
has been documented
irritatit)n.
hoarseness,
coughing, gagging, and infection with Candida.
B\ analogy, use of the Gentle-Haler may also
determining t)ptimal deposition of the
aerosolized medication.
'^
Matthys and Kohler'' found
residual
\olume (RV)
The manufacturer's marketing
that inhalation
from
the
strategy
S5.00/unit.
Inasmuch
bt)lh a sjiacer
it
is
Gentle-Haler to pharmaceutical
price of the Gentle-Haler to
that
rather than from functional
>
'"'
ield
similar desirable results.
panies for the dispensing of medications.
tant factors
MDIs
particularly important in the
aerosolization of steroids.
Coordination of actualion/mhalation. proper inha-
and
are
with spacers easier to use, they are cost-effective.'^
delivery of drugs to the respiralor\ -tract receptors.
temporal spacing of multiple inhalations are impor-
co-
and inhalation
cense
lation flowrate, breath-holding after inhalation,
whom
with conventional MDIs, spacers have been found
to
to
MDI, and
treated in this study
acutely
to
the patients in this study
use a standard
1420
readily in-
hale the aerosol at any time, and their effective use
to
li-
com-
The 1992
such companies
is
as the Gentle-Haler replaces
and a standard actuator, we believe
has the potential to
cost-effective than
when
make MDI
a spacer
use
more
and standard ac-
tuator are used.
RESPIRATORY CARE
•
DECEMBER
92 Vol 37
No
12
.
In Siiinmary
9.
Tschopp JM. Robinson
S.
Caloz JM. Frey JG. Broncho-
dilating efficacy of an open-spacer device
No
or statistically significant differ-
clinically
10.
among
ences were found
patients using the Gentle-
1
1.
Gentle-Haler because
it
is
was a preference
compact and easy
of asthma. Chest
12.
tor the
Gershwin ME. Bronchial asthma. Orlando FL: Grune
American Thoracic Society. Lung function
lection of reference values
to use.
Am Rev Respir Dis
13.
PRODUCT SOURCES
Monaghan Corp,
Plattsburgh
MDI
NY
14.
challenge procedures.
Nelson SB. Gardner
formance
CA
.Allergy
J
Im-
Clin
RM. Crapo RO.
Jensen RL. Per-
contemporary
of
evaluation
spirometers.
Chest 1990:97:288-297.
Medication
&
Placebo:
15.
Albuterol >ultate iProventil). Schering Corp. Kenilworth NJ
Demonstration MDI. Schering Corp. Kenilworth NJ
16.
CO
theory
Statistical
in
re-
SW. George RB.
In-
York: McGraw-Hill. 1952:227-240.
Guidry GG. Brown
WD.
Stogner
sonnel. Chest 1992:101:31-33.
17.
Software:
Institute Inc.
New
correct use of metered dose inhalers by medical per-
C\ bennedic CM-3.^5. Cybermedic Corp. Boulder
SAS/STAT. SAS
Anderson RL. Bancroft TA.
search.
Pulmonary Function .Apparatus:
Stati.stical
McLean
Standardization of bronchial
et al.
munol 1975:56:323-327.
Gentle-Haler actuator. Vortran Medical Technology. Sacra-
mento
strategies.
1991:144:1202-1218.
Rosenthall RR.
inhalation
spacer.
&
testing: se-
and interpretative
Chai H. Farr RS. Froehlich LA. Mathison DA.
i.\.
MDI Accessories:
Aerochamber
clas-
1992:101(6. Suppl):393S-
Stratton Inc. Harcourt Brace Jovanovich. 1986:3-18.
FEF:s-75. All patients tolerated both devices with-
out adverse effects. There
to
395S.
parameters of
functit)n
Grammer LC. Greenberger PA. Diagnosis and
sification
when evaluated by pulFVC. FEV,, and
Haler or Aerochamber
monary
compared
three other spacers. Respir Care 1992;37:61-64.
Cary
NC
Matthys H, Kohler D. Pulmonary' deposition of aerosols
by different mechanical devices. Respiration 1985:48:
269-276.
ACKNOWLEDGMENTS
18.
Newman
SW. How should
SP. Pavia D. Clark
pressur-
ized beta adrenergic bronchodilators be inhaled? Eur J
We
H
thank Dr Neil
Respir Dis 1981:62:3-21.
Willits of the University of California.
19.
Davis. Division of Statistics, for performing the statistical tests
used
in this study. Julie
LVN
Engleman
was
dose inhaler.
ordinator.
20.
REFERENCES
1
Grammer LC.
21.
Basic pharmacotherapy for asthma. Chest
3.
5.
Engl
J
Med
methods
22.
1986:315:870-874.
A
Salzman GA. Pyszczynski DR.
livery
4.
N
comparison of iw o de-
Am Rev Respir Dis
Pedersen
S.
lung
1976:114:509-515.
Optimal use of tube spacer aerosols
in asth-
Kim
C.
Watson H. Sack-
to bronchodilator
drug administra-
Tobin MJ. Jenouri G. Danta
I.
ner
MA. Response
tion
by a new reservoir aerosol delivery system and
delivery
auxiliarv'
systems.
Am
a re-
Re\
23.
C. Patient error in the use
Newman
SP. Bateman
JRM.
Pavia D. Clarke
SW. The
importance of breath-holding following inhalation of
Med
pressurized bronchodilators.
J
1976:1:76.
Crompton GK. Problems
aerosol
inhalers.
vances
patients have using pressur-
Eur
J
Respir
Dis
\m
J
aerosol
In:
therapy.
S.
Baran D. ed. Recent ad-
Brussels:
The importance of
two puffs of
a pause
terbutaline
aerosol with a tube spacer.
1980:69:891-
UCB
Pharma-
J
between the
in-
from a pressurized
.Allergy
Clin Iminunol
1986:77:505-509.
894.
Newman
SW.
Pedersen
halation of
inhalation of aer-
Med
in
ceuticals. 1979:117-122.
1982:119
24.
Shim C. Williams M. The adequacy of
osol from canister nebulizers.
SP. Pavia D. Moren F. Sheahan NF. Clarke
Deposition of pressurized aerosols
respiratory tract.
8.
volumes.
of asth-
at different
Respir Dis 1982:126:670-675.
(Suppl):10l-104.
7.
Ann Allergy 1984:52:279-281.
BW. Edelman NH. The response
Weitz
of bronchodilator metered aerosols (short report). Br
ized
6.
J.
view of other
for aerosolized metaproterenol sulfate. J
Asthma 1986:23:297-301.
Orehek J. Gayard P. Grimand
Reily
Mod-
from a metered
matic children. Clin Allergy 1985:15:473-478.
Newhouse MT. Dolovich MB. Control of asthma by
aerosols.
Bradley D.
P.
matic subjects to isoproterenol inhaled
1992:101(6. Suppl):405S-406S.
2.
William ST. Reilly PA. Thomas
ifying delivery techniques of fenoterol
the study co-
in
the
25.
human
Heimer D. Shim C. Williams MH. The
Thorax 1981:36:52-55.
ma.
Dolovich .MB. Ruftln RE. Roberts R. Newhouse MT.
26.
J
Allergy Clin Immunol 1980:66:75-77.
Levison H. Reilly PA. Worsley GH. Spacing devices
Optimal delivery of aerosol from metered dose inhalers.
and metered dose inhalers
Chest 1981:80(6. Suppll:9I 1-915.
diatr
"92 Vol 37
No
effect of se-
quential inhalations of metaproterenol aerosol in asth-
12
in
childhood asthma.
J
Pe-
1985:107:662-668.
1421
27.
Konig
P,
inhaler and
28.
of albuterol aerosol by Aerochamber to young children.
Gayer D. Kantak A. Kreuiz C. Douglass B,
Horovik NL.
A
trial
Ann
of metaproterenol by metered dose
two spacers
preschool asthmatics. Pediatr
in
34.
treatment of asthmatics with severe airflow obstruction:
1989:6:26.^-
35.
Chest
1989;
Noseda A, Yemault JC. Sympathomimetics
in
acute se-
EurRespirJ 1989:9:377-382.
19S7:
36.
J.
for treatment of acute airflow obstruction. Chest 1988;
Experience with metered dose inhalers with
a spacer in the pediatric
emergency department. .Am
93:477-481.
J
37.
Dis Child 1989:143:678-681.
Ruiliii J.
Turner JH. Corkery KJ. Equivalence of continuous How
nebulizer and metered dose inhaler with reservoir bag
Benton G, Thomas RC. Nickerson BG. Mcguitt.\ JC.
Okikawa
MIndorff C, Reilly
P.
halation devices.
J
new device (Aerochamber)
in-
for use of aerosol drugs in
asthmatic children. Arch Dis Child 1981:56:787-789.
RM Barbera JM. Middleton B. Eby DM. Delivery
Elston R. Tharpe L. Nelson S. Haponik E.
deliver},'
methods
—
relative im-
pact on pulmonary function and cost of respiratorv care.
Arch
Pediatr 1984:104:470-473.
Gurwitz D. Levison H. Mindorff C. Assessment of a
Summer W.
Aerosol bronchodilator
Levison H. Pulmonary
response to a bronchodilalor delivered from three
142:
methods.
the
vere asthma: inhaled or parenteral, nebulizer, or spacer.
Lee H, Evans HI. Evaluation of inhalation aids of me-
Sly
delivery
in
95:1017-1020.
91:366-369.
33.
DR. Aerosolized metaproterenol
of two
comparison
inhaler and
tered dose inhalers in asthmatic children. Chest
32.
RM,
Elenbaas
Conner WT, Dolovich MB. Frame RA. Newhouse MX.
Reliable salbutamol administration in 6- to 36-month
267.
31.
JP.
Pyszczynski
means of a metered dose
Aerochamber with mask. Pediatr Pulmonol
30.
Allergy 1988:60:403-406.
Salzman GA, Steele MT, Pribble
Pulmonol 1988:5:247-251.
old children by
29.
& SPACER
38.
Intern
Med
1989:149:618-623.
Salzman GA. Pyszczynski DR. Oropharyngeal candidiasis in patients treated
with beclomethasone dipropionale
delivered by metered-dose inhaler alone and with Aero-
chamber.
J
Allergv Clin
Immunol 1988:81:424-428.
"92 Vol 37
No
12
.
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a
Classic Reprints
A
Critical
Carol
Being an Essay on Anemia, Suffocation, Starvation, and
Other Forms of Intensive Care, After the Manner of
Dickens
Robert H.
M.D..F.C.C.P
Bartlett.
St.
WE
night and be delivered, bones braced and viscera re-
tlie
1
Now, four nights later, the fire of life
burned for Charles Cratchit, but needed constant
paired, to the ICU.
Starmncvs Ghost
still
Starling was dead, (".roun Prince ofPhvsioIog), discoverer
i)(
hormones, physical alchemist of the interstitial
space, seeker of truth, finder of wisdom, man of the heart.
Starling was dead as a doornail. He's been dead and bmied since 1927; buried in a
little
churchyard cemeter)'
Coventn', where violets grow and sparrows sing.
imagined
nodding
it,
sive care unit.
tion, the
The
my
into
hausted, in a cardiac chair
so
end of the
inten-
zephyrs of compressed gases blended together
room. The
few windows glared the blackness that comes before dawn
and
after the last piece of cold pizza has
by the night
shift.
A
glance
at
my patient is stable, I return
The paUent who holds me
that
been consimied
the oscilloscope
tells
me
is
Charles
Oatchit. At the age of ,5,5 years, CHiarlie was healthier than
most, considering that for 40 of those years he
more than he should,
ate
and stayed too long, on
was the
last
smoked
more than he could metabolize,
occa.sion, at
Muldoon's Pub.
It
habit which interfered with his usual stale of
when, on Fridav last, having cashed his paycheck
Muldoon's. he exited Muldoon's door, stepped over
health,
at
the ciub and into the path of an
oncoming
cit\
filled
bus. Ribs,
femur, and fibula, spleen, bowel, and pancreas were ren-
dered asimder by the impact. But Divine I'rovidence. assisted by a fast ambulance, good surgeons, and a wellstocked blood bank, decreed that Charlie would survive
he
stilted slightlv
Bartlett
is
Profes.sor of Surgen',
Care Unit, University of Mich-
igan Medical Center, .\nn .\rbor. Michigan.
—
all
the bottle
good
signs.
mv
air,
the chest drain-
had stopped bubbling,
I rose from the cardiac
grainv coffee, kicked off niv
moment, recording by instinct the scene across tlie
room. Before surrendering again to sleep, I replayed the
for a
scene
— the
oscilloscope tracings, the reassuring
of the ventilator, the
my
tion,
unhuriied
became
man
tiuise, the
The man standing
eyes closed but
fullv
whoosh
standing
at tlie bedside!
A
awake.
bit
kept
I
of imagina-
—
perhaps, or a janitor, or a resident. Yes, that's
resident. .Mv
No doubt
mind would not
about
it.
There was
relax.
a
man
I
had
it
to look agaiti.
standing bv the
bi'd-
on one elbow and rubbed mv eves. His silvei hair, neativ cut and
combed, and an air of tolerant confidence gave him the
a|jpearance of a man in his late 50s. He wore a gray, pinperfectly tailored
with a vest and silver tie.
striped suit
His high-necked shirt had a stiff, rounded collar transfixed bv a gold bar which looked like pictures I bad seen
of mv giandlatlu'i in his bovhood. He stared al me expectantly, as if waiting for me to comment.
side
(if
Cliailes Cî.uchit, lookint^
"I
help you?"
I
know who you
"I'm
Ernest
and
iologisi."
al
me.
I
rose
—
—
here."
1424
of his exhaled
.iiid
on the gurne)- across from Charles
Cratchit and slipped below the surface of consciousness.
When I had slept what seemed to be a verv short time I
rolled to the other side and in so doing opened mv eves
Al the suêilion of UmritI J Pimon MD. Htnhon'ini' Medical Center,
Seattie, Washington, this paper is reprinted, with permission of the author
original publisher.
liter
shoes, stretched out
"Can
Dr
with a
at the bedside.
to the textbook.
here tonight
meter
age tube was eniptv
I
drones, the beeps, the bubbling suc-
into the low roar interpreted as .silence in this
electronic analogues of his intravascular
pressures swept smoothlv across the screen, the spiro-
chair, slurped the rest of
textbook, slumped, ex-
the quiet
at
Or
in
The
lending.
I
said, rising
are,"
he
I'm
Starling.
from mv
col. "I'm Dr.
said, pleasantiv
concerned
."
.
.
enough.
.ihoiii
"Ernest Starling?- Ernest Starling was a xcia
h.trlie
(
l.iiiicius
ph\s-
'
"92 Vol 37
No
12
—
"
CLASSIC REPRINTS
certainlv can. Quite so."
"It
He
was politeh ignoring
misconception. ".\nd what do you do
mation?
vsilh
thai
mv
infor-
mean, once vou've measured the pulmonan'
I
arteiT pressure."
"We use
it
measure the
to
lilling
pressure of the
left
ventiicle."
"To what end?"
"It is
related to the cardiac output. Your namesake, Star-
ling, gets
the credit for relating
filling
pressine to cardiac
output."
was Fiank, actualh, and stroke volume related to
"It
end-diastolic pressine, but
cany on."
"Well, w'hoever described
it," I
said,
becoming
slightly
annoved, "we measure the filling pressure bv inflating a
small balloon near the tip of the catheter, occluding the
pulmonan arten, and recording the pressure downstream, through the pulmonar)' capillaries into
tlie
left
atrium."
"Oh,
I
see! Like Dexter's ^v•edged pressure.
yes, quite famous.
know him well."
"Know him well?"
"Know o/him. I should sav." He smiled. "He would be
or would have been \en interested in all of this physio-
"Oh,
I
—
logic
gadgetrw
here.
\'er\'
And
of course very interested in Cratchit
interested."
He spoke
which made him soiuid erudite.
"Oh, he would. I know he would," I exclaimed, eager to
expound my favorite subject in modern medical historv',
diac output,"
yes,
I
"Look here,
ven'
much.
"Bv using cold as the indicator."
for example, this
catheter goes
through the right heart into the pulmonarv arten."
".\nd the pressure is 38/18
Hg, if I read vour oscilloscope correctly." He made this observation without re-
\ellow
hands from his lapels, where he had been
He had traced the end of the catheter
through the transducer through the wire and identified
the correct tracing all with his eyes. "At one time, vou
know, we used smoked paper on a kymograph drum. We
used to spray it with shellac if we wanted to presene it.
is
so nice, so ver\ nice.
at his
He
smiled again.
perception, but he had the niunbers
tention to those."
\en impressive, doctor, veiy impressive. I must say,
its way to the bedside care
of sick patients makes me feel very good." His comment
made me proud, although I could claim no personal credit. On reflection, there was no reason that making him
feel good should make me proud. Nonetheless, I felt the
"It is
played on the preamplifier.
"Oh,
that's
an
artifact
liked that
our Starling cune reporting sheet." I proudh' demonstrated the papers on the bedside clipboard. "Arterial oxygen
content is 13.6 volumes percent, and the venous is 9.5, so
his calculated oxvgen consumption is 328 ml minute. By
direct measurement with this spirometer, we found 310
ml/minute. Then here's a whole list of calculations based
on those numbers, cardiac index, stroke-work index, systemic oxvgen deliven', and ihe like. I don't pay much at-
WTong. "The smoked paper doesn't have a digital readout:" I quipped. "You see, the pulmonary' arter\' pressure
is actually 49/12." I pointed to the flashing niunbers dis-
ital
smiled again. "Oh,
we can measure ox\gen consimiption as \ou
and double check the accuracy of our indicator
dilution method. For example, the most recent measurements on Clharlie here showed cardiac output of 8 L/
minute at a wedge pressure of 15. That puts him here on
his
marveled
He
\en much. Starling would have
"/And then
holding them.
I
like that
suggest,
mm
This
ver)'
I
.
with a well-schooled Brit-
ish accent
mo\ing
How
assume vou measiu e cardiac output l)v Pick's
method, measuring oxvgen consimiption across the lung
and sampling mixed venous blood from your catheter in
the pulmonary arterv'. How very clever!"
"More clever than that," I offered, pleased with his
response. "The same catheter carries a small electronic
thermometer into the pulmonaiT arten Bv injecting cold
solution intravenously, we get an indicator dilution carclever! .\nd
centuiy-old physiology finding
of respirauon," he
said.
system just displavs the highest and lowest
"Your dig-
number
as
and diastolic, including die inspiraton vallev and
ventilator peak artifacts. \bu nnist read the pressure onlv
at end-expiration, and that vou must get from vour oscilk>scope. I learned that from Dickinson Richards." He
systolic
flow of self-satisfaction.
St.we 2
smiled again.
"What a pompus little in.ui." thought to mvself, but he
didn't seem arrogant rather more testing. Moreover,
thinking over what he said, I realized that he was right.
"Yes, of course," I said. "The digital readout can be mis-
that brings
leading. Quite misleading."
icallv.
1
A S.wc.iiNF, Spirit
—
RESPIRATORY CARE
•
DECEMBER
'92 Vol 37
No
oxygen deliven calculation
you tonight. Or, more specif\our habit of using anemia as a treatment."
"Now," he
12
it is
said,
me
"it
is
diis
to talk to
1425
CLASSIC REPRINTS
"I
has an elevated metabolic rate
lUmi understand."
"Anemia. Vbu bleed poor Charlie
him with
ever\'
a hematocrit of 32. You're a
dav and leave
modern-day
in-
just a
minutel"
I
exclaimed, astonished by the au-
dacity of this .self-appointed consultant.
compared to a leech. This patient
do you tliink you are, an)'way?"
"WTio
I
am
is
"I
resent being
not anemic, and
cussion," he answered drily, "and Charlie's hematocrit
is
"That's not anemic."
over
He
really?"
arched
his
eyebrows and peered
at
mean,
it's
".'Vnd
I
ill
to
critically
ill
patient.
Most
patients have hematocrits in the 30s."
feel
somewhat
all
I
tered.
"The
fact that
of your patients in this fashion
could not
is
the
coun-
I
directly proportional
keep the hematocrit low
He
chuckled for the
to de-
first
time. "This
You make the patient anemic,
crease the oxygen delivery to the
other tissues to
make
it
make
be greater.
"Well, no.
I
mean
"Think about
"Well,
blood drawing and bleeding and dilutional effects. ..."
"Come, come, now. doctor," he interrupted. "This vast
and you
array of physiologic monitoring equipment
"Yes."
—
whether or not
voin- patient has a
normal
blood volume?"
in-
it,
myocardium and the
the viscosity lower so that oxygen deIs
that what von're telling
me?"
... to avoid capillars sludging
man. Wlien does
.
."
.
a high hematocrit
I
can decide.
most of our patients are a
little
"Well, I'm glad at least that
the reasoning
.
.
1
.
just
meant
anemic."
we agree on the
is
that, well,
definition.
very simple. Mr. Cratchit
all
the time. Polycythemia."
He waited.
"Congenital heart disease
ssith csânosis."
"Yes."
"Ness'born hspersiscosirs syndrome.
",\iid
"Well, of course
From here on,
I
remembered
cause rheologic problems?"
difficult to
can't decide
I
We
really preposterous.
keep the hematocrit up, what with
it's
and
perfect sense,
of the blood
xiscosiU'
"Oh, come now."
is
livers' will
imeas\'.
know," he said calmly. ".\nd does the
you mismanage
normal?"
"Well,
made
crease the cardiac output, increase the filling pressure, de-
not anemic for a
critically
was beginning to
"Yes.
old Charlie in a yer\ difTicult position."
rheology gambit. "Rlieology. That's the reason,"
me
what do you consider
be the normal hematocrit?"
"I
left
His argument
crease the viscosity."
his rimless .spectacles.
of our
you've
to the hematocrit.
32 percent."
"Oh,
The anemia impairs the delivers sysmore increase in cardiac output. To
get a higher output requires a higher filling pressure, so
who
this dis-
sys-
the need bv increasing
think of a reasonable response, until
not important for the purposes of
is
his cardiac output.
—an increased need for
He meets
deliver\'.
tem, requiring even
tensive care leech."
"Now.
temic oxygen
svhat
is
die
Thermal burns."
common denominator
to all
diose
dis-
were a grammar school student.
"High hematocrit. Oser 55 percent."
".\nd svhat is the rheologic implication of a normal
orders?" he a.sked, as
if
I
hematocrit?"
^5N
1426
RESPIRATORY CARE
•
DECEMBER
'92 Vol 37
No
12
CLASSIC REPRINTS
\\cll.
"|usi
ii's
.
normal."
.
.
"Well,
and a lilllt'
some tliouglu."
Kininioii sciisf
voung man.
plivsics,
"No,
marked
Willi ihal. hi' turned
Vou should givf it
and walked away, disappearing into the dark corner near
the door of the KX!. I looked more carefiillv at Charles
(rail
appear
H<- did
hit.
pushing against
at
thought
1
a rate of
impulse
llu-
was
his chest wall
was working hard,
ot .meniia,
pale,
resolved to consider
1
the morning, relurning to the giunev
hours
still
he
,i
liiilc
.memic.
."
.
.
said
pointing
The
IM\' volume w-as
The PcO' was
41
and
to
the
section
I
L,
at a
was 82 nun
llu' I'o.
problem
lo
—an
me,"
1
muinhli'd.
arrli\ihniia of
new carThe pulse
"Musi be a
some
tv])e."
was 130 beats/mill, and the blood pressure was 90/60
Hg.
in
mon-
a li'w
t'oi
it
niin.
"Looks good
diac
10 beats per miiuite. ,Signs
1
lo m\sell.
here,"
Hg.
His heart
easily visible.
suppose he's
respiratoiT status.
rate of 6
heart
oi his
1
here,
"|ust
look
al
the palienl." he said.
"He (an
k'll
mm
you the
problem."
ol sleep.
Cratchit had the physiognomv' of dyspnea
Sx.Wt 3
—wild-eved,
nostrils flaring, resdess, sweating profusely. Evei"\' ten sec-
onds, the ventilator delivered a 1-L breath, although this
A
morning
In the
I
noctinnal usitor until
reviewed the laboratoiT data in
I
The hematocrit was 34
percent,
up from
32,
anemic. Charlie, however looked somewhat bet-
but
still
ter.
So much
better, in fact, that
be weaned from the ventilator.
tinued
that tJie pressure had reached 45 cm of water and the remaining volume was clumped. Between these periodic inflations, he was attempting lo breathe at a rate of approximately 30 /min, tugging during inspiration and exhaling a pitiful 300 ml into the expiratoiT spirometer.
"\nd how does he look?" asked my uninvited con-
ordered a hematocrit and went on
business. I completeh' forgot about mv
about m\ dailv
the evening.
was frequently met with an aggravating hu/z, signifsing
Si Bii.wT Spirit
my
it
seemed
to
me he
could
Some measmements
1,800. His
and
P<)-_>
vital
"He looks short of breath." allowed. "But he's fighdng
Maybe he needs a little sedation."
"You mean he's so short of breath that he tries to
I
cm
impression. His inspiratorv force was - 40
of water. Tidal volume was 500 ml, with
sultant.
con-
the ventilator.
capacitv'
were normal on 40 percent oxy-
Pc;02
gen, and assist-coiUrol ventilation at a rate of 13 with
breathe out dining the inflation cycle of the ventilator.
L/
thai
date on the latest pulmonary
with
1
bre.ith.
"I
Of course I was up to
management abbre\iaUon
—IM\' for intermittent manda-
rate of
I2/min and
I
dialed in IM\' at a
hours as long as the blood gas measurements showed adequate gas exchange.
logic approach,
rate
I.\r\'
I
My
\isitor
was down to
9min.
fell
was having a problem
ing the ventilator.
utes later,
tlie
like diis physio-
few hours
later,
the
a bottle of
I
Heineken,
on the couch.
asleep
The telephone jarred me awake
it
A
Pleased at the progress,
went home, downed a steak and
and
would
tfiought to myself.
.\M.
Charles Cratch-
— tachycardia and
.sweating, fight-
When
I
at
4
arrived at the bedside 20 min-
same tweedy gentleman was
sitting
near the
ventilator looking very annoyed.
"Oh,
it's
you again,"
I
said,
none too
pleasantlv. "You'll
have to excuse me. There has been a sudden change
in
C.ratchit here."
Sudden, no. You have been suffocating
hours, and the nurse has suddenly become aware of it."
"A change,
(
liarlie for
yes.
the
last several
"N'ow see here,"
1
began.
He
held oiu the
vital
when vou were
He shook
sign data sheet for
learning a
the data sheet at
RESPIRATORY CARE
•
to
argue
short of
He
'
"No, vou see here, young man."
'Just
how can he be
ventilator
orders to decrease this everv two
left
British physiologist. "But
Is
is getting six big breailis per minute from the
and doing a lot more on his own. Not onlv that,
but his blood gases are also normal."
"You've answered your own quesuon" he said. "Look
how hard he has to work to keep his PcOa normal. Before
you started all this, he needed a minute ventilation of
13 L to keep his Pcoa normal. That was all supplied bv the
machine, so most of each breath was alveolar vendlation.
Now you've cut him down to 6 L/min, so he has to provide the other seven bv breathing spontaneously. But you
asked him to do it through this narrow tube and to trigger
tfiat demand valve in the ventilator each lime. So now
he's wearing out, and he has la breathe 30 times per minute at a volume of 300 ml to get the same alveolar vendlation he was getung before on the ventilator."
"But he's exercising his diaphragm."
"Exercising it and exhausung it," he pointed out. "Look
at vour data. He started out yesterday breathing 400 ml at
a rate of 20/min. He could have been extubated then, but
it takes so much pressure to breathe through this endotracheal tube and trigger the demand valve that he just
can't handle it anv more. Suffocation IM\'." He glared at
me, waiting for a lesponse.
"But everybody uses IM\', 1 complained weakly. "We've
been using IMV for w'eaning for years now."
"Quite so," he said. "Makes vou wonder how patients
Just the ticket for
of the modes of .support. Accordingly,
my
breath?
weaning patients. In
lact, oiu hospital had provided us with the ven latest mechanical ventilator in which IMV could be selected as one
ton ventilation.
what you mean bv fighting the ventilator?"
suppose it is." I was beginning to learn not
me
little
me
to
examine.
applied physiology."
ever got off ventilators before IMS'."
"Well, vou have a point.
in disgust.
DECEMBER
'92 Vol 37
No
12
What would vou
suggest?"
1427
CLASSIC REPRINTS
"Now uc
re gfltiiii; soiiuulurc. In ilic
know.
not reaflv to he weaned. Oli.
ton force and vohinie are adetjuale.
I
He
aholic.
lias to breallie
1!5
S T.W
place he's
K
4
Bill he's
,A .Saii
hypermct-
rsinkSpirit
luin just to get rid of his
I.
—von
lirsl
kiunv: his inspira-
I
been here, \\1icn you finally start to feed him. his RQ will
go up and his minute ventilation requirement will be even
Two davs later, (^larlie (aaichil was still on a ventilator.
He was febrile and toxic. His minute \entilation was up to
lo liters a minute. My Briush consultant had been correct;
higher."
Charlie
and he's
CO-.>,
starving
him
haven't led
since he's
"
"1
He stopped
gusted look.
explanation to give
in his careful
vou don'l undeistand
"If
me
a dis-
what are you
that,
doing taking care of this patient?"
"Now, see here," said. "1 was taking care of this patient
very well before vou started appearing. .\nd he's still doing very well. VVTio do \()u think \ou are. anyway?"
I
"Young mail, I'm
trying to help vovi with a
just
required ventilation support. Examination
still
suggested a
don't iindeistand ihal.
little
let me show \()u something. Lie
where you were sleeping last night."
"Now put this in vour mouth. Close your lips
h\
llic
CVr
room and
posterior
subphrenic abscess, which was confirmed
left
scan,
took Mr, Cralchit to the operating
I
him of a quari of pus. providing wide
drainage. The next dav. he was much improved,
relieved
and, for the
time in a week.
first
I
to find
mv
"Well,
I
was even pleased
mvsterious consultant standing
sir."
mv
looked fonvard to
evening rounds with great anticipation.
al
the bedside.
began, thinking that a strong offense
I
common
sense. Look,
would anticipate
down on
that gurne\
ing like draining an abscess to improve lung function.
1
did.
aroimd it tighlh." He look a No, 10 endotracheal tube
from its wrappei and placed it carefully between my teeth.
He pioduced a padded nose clip and closed my nostrils.
"Now biealhe through that lor a few
some thought to Mr. Cratdiil here."
miiniles.
Then
VVilh thai
give
he disap
peared.
Our
his penetrating questions. "There's noth-
good
friend looks
tonight!"
"Better ihan he did
He
was not
in for
in a jovial
more
—
Good
yes.
mood
as
I
was
irritated with myself at
unsoli( ited directions,
I
compelled
felt
accepting these
to try his little ex-
it was ea.sy to breathe thiough the large
imagined that if the tube were really in my
trachea, it would be quite uncomfortable. (I was already
filling up with saliva,) But the rebreathing space would be
less
it might be even easier to breathe. .After a minute or
two,
tiied to take a deeper breath and found it more dif-
periment. Al
plastic tube.
first
I
—
tell
thai
I
was
"You were right about his breathing," I acknowledged.
I have been keeping his Inematocrit up. Wliat's the
".\nd
Malnutrilion.
"Stanation.
Can't you see
"Can't
I
M.n.isnuis.
seemed to require greater effort.
was focusing on it loo much. I tried to think of
see what?
"Nonsense. Look
Look
roll
over in bed.
ergv'
he has just
He can
to
make
at
him
"But he's obese."
I
The urgencv
else.
thoughts to the
si/e
of the
of breathing returned
my
Each breath seemed
and faster, with shallow
aii"wav.
breathed faster
breaths, because each deep breath took so long Lliat I experienced the sensation of dvspnea during the breath itbegan to experience panic and at the same lime fasself.
cination bv the lad that was panicked.
diHicult.
I
can afford
"It's
4.").0()()
I
— he's getting better."
Look at his arms. Ten
suong man. Now he can't even
al his
davs ago this was a big,
weight, riiat's
Kw.ishiorkor.
it?"
riien each breath
soiiuthing
more
(ould
advice.
quads.
hardly breathe.
It
lakes
all
the en-
pus."
1
Perhaps
should think not."
I
I
problem tonight?"
As much
ficult,
—
tonight.
insisted.
He's ten pounds over-
calories woi ih of
fat
right there.
He
it."
not the
tat,
\oung man. It's llie protein. Look at his
know.
.it
his serum .ilbiiiiiiii <)li.
muscle mass. Look
1
1
cccfffrfff
1
1
I found
hing veiT still and breathing veiT gentlv. Each ii i.il ,u a deep breath returned the
uiKomfortable sensation.
decided to end the experiment, but lound that for some rea.son I could not withdraw mv lips from the tube or move mv hand to in\
mouth to remove it. Panic took over again as I rolled my
head from side to side. Finally, with what seemed the
greatest effort,
spit out the lube and lav gulping great
Alter what
that
1
seemed an
could control
lioui
of this experiment.
ni\ Ir.ir In
I
I
gasps of
air, saliva
clock indicated
minutes,
.Still
drooling
ili.it
1
li.id
shaking from
room and ntuiiud Mr.
control.
The
almost seemed to smile
fell
asleep.
.\
this
experience,
look
at
me. He
<
al
the
for only ten
I
crossed the
Oratchit's ventilator
wide-<'yi'd look disajipeared
He
1428
down mv cheek,
been "intubated"
from
to
assist-
his face.
losed his eves and
'92 Vol 37
No
12
—
"
CLASSIC RHPRINTS
know.
been
\'()u'vf
ihosc up."
He
him
i;i\iii,i;
uiihoul
Bui
iiiiravenoush.
.miiiio acids .iiul .ilhumiii
ilii-
calories,
just
lu-
Si
looked exaspeiated, now paciug hack
because of his intestinal
to
meet
A
ileus.
Hide sugar, a litde
metabolic needs.
his
A little protein,
or 2 g/kg. .About what vou would eal
that's
in a
awoke with a start. The room was light. The horror of
week and the past night lanie lo me instantly.
The famih. had left the Cratchit family in the little waitI
ing
catheter might
glycemic.
become
He might
infected.
He might be
have a reaction to the
will not.
orities in order.
this
hyper-
man's
"Wliy,
gled
certif-
certificate,"
"1
tit\
"We
drily.
print
them
in
insisted.
I
sir.
picture of the absent-minded surgeon, but
A
I
great feeling of relief and excitement over-
one
it
all
night."
"Wliat's that, sir?" asked the nurse.
death
"Never mind, never mind. Cratchit looks manelous,
marvelous. You're doing a wonderfid job there,
observed. "This looks like a standard form."
know." he said
—
name
I
I
ver\'
is it?"
the 24Lh,
"The 24th. Of course. Wonder of wonders, he did
was
complicaUons were, for the
this
sir.
whelmed me.
in
no name on
Thursday,
disorientation.
it's
cared not.
said, holding it forward.
trauma complicated by anemia, suffocation,
part, iatrogenic. "But there's
which attracted attention
what da)' is it?"
Thursday, of course." She gig"Nur.se,
"What da\ of the month?"
You popped up from that gurney too fast. WTiy don't you lie back down, and we'll get
you a cup of coffee." She giggled again. I must have been
"Read the summary," he
most
fact, as
cried, in a voice
I
it's
at niv
"\Miy,
the
chilled to realize diat these
life, still on the
and looking ven well inhe did on the night of mv first
Charles Cratchit, big as
Starling.
"Wliat date
icate.
I
from
"Nurse!"
.
malnutrition, and other forms of intensive care."
sat
from throughout the room.
pri-
want a good meal b\ now.
"And what will happen if I don't?" I asked cautioush alread\ knowing the answer. W'ithoiu saving a word, he
".Multiple
There
deed. Looking, in
visit
blood, and ventilation. .Surely he must
reached into his coat pocket and produced a death
form"
jumped from the
I
ventilator but pinching nurses
lipid."
You've taken responsibilin' for
fluids, electrolytes,
xision of the "standard
—
The
Come, come, yoinig man. Get your
.\
ginnev and threw open the cintain.
Wonder of wonders! It was bright (la\lighl. The ICl'
bustled with activity' the workaday business of life sup-
I
normal dav
argued. "He's septic.
the hall.
death certificate came to m\ mind.
".\nd he might be hit by a falling meteorite, but he
probably
room down
port.
I
i
I
fat,
say
I
the past
what he needs."
"But the complications,"
5
F
The End ok
.uid
lonh aud intei'niittemi\ menacing me with a long and
honv finger. A chill came over me.
"Tell me what must he done. then, because vour adncc
has been wise before."
"It's not hard, voimg man. [ust feed him. Intravenously
enough
w
liuins
truh
bulk cjuan-
lecnurse." A plumpish young boy happened b\. whom
ognized as a medical student. "Toung man!"
"Yes, sir." He stated at me. bewildered at m\ eagerness.
'\'oimg man, do you know those great bulging bags of
I
its
such a conunon
final diagnosis. .\nd there
is
a
..."
looked again.
barely read
it,
"It's
the light
rather faint.
is
so
It's
in pencil.
I
can
dim here."
packed red blood
"Look again."
With a sense of foreboding. turned the paper toward
the fading light from the window. The name on the top
line blurred and cleared, blurred and cleared, then
seemed to leap out at me. Charles Cratchit. "No, not
Cratchitl" I e.xclaimed. "Must it be so? Tell me. Must it be
so?" I reached oiu to grasp his arm, bin found only air.
"That's up to you," he said, and was gone.
I looked at Cratchit. Discounting the edema, he was indeed wasted. His eyes were sunken in, his arms and legs
v\'ere scrawny. This recendy robust man looked exhausted,
emaciated. As I watched, he seemed to age before nn
eyes. He awoke briefly and looked at the ceiling, then at
me. Then, in an instant, his eves rolled hack. The monitor
registered a flat line and stopped beeping, and he lost all
tone. The team assembled, and we went through the ('.PR
ritual, but to no avail. Exhausted and drained, I needed
"Well,
RESPIRATORY CARE
•
DECEMBER
'92 Vol 37
hanging
in the
blood bank?"
the blood bank.
.
but
sir.
never
I
man. Fetch them
.
for Cratchit here.
Two
great, glorious,
No, three. Make it three." He
went scun"\ing off in the direction of the blood bank.
"Ninse! Mr. Cratchit looks to be a little dvspneic. Wliat
bulging bags of red
cells.
are the ventilator settings?"
"IM\' of
doctor, just as you ordered. His rate
is 24/
own."
"Of coinse he's not, young ladv. Neither would vou if
you had to breathe through that imcomfortable narrow
tube, .\ssist! That's the watch word. PiU him on as.sist. Give
8.
min, but he's not moving
him
a
much on
good big breath with eveiy
of having that nibe
down
help him out a litde
bit,
he wants,
his
effort. Wliat's the
his throat
if
point
we're not going to
eh? Assist-conlrol
at
whatever rate
that's the ticket."
re-
The settings were changed and Cratchit was obviously
more comfortable. I listened to his breath soimds. felt his
belly, and fairly pranced down the hall, giving an overly
al-
optimistic report to the (âtchit famih in the
time to collect myself before contacting the family.
on the empty- gumey across from the
mains of Cratchit. Sweet sleep pulled me down, and
though I resisted for a short time, I soon succumbed.
cells
know of
."
thought of the packed cells as.
"Bulging, \es. Bidging and glorious. Fetch them, voinig
I
stretched out^
I
I
No
little
waiting
room.
12
1429
CLASSIC REPRINTS
planned the day to arrive back in the ICU at
I parked mvself at the bedside
and put on m\ most pretentions scowl. True to form, the
resideins arrived at ten minutes after the hoiu'.
I
carefully
minutes before 5 PM.
five
"You're late,"
late,
I
growled.
"Damned
residents are always
rhev don't make residents the way they used
to,
do
they?"
"No,
you
sir. ,\s
.say,
ihev don'i
make
lesidents as they
We were in the operating room and. ..."
excuses! A siugcon has reasons, never excuses.
u.sed to.
"No
member
"Yes,
Re-
that!"
sir.
Reasons."
"Now about the managemenl ol .Mr. tiialcliit here.
You've made some grievous errors, grievous. And it's going to lake all of tonight and tomorrow to gel them
straightened out. We spend our lives correcting our own
errors. And there is so much to do, so much to do!"
"Excuse mc,
sir,
but we've been following your direc-
And it's Christmas
home for a few. ."
tions to the letter.
get
mv
intern
.
"Home?" Their
resident
shall be.
le( luie. I
Home
Eve.
was hoping to
I
.
faces fell, expecting ihe lazy modern
broke into a wide smile. "Then home it
for the intern
and home
for the rest of
For a well-deser\ed Christmas E\e and holidav
with your families. I'll look after (^ratchit here, and mend
you
fellows.
my
physiologic errors. Off with you
now
— and
Merry
C^hristmas."
.Ama/eri
dents
and delighted by
iiearlv
this turn
ran to the door.
of events, the
One looked
resi-
over his shoul-
der as if to ascertain my state of mental health, so smiled
to pro\idc reassurance and waved him on.
Bv Christmas night, Cratchit's hematocrit was 45 perI
and wedge pressure all
were down to comfortable levels, and his assisted minute
had gi\eii him 2,-500 calories
volume was 10 L/min.
worth of carbohvdrale and fat and 100 g of protein. \l
came in the form of honied amino acids, sugar, and emulsified oil, but I imagined that these choice nutrients were
decanted from a puree of roasted turkey stuffed with
bread, herbs, and raisins, lopped with cranberry .sauce
and gihlet graxT, mixed with plum pudding and maple
The next day he was extubaied
cent, his cardiac output, pulse,
I
sugar caiidv. While Cralrhit eiijoxed his Christmas
ilic
luiiscs ,uid
1
loasied
him
willi a
white buigundv
— nol f)om Perignon, bul the best
Inid at the
drug
1430
liltle
store across
feasl.
Monterey 'Vineyard
from the
I
hospital.
could
— abrupllv and withoiu
On New
Year's Day, he was discharged from the ICU, eating the hospital version of
creamed chicken, and asking for some good Irish whiskey
great ritual,
to
wash
I've
it
I
might add.
down.
not seen .Starling since, and have
might have been a dream. Except
from lime
logic
to
time urging
me
that
to ihinl^
c
come
I
to believe
il
hear the voice
lc,ul\
about physio-
pioblcms. Normal hematocrit. Normal liieathing.
Normal
feeding.
Il
seems
all
.so
simple now.
.\iid
I've
heard the residents say on occasion, "He takes good care
and he knows how to keep Chrisimas
of sick patients
.
.
.
well."
RESPIRATORY CARE
•
DECEMBER
'')2
Vol
.^7
No
12
Expand Your Department's
ServUes
vfith
NIK,
the Nieotine Dependency
Intervention Program,
NIK (Nicotine Intervention Kit) is o complete do-it-yourself kit for establishing o
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It
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a business plan to help sell the program
to management, a complete set of
reproducible forms for use in patient
education and counseling, and a list of
the latest resources to help inform both
patients
and
Ettsily
Implemenfod
NIK makes
staff.
the implementation
management
of a bedside
cessation program simple
straightforward.
It's
help your patients
and
smoking
and
a great
way
to
and expand your
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êm
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for
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Orders with Credit Cards or P.O. Numbers may
call
(214)
243-2272
or
FAX
it
to
(214)
484-2720
—
.
PFT Corner
Jack
Wanger
MBA RCPT RRT and Charles
Ir\in
PhD. Seciion Editors
PFT Corner #47—
What Is Wrong with This Fit, Young Cyclist?
Monica
The
patient, a 24-year-old
Riiill
man.
MD,
Cecila Rose
Table
1.
nea on exertion. He
bic>cle team
ith his
Chills,
Charles
C
Inin
PhD
Function Tests Administered to a 24-Year-Old with
and Dyspnea on Exertion
noticed that
first
he had "a hard lime breathing" while
he was cycling w
Results of Pulim)nur)
Cough,
referred for evaluation of dysp-
was
MD, and
TLC
After Albuterol
Before Albuterol
Measurement
6.61 (106)*
6.42(103)
TGV (L)
3.79(112)
3.38(100)
experienced chills and a cough pro-
RV(L)
1.41(137)
1.46(142)
ductive of white to yellow sputum.
FVC
5.20(100)
5.08
He was
FEV,
at
A
high altitude.
few days
he
later
treated with antibiotics but
noticed no particular improvement.
end-
at
inspiration but no whee/ing.
The
exam was
mainder of
his
mal
Pulmonary function
limits.
were ordered, and the
shown
tests are
Table
in
4.33(105)
4.22(102)
(L)
81
(^f)
sGaw (L/cm H:0/L/s)
Dtcosb (mL
•
min
0.13
36.3
torr"')
(98)
85
(103)
(108)
0.27(150)
(76)
(101)
re-
within nor-
*Values in parentheses are percent predicted.
tests
results of his
1
(L)
FEV, /FVC
Physical examination revealed dry
crackles in the lung bases
(L)
and Figure
This conclusion
initiallv
1
is
supported by the
decreased sG.m and the im-
pro\emcnt
in
and marked
in sGjv^
fall
lung volumes following maximal
bronchodilator treatment.
Question
1:
Question
What
is
your
of
interpretation
these pulmonary function
2:
Although these mild abnormali-
tests'.'
ties are consistent
InterpreJation of Initial Tests: The
lung
volumes are within predicted
limits,
as
is
the FEV,. but there
nea
icine
low
Assistant Professor of
and Dr Kraft
is
a
Med-
Pulmonary
Fel-
— Pulmonary Sciences Division, DeMedicine.
partment
of
Colorado
Health
University
of
Sciences
Center and
National Jewish Center for
Immunology
and Respiratory
Medicine; Dr Ir\in
is
Associate Director, Pulmonary Physiol-
ogy Unit. National Jewish Center for Immunology and Respiratory Medicine
Denver, Colorado.
1432
young man
further
is
testing
experiencing.
do you
rec-
ommend'?
Flow-volume relationships for
a young man presenting with dyspnea and chills. Flow was determined
by pneumotachograph, and volume
was determined by body plethysmograph. The loops are plotted at
absolute lung volume by first measuring thoracic gas volume with the
Fig,
is
this
What
Volume
is
evidence of mild airtlow limitation.
Dr Rose
with a diagnosis of
asthma, they hardly explain the dysp-
1.
Boyle's
Law
dashed
volume
line
technique.
is
the
The wider
reference flow-
relationship, the solid line
is
baseline loop, and the finer
dashed line is the loop obtained after
maximal bronchodilator treatment.
Further Testing: Asthma
dition characterized
perresponsiveness.
was
felt
that
this
is
a con-
by airways hyAccordingly,
it
might be
patient
experiencing exercise-induced bron-
chospasm (EIBl. Therefore, an exercise protocol
was ordered
to deter-
mine the presence or absence of EIB.
the
Spirometry was done before and after
RESPIRATORY CARE
'a
•
10-min exercise bout
DECEMBER
at
5
"92 Vol 37
A mph
No
12
5
a
PFT
and
7%
crease
grade, which produced an
in heart rate to ^5'7c
in-
Concentrations of oxygen and carbon
cremental
of the pre-
dioxide were measured in a mixing
graphic form
dicted
maximum. The FEV,
L
before exercise and 4.47
4.64
CORNER
minutes after the end of the
was
L
test
1
—
chamber w ith
a rapid
an infrared
CO:
variables,
measures
To
O: analyzer and
From
analyzer.
of
these
data
pared to a
ventilation
response
is
in
3.
appropriately interpret this
patient's
ihc
presented
are
Figures 2 and
in
first
test,
com-
of predicted responses
set,
negative study. However, the arterial
[oxygen consumption (Vq;) and car-
based on age, height, and weight.' In
oxygen
bon dioxide production (Vco:)] were
this
saturation, as
measured with
was noted
a pulse oximeter,
from a value of 92-95'^
lo fall
obtained.
A
was placed
catheter
the radial artery to obtain samples for
cise,
exercise value of 80*^.
blood gas anahsis (PaO;. PjCO:. and
148% of
122% of
Question
gas
at rest to
an
pH) from which other variables of
3:
exchange
could
be
fall in arterial
was
saturation
was no
intriguing. gi\en that there
more profound lung
the recording of resting or base-
disease in which gas exchange
what further
fected? If so,
is af-
testing
would you recommend?
measurements (Table
line
which were continued
was reached before
state
Further Testing and Discussion:
In
distinguishing
in
between
minute by 25-watt increments
exhaustion (Table
2.
wall and respiratory muscles, heart
deconditioning.
from the EIB protocol
differentiate
among
to
various disease
processes; hence, variables of cardio-
vascular function, ventilation, and gas
exchange are measured. Because of
this patient's history
of dyspnea with
extreme exercise, he underwent an
exercise tolerance test taken to the
point of
maximal
exertion.
In addition to 12-lead
ECG
meas-
urements, blood pressure was measured at rest and
each stage of ex-
at
ercise to assess cardiovascular per-
formance.
To measure
function, a
mass flowmeter was used
to
measure
expiratory
which minute ventilation
volume (Vt), and
ing
frequency
ventilatory
flow
from
(\t). tidal
respiratory breath-
(f)
were
present the car-
2A) but
linear (Fig.
is
is in-
individual. Normally,
training
results
in
an
in-
to
an increase
\olume.- In
in stroke
the trained indix idual. heart rate de-
creases
and maximizes
The
fit
stages of exerci.se as the
volume maintains
necessary
output.
the
in-
at all
increase in stroke
cardiac
The
This
type of testing uses a \ery different
protocol
above normal,
creased cardiac output, priinarily due
until
the cardiopulmonary stress.
and
exercise
""maximal exer-
to the joints
disease,
3A & B
with exercise
start-
Such a protocol minimizes
parenchymal
Figures
60 watts and increasing each
at
trauma
diffuse
is
consistent v\ith his
dicative of a
cise"").
disease,
is
diovascular data. The heart rate rise
between 60
lung disease, diseases of the chest
cular
does not ha\e
The
patient then pedaled
ox-
illustrated in Figure
this patient
below predicted values, which
blown exercise tolerance
helpful
maximum
intense training regimen.
the graded,
ing
obstructive disea.se. pulmonary vas-
his predicted
multistage exercise test was begun.
and 80 revolutions per minute
can be
attain
work load and
or high, which
steady
the circumstances described, a fulltest
to
his predicted
exercise tolerance
2, "rest"),
until a
With exer-
an exercise intolerance; indeed, his
oxygen-tension difference, P(A-a)0:)-
The exercise protocol began with
2).
was able
the patient
2A. Thus,
alveolar-to-arterial-
this
evidence to suggest ElB. Could
patient have a
VdA't, and
tio.
(Table
at rest
ygen uptake, as
calcu-
lated [dead-space-to-tidal-volume ra-
The
no abnormalities were
patient,
apparent
in
obtained.
Table
2.
Ventilatory. Cardiovascular, and
Maximal Exercise (Exhaustion)
Gas Exchange Measurements
in
at
a Patient with Cough. Chills, and
Rest and
Dyspnea
PFT
CORNER
PFT CORNER
A
B
PFT CORNER
exercise results
in interpreting tiic
due
to his
ness: in spite
ot"
a very
enhanced
this patient is
exchange
in
fit-
marked gas
the
patient
does not have an exercise
intoler-
abnormality,
ance. However, a multistage exercise
with blood gas measurements
test
re-
\ealed an important abnormality that
prompted further evaluation. Exercise testing can be useful both for d:
agnosis and, as illustrated here, for
following the effectiveness of treat-
ment.
REFERF.NCE.S
1.
Jones NL, Makrides L, Hitchcock
Gives you the support of an iu-curalr. reliahle system of
C, Chypchar T, McCartney N. Nor-
mal standards for an incremental
progressive
Am
cycle
ergometer
Rev Respir Dis 1985;131:700-
708.
2.
\'<»luine 1:
Follows
and
Whipp
regulations
testing
Principles
BJ.
of exercise
\
siili|ian
.1
i5>:
&
J
Allergy Clin
and expense.
Immunol
|y87;79(4):558-.'^7l.
Volume
2: Clinical
Laboralory SCandartIs
(ônlain.s detailid cxplatialioiis
and
CLIA standard
K.
\ali<lati(jii
in
(subparts
von
—
iiiaiiagiiiii'iil
and
.|(
W lO
—
3:
that calls for
is fill
in llic
and procediircs.
blanks for
l.oiiis
spreadsheets
are iiiehiiled.
LabCiounls
integrated system of worksheets that satisfies (;LI.\
insliiiineiil
this
Or Order
All Four
\ol limes In
Blood Gas Laboratory Q.V Notebook — An
(!AP standards. Use
(Member $118)
work-sliecl lur laili
M)
do
VV«>rkl)(»ok
Item Bk32
Volume
VDUR
II. J.
Iuinp lo
of iiisiniincnls
IBM format
Relations
ii'iiii
III
rnveriiig patifiil test
Item ItK.n
(Idciinii'iilatioii. .Ml
Public
K
and slumlards.
Febiger, 1987.
Salvaggio JE. Hypersensitivity pneumonitis.
saves you time
ipialitv coiilrol. .VIso conlain.s related (!-\P
and interpretation. Philadel-
Lea
tliat
Suninian' of Clinical Laboralorj- Kcîlntioiis
f :LI
Was.semian K. Hansen JE. Sue DY.
phia:
3.
documentation
test.
manual
And Savel
and
on
to record daily data
maiiUenaiiee and ralibialioii. ll5M-eonipalible
Item Bk35
Ldliis s[>readslieets are iiiehided.
Item Bk33
The best public relations
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Charles
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IXirbin Jr
MO and
Radiologic Skill
Douglas B Edeii BS RRT. Seition Hdilors
An Unusual Cause
Douglas
A
of Dyspnea in a 13-Year-Old Boy
M Pursley RRT and Timothy A Tesmer MD
previously healthy 13-year-old Caucasian boy
weighing 65 kg was admitted
emergency room with
piratory rate
to a local hospital's
difficulty
upon admission was
breathing.
Res-
36. blood pres-
sure 148/90. and heart rate 97. Stridor
was present
during both inspiration and expiration, but breath
sounds were otherwise
The
clear.
was ex-
patient
tremely anxious, unable to speak, and could maintain
an airway only
in the
He was
upright position.
drooling, retching, and coughing during his entire
emergency room. He vomited a brown.
stay in the
foul-smelling liquid and was constantly
bloody saliva into a bucket
nasal cannula with
oxygen
at the side
6 L/min was
at
spitting
of his bed.
A
in place,
and pulse oximetry revealed an oxygen saturation
of 99%.
(Fig.
A
lateral
neck radiograph was obtained
1).
Questions
Radiographic Findings: What abnormality
on Figure
is
seen
1?
Treatment: What treatment
is
indicated'^
Fig. 1. Lateral neck radiograph from 13-year-old boy with
dyspnea, taken on admission to emergency room.
Mr
Pursley
is
Clinical Coordinator.
School of Respiratory
Care. Heart of the Ozarks Technical
Springfield,
now
Missouri.
Community
Dr Tesmer. formerly of
Answers
College.
&
Discussion on Next Page
Springfield,
practices al Colorado Springs Medical Center, Colorado
Springs, Colorado.
RESPIRATORY CARE
•
DECEMBER
"92 Vol 37
No
12
1437
TEST YOUR RADIOLOGIC SKILL
Discussion
Answers and Discussion
Radiographic Findings: The pharynx is obstructed by a foreign body. While at the lake with
friends, the patient attempted to swallow a 4-in
apparently on a dare from his companlong perch
ions. After realizing that he could neither swallow
—
the fish nor spit
it
of his friends to
drove the boy
out. he panicked,
summon
a
prompting one
who
b\slander
then
the
of a fish
skeleton
completely filling the pharynx and hypopharynx.
The head of
esophagus
at
the
fish
extends into the cervical
the level of the sixth cervical vertebra
(C6) while the
tail
is
luses, buttons, safety pins,
and
mon
common
foreign bodies.' Less
balloons- and dental plates.'
that in the
United States
1.
food
Coins,
obstruction.
plastic toys are
bo-
com-
objects include
has been reported
It
500 people die yearly as
a consequence of obstruction of the upper aero-
digestive tract by foreign bodies.' In children, mor-
to the hospital.
The radiograph shows
This case represents an unusual cause of upperaerodigestive-tract
positioned at the base of the
tality rates
The
may be
as high as
45%.^
constrictor muscles of the pharynx are very
strong and can force large and irregular objects into
where they are
the esophagus
likely to lodge just
below the cricopharyngeus muscle.''
In
our case,
the sheer size of the foreign body caused near total
tongue.
obstruction of the airway in the upright position
Treatment: Immediate extraction of the fish is indicated. Because the tail fin could be visualized in
the oropharynx, Magill forceps were used to try to
and complete obstruction when the patient was
was still in the
emergency room. This attempt was unsuccessful;
so, it was deemed necessary to transfer the patient
foreign bodies from the upper aerodigesti\e tract,
extract the fish while the patient
to the operating room for assessment of airway ob-
struction and removal of the fish.
A
flexible na-
sopharyngoscopy was performed and showed the
fish completely blocking the hypopharynx with the
dorsal fin
embedded
in the right lateral
wall. Neither the epiglottis nor
structures
could
be
pharyngeal
any of the laryngeal
visualized,
making
it
im-
placed
in the
supine position.
Various methods have been employed to remove
and
tlexible
endoscopes.
Foley
The
safest
including
rigid
catheters,
and proteolytic enzymes.'
methods are those employing endoscopes under anesthesia.^ In our case, establishment and maintenance of the airway was of a paramount importance. Tracheostomy tube placement bypassed
the supraglottic obstruction. Sharp foreign bodies,
such as the dorsal
lodge
in the walls
of the fish
fin
in this case,
can
of the pharynx or esophagus and
one
possible to slide an endotracheal tube into the tra-
make removal
chea over the nasopharyngoscope. At
must disengage the shaip point before the body can
was decided
that a
this time,
it
tracheotomy was necessary for
difficult.
neck and back
at a
the
patient
45° angle
sitting
REFERENCES
with his
L
to the bed.
General
and removed from
fin
the pharyngeal wall.
dorsal fin removed, the fish
was
easily
was cut
With the
remo\ed
both of which cleared after a few days. His
_?.
way: unsuspected cause of obstruction. Postgrad
1438
Med
1989.86(.^):235-237.
4.
Lima JA. Laryngeal
foreign bodies in children: a per-
sistent, life-threatening
problem. Laryngscope 1989;99
(4):4 15-420.
total
was 7 days, and he was decannulated
before discharge.
Henderson JM. Balloons as a cause of airway obstrucAm Fam Phys 1989.40(2):1 171-17.^.
Blaschke U. Cheng EY. Foreign body in the upper air-
tion.
5.
hospital stay
W'A. Management of foreign bodies of the upper
216.
2.
from the oropharynx. Postoperatively, the patient
developed a small pneumomediastinum and discoid
atelectasis in the middle segmenl of the right lung,
Webb
gastrointestinal tract. Gastroenterology 1988:94(11:204-
anesthesia was administered following placement
of the tracheostomy tube. The dorsal
instances,
these
be removed.
airway maintenance and support. The tracheotomy
was peiformed with
In
Ballenger
JJ.
and neck.
Disease of the nose, throat, ear. and head
1.3th ed.
Philadelphia: Lea
&
Febiger 1985:
L369-1372.
"92 Vol 37
No
12
Respiratory
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75229-4.'i93.
McGill Uni\ersity and
structive sleep apnea, neuromuscular
SIDS Re-
disease, craniofacial syndromes, and
Director of the Center for
C Beekerman MD. Robert T
Brouillette MD. and Carl E Hunt
search
pital.
Dr Hunt
MD.
illustrat-
man
of Pediatrics
Wilkins,
College of Ohio. In addition, they
cusses
have enlisted
demiology,
Robert
Hardcover. 429 pages,
&
Williams
ed. Baltimore:
1992. $69.00.
Montreal Children's Hos-
at
laborators,
the
In
made
20 years, advances
last
in prenatal care,
intensive
pediatric
neonatal and
rehabilita-
care,
and home monitoring and
tion,
treat-
nowned
Professor and Chair-
is
international
4.^
control
The
state
work
intended to be a ref-
in
erence source for
thrive despite their disabilities. Res-
diatric respiratory control."
from such diverse etiologies as cranneuromuscular
syndromes,
iofacial
bronchopulmonary dyspla-
diseases,
and obstructive sleep apnea are
sia,
now
more
thoroughly
and are amenable
Yet.
to
understood
many
such
sudden
as
however, that
Ircmeh
many
the chapters
cinct,
and
selected
atory control
history,
more of
section has
point,
and many of these chapters are
as valuable sources of reference.
The concluding chapters emphasome of the practical problems
size
in
providing care for such a myriad
v\ill
well
readable.
suc-
written,
v\ith
minimal
Each chapter includes
bibliography,
with
a
refer-
w ho care
therapists and nurses
fants
treatment
are
for their coverage.
From
tilation at
ic
home and modes
home monitoring
the monitor, these chapters
comprehensive
nine chapters build se-
i|ueiitiall_\
on the basic science
has developed
m
this field.
that
From
de-
until
now
growing
to discontinue
of
field
home
formation on ""how
to
chemical synaptic transmission
are present. Relativelv
the
de\elopment. anat-
physiology,
and
patho-
physiology of respiratory control
orders
In Infants
tempts to do
The
atrics
at-
is
in this field.
Dr
Pulmonary section
at
Tulane University School of Medicine.
1440
Dr
Brouillette
the
in
nerviuis
is
Professor of
one
at
text,
summar-
deficiencies
minor weak-
nesses include the occasional poor
system, to neuromuscular conlrol of
selection and reproducibilitv of pho-
the upper airway and maturational
tographs. For example, one puiports
breathing control
fant,
these
iology of the
in the fetus
and
heavily
chapters
in-
em-
field,
with
little
clinical
Chapters 10-18 address particular
problems with control of breathing
infants and children.
From
in
periodic
breathing and apnea of prematurity
to
to
show
a
child
with
Treacher-
Syndrome on Page 299 as an
example of the many craniofacial
Collins
svndromes
that
involve mandibular
The angle at which the
photograph was taken and the quality
hypoplasia.
practice discussed.
a Professor of Pedi-
and Physiology and Chief of
Pediatric
developing
phasize the basic science and plivs-
editors are eminently quali-
Beckerman
the
and Children
just that.
and established
fied
in
Respiratory Control Dis-
mature
and
it."
As with any attempt
i/iiig a field in
clinical
what
care and in-
do
of breathing, through mechanisms of
cumulated basic science and
fill
has been a gap between the
of the ac-
all
of chron-
available to teaching
ventilation
concluding remarks.
grates into a single text
children
the discus-
sion of candidates for chronic ven-
velopmental aspects of neural control
and
encvclopedic
technique of
initial
for in-
home and
at
home monitoring
apnea and when
The
two
and children. The chapters on
pediatric reference source that inte-
omy
note,
and would be especially helpful to
Care
ventilatorv
are
Of
group of disorders.
tor
to this time, there has not ex-
This
a clinical view-
the
same
treat-
that particular condition.
most also have useful summaries or
isted a coordinated or
knowledge on
symptoms,
pathophysiology, diagnosis, and
ment of
epi-
definition,
and
signs
ences both classic and recent, and
cannot be said for pediatrics.
Up
the
liter-
extensive, the
is
dis-
disorders of respir-
Although the medical
adult
Each chapter
many
Nonetheless,
helpful.
repetition.
on
conditions.
ical
chapters are particularly impressive
Although there are many authors,
mystery to both researchers and
ature
clin-
directed primarily
comprehensive source ex-
find this
death syndrome (SIDS). remains a
nicians.
is
ap-
is
It
few chapters,
first
physicians.
infant
cli-
it
students of pe-
"all
readers of Rt-;spiRATORY
therapies.
pathophysiology of
the
disorders,
is
parent after the
at
preface
the
editors
of respiratory control to survive and
arising
dis-
common
excellent summaries that can serve
that the
disorders
of
t~ield
orders.
with inherited or acquired disorders
control
re-
produce a 27-
to
respiratory
pediatric
col-
and
recognized
all
experts,
chapter work that covers the
ment have allowed many children
piratory
Medical
the
at
gastroesophageal reflux, this section
covers a w ide range of
sudden infant death svndrome. ob-
of the reproduction, however,
fail to
provide the visual impact one wiuild
expect from a work such as
addition, the inevitable
hit;
92 Vol
this.
In
time be-
.^7
No
12
.
BOOKS, FILMS, TAPES, AND SOFTWARE
tween writing and producing a
book
SIDS ha\e
chapters on
or no
little
discussion of the controversy about
whether infants should sleep
spective,
book's
the
have been enhanced
in
my
prone position. FinalK, from
The
text-
reflected in the fact that the
is
the
per-
would
some of the
of respiratory care and
tleld
pulnionology
changing,
rapidly
is
with advances in both adult and pe-
Two
diatric disciplines.
re\iew these advances
recent hooks
piilmonars
in
Recent .Advances in Respiratory
is a nmnogiaph written by
However,
monitoring.
these chapters pio\ ide a great deal of
information to the reader and provide
balance on an emolionally chargeti
The
issue.
home apnea
care.
value
home
and
on
NIH Consensus
with the
line
In
al.
recommendations
monitoiiiig arc. in gener-
on
Apnea and
Medicine
Statement
controversial elements of mechanical
authors from the United States. Eng-
Home
ventilatory strategies involved in car-
land, France, and South Africa
ing for these children had been ad-
review adult respiratory distress syn-
monitoring
dressed more direct!)
drome, new concepts
Massachusetts General Hospital.
if
who
asthma, re-
in
ly's
Infantile
Monitoring. Dr Dorothy Kel-
chapter
how home
made at
describes
decisions
are
summary. Respiratory Con-
cent research in diseases such as sar-
trol Disorders in Infants
coidosis and cystic fibrosis, and the
dren
is
and Chilmagnificent work. The ed-
pulmonary complications of .AIDS.
A
breathing
control
itors
have provided a comprehen-
by
sive
pediatric
minisymposium on lung
tation makes up the final four chap-
newborn,
ters.
Drs McLoughlin and McColley on
In
a
source on
reference
respiratory control in children.
whether you are a
ever,
physician,
ommend
or
nurse,
therapist,
cannot rec-
I
you purchase
that
How-
book
this
unless you are a specialist with re-
search interests in this field and will
want the major focus on the basic
and
science
clinical
On
ommend
here.
presented
as
the other hand.
would
I
transplan-
As
of multi-author
typical
is
books, the coverage of topics
many of
even, and
un-
is
the chapters are
Excellent
Beckerman and
chronic
lung
disease,
and by
Drs
Blancherd and Arande on pharmacotherapy round out this excellent
text.
quite brief.
However,
be ex-
Although many of the chapters
pected
slim publication of under
contain typographical errors, they are
in a
300 pages, which
this is to
ob\iously not
is
intended to be an exhaustive or definitive
partments and intensive care units or
and
fetus
the
in
Drs
Hunt on neuromuscular disease, by
complete and provide recent
general,
In
text.
ences are up to date, but
what
disappointed
in
recommend
refer-
book
I
refer-
to all
who work
am some-
fants,
and children with respiratory
the
I
highly
ences.
rec-
that respiratory therapy de-
Dr Hen-
by
chapters
rique Rigatto on the maturation of
limited
the
this
with neonates,
in-
disorders.
rehabilitation facilities that care for
and children with these prob-
infants
lems buy
this
work
as a reference
source. Pediatric health professionals
in
many
disciplines need education
in this
expanding
cise 8
by
1
field,
and
this
con-
inch hardcover deserves
1
discussion of high frequency ventilation
and surfactant replacement
ARDS. There
Howard
ther-
Burns
MD
Fellow, Pediatric Critical Care
Harvard Medical School
The Children's Hospital
Boston, Massachusetts
Respir.'\tory C.-^re
now
neonates,
considered a stan-
RDS
dard of care in
other
clinicians
in
Director
neonates re-
vid
M
Mitchell
in
Respiratory
providing
adult patients with
lems,
Division of Neonatology
care
Agnes Hospital
St
Baltimore, Maryland
to
pulmonary prob-
monograph provides an
this
Handbook
of Mechanical Ventila-
'easy read' with generally useful up-
tory Support, edited by Azriel Perel
to-date information.
MD
and
M
Christine
308
Respiratory Control
Softcover,
Disorders of Infants and Children
Baltimore:
1992. S35.00.
In contrast.
Recent .Advances
Medicine, Number
MD
1987 reference for surfactant therapy
in
only
is
Nevertheless, for physicians and
Jeffrey
Birenbaum
Consulting Editor
in
quiring mechanical ventilation.
our attention.
J
one
apy
5, edited
by Da-
provides more exhaustive treatment
MD. New
York:
of topics which are useful for pe-
Stock
pages,
Williams
MD.
illustrated.
&
Wilkins,
and neo-
This comprehensive, easy-to-read
a
handbook contains contributions from
Respiratory Control Disorders in
multi-author book and. in this case,
24 of the most w idely published au-
and Children, edited by
Robert C Beckerman MD. Robert T
Brouillette MD, and Carl E Hunt
there
MD.
threatening events; and apnea of in-
Churchill Livingstone, 1991. $59.00.
diatricians, pulmonologists,
natologists.
Infants
Baltimore: Williams &Wilkins,
it
is
also
repetition of information in
thors in the field of respiratory care.
chapters on periodic breathing: ap-
The editors (Dr Perel. Chairman. Depanment of Anesthesia, The Chaim
Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel, and Dr
is
nea of prematurity: apparently
life-
fancy, sudden infant death syndrome.
1992. $69.00.
RESPIRATORY CARE
However,
•
DECEMBER
'92 Vol 37
No
12
1441
BOOKS. FILMS, TAPES, AND SOFTWARE
Stock, Associate Professor, Depart-
computer technologies designed
ment of Anesthesia. Emory Univer-
calculate
sity
Medical School, Atlanta. Geor-
work of breathing from pressure and
have produced a book
flow measurements. Practitioners
gia)
the large
tills
mechanical
that dis-
body of information on
\'entilatory
support into
clear, straightforward concepts.
Section
begins with
a
chap-
monitoring and progresses
sub-
in
and side effects of
benefits,
PEEP and CPAP.
Chapter
in-
pn)\ides
10
succinct
a
overview of pressure support ven-
ment should be aware of
tilation
im-
this
Section
tains
1
Breathing Modes, con-
II.
chapters devoted to familiar
1
(PSV). including a discussion
work of breathing
of spontaneous
portant limitation.
on ventilator fundamentals and
formation on the uses, potential misuses,
\ol\ed with the use of such equip-
General Aspects of Ven-
1.
tilatory Support,
ter
to
pulmonary mechanics and
and not-so-familiar modes of ventilation. In addition, there is a
chapter on
and pressure-volume curve interpre-
The
tation.
figures illustrating these
work-of-breathing concepts are particularly timely in light of the
many
now
sequent chapters to more complex
various
discussions of pulmonary, cardiovas-
and the potential effects they have on
available that provide real-time dis-
spontaneous work of breathing.
plays of pressure-volume curves. In
and gastrointes-
cular, renal, hepatic,
effects of mechanical
tinal
ventilatory
support circuits
Chapter 7 contains a discussion of
ventila-
controlled and assist/control ventila-
tion.
Chapter 2 contains a few terms
many
with
tion,
illustrations to help
somewhat awkward. "Mechanical inhalation" is used where
the reader understand the concepts.
"mechanical ventilation" or "inspir-
puzzling.
that
find
I
would
atory phase"
on Page
tion,
1
suffice. In addi-
7 the term "ejected"
is
However, one contradiction was a
On
paragraphs are devoted to the
used to denote gas flow from a vol-
ventilation
ume
Page
ventilator. This
used
propriately
in
frequency
high
term
is
more ap-
context of
the
Other
ventilation.
or
lems, this chapter provides an excel-
breathe
overview of the fundamentals of
mechanical ventilators.
ened
I
was
heart-
on Pages 8 and 10
to see that
the authors describe the therapeutic
This
mechanical
of
aspects
in contrast to the first sen-
is
describe mechanical ventilation
itors
as only supportive.
a
in
for
this
in
3.
two points
noteworthy.
to
On Page
monitoring
during
importance
of clinical
On Page
vides
advantages
IMV
of
monary
than
Again, excellent use of simple
illus-
enhances the reading.
The author encourages
the
of
u.se
assessment as the best indi-
IMV
or
SIMV
is
be-
ing tolerated.
—
tion
(MMV)
not
garnered
search or
a
technique that has
much support in repractice. As a result, most
of this chapter pertains to ventilators
that provide the
MMV mode.
High frequency \entilation (HFV)
is
detailed in Chapter 12. Attention
given
problems
may
that
and
aspects
technical
to
is
to
be encountered
with equipment. Clinical indications
HFV
for
are described, and graphs
illustrations are
used to clarify
and emphasize points.
13 through
Chapters
present
15
inverse ratio ventilation, airway pressure relief ventilation, and continu-
—
modes
employed onl\ in special situations. The information should allow most clinicians to recognize indications, employ the proper equipous-flow apneic ventilation
usually
mechanical
of technical considerations, although
less-often-used modes.
observation
about
ventilation. This point
pecially timely in light of the
144:
dis-
SIMV.
and
presents a brief dis-
1
1
ment, and understand the physiology
34. the author notes
circuit
Chapter
cussion of mandatory minute ventila-
and potential complications of these
more information about
breathing
very
is
PEEP
proximal airway pressure pro-
that
and
research
needed.
and CPAP. begins with a discussion
and auscultation as a means of monitoring.
still
reference
author stresses the
the
slight
chapter
and purported advantages and
Chapter
are particularly
.32, in
ventilation,
and
this
Chapter 8 discusses the history
cator of whether
Chapter
Except
much
yet recognizes that
and
clinical
In
unable to
.."
informative.
about the effects of mechanical ven-
on major organ systems.
.
accurate,
read,
to
found
I
section provide valuable information
tilation
is
.
contradiction
this
easy
who
patient
trations greatly
The other four chapters
respiratory rate are
spontaneously
condescension.
ventilation.
tence of the book in which the ed-
on
"The
state.
author summarizes
amount of research on PSV
the large
straightforward in a paralyzed patient
than these minor terminology prob-
lent
authors
Vt and
choice of
However,
settings.
90 the
in-
mechanical
packages
graphic
this chapter, the
bit
Pages 86 and 87. three
tricacies of establishing
computer
the
pulis
es-
new
it
9,
which
details
might better have been placed
the
end of the chapter
and
physiology
various
—
after
and deleterious responses
PEEP
and
ed.
The
section
siderations
technique
this
left
is
the
ad\antag-
eous
CPAP
at
to
Chapter
16. the
authors present
(DLV). Tables and
tilation
tions
illustra-
make information easy
to as-
have been present-
similate. Various techniques used to
on technical con-
achieve
me wondering which
best
In
an overview of differential lung ven-
and why. Overall
chapter provides excellent
in-
tential
DLV
and
its
associated po-
complications are discussed.
Chapter
17
breAthino and
addresses
how
work of
the choice of
92 Vol 37
\
No
en-
12
BOOKS. FILMS, TAPES. AND SOFTWARE
tilatory
M
David
can help or hinder
circuits
The authors
spoiiianccHis brealhing.
PhD RRT
Barton
De\elopment
Staff
anti
physiology
CQI Coordinator
and mechanics of spontaneous breath-
Department of Respiratory Care
thoroughly
discuss
the
Llni\ersily of Virginia
ing and the effects that \arious lung
volumes
and
breathing
work.
case
using
for
on
Health Sciences Center
making the
Charlottesville, Virginia
have
resistances
After
high-llow systems, the authors detail
Bronchial Mucology and Related
the pros and cons of
Diseases,
Section
which
III
arious circuits.
\
contains 5 chapters in
the etiology
pathophysiology,
.
recommended
diagnosis, and
venti-
cluded are chapters on
injuries,
acute
and
lated Diseases
support
fol-
the Bronchial
is
may
one
encounter
ventila-
Although there
nothing
is
new
or
MD
Each chapter
utors
from
cluding
tory support.
a
is
book
this
who would
att)ry
parent
Rein
Because this book assumes
some medical background.
do not
I
believe
is
it
suitable
the
for
States.
one might think
would be
a tendency
L Adamic BA RRT
Sherry
Care Medicine
Critical
Section of Respiratory Therapy
The Cleveland
Clinic Foundation
Cleveland, Ohio
toward
this is not ap-
Application
Clinical
Respira-
of
tory Care, 4th edition, by Barry
organized
is
and up-to-date reading.
that
m this series.
The book
teresting
Kingdom,
With such va-
format
in a
reviews the pulmonary anatomy
that
and physiology plus the physiochem-
The
few
Shapiro
MD,
M
Robert
PhD RRT. Roy D Cane MD, William T Peruzzi MD. and David
Hauptman
RRT.
ical
port.
chapters tend to go into great detail
pages, illustrated. St Louis:
on the various aspects of mucus.
Year Book
book provides
ventilatory support.
It is
easy to read,
and figures and graphs greatly enhance the explanation of physiologic
and
technologic
Each
principles.
chapter has a comprehensive
Minor
list
of
aspects of mucus.
These chapters were
to
me
first
Hardcover,
525
Mosby-
Inc. 1991. $57.95.
less interesting
than the later chapters on dis-
This textbook
well
is
practitioners, students,
eases.
The chapters on
A
Kacmarek
drawing mechanical ventilatory sup-
this
new
Bronchial Mucology
and Related Diseases makes for in-
countries, in-
the process of providing and with-
summary,
respir-
on bronchial mucol-
literature
and Pier
technologic coinplexities involved in
In
con-
ogy.
the United
Italy,
and the LInited
brings together the physiologic and
an in-depth overview of mechanical
the
lor
like a
Department of Pulmonary and
redundancy: however,
section
recommend
I
practitioner
written by contrib-
presented
This
MD
number of
there
essential to appropriate
inlbrmation.
Staff Respiratory Therapist
are well written and the information
is
dis-
Italy.
riety in authors,
management.
is
very useful
Series edit-
of Milan,
revolutionary in these chapters, they
patient
is
it
medical, respiratory, or nursing stu-
book
the third
Mucology
Carlo Braga
when providing mechanical
though each systemic disease
cussed only brietly,
dent. 0\erall.
Mucology and
Bronchial
ed by Luigi Allegra
pitfalls
New
York: Raven Press, 1991. $65.00.
mechanical ventilation, and tempta-
and
Hard-
illustrated.
lowing major trauma, weaning from
tions
Allegra
major causes of
latory support of the
lung
224 pages,
cover,
respiratory failure are discussed. In-
chronic
by Luigi
edited
MD and Pier Carlo Braga MD.
their
impact on the respiratory system. Al-
densed review of the current
and
low-resistance
on systemic diseases and
lion
related diseases
include chronic bronchitis, cystic
brosis, bronchial asthma,
fi-
and bron-
in
known
to
and educators
respiratory care and has been a
standard reference since the
tion
was published
in
1975.
first
edi-
The au-
editorial
chiectasis plus the role the airways
thors are recognized teachers, speak-
and organizational flaws detract very
play in systemic disease (including
ers,
pertinent references.
little
from the overall positive
as-
pects of this book.
I
recommend
who would
this
like to
book
to
anyone
have a compre-
bronchiolitis
obliterans
pneumonia).
These
chapters
some review while introducing
concepts from the current
offer
new-
literature.
and researchers
care
and
strong
fourth edition
book would be of
particular benefit
discussions not only a review of the
es,
med-
disease, but the latest treatment and
sumes
titioners
who wish
to update their
li-
braries.
medical
findings
each disease
nus
entity.
in their
associated
It is
with
an added bo-
that the authors include the sec-
"92 Vol 37
No
in
is
with
physiology,
The
intended to provide
on the essential concepts of acute
is
however, the authors include
and respiratory prac-
backgrounds
research, and clinical practice.
mechanical ventilatory support. This
students,
respiratory
in
qualified
a relatively nontechnical perspective
more common
ical
well
given to the
Considerable attention
book on
to respiratory therapy students,
are
respiratory ailments:
hensive, relatively inexpensive handthe current state of the art in
organizing
12
respiratory care for physicians, nurs-
and respiratory therapists, and asthat readers
formation covered
understand the
in
all
in-
preceding
sections as they progress through the
text.
1443
BOOKS. FILMS. TAPES. AND SOFTWARE
liitroducton Hsscntials. pre-
howe\er.
thai
sents a review of the tLiiiclinnal anat-
tialK the
same
omy
editiim. In addition, the author
Part
1.
of the respiratory system and
of
aspects
specific
relates
clearly
anatomy and physiology
to disease
and appropriate therap\. The
states
chapter on clinical exaliiation
however,
out:
it
covers the "need to
know" information
format. This
in a
quick re\ icw
section does an
initial
excellent job of bringing readers "up
esscn-
is
if
a
Part VII. Special Considerations,
would
covers the disease states most com-
more in-depth review of ox-
monly
Airway Management,
is
we have found
tion,
in
any general
res-
monia. This section provides an ex-
focused on information involving the
cellent synopsis of these conditions,
placement and use of
emphasizing essential
air-
artificial
common
abnormalities of the muco-
escalator and
ciliary
nism and goes on
to
cough mechacover humidity
and aerosol therapy, pharmacology
this
section
and
section on
pharmacology presents a good
view of
commonly used
but
omission of se\eral drugs (eg.
an integral part of
187. the tech-
nique to achieve minimal occluding
volume
(MOV)
because
technique de-
the
actual 1\
is
de-
incorrectly
is
minimal leak
the
technique (MLT).
The
Assessment
section Clinical
of Cardiopulmonary Function
com-
is
prehensive and addresses most of the
This section
mark-
critical points.
ith
edly different from the previous sec-
the
bitol-
represent
tions in that
is
it
much
is
is
harder to read.
more oriented toward physiology
is
major
a
re-
and headings
in the
third edition, published in 1985.
Spe-
cific sections have been updated to
new equipment,
include
drugs, and
treatment approaches referenced to
more current
t)n
re-
agents w
recommendations,
specific
is
On Page
airway care.
application of humidifiers and nebu-
The
edition
fourth
this
to
which currenth
scribed
lizers is concise, straightforw aid.
supposed
are almost identical to those
scribed
relevant to practice.
rationale.
vision, the categories
application and evaluation of bron-
hygiene therapy. The clinical
the abbre\iated
is
and con-
facts
management guidelines
Although
limitation to
dis-
with
cussion of the closed suction system.
of inhalational agents, and clinical
chial
A
the patient's airway.
Bronchial Hygiene Ther-
and Pneiiwocysri.s carinii pneu-
is
piratory care textbook. Attention
and
II.
toxic
as
ures designed to ensure patency of
addresses the physiology and
disease,
inhalation. ner\'ous system dysfunc-
ways and airway clearance proced-
Part
edema.
lung
complications,
postoperative
on respiratory anatomy and
apy,
obstructive
complete a section on airway care
prepares them for the sections that
fol]ov\.
respiratory
in
pulmonary
as
cepts
to speed"
encountered
including
care
ARDS.
ygen hazards had been included.
Part IV.
pressure release ventilation.
as that in the previous
ha\e better accomplished the section
goal
brief
is
and superficial, as the authors point
section
this
is
literature.
PiH'iinwcystis ccirinii
an important
The chapter
pneumonia
and
addition
is
good example of the authors'
to
a
intent
provide a text that addresses the
current topics in respiratory care.
The book contains 955 references
and prac-
that reflect current theorv
draw-
tice. Illustrations include clear
im-
than clinical practice, and presents
ings and diagrams
the chapter incomplete. Application
numerous
portant concepts and tables summari-
and evaluation of bronchial hygiene
(Pages 241-244)
terol. pirbuterol.
is
addressed
and ribavirin leaves
1
very
providing
well,
that
must be nav-
igated before one arri\es
the clin-
at
at
Part VI. Positive Airwa> Pressure
physiology of oxygen transport
Therapy, clearly represents the major
Part
III.
Oxygen Therapy, looks
and continues into the pathophysiol-
ogy of hypoxia. This prepares the
reader to appreciate the next two sections,
which concern the
How To
Why
and
guidelines for oxygen ad-
The
ministration.
and
results if use
The
author presents Part
is
clear and systematic
still
potential
attempted.
a very
III in
manner
that alin-
sights for a logical approach to oxy-
1444
it
contains
six
chapters and covers the concepts of
juncts.
It
and
ventilation
is
not just
ad-
its
massive
that
ing added, the authors have revised
lows the reader to develop the
gen therapy:
section
area de-
indicates
end
preface.
This
which oxy-
gen therapy has limited therapeutic
usefulness
mentioned
authors'
the
in
amounts of new technology are be-
last topic
scribes the situations in
revision
mechanical
must be pointed
out.
what they alread> had
a
in
manner
that gives this section a continuit\
did not have before. In addition
it
the
.
authors have included the newest mechanical
zing data and recommendations.
ventilator
technology
con-
cepts such as pressure support x'entilation.
pressure
imersc
ratio xentil.ition.
control
The
authors do not hesitate to state their
opinions, and
ical application.
clear therapeutic guidelines.
the
formulas
mathematical
that illustrate
when
do so
the\'
their
statements are clearly indicated by
(from Page 71. "The admin-
italics
of higlt-voliime aerosol
therapy for 30 minutes every 4 lioiirs
istration
nil!
accomplish as adequate mobil-
ization
of dried, retained secretions
as a continuous ultrasonic aerosol.
Overall,
we
believe
fourth edition retains
tures
tions
we
that
")
this
of the fea-
all
appreciated in earlier edi-
—being easy
to read
and undermost
stand, practical, and including
of the topics important to the current
practice of respiratory care.
It is
ten at an appropriate level
phvsicians.
ventilation,
piratory
and airwa\
nurses: and althou>;h
therapists,
it
writ-
for res-
mav
'92 Vol 37
and
not be
No
12
BOOKS. FILMS. TAPES, AND SOFTWARE
the mosi
able,
comprehensive
avail-
text
accomplishes
certainly
it
its
purpose of piwiding a clinical per-
mainder of the
text
is
then divided
proach to the diagnosis of thoracic
recommend
chapter on .MDS, though brief, pro-
intnxluces the reader to a
vides an introduction to radiographic
diseases
imaging of the chest with CT. The
text
our students as an excellent reference
subject with an approach to multiple
textbook.
diagnostic
to
Clinical
first
a
possibilities.
reader proceeds to Section
Thomas V
Hill
MS RRT
Professor and Chairman
specific diseases
diography.
.Associate Professor
Section
Respiratory Care Program
Kettering,
A
Ohio
Radiologic Approach to Diseases
of the Chest, b\ Irwin
MD
and David
G
Bragg
cover. 560 pages,
Williams
more:
M
Freundlich
MD.
illustrated.
&
Wilkins,
HardBalti-
1992.
$95.00.
A
Radiologic .\pproach to Dis-
erence.
The book begins with
ref-
a brief
introduction to the standard and an-
which
of the thorax are
is
ex-
I
includes topics such as
and
chapter on pneumo-
the
in
summary.
In
meets
A
Radiologic Ap-
to Diseases of the Chest
stated goals of introducing
its
who have undergone organ and
the reader to an approach to thoracic
bone marrow transplantation are sub-
abnormalities and of providing more
divided based on post-transplant days
information on specific diseases of
of less than 30 days. 30-120 days,
the chest.
and greater than
1
20 days.
and
Section 2 deals with specific dis-
is
excellent
atory
lomatous infections, bacterial and
medical
ral
infections,
mediastinal
vi-
masses,
gic lung diseases written
A
Ian
H
Kerr and Anthony
by Drs
Newman-
anatomy follows, and contains an abatlas of major anatomic
Taylor provides a thorough discus-
structures found on the plain chest
on asthma, pulmonary eosinophilia.
radiograph and the computerized
to-
hypersensitivity pneumonitis, chron-
The
re-
ic
sion and includes chest radiographs
beryllium disease, and Goodpas-
MURDER MYSTERIES
care
The
text
is
quite readable
well indexed. This book
eases of the thorax, such as granu-
chapter on hypersensitivity and aller-
the chest.
host
by apparently underpenetrated radio-
proach
chest radiograph, and obser\ er error.
mography (CT) of
limited by the paucity of fig-
immunocompromised
the
includes well-organized and easy-to-
considerations, the approach to the
breviated
is
ures in the chapter on infections in
read tables. For example, causes of
and collagen vascular diseases. The
basic discussion of physiology and
Although generally excellent, the
conioses.
on chest radiographs of pa-
malig-
sarcoma and non-Hodglymphoma.
kins
graphs
infiltrates
and
as Kaposi's
on the imnumocompromised patient
tients
more common op-
inleclions
nancies associated with .AIDS, such
solitary pulmonar\ nodule, the
imminiocompromised patient, and
interstitial lung disease. The chapter
views of the chest, technical
cillary
findings on the
portunistic
book
the
eases of the Chest adequately bal-
ances the goals of readability and
2. in
the
topics in chest ra-
to special
D Lanime MS RRT
Kettering College of Medical Arts
Then
discussed. Finally, the reader
posed
Robert
on
and
includes
3
unique format, the
Employing
specific
Application of Respiratory Care to
tinue
AIDS,
a comparison of inagnetic resonance
abnormalities,
the thorax, and special topics.
con-
topics
digital chest radiography,
Section
of
specti\e on the essential concepts of
acute respiratory care. \\'c w
ill
syndrome.
ture's
sections covering an ap-
into three
reference
care
student
students,
physician
w ith pulmonary
for
or
the
is
an
respir-
practitioner,
and the primary
caring
for
patients
diseases.
MD
Raul J Seballos
Pulmonary and
Critical
Care Fellow
Department of Pulmonary and
Critical
The Cleveland
Care Medicine
Clinic Foundation
Cleveland. Ohio
Leiicr on topics of currcnl intcrcsi or
or decline a
letter
pretation of information
No anonymous
in print.
Letters
10.10
1
commenting on
—not standard
letters
Ahlcs Une, Dallas
can be published. Type
saline,
in
antibiotic
therapy in patients with cystic fibro-
Our
increasing.
is
institution
we have avoided
administering colistimethate sodium
foam produced. This
the excessive
foam makes
and
cians
because of
inhalation
b\
(colistin)
for
difficult
it
care
respiratory
lized.
We
vitro
which
out to determine in-
set
soluble
we
tested
alcohol.
in
two
different
of 75 mg/niL colistimethate sodium (Parke-Davis lot #028N1P. ex-
We
piration 10/94).
first
drops of polysorbate 80
mL
100%
of
in
1
mL
.5
of
The
alcohol.
Chemical,
80
in
100%
Company,
20%
pro-
normal saline (Texas
Children's Hospital
eth>l
(City
80)
lot
#L13791). or
alcohol (USl Chemical
expiration
10/94)
colistin mixture. Polysorbate
to
SO
the
failed
to dissolve in the saline mixture,
and
was no difference in the amount
of foam when 4-6 drops of polymL of sasorbate 80 was added to
there
I
line
and then mixed with 2
mg/mL) of
colistin
mL
and nebulized
L/min via a hand-held nebulizer
er
1.5
mL
was added
to 2
6
(Salt-
trying a
We
solution and checking to ensure that
no significant foaming occurs.
believe that colistimethate so-
dium should be mixed with ethyl alcohol and polysorbate 80 in the proportions listed above to ensure the
total
amount of drug
delivered to
is
the patient.
\
Christine
Lindsay
PharmDt
oxygen
6 L/min for 15 minutes.
at
The
Clinical Shift
Respiratory Care
Gunyon Harrison
solution of 6 drops of poly-
sorbate 80/1.5
had
cohol
Lee \V Evey RRT
Manager
#110291) driven by
part #8911. lot
mL
of
100%
Pediatric
both
Texas Children's Hospital
Houston, Texas
solutions, the liquid layer present in
the nebulizer
foam
the
cup was greater than
The condensation
layer.
formed droplets
that easily returned
to solution, unlike ct)listimethate
which
saline,
reiriained as
activity
logic
and
foam.
of colistin, ethyl
al-
we
Davis,
can
find
with
Parke-
no
contra-
indication to mixing these three
gredients.*
We also recommend
editor,
Coordinator
Relations
for
of colistimethate as described
an 'off-label' use of this drug
tion
is
communicalitm
by the
Parke-Davis, stated "The administra-
cohol, and polssorbate 80 and personal
When approached diSandra Homer,
*Editor's Note:
rectly
Media
re\iew of the pharmaco-
.After a
MD
Pulmonology
ethyl al-
With
foam.
less
.
.
.
.
ateness or safety
.."
.
.
mak-
tAt the time the work was perfomied. Dr
Lindsay was employed
dren's Hospital in Houston. Texas. She
mL
by respiratory care technicians or pa-
of colistin. again
We
that
can he used
would not recommend
buterol) to this mixture because this
see a foam-fluid level. Combinations
of ethyl alcohol and propylene glycol
and of ethyl alcohol diluted
also
failed
nificantly reduce the foam.
adding any additional drugs (eg.
ma>
this
dilute the surfactant effect,
practice
is
not
.
we cannot comment on appropri-
and polysorbale SO
#110291).
.
in-
The ethyl alcohol produced a somewhat better mixture;
however, foam still remained in the
nebulizer cup. and it was difficult to
1446
recommend
tried.
50-70% alcohol
of propylene glycol
lot
saline.
saline
may be
alcohol solution
dilute
hand-held nebulizers (Salter labs
tients.
normal
more
Pharmacy
in 2
no significant difference was found
when compared to the colistin and
normal
CARE Journal.
ing a stock solution of the alcohol
Labs part #8911.
When
(75
at
RESPIRA'TORY
colistimethate sodium and nebulized
tion.
we added
trials,
(Tween
#88K137),
lot
pylene glycol
agents
colistin.
During several
polysorbate
inter-
Clinical Coordinator
of foam and consistency of the solu-
the
to
it
effect of the alcohol, a
al-
amount of
reduce
best
foam produced by
accept
cohol mixtures were added to the
The two nebulizers were compared
side-by-side for differences in amount
would
may
and then 6 drops
ethyl alcohol
1.5
dissolved 4
routinely used in nebulized solutions
surface-active
Editors
simply reflect the author's opinion or
We
mL
100%
foams when shaken or nebu-
that
difficult to dissolve
is
Both solutions tested contained 2
in
a polymy.xin antibiotic
is
may
"For Publication." and mail
sorbate 80.
physi-
has been deli\ ered to the patient.
Colistin
it
and varied the amount of poly-
hol,
practi-
how much drug
tioners to determine
published
solutions of colistin and ethyl alco-
routinely uses nebulized tobram\cin
therapy; however,
double-spaced, mark
letter
is
it
Therefore,
(CF)
The
will be considered for publication.
letters as
practice or the Journal's recommendation. Authors of criticized material will have the opportunity to reply
polysorbate 80
Inhaled Colistin
sis
RESPIRATORY CARE
TX 75229-4 .'i93
Formulation for the Use of
The use of nebulized
material in
or edit without changing the author's views. The content of
al-
currently
Clinical
at
Texas Chil-
Coordinator.
is
Phar-
macy. Children's Medical Center, Dallas,
Texas.
In Support of
and
ACLS Certification
therapeutically
useful.
If.
this
after repeated administration of
colistin/alcohol/polysorhate
80
I
am
writing in response to the
editorial b\
Thomas Barnes &
1
w ith
of ex-
Charles Durbin' concerning Ad-
to
sig-
cessive dryness or irritation of the
vanced Cardiac Life Support (ACLS)
Although
posterior pharynx secondary to the
that 'appeared
1
:
mixture,
patients
complain
in
the June issue of
"92 Vol 37
No
12
.
LETTERS
Respiratory Care and
nierous letters of support
lowed
add
August.-''
in
that
burgh
at
Johnstown's
Bearden
3.
fol-
Gallo SR. More on
4.
ACLS
ACLS
Respir Care
(letter).
1992:
as an option for student
Respir Care
(letter).
professional development. Initially, a
ACLS
participating in
Mr Burns
Our
torial
writing in regard to an edi-
August 1992 issue of
the
in
Care titled "On Myand Naked Emperors: What
Respir.atori'
students don't consider the
course to be easy, but they approach
it
am
I
well prepared and with a great deal
thology
are
You Doing With
bers You're Writing
Num-
All Those
gree
and
of success
knowledge,
the
that
feel
and
skills,
confidence
are well worth the effort. In addition,
participating in
ACLS
Certification
promotes a higher level of credibility
and
improved
interdisciplinary
re-
lationships.
and
Care
this vital training in Respiratory
Programs,
we now
making
feel
ACLS
a
riculum requirement.
the impact that
program
for
ACLS
will serve as
who
others
ACLS
as
Mr Bums"
ophy of
a mistake that
we can
jus-
formal
cur-
We
hope
that
has had in our
encouragement
editorial.
troubled me.
measuring
of
static
air."
each
cm H:0, Mr
cm H:0 pressure
40
plateau pressure of
was required
to
move each niL
of
into the patient's lungs (800/40).
tually
20
1
mL
cm H:0
of
Obviously, the sen".
cm H;0
.
20
.
reread the galley proofs after the
air
Ac-
Tom
Burns
at
Johnstown
Johnstown. Pennsylvania
Oral vs Nasal Breathing: Effects
on O2 Concentration Received
The
title
of the paper "The Effect
of Oral versus Nasal Breathing on
Oxygen
static
from Nasal Cannulas"' caught
mL
per
cm H2O.
in a recently released
Received
Concentrations
REFERENCES
Barnes TA. Durbin
CG
Jr.
skills for the respiratory
ACLS
Poulton
et a|- 12
years ago.
Our con-
who
use nasal cannulas
demands
result
skills
therapist
(20 X 800).
hope
to
any
I
am
never encounter
Burns" ex-
mL
of
sure
we
that the reader
is
en enough information about the gas
sampling technique to assure confidence in the data.
The
size of the
all
this scenario
the aspiration are not clear,
I
believe
sample should consist
of gas aspirated throughout the in-
Peter Hansen
RRT
Technical Director
for the res-
Respiratory Care
Respir
Bayley Seton Hospital
Staten Island,
DECEMBER
do not believe
I
giv-
aspirated sample and the timing of
patient.
Care 1992:37:945.
•
air,
Dunlevy and Tyl paper.
that ideally the
therapist;
(letter).
RESPIRATORY CARE
Mr
volume would be 16.000 cm
Care 1992:37:516-519.
piratorv
In the
the pressure required to deliver the
H:0
to this
question.
ample of 20 cm H:0 per
time for a mandate (editorial). Re-
Horn C. ACL.S
of
a
is
C=_V.
AP
in
my
'educator's eye" as had the article by
cern for oxygen-dependent patients
Compliance
set tidal
RRT
Phoenix. .Arizona
move
textbook:"
BS RRT
University of Pittsburgh
is-
sue had gone to press.
required to
compliance of 20
Using the
I
did not notice the transposition until
complete and accurate answer
Respiratory Care Program
mL
pressure."
an effective
is
air for
As explained
the
compliance using a
Clinical Instructor
2.
air for
out
pressure"
found
I
volume of 800 niL and a
set tidal
an option for their cur-
Terri Shaffer
spir
of
858. Paragraph 4, in the example of
riculum.
1.
"mL
of course, and
pointing
"cm H2O
On Page
considering
are
for
tence should have read
Down?"' While
thoroughly agree with the philos-
Burns stated 20
In view of the recent support for
tify
I
right,
is
him
transposition of
I
of enthusiasm. They enjoy a high de-
responds:
Mr Hansen
thank
1
have the majority of
ACLS.
Inc.
1992: LV
Error in Statement
About Compliance Measurement
vious years have spread by word of
our students (80-100%) voluntarily
New
Livingston
Churchill
948.
cess and positive experiences of pre-
We now
York:
1992:37:947-
How-
ever, with each passing year, the suc-
mouth.
RM. Foun-
of respiratory care.
dations
Emergency care and
T.
Care
Respir
(editorial).
Pierson DJ. Kacmarek
2.
37:946-947.
Bums
and naked
numbers you're writing
tho.se
all
1992:37:857-861.
6.
trickle of students participated.
1992:37:945-
Henson D. Dinosaurs. RCPs. and
For the past 7 yeiys. we have of-
ACLS
On nn ihokigy
T.
down?
into our curriculum.
fered
Bums
emperors: what are you doing with
training
946.
5.
Certification
Re1
ACLS
Respir Care
(letter).
Respiratory
REFERENCES
de-
(lellerl.
Care 1992:37:945.
spir
like to
Care Program we ha\e been successful in integrating
ACLS —one
EF.
partment's experience
University of Pitts-
the
at
that
would
1
mi-
lo the
'92 Vol 37
No
12
NY
spiratory phase
The
cles.
and over several cy-
text is
vague on
this
key
point.
It
has been
tients
my
observation that pa-
preferentially
breathe through
1447
.
For your convenience, and
LETTERS
advertisers in this issue
direct access, the
and
their
phone num-
bers are listed below. Please use this directory
for requesting written material or for any
question \nu
noses
their
made by Dunlew and Tyl
experience
they
unless
complete nasal occlusion or
partial or
become
short of breath to the point
that the
added resistance of the nose
rect,
M Hughes
John
don't
I
methods
used
Program
simulate
in
Millers\ille University
mouth-
Millers\ille, Pennsylvania
breathing
REFKRENCES
A
used
simulate
to
gen concentration received from na-
question the validity of any conclu-
800-843-2978
Inc
HealthScan
Impact
Instrumentation
Comer PB. Gibson RL.
Poulton TJ.
2.
oxygen
Tracheal
concentrations
with a nasal cannula during oral
duces a confounding variable. While
and nasal breathing. Respir Care
Ross Laboratories
1980:25:739-741.
Sherwood
the subject
exhaling, the cannula
is
continues to provide
100% oxygen
nasopharyngeal
the
this
to
pro-
reservoir,
Medical Systems
Mr
variable serves to widen the gap (sig-
taken.
nificance) between the data sets.
of gas during inspiration,
B
used
simulate
to
failed to ex-
mouth-open breathing
clude the possibility of a combina-
mouth and nose breathing.
tion of
who might
suggest to those
to restudy this
spirometer
be
I
attempt
issue that a second
placed
on
the
in-
To
clarify,
we
over several cycles.
which was used
aspirated 3
mL
but
not
Apparatus
to
allow us to monitor each subject's
ti-
As explained
volume.
subjects
paper,
breathe
onl_\
were instructed to
mouth
the
curred.
measure.
If
a
difference
is
perceived, the data could not be said
to represent
when
tained,
it
mouth breathing. In fact,
oxygen is obfairly certain that some of
greater than 2\^(
it
is
came from
I
too
COPD
that
B and were
some
comment that COPD
patients may move their cannula to
their mouth during exertion or exFinally, our
acerbation
breath
of
their
was conjecture.
shortness
We
of
did not
for the behavior.
patients place their cannulas
mouths when they are short
of breath. This is likely due to the
in their
Crystal
L Dunlcvy EdD
RRT
Assistant Professor
fact that there is less resistance to air-
Director of Clinical Education
mouth than through
Respiratory Therapy Division
llow through the
the nose, particularly
is
blocked by
nasal
when
the nose
prongs.
I
in-
tuiti\elv believe that the conclusions
1448
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gi\
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Dunle\ y CL. Tyl SE. The effect of
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these limitations.
sions
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provide adequate supplemental oxygenation.
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not adequate to support them.
the cannula cannot be expected to
ist,
are cor-
but the methods and the data are
intolerable. If these conditions ex-
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The Ohio State University
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EOF.
JO/
NORTHERN VIRGINIA
DOCTORS HOSPITAL
Appreciation of Re\dewei s
The Editors of Rcspiratory Care
contributed their expertise and time to the reviewing of manuscripts
and Open
Forum abstracts
MPH RRT
Alexander B Adams
are deeply grateful to the following persons
who have
during the past year.
BA
D East PhD
C Mishoe MEd RRT
RCP RRT
J Nicks RRT
John Dziodzio
Shelley
William Anton
Thomas
Ronald P Mlcak
Ken Band>
Sherry L Bmnhart AS RRT
Thomas A Barnes EdD RRT
Ralph E Bartel MEd RRT
Douglas B Eden BS
RRT
BS RRT
M Barton PhD RRT
David
Michael Benson
BS RRT
William
N
Morris
Bierman
1
Ellen Bifano
Howard
J
MD
MD
Bernhard
MD
Raymond
MD
Robert Fallat MD
Daniel J Farrell MA RRT
R
Donald
Elton
R Fluck
L
Fried MA RRT
M Granger PhD RRT
Michael Bishop
MD
John Graybeal
MS RRT
Tawfic S Hakim
Richard
D
RRT
Branson
MD
Ralph Braunschweig
MD
Brooks MD
Lee
J
Robert
RCP RRT
R Byron PhD
Robert S Campbell
G
RRT
MD
MD
Kathleen S Carlson MD
Irvin
PhD
Kathryn Kandall
Waldemar Carlo
Robert
Kimberly
A
RRT
Cathcart
Kim Cavanagh MEd RRT
Bartolome R Celli MD
Richard
E Chaisson
William
H
Charney IH
Robert L Chatburn
Frederick
MD
RRT
W Clevenger MD
Michelle Cloutier
MD
E Courtney MD
Hanson B Cowan MD
Bob Czachowski PhD
Sherry
Michael Czervinske
RRT
Randy De Kler RRT
Steve Donn MD
Charles
G
Durbin
Jr
MD
MD
MarDiene Jeffs RRT
Jay A Johannigman MD
Arthur P Jones EdD RRT
Terence Carey
RRT
M
Kacmarek PhD
Virginia Kennedy RN
Colleen
M
Kigin
RRT
MS MPA RRT
Burton R Klein
T Kochansky RPFT
Wayne A Kradjan PharmD
Michael
RRT
Lewis BA RRT
Delite Lester
Robert
M
MD
Donald A Mahler MD
Neil
R Maclntyre
Rex Alan Marley
Richard Martin
Rick
J
MS CRNA RRT
MD
Martineau
BS RCPT RPFT
RRT
Mike McManus MD
Michael McPeck BS RRT
Louis F Metzger RPFT
92 Vol 37
No
12
MD
MD
MD
Pierson
J
F Quan
Quinn RPFT RRT
Joseph L Rau Jr PhD RRT
RCP RRT
MEd RRT
Michael Jastremski
David
William
MD
HF Helmholz Jr MD
Charles
Stephen Picca
Stuart
PhD
John E Heffner
Dean Hess
A Brown RRT
James E Burchfield BS
Jeffrey Burns MD
Peter
CRTT
Barbara Hendon
Lela Brink
EdD RRT
BSN CRTT RRT
Larry Peregrine MBA RRT
Cathy Peterson AS RRT
Rick L Orton
MS RRT
Jr
MD
Timothy B Op"t Holt
Leo Foxwell
Wesley
PhD RRT
Walter JO" Donohue
J
Robert
Gary F Nieman BS
Jon Nilsestuen
Tim
Blanchette
Joanne
MD
Nemir Eid
Jacob
MD
Birenbaum
RRT
EdD RRT
S Edge
W
Joan Reisch
PhD
R Robinson RRT
Thomas C Rutan RN MSN
John W Salver RRT
Catherine SH Sassoon MD
Douglas
MD
Paul
A
Gina
M Servant
John
W Shigeoka MD
Selecky
BS RRT
Mark Simmons MSEd RPFT
RRT
MD
R Brian Smith MD
Dennis C Sobush PT MA
Peter Southern MD
James K Stoller MD
Gerald Smaldone
John E Thompson
Martin
J
Tobin
RRT
MD
MEd RRT
Linda Van Scoder EdD RRT
Jack Wanger MBA RRT RPFT
Jeffrey J Ward MEd RRT
D
Theron Van Hooser
H Wan-en MD
Kaye R Weber BA RRT
Robert
Witek DrPH
Theodore
J
Richard
Zahodnic BS
J
Barry Zieloff
RPFT
RRT
MD
1449
—
to Volume 37 (1992)
Author Index
JAN
FEB
313-400
APR
1137-1216
401-488
MAY
641-832
833-960
JUL
105-208
AUG
1217-1388
209-288
MAR
489-640
JUN
961-1136
SEP
1389-1484
1-104
Adamic SL: review of Bronchial Mucology and Related
&
eases [Allegra
Adams AB. coaulhor: Ebert 37(81:862
Agarwal NN. coauthor. Hess 37(21:181
Angelillo VA, coauthor. Klaas
37(1):79
VA: Reactive airway dysfunction
Angelillo
(
RADS
):
37(3):254
a report of three cases
Fdo:
Atlas G: Calculating
Dis-
for mixtures of air
Disorders
Blanchette
syndrome
oxygen
Pco:
T &
Brandsburg
therapist: time for a
CO
Jr:
37(3 1:233
ACLS
mandate
Barnes TA: Emergency
skills for the respiratory
ventilation techniques
&
related equip-
icw of Winning
in
—
RE: Professional
RH:
A
37(51:478
literacy revisited
critical carol
suf-
manner of Dickens 37( 12): 1424 classic reprint
DM: review of Handbook of Mechanical Ventilatory
Barton
Support [Perel
Beam WR.
Bearden EF:
945
&
Stockj
coauthor:
ACLS
—one
37( 10):
KE
et
al:
management of
The
department's experience
a blood gas analyzer
Practice [Gal]
of Respiratory
&
end-tidal
corrected ver-
J,
37(10): 1197
coauthor. Chauhan
37(4):365
37(8):952
letter
RD &
Campbell
Kiltredge's Corner:
critically
ill,
mechani-
37(7):775 conference proceedings
RS:
technical
A new
journal
feature
aspects of respiratory
care
37(5):422e(//ton'(//
Branson
RD &
Campbell RS: reply
to
Rendell-Bakcr
37(8):
letter
fresh
RD &
Campbell RS: Sighs: wasted breath or breath of
37(5):462 Kittredge's Corner /table omitted,
air'.'
ta-
ble on 37(6): 634]
Branson
Chatbum RL: Technical description & classimodes of ventilator operation 37(9): 1026 con-
RD &
fication of
37(8):
37(8):933
Branson RD. coaulhor. Consensus statement on the essentials
I9'J2
37(91:1000 amference
of mechanical ventilators
—
effect of respiratory care
of arterial blood gas utilization
Biddle C: review
[fii;ures omitted,
Branson RD. coauthor Campbell
187
letter
Beasley
1450
1
eds]
ference proceedings
hook review
37( 12): 1441
Wanger
al.
37(3):240 research article [cor-
cally ventilated patients
Branson
h'lier
—being an essay on anemia,
focation, starvation, and other forms of intensive care, after
the
Transcutaneous Pco:
J:
coauthor Maron
Branson RD: "Bye sigh
951
view
Bartlett
FJ,
Branson
Your Profession by Writing
Books A How-To Book for Professionals in the Biomed37(10): 1204 hook reical Sciences & the Law [Hosfordl
Bartel
Dziodzio
Branson RD: Intrahospital transport of
37(6):516 editorial
res
et
sion on 37(6): 635]
Bosso
ment
and Children [Beckerman
37(3):270 Historical Notes
Durbin
Respiratory
in
and Respiratory Control
Boiler LR. contributor. Listening to the chest in the 1930s
Banner MJ. coauthor. McGough
Barnes TA:
Infants
in ventilated adults
Bandy KP. coauthor Servant 37(3):249
Banks RE. coauthor Kollef 37(10):1166
TA &
in
(Mitchell]
5
rections on 37(5): 431]
37
(5):477 letter
Barnes
Number
37(12): 1441 hook review
ra.se report
&
Birenbaum HJ: reviews of Recent Ad\ances
Medicine,
37(12): 1443 hnok review
Braga]
OCT
NOV
DEC
dcpartmenl
on the appropriateness
37(4):343 research article
Physiology
37(4):377 book review
in
Anesthetic
proceedings
Brougher
Brougher
P:
P:
response to
A
letter
new look
pointers on staying
'in
for
by Pierson
37(10):1211
Open Forim
fashion'
'93
letter
— with
.some
37( 12):1405 editorial
Brouiiher P, coauthor. Consensus statement on the essentials
RESPIRATORY CARE
•
DECEMBER
"92 Vol 37
No
12
1
1
AUTHOR INDEX TO VOLUME 37
of mechanical vcniilators
— 1992
1992)
(
Cullen DL, coauthor O'Daniel
37(9):1000 conference
proceediiifis
37(5):444
P. cociurlwr.
Hess
37(8):855
Daugherty A. coauthor: Hess
Bmugher
P. axiiithor.
Hess
37(10): 1209
Davis
school ch
Bruce
i
RD et
lilren in
1
Does
al:
898
37(
1 1
) :
1
270 Historical Notes
improve oxygenation
a sigh breath
CPAP'
intubated patient receiving
Day
in the
ing with
down'
those numbers you're writing
all
T: response to
Hansen
37(12):1447
37(
37(8):933
suction button?
1
Kiitreiltie's
108
1
&
of
livery
An
Steinberg EA:
ribavirin
method
alternative
nonventilated
to
for de-
I
Durbin
on
vice:
— 1992
Brandsburg
J:
37(4):365 Test Your Radiologic
et al: Clinical
&
Cimo DD: review
tional Evaluation of
dren [Aday et
al)
Programs
Copeman SE: Stumped
in the
East
Skill
Care: Results of a Na-
&
printers
37(5):458 Test Your Ra-
— 1992
J et al:
electronic flow interrupter
&
a
Eitel D.
An
evaluation of
coauthor Hess
inter-
37(4):348
spacers
&
adapters: their
37(8):862
Farrell E, coauthor:
No
37(2): 129
37(12):1446
oscillator
"92 Vol 37
37(1 ):65
37(2): 129
Fanta CH: Emergency management of acute severe asthma
1241 device evaluation
MDI
37(7):739
GR. coauthor: O'Daniel
Elton CB. coauthor Scuderi
Ellon DR. coauthor Scuderi
comparison of an
new pneumatic
the essentials of
37 (9):Hi(i(i conference pro-
on the respirable volume of medication
Evey LW. coauthor: Lindsay
ventilation:
37(9): 11 13 conference
research article
research article
):
computers
Eden DB: review of Atlas of Radiology of the Chest |TumerWarwick M et al. eds) 37(8):943 hook review
The high-frequency pneumatic flow
High frequency
Blood
37(3):240
TD. coautluu" Consensus statement on
effect
37(2):198
rupter: effects of different ventilatory strategies
et al:
&
Ellis
et al:
de-
ceedings
Ebert
diologic Skill
L
coauthor Blanchette
mechanical ventilators
for Ventilator-Assisted Chil-
ICU
J.
tilators
37(10):1206 hook review
Clevenger FW, coauthor Kohr
CO: removal
37(2):147 symposium proceedings
proceedings
in a
Home
Intravenous oxygenation <&
TD: Computers in the ICU: panacea or plague? 37(2):
170 symposium proceedings
East TD: Digital electronic communication between ICU ven-
comparison of Gentle-Haler actuator
of Pediatric
Jr:
IVOX
East
and Aerochamber spacer for metered dose inhaler (MDl)
use by asthmatics
to Hughes
37(12): 1447 letter
Emergency respiratory care: conference sum-
CG
Dziodzio
in a patient
working
consump-
CG Jr: review of The Oxygen Status of Arterial
& Mertzlufft] 37(4):379 hook review
Durbin CG Jr, coauthor: Bames 37(6):516
Durbin CG Jr. coauthor Beasley 37(4):343
Skill
Abnormal radiograph
&
[Zander
with a history of lung cancer, radiotherapy,
Jr:
Durbin
the essentials
Chatbum RL: response to Jones 37(1 ):86 letter
Chatbum RL: response to Reynolds 37( 1 ):89 letter
Chauhan D: Foul-smelling sputum, malaise, & night sweats
CG
mary
37(9):
Equation
asthma
Dunlevy CL: response
Durbin
to
for
1903
tion in
patients
pediatric
Classification of mechanical ventilators
of mechanical ventilators
37(5):439
37{S):940 hook review
proceedings
Cordero L
Your Radiologic
Te-<it
Tyl SE: The effect of oral versus nasal breath-
Dunlevy CL. contributor: Treatments
Chatbum RL. coauthor Branson 37(9):1026
Chatbum RL, coauthor. Consensus statement on
BE
simple case of respiratory
37(5):473 video review
(Spesseil]
37(11): 1273
quarry
Is this a
37(10):1193
Dunlevy CL: review of QuitSmart Stop Smoking Kit (Shipley]
37(8):951
1009 couference proceedings [correction
D&
Carlson KS:
Dunlevy CL: review of Chairobics Video Exercise Program
37(8):877 device evaluation
Chatbum RL:
37(8):941 hook re-
37(10): 1193
Carlson KS. coauthor Douglas
1
endo-
37(3):249
Dunlevy C. coauthor Op"t Holt
Corner
37(5):462
37(
to assess
oxygen concentrations received from nasal cannulas
ing on
37(5):422
Campbell RS, cwn/r/wr Branson
CL &
Dunlevy
letter
Campbell RS. coauthor: Branson
Cordero
37(9):
re
CO:
161 research article
1
Resources |Pugliese, ed|
syndrome?
distress
):61
Campbell RS, coauthor. Branson
JL
&
KA &
Douglas
do-
37(8):
& Branson RD: How ventilators provide tempoO: enrichment: what happens when you press the 1()0</^
Chipps
37( lOl:
Donn SM. coauthor Servant 37(3):249
Douce FH. coauthor: O'Daniel 37( 1 ):65
Campbell RS
Chauhan
):29
Skill
Caloz JM, coauthor. Tschopp
Cefaratt
1
view
et al, eds]
editorial
rary
coauthor Maclnt\
cedures,
Infants
in
Bums T: Emergency care & ACLS 37(8):947 letter
BumsT: Baggers, not beggars 37(10): 1211 letter
Bums T: On mythology & naked emperors: what are you
Bums
S,
37(
Rapid anal\sis of exhaled
et al:
DeFilippo VC: review of Universal Precautions Policies, Pro-
and Children (Beckerman
857
coauthor Campbell
Dechert RE, coauthor Servant
37(12):1409 research
review oi Respiratory Congrol Disorders
J:
Jr.
tracheal tube placement
article
Bums
K
Day S
Applied physiology" for primary
eontribulor:
P.
):65
1
37(4):343
Brougher
Brougher
37(
Darin JM. coauthor Beasley
12
Thompson
37(6):582
1451
AUTHOR INDEX TO VOLUME 37 (1992)
Fields JK; re\ iew of Egan's Fundamentals of Respiratory Care,
5th edition [Scanlan et
37(61:630 hook review
eds]
al.
Prey JG. cmiiilhor Tschopp
37(
1
\
RM. coumhor.
Gardner
&
Gurza-Dully P
&
anahsis
as pre-
respiratory ther-
37(2):137 research
S, coauthor:
measure-
inhalation injur)
;
some
priorities for res-
37(6):609 conference proceed-
piratory care professionals
TP & Mahutte CK:
37(
1 1 ):
through the patient valves of twelve adult manual resus-
D&
what?
1209
Hess
More
clinical practice guidelines:
Brougher
P:
letler h>
Kigm
37(10):
Monitormg during
Eitel D:
et al;
resuscitation
&
Positioning, lung function.
37(7):739
D
et al:
kinetic
bed therapy
at
37(5):444 research
three levels of fullness
RD:
re\
iew of Clinical Application of Res-
piratory Care. 4th edition (Shapiro et al|
37( I2):1443
hook
37(8):945
tion received
vs nasal breathing: effects on
O: concentra-
37(12): 1447 letter
Hurst JM: Thoracic trauma
ings
1
I
84
Jr,
MR: PIP
letler
1452
Kohr
&
J
VA:
Angelillo
man?
37(
1
coauthor: O'Daniel
&
repair costs:
37(11): 1256 research
&
Other Stories of
In-
Bilateral hilar
masses
in
a 23-
):79 Test Your Radiologic Skill
Clevenger FW: Radiographic findings following
37(2): 198 Test Your Radiologic
Skill
MH
el al:
The
effect of partial upper-ainva\ bypass
1166 research
Kratohs
article
coauthor: Kacmarek
J.
il
M
What
37(
wrong with
37(12):1432P/TConi£'r
el
al:
on
37
subglottic pressures during acute lung injury in sheep
is
37( 10):1207
[Niederman. cd|
Lamme RD.
coauthor: Hill
1
):37
this
young
fit.
cyclist?
Lewis
RM:
37(
1
1
hook review
37(3):249
Chest physical therapy: time for a redefinition
renaming
Lindsay
afi'ecting
37(
I ):
a
lung \okime changes during neu-
CA
M. coauthor: Cordero
et
al:
37(10): 1153
37(12): 1446
/(»('/•
NR & Day
37( 9 ):
1 1
37(11):1241
Formulation for the use of inhaled col-
Lorance ND, coauthor: O" Daniel
37(
1
):65
S: Essentials for ventilator-alarm sys-
08 conference proceedings
Maclntyre .NK. coauthor: Consensus statement on the essentials of
mechanical ventilators— 992
1
37(9): 1000 con-
ference proceedings
Marini
):65
barotrauma: a response to Chatburn
&
37(5):419 editorial
research article
Mahutte CK.
):29
37(
hook review
37( 12): 1443
Maclntyre NR. coauthor Da\
proceedings
Johnson DJ, coauthor: Campbell
Jones
year-old
tems
):29
CG, coauthor Wanger 37(8):929
CG, coauthor: Kraft 37( 1 2 ): 1 432
M: Air medical transport in Wl
Johnson PL
MA &
Klaas
Maclntyre
37(
37l 10):
tensi\e Care [Martin]
istin
37(7):7()8 conference proceed-
Hurst JM. coauthor Campbell
&
Bronchoscope damage
et al:
Kittredge P: review of "Pickwickian"
Lichtensteiger
letter
Hughes JM: Oral
Irvin
MB
results of a regional postal surve\
born mechanical \enlilalion: a bench study
1
Jeffs
Objections to postural drainage guideline
letter
Lewis RM: Factors
review
Hoffman PJ. coauthor Kirkpalnck 37( 1 ): 1256
Horn C: ACLS skills for the respiratory therapist
Irvin
CM:
Lathrop C, coauthor: Ser%anl
article
TV & Lamme
37
Fno; estimation
useful:
still
Krieger BP: review of Respiratory Infections in the Elderly
The volume of gas emitted from fne metered
dose inhalers
Hill
Kigin
Kraft
37(10):! 1951
37(2):181 syniposiuni proceedings
Hess
Nothing new but
(81:948 letter
(10):
letter
D&
D
& Rehabilitation: Prin& Axen. eds| 37(5):
2nd edition |Haas
Practice.
474 hook review
Kollef
response to
conference proceedings [correction on
Hess
now
37(8):855 editorial
D &
Hess
P:
&
feeding-tube placement
Brougher
man
a 3.''-year-old
in
article
Harwood RJ. coauthor. Rau 37( 1 1 ): 1233
Hasegawa T. coauthor: Sato 37(8):869
Henson D; Dinosaurs. RCPs. & ACLS 37(8):946 letter
Hess D & Simmons M: An evaluation of the resistance to flow
citators
emer-
37m):l266 PFT Corner
Kirkpatrick
37l I2(: 1446 letter
Evaluation of a closed-system, direc-
tional-lip suction catheter
double-
a
role of the respirator) therapist in
Kelley R: Results of exercise testing
1209
ings
Harrison G, cociiithor. l.indsuv
of
gency care
Keltell C:
37(12):1447/('fr<'/-
Haponik EF: Smoke
Hess
E\aluation
37( 1 ):37 device evaluation
virin administration
ciples
37(I2):1409
Bruce
Error in statement about compliance
P:
ment
Hart
J:
Kelly C: review of Pulmonary Therapy
article
Hancock
Hansen
Kratohvil
Kacmarek R.\L The
among
longevity
apists: a multiple regression
RM &
Kacmarek RM: Respiratory care practitioner: carpe diem!
37(31:264 Program Committee lecture
37(8):862
Melaney M: Application form items
dictors of performance
A
37(9): 1113
East
Green-Eide B, coauthor. Eberi
gas deli\ery features of mechanical
37(9): 1045 conference proceedings
enclosure, double-vacuum unit scavenging system for riba-
37( 10): 12()5 hook review
Guide (Ouellct|
R.\l: Essential
entilators
Kacmarek
):61
More on ACLS training 37(81:945 leiier
Ganetis JA: review of Hemodynamics & Gas Exchange:
Gallo SR:
Clinical
KacEnarek
JJ:
<(-<(i(f/;()r:
Han
What derived
37( 10l:l 161
37(11): 1260
variables should be monitored during
mechanical ventilation?
37(91:1097 conference proceed-
ings
92 Vol 37
No
12
s
AUTHOR INDEX TO VOLUME 37
Marini
— 1W2
MB &
Bosso
37(
1 1 ):
"Murder master)"
FJ:
der my.stery [Answers
&
Opt
for student practice
mur-
37(10):1197
37(11):1274|
Marsh PC: review of Shortness of
A
Breath:
Breathing. 4th edition |Moser
Ginde
MP
Martinasek
Martuiasek
c*v:
Lethal
May DF. coauthor
37(
Shelled)
McComiack MT. coauthor
McGarrv \VP 111: BiPAP in
magnesium
properties of
37(
1
1
Pierson DJ:
(2):
Thompson
37(6):582
37(2):137
111.
,,
MiklesSP. <on«;/iw: O" Daniel
37(11:65
Mikles SP. t(«i((;/wr Shelledy
37(1 ):46
m(y
Miller
whole blood analytes measured on
C\J&
Miller
37(
1 1 ):
MK. coauthor
Momii KR: review of The
An
approach
to
vascular smooth-muscle
1
1
1 ):
1233 research
Some
S.
37(
coauthor. Tschopp
37(7):695 confer-
Sato
— another view
T
37
):65
1
37(
):61
1
37(2):154
37(81:869
et al:
&
function: the
Evaluation of the ability of the Syncoxy breath-
37
synchronized valve to provide adequate oxygen levels
(8):869 research article
Schachter EN. coauthor Witek
Scuderi
J et al:
A
the Chest [Freundlich
Servant
GM
37(3):231
cart to provide high
during transport of neonates
Respiratory Care: Patho-
et al:
A
&
frequency
jet \entilation
Radiologic .Approach to Diseases of
Bragg]
37( 12):1445 book review
Feasibility of applving flow-synchronized
ventilation to very low birthweight infants
et al,
DECEMBER
37(8):950
trigger vanable
37(3):249
•
bench
37( 12):1432
Saito N. coauthor Sato
Seballos RJ: review of
RESPIRATORY CARE
options
history related to the sigh
Rutherford EJ. coauthor. Nelson
Treatment of Inhalation Injury [Cioffi
a
37(41:348
Manager:
37(6):600 conference pro-
in
on aero-
article
37(5):475
Rutherford EJ: Monitoring mixed venous oxy-
&
Effect of nebulizer position
Rose C. coauthor Kraft
37(I2):1414
Nieman GF: review of Problems
37(5):
letter
Robinson
37(3):258 special article
coauthor. Servant
physiology
bench study
^-©^
HD: Airway management
a):»3
ceedings
edsl
nebulizer position on aerosol deentilation: a
Reynolds R: Pressure control ventilation
175
JJ,
\
a 13-
in
Skill
letter
metabolic acidosis for the res-
Nemiroff MJ: Near-drowning
Nicks
37(
Rendell-Baker L:
article
37( 10):
in
re-
ence proceedings
37(2): 181
piratory care practitioner
LD &
mechanical
dyspnea
Your Radiologic
through a neonatal endotracheal tube:
sol deli\er\
study
Te.st
new
Effect of a
<.\;
a multichannel blood
Strategic Health Care
PF. coauthor: Chipps
Neiberger RE:
37
ICU'^
37(9):1 124 conference
Sassoon CSH: Mechanical ventilator design
book review
Myers CL. coauthor Hess
letter
in the
T.A: .An unusual cause of
37(12): 1437
Reicosky C. coauthor. Cordero
Mastering Essential Leadership Skills [Stevens]
gen
Practi-
37(11): 1250
Miller
1241
37(8):950
Rinker R. coauthor O'Daniel
Miller
Nelson
A
37(101:1175
((-(mz/K-r Miller
1:
1
37( 7 ):769 conference proceedings
Harv\ood RJ:
Rau JL Jr
article
JWR.
Naumann
WW:
Reines
regulation: the role of inhaled nitric oxide gas
Miller
1
constitutes an order for mechanical ventila-
Tesmer
livery during
37(11):1256
1250 research
JWR: Pulmonary
37(
37(10):1211
should give the order?
year-old boy
of lithium heparin concentration on
gas/electrolyte system
D&
Parsley
coauthor: Kirkpatrick
et al: Effects
&
37(4(:348
Horizons Vll: what's neu
What
suscitation
&
37(3):233
'ir
Cji
37(5):
determining forward blood flow during cardiopulmonary
Quinn
Metzger LP: review of Pulmonary Function Testing:
RM
Pelton]
1
Melaney M. coauthor Gurza-Dully
Approach [Wanger]
Pocket Reference
tV:
Porembka D. coauthor. Campbell 37( 1:29
Porter T et al: The role of transesophageal echocardiography
37(8):948
volume with portable
in tidal
Melker RJ. coauthor McGough
37(4):.M8
Ponce C. coauthor. Theroux
37(10): 1166
coauthor.
New
& who
tion,
JE: re\iew of Clinical Blood Gases: Application
Middleton
[Murphy
proceedings
the acute care setting
Noninvasive Alternatives [Malley]
A
Essentials:
144 symposium prciceediugs
Pierson DJ:
book review
):82
):46
Kollef
Variations
et al:
transport ventilators
McManus M.
37(7):769
ECG
Bug? Yes.
Pierson DJ: Insect? No.
letter
McGowan
coauthor Porter
criteria
4-year respiratory care cur-
in a
Peternian P. coauthor. Cordero
Mathewson HS: re\iew of Cardiopulmonar\ Pharmacology: A
Handbook for Respiratory Practitioners & Other Allied
McGough EK
riculum
JP,
):65 special article
1
The use of preadmission
Diinlevy CL:
academic success
Pawel B. coauthor Cordero
mito-
infantile
37(4):361 Drui; Capsule
Health Personnel [Howder]
37(
37(8):869
471 book review
37l8l:925
l)J:
Mathewson HS: The bronchodilator
sulfate
TB &
Holt
Palmisano JM: review of
37(3):279
et al|
37(8):925 Blood Gas Corner
chondnal disease
;-<'i/('vr
37(7):769
future educational needs of respiratory
for Systematic Interpretation
Martinasek DJ. coauthor Martinasek
Miller
The
to predict
Omato
to Better
hook review
'
et al:
Oka/aki N. coauthor Sato
1250
of pulmonary physiology calculations
cal
1
care practitioners: a Delphi study
ceed ins;
Living
C
0"Daniel
37(91:1000 conference pro-
Marlow NM. coauthor. Miller
Maron
'M2
1
Nixon JV, coauthor. Porter
coauthor. Consensus staiemcni on ihe essentials of
JJ,
mechanical ventilators
(
37(3):249
re-
search article
"92 Vol 37
No
12
1453
1
(^'^
^
d
i^ l^
AUTHOR INDEX TO VOLUME 37 (1992;
Shaffer T: In support of
ACLS
37(12):1446
certification
ler-
Shapiro BA:
37(2): 165
Shelledy
tent
DC
In-\ i\o
monitoring of
arterial
job
37(
MP:
1
& pH
blood gases
symposium proceedings
et al:
Analysis of job satisfaction, burnout.
&
in-
field or the
37(9): 1070 conference
Diagnosis.
Differential
Diagnosis.
&
Therapy
ing Manual. 6th edition (Slradlingl
Critical
A
Teach-
Anway Endoscopy
in
An-
37(8):939 hook re-
Care [OvassapianI
37(5):432
coauthor. Hess
Smith JR. coauthor: Kirkpatrick
GM:
Steinberg
EA, coauthor.
MC.
37(
&
MC et
airway?"
Could you be the reason
al:
37(8):950
et al:
for a "spider in the
letter
&
Neonatal
pediatric airway emergencies
ing
&
tidal
volume dur-
37(91:1081 conference pro-
mechanical ventilation
ceedings
Valeri
37(4):357
KL: review of Respiratory Therapy Examination Re-
& Gallagher] 37(8):939 book review
& Beam WR: Asthma & vocal cord dysfunction
view [Heath
Wanger J
drome: when wheezing
1 1 1: 1
Wanger
37(5):444
is
37(10):1187
hysterical
syn-
PFT
Stoller JK: Diagnosis
&
management of massive hemoptysis
A Team
Approach [Thurlbeck et al] 37(4):379 book review
The EsTaft AA: review of Pulmonary Pathophysiology
sentials. 4th edition [West]
—
37(4):348
37( 12): 1409
Weaver LK: Hyperbaric treatment of
&
a bronchial challenge
respiratory emergencies
37(
1
37(11):1241
):65
proceedings
Witek TJ
37(61:564 conference proceedings
Sloller JK: review of Diffuse Diseases of the Lung:
Tarras E. coauthor: Bruce
CG: Problems with
Comer
Wilson RS: Upper airway problems
37(12):1409
Tallman R, coauthor Cordero
Irvin
Wiezalis CP, coauthor 0"Daniel
37(8):877
Cefaratt
&
37(5):448 point oj view
coauthor: Bruce
J
3HS):')29 I'FT
256
Patient-focused hospitals: an opportunity for res-
piratory care practitioners
1454
37(1 ):61 research
Corner
view
Simmons M.
Snyder
Theroux
Tyl SE. coauthor Dunlevy
Shigeoka JW: review of Fiberoptic
&
Becker]
|
book review
Shigeoka JW: review of Diagnostic Bronchoscopy:
esthesia
device compared to three other spacers
Tobin MJ: Monitoring of pressure, flow,
proceedings
Shigeoka JW: re\iew of Atlas of Bronchoscopy: Technique.
37( 10): 1205
Bronchodilating efficacy of an open-spacer
et al:
Thompson JE
):46 research article
Inspired gas conditioning
37(121:1437
coauthor: Pursley
JM
article
of respiratory care practitioners to leave the
Shelly
Stock
TesmerT A.
Tschopp
ler
Jr
&
Schachter EN: ,Ain\a\ h\ pcrresponsiveness:
what can we learn from RADS!"
Wong GA, coauthor
Wooten
Young.
L.
Chipps
coauthor Day
WH.
coauthor East
37(3):231 editorial
37( 12): 1414
37( 10):
1
161
37(9):1113
37( 1 1:46
Yout.sey JW. coauthor Shelledy
Zagnoev M. coauthor: Theroux 37(8):950
"92 Vol
.^7
No
12
Subject Index to
1-104
Volume 37
(1992)
SUBJECT INDEX TO VOLUME
Anemia
37(7i:695 confer-
Airway management options [Reines)
A
ence proceedings
eter
I
Hart
&
37(
Maliutte]
1 1 ):
Bug "les. Insect' No. (Piersonj 37( 10): 121 1 letter
Could you be the reason for a "spider in the airway?" [The.'
ings
&
Monitoring during resuscitation [Hess
Neonatal
&
airway emergencies [Thompson
pediatric
et
&
37( 7 1:720 conference proceedings
kinetic bed therapy [Hess
et
37l2):181 svntposiiint proceedings
all
Rapid anul>
CO:
of exhaled
sis
placement [Day
three cases [Angelillo]
Airway
hyperresponsi\eness:
RADS?
emergency care [Kac-
[Witek
&
Asthma
hysterical
is
from
learn
[Wangcr
&.
when
syndrome;
Beam]
37(10): 1187
comparison of Gentle-Haler actuator and .Aerofor metered dose inhaler (MDI) use by
asthmatics [Chipps
Airway Pressure
Emir m statement about compliance measurement [Hansen]
we
can
37(3):231 editorial
chamber spacer
37(61:533 conference
proceedings
what
Schachter]
PFT Comer
Clinical
ings
&
vocal cord dysfunction
the
wheezing
Upper airway problems [Wilson]
night sweats [Chauhan]
Skill
Asthma
marek]
Thoracic trauma [Hurst]
&
37(3):254 case report
role of the respiratory therapist in
sputum, malaise.
oiil-sniclling
to assess endotracheal tube
37(10):1 161 research article
et al]
Aspiration
I
Reactive airway dysfunction syndrome (RADS): a report of
The
Hxpcrbaric treatment of respiratory emergencies [Weaver)
al]
/f»c;-
Embolism
Arterial (las
conjerence proceedings Icorrection on 37(10):! 1951
37(8):950
rouxetall
37(7):739
Eilel]
37(12): 1424 classic reprints
of Dickens [Bartlett]
Arachnids
mechanically \enlilat-
ed patients [Branson]
star-
and other forms of intensive care, after the manner
vation,
1260 device evahialioti
ill.
being an essay on anemia, suffocation,
critical carol;
Evaluation of a closed-system, directional-tip suction cath-
Intrahospital transpon otcriticall\
37 (1992)
37( 12):1414 device evaluation
et al|
Emergency management of
asthma [Eanta] 37
acute. se\ere
(6):551 conference proceedings
Reactive ainvay dysfunction syndrome (RADS); a report of
37(12):1447/c-/f(';-
Mcchanical ventilator design
able [Sassoon]
\entilation [Tobin]
&
857
&
84
letter
1
re
down? [Bums]
Awards
for Publication
37(8):
compliance measurement:
37(I2):1447]
Barotrauma
Does a sigh
37(1):
letter
— another
awards
14'): litcraiy
37(12):1472
breath improve oxygenation in the intubated pa-
receiving CPAP-;" [Bruce
tient
\ie\\
[Rc\nolds]
37
PIP
&
84
Alarms
ventilators
[Chatburn]
(9):
1009 conference proceedings [correction
I
37III):I273]
to
37
Equation
37(9): KtOO conference proceedings
Essentials for ventilator-alarm systems [Maclntyre
37(9):
1
venti-
[Branst)n. Brougher. Chatburn. East. Marini.
Thoracic trauma Hurst
Day]
108 crmference proceedings
Intrahospital transport of critically
ed patients [Branson|
ill.
The
Is
a
this
37( 7 ):7()8 conference proceedings
simple case of respiratory distress syndrome?
&
Carison]
37( 10):1 193 Tc\i
Your Radiologic
Skill
blood
tias
data, with questions, answers,
&
di-scussion)
Lethal intantilc mitochondrial disease (Martinasek
&
Mar-
37(8):925 lilood Gas Corner
effect of respiratory care department
blood gas utilization [Beasley
et al]
An approach
to
metabolic acidosis for the respiratory care
practitioner [Neiberger]
management of
blood gas analyzer on the appropriateness of
1456
|
Continuous Positive Airway Pressure
Blood Gases/pll: Also see "Blood (Jas Corner" Features
approach to metabolic acidosis for the respiratory care
article
37
|Rcynoldsl
Birth Uclccts
tinasckj
Algorithms
— another \icw
"Blood (ias Corner" Features (briefcase reports in>olving
mechanically ventilat-
ings
An
.See
[Douglas
&
1:
{D-.m Idler
HiPAP:
Consensus statement on the essentials o[ mechanical
Maclntyre]
re-
37(1
barotrauma: a response to Chatburn [Jones]
|
— 1992
37(12):1409
al]
letter
Pressure control \cnlilation
of mechanical
et
search article
):83 letter
lators
cigar-
view
barotrauma; a response to Chatburn [Jones]
Classification
&
37(8):940 hook re-
[Dunle\yl
Pressure control ventilation
(
QuitSmart Slop Smoking Kit (book, audiocassette.
ette substitute) (Shipley)
naked emperors: what are you doing with
editorial [correction
Hansen
see
Audiocassette Reviews
volume during mechanical
all
PIP
&
three cases [.Angelillo]
function; the trigger vari-
Monitoring of pressure, tlow,
On mythology
&
a
arterial
37(4):343 research
The
department management of a
blood gas analyzer on the appropriateness of arterial
37(4):343 research
blood gas utilization [^Beasley et al]
article
"92 Vol 37
No
12
Effects
heparin
lithiiini
1)1
measured on
analyies
on uholc blmid
(.'oiicciilialion
Problems
In-vivo monitoring of arterial blood gases
& pH
&
Pulmonary Pathophssiology
&
Pulmonary Therapy
pr<)cceilini;<.
(Haas
Near-drowning |Nemiroff| 37(6):600 conference proceed-
Practical
Approach (Wang-
—The
Essentials. 4th ed (West)
&
Rehabilitation: Principles
913
|AARC|
for arterial blood gas analysis
ette
37(81:
some
inhalation injury:
professionals (HaponikJ
substitute)
A
priorities for respiratory care
&
conference proceed-
Ji7i.<i):6{i9
ings
&
IBlanchette
&
Pro:
end-tidal
wrong with
is
37( 12): 1432
Book Reviews
I
this
Advances
young
(Beckerman
&
Therapy (Becker
mvAlQ?. hook
review
et al.
ga) [Adamic[
37( 12):1443
Practitioners
&
.'\
Other
(Howder) [Mathewson]
Allied
Disorders
in
the
in
The
for Respir-
Health
Intants
and
Elderly
(Niedermann. ed)
A
Guide
to Better
Strategic Health Care
&
Living
(
& Lammel
tives (Malley)
[McGowan]
A Team
Diffuse Diseases of the Lung:
37(5):475 hook
&
A
Manual. 6th ed (Stra-
&
(Ovassapian) [Shigeoka[
Handbook of Mechanical
Programs
[Cimol
time for a redefinition
&
a
renaming
[AARC]
37(8):898 clinical prac-
37( 10): 1209
in
Anesthesia
&
Ventilatory
&
Gas Exchange:
A
Care
Critical
Bronchial provocation
tice
Support (Perei
Clinical
&
{S):929
Guide (Ouel-
a bronchial
challenge [Wanger
&
Irvin|
37
PFT Corner
&
Bronchodilator Ad-
ministration
Blood (Zander
&
Bronchodilating efficacy of an open-spacer device com-
Mertzlufft,
pared with three other spacers [Tschopp
Care: Results of a National Evaluation of
for Ventilator- Assisted Children
(Aday
thewsonl
"92 Vol 37
No
12
et al[
37(1):61
research article
The bronchodilator
et al)
37( 10): 1206 book review
DECEMBER
Bronchodilalors, Bronchodilatation,
•
[AARC]
guideline
Problems with
RESPIRATORY CARE
/('»£/•
Bronchial Provocation Testing (Bronchial Challenge)
Status of .Arterial
Home
Behavioral
37(10):1204
tice guideline
Stock) [Barton]
Pediatric
:
Nasotracheal suctioning
37(5):471
Fiberoptic Airway Endoscopy
eds) [Durbin[
(Hosford) [Bames[
Objections to postural drainage therapy guideline [Kigin[
et al, eds) [Fields]
The Oxygen
Law
— A How-To
&
37(5):419 editorial
[Lewis]
book review
[Ganetis]
the
Chest physical therap\
Egan's Fundamentals of Respiratory Care, 5th ed (Scanlan
Hemodynamics
&
Biomedical
book review
Approach (Thurlbeck
[Palmisano]
Pelton)
Your Profession by Writing Books
Bronchial Hygiene Therapy
Pocket Reference for Systematic Inter-
(Murphy
in
Resources
for Professionals in the
Sciences
et al) [Stollerl
Essentials:
Book
dling) [Shigeoka]
Pugliese. ed) [DeFilippo[
Winning
Noninvasive Alterna-
A Teaching
Diagnostic Bronchoscopy:
pretation
&
Breathing.
review
Blood Gases: Application
Gal-
Manager: Mastering Essential
Leadership Skills (Stevens) [Momii]
Personnel
&
Universal Precautions Policies. Procedures.
al) [Hill
Children
Anesthetic Practice (Gal) [Bid-
in
Clinical Application of Respiratory Care. 4th ed (Shapiro et
Clinical
Children
hook review
4th ed (Moser et al) [Marsh[
Handbook
and
Shortness of Breath:
Bra-
hook review
Cardiopulmonary Pharmacology:
atory
&
Infants
Respiratory Therapy Examination Review (Heath
eds)
[EdenI
in
lagher) [Valeri]
Bronchial Mucology and Related Diseases (Allegra
5
[Bums] 37( 12):1440 hook review
Respiratory Physiology
die]
Atlas of Radiology of the Chest (Turner-Warwick
et al)
37( 10): 1207
[Krieger[
37
[Shigeoka[
al)
et
Disorders
Infections
Respiratory
titles)
Atlas of Bronchoscopy: Technique. Diagnosis. Differential
Diagnosis,
Number
Medicine,
[Birenbaum[ 37(12):1441 hook review
et al)
Control
Respiratory
cyclist? [Kraft et al]
PfTCorm/-
alphabetically by
Respiratory
in
Control
(Beckerman
fit.
Bragg, eds) [Seballos]
Respiratory
Dziodzio]
cigar-
(Mitchell) [Birenbaum[ 37(12):1441 hook review
ventilated adults
in
[correction on 37(5):43l]
let)
&
37(8):940 hook
[Dunlevy]
(Shipley)
Radiologic Approach to Diseases of the Chest (Freundlich
Recent
Transcutaneous Pco:
Practice
review
clinical practice guideline
Smoke
ECG
&
Axen. eds) [Kelly]
QuitSmart Stop Smoking Kit (book, audiocassette.
ings
Sampling
Treat-
eds) [Nieman|
al.
[TaftI
Rutherford]
et
[Met/gerj
er)
37(7):739
conference proceedings Icorreclion on 37(10):I195]
Monitoring mixed venous oxygen [Nelson
symposium
A
Pulmonary Function Testing:
Monitoring during resuscitation [Hess &. Eilelj
37(2): 154
(Ciofli
279 Iwok review
37(3):
jShapiro]
37(2): 165 sxmposiiim proceedings
&
Respiratory Care: Pathophysiology
in
ment of Inhalation Injury
ticle
What
Other Stories of Intensive Care (Martin)
[Kiltredge]
37(111:1250 research ar-
trolyte sysleni [Miller et al]
&
"Pickwickian"
hlood gas/elec-
niullieliannel
a
37 (1992)
properties of
magnesium
sulfate
[Ma-
37(4):361 Drug Capsule
1457
comparison of Gentle-Haler actuator and Aero-
Clinical
for metered dose inhaler (Ml)Ii use by
chamber spacer
asthmatics [Chipps
37(12):1414 device
et all
eviiliialion
Comparison of nebulizer delivery methods through a neonatal endotracheal tube: a
37(
1 1 ):
&
bench study [Rau
Harwood]
&
(Witek
from
learn
the
American
&
Bronchoscope damage
repair costs: results of a regional
postal survey [Kirkpatrick et al|
37(11):1256 research
some
inhalation injury:
on 37(10):! 1951
Humidificalion during mechanical ventilation
&
micnl of respiratory
care practitioners to leave the field or the job [Shelledy et
now
&
[Hess
what!'
37(8):898 clinical practice guide-
Objections to postural drainage therapy guideline [Kigin]
37(10): 1209 /<-w/-
1
resuscitation [Hess
&
37(71:739
Eitel]
37
or extended care facility
[correction
cm 37
(10):!195}
37(Sl:8S2 clinical prac-
37(8):913 clinical
blood gas analysis
for arterial
practice guideline
37(8):891 clinical
Selection of aerosol delivery device
conference proceedinfis fcorrection on 37(10):II95J
practice guideline
Carbon Dioxide
&
Intravenous oxygenation
COi removal
device:
IVOX
&
37(7):739
Eitel]
placement [Day
CO:
Transcutaneous Pco:
&
IBIanchette
&
37(3):24()
inhalation injury:
research article
Hyperbaric treatment of respiratory emergencies [Weaver]
37(7 1:720 conference proceedings
pulmonarv phys-
&
37(10): 1197 mur-
iology calculations [Maron
Bosso]
<&
murderer
re-
vealed on 37(1 2): N-45]
inhalation injurv
:
37(2):
&
communication between ICT'
&
computers
ventilators
37(9):1113 confer-
printers [East et all
ence proceedings
& Symposium Proceedings
Consensus Conference on the Essentials of Mechanical Ventilators
37(9):1000-I130
Emergency Respirator)
C
aic
&
37(6):523-629
37(7):673-
812
some
professionals jHaponikl
Conference
for student practice of
der mystery [answers on 37(]1):1274
et
& Computing
Digital electronic
F'oi.soning
"Murder mystery"
bed therapy (Hess
kinetic
Coitiputers in the ICU: panacea or plague? [East|
[corrections on 37(5):43lj
Carbon Monoxide
some
professionals [Haponik[
Computers
end-tidal Pco: in ventilated adults
Dziod/io]
&
ings
37(10): 1161 research article
et al]
37(2): 181
al)
Smoke
conference proceedings [correction on 37(10):! 195]
Rapid analysis of exhaled
Complications
IDurbinj
home
practice guideline
Patient-ventilator system checks
Sampling
Monitonng during
in the
clinical
tice guideline
Capnography
priorities for respiratory c;u"e
ings
New
Horizons VII:
Whafs New
in the
ICU.'
37(2): 144-
197
Continuing Education
Cardiopulmonary Resuscitation: See Resuscitation
suscilalion Devices
&
<.^
Ke-
C"RC"H answers
CRCE through
Supplie.s
Case Reports
37( 101:1212 examination key
the journal
37(7):813 examination
Continuous Positive .Airway Pressure (CP.AP)
Reactive airway dysfunction syndrome (RADS): a
three cases
I'liysical
|
Angelillo]
rept)rt ot
Does
&
a
renaming
37(5):419c(/;7()n(;/
in
the acute care setting
[McGarry]
37(8):948
let-
a sigh breath
tient
receiving
improve oxygenation
CPAP'
[Bruce
et
in the
intubated pa-
37(12):1409
re-
Cost Issues
Bronchoscope damage
37(101: 1209 /rt/<T
&
postal survey [Kirkpatrick et al[
Classic Reprints
being an essay on anemia, sulfocation.
al]
search article
Objections to postural drainage therapy guideline [Kigin]
critical carol:
Bil'AP
ter
Therapy
Chest physical therapy: time for a redefinition
1458
37(8):887
37(8):855 editorial
(8):918
Burnout
A
guidelines:
practice
clinical
Brougherl
Oxygen therapy
[Lewis[
37(8):902 clinical practice guide-
37(8):907 clinical practice guideline [correc-
uration
professionals [Haponik]
ings
Chest
published by
line
article
Smoke
&
.Association for Respiratory Carel
More
Bronchoscop)
37(
manner
al]
care, after the
37( 12):1424 classic reprints
Clinical Practice Cuidclincs (formulated
tion
37(3):231 edilorial
Schachter]
Smoke
and other forms of intensive
Exercise testing for evaluation of hypoxemia and/or desat-
what can we
hyperresponsiveness:
RADS?
vation,
line
Bronchoconst fiction
Airway
37 (1992)
star-
37(11): 1256 research
article
"92 Vol 37
No
12
&
37(7):739
Eitel]
Critical Care: See Intensive
The
Airway Pressure
Care
37(2):
|East|
cer, radiotherapy.
lators
communication between ICl'
&
computers
37(
1266 PFT"
An
]Chauhan
a quan'y
in
&
."^.^-year-old
man
]Kelley]
Co/He';-
unusual cause of dyspnea
What
Decompression Sickness
Hyperbaric treatment of respiratory emergencies [Weav-
Your
37(5):458 lest
is
in a
.-^-year-old
1
boy ]Pursley
37( 12):1437 Test Your Radiologic Skill
wrong with
this
young
fit.
cyclist'.'
]
Kraft
el
al|
37(l2):1432Pfrrwi!('/-
Echocardiography
Your Radiologic
with a history of lung can-
working
ICU [Copeman]
the
in
& Tesmer]
Diagnosis: Also see Test
]
Radiologic Skill
ence proceedings
er]
1):
1
Stumped
ventilators
37(9): 11 13 confer-
printers (East et al]
in a patient
&
Results of exercise testing in a
East, Marini.
Maclntyre]
Digital electronic
&
mechanical venti-
ot
— 1992 (Branson. Brougher. Chatburn.
emergency care Kac-
37(4):365 Test Your Radiologic Skill
Brandsburg]
Consensus statement on the essentials
37(8):862
Dyspnea
Abnormal radiograph
ICU: panacea or plague?
in the
adapters: their effect on the
marek)
Data -Management
Computers
&
spacers
research article
37(51:448 point of view paper
Positive
MDI
respirable vt)lume of medication |I{berl el al]
Patient- focused hospitals: an opportunity lor rcspnalorv care
practitioners [Snyder]
1992)
(
.An e\ aluation of
confereiue proceedings [correelion on 37(10):1 195}
CPAP: See Continuous
37
Skill,
and "Blood
The
of tran.sesophageal
role
echocardiography
deter-
in
Gas Corner." and PFT Corner Features
mining the mechanism of forward blood flow during
An
closed-chest cardiopulmonary resuscitation [Porter
Diagnosis
&
Education: Also see Continuing Education
[Stoller]
ACLS
inhalation injury
:
some
ACLS
ACLS
gevity
Dinosaurs. RCPs.
&
& ACLS
[Henson]
37(8):946
"Drug Capsule" Features
The bronchodilator properties of magnesium
thewson]
Drugs & Drug Therapy
tilated pediatric patients [Cefaratt
&
&
Melaney]
37(2):137 research
& ACLS
[Henson]
37(8):946
letter
needs of respiratory care practi-
educational
[O'Daniel
37(1 ):65 special
et al]
training [Gallo]
37(8):945 letter
Respiratory care practitioner: carpe diem! [Kacmarek]
Steinberg]
Program Committee
(3):264
In support of
37(8):
ACLS
37
lecture
certification
The use of preadmission
37(1 ):61 re-
et al]
in
search article
[Shafferl
37(12): 1446
properties of
magnesium
sulfate
[Ma-
comparison of Gentle-Haler actuator and Aero-
al|
(MDI) use by
natal endotracheal tube: a
bench study [Rau
&
a
&
Eitel]
37(7):739
Electrolytes
Effects of lithium heparin concentration on whole blood
neo-
analytes
Harwood]
trolyte
measured on
system [Miller
a
multichannel
et al]
blood gas/elec-
37(11):1250 research ar-
ticle
Evaluation of a double-enclosure, double-vacuum unit scav-
enging system for ribavirin administration [Kacmarek
Emergency Care
&
Air medical transport
in
1991 [Jeffs]
37{7):796 conference
proceedings
Dun-
cimference proceedings [correction on 37(I0):1195]
Comparison of nebulizer delivery methods through
&
Electrocardiography
for metered dose inhaler
academic success
criteria to predict
a 4-year respiratory care curriculum [Op"t Holt
levy]
asthmatics [Chipps et
lon-
letter
pared to three other spacers [Tschopp
Kratoh\il]
future
More on ACLS
chamber spacer
&
article
Clinical
editorial
respiratory therapists: a multiple regression
tioners: a Delphi study
[Ma-
sulfate
altemati\e method for delivery of ribavirin to nonven-
thewson]
among
Dinosaurs. RCPs.
The
The bronchodilator
Mi6):516
Durbin]
article
ings
An
&
analysis [Gurza-Dully
letter
Near-Drowning
Near-drowning [Nemiroft]
time for a mandate
skills for the respiratory therapist:
Application form items as predictors of performance
Dinosaurs
Drowning
37(8):945
[Horn]
skills for the respiratory therapist
[Barnes
ings
37(8):945
letter
—one department's experience [Bearden]
letter
Smoke
et al]
92 Vol 37
No
12
1459
1
Airway managcnicnt options IRcincsl
37(7):695 conjer-
in the
&
Diagnosis
acute eare setting
(McGam
1
37(8):948
management of massive hemopt\sis:
Ictler
review
a
Emergency care
& ACLS
|Bums|
37(8):'»47 letrcr Icor-
"beggarx" should be "baggers"
reclion:
management of
F'.niergencN
371 10): 1211 1
severe asthma |Fanla|
acute,
|Durhin|
respiratory care: conference sumniarv
&
equipmeiu
related
naial endotracheal tube: a
Hyperbaric treaiment of respiratory emergencies [Weaver]
ill.
&
37(7):729
Eitel]
Near-drowning [Nemiroff| 37(6l:6(H( conference proceedings
[Thompson
— 1992 [Branson. Brougher. Chatburn.
Maclnlyre]
rouxetal]
computers
&
ventilators
37(9i:1113 confer-
position on aerosol deliverv dur-
37
|(ûiiui|
effect of oral versus nasal breathing
on oxygen con-
ceiuralions received from nasal cannulas |Dunle\y
&
Tyll
Effects of lithium heparin concentration on whole blood anrole
echocardiography
of transesophageal
deter-
mi
closed-chest cardiopulmonary resuscitation [Porter et
alytes
al]
measured on a multichannel blood
Emergency
Smoke
[
inhalation
injuri.
some
:
Barnes
ings
37( 7 ):708
)
Upper airway problems [Wilson
|
i
ga.s/electrolyte
1250 research
techniques
&
article
related
equipment
what
hyperresponsiveness:
RAD.S7 [Witek
&
Schachter[
we
learn
froni
37(3):231 edUoricd
I
(
&
Mahuttel
Kratohv
il
1
37(
evaluation of
respirable
|Jeffs|
37(
1 1 ): 1
Day]
1
&
):37 device evaluation
MDI
spacers
&
volume of medication [Ebert
Evaluation of the
l')')l
111
&
inference proceedings
et all
37(8):862
research article
37(7):796 ro/i/i'/c^cc
proceedings
ahilitv
oi the .Syncoxy breath-svnchro-
nized valve to pnnlde adequate oxygen
lex els |.SaIo et al[
alternative melhotl lor deli\eiy o\ Mba\iriii lo iioiucn-
tilated pediatric patients [Cefarall
l*»:
Steinberg
37(8):
|
evaliuilion
Broncliodilaling
08
1
Evaluation of a closed-system, directional-tip suction cath-
An
.Supplies
877 device
) :
enging system for ribavirin administration [Kacmarek
can
37(3):254 case repori
iK:
37( 9
Evaluation of a double-enclosure, double-xacuum unit scav-
elTicacy
of an open-spacer de\ice comet al|
37(
I
):61 re-
search article
Bronchoscope damage
An
evaluation of the resistance lo flow through the patient
valves of
mons]
twehe
adult
manual resuscilaiors [Hess
iK:
.Sim-
37(5):432 research aniilc
Factors affecting lung \olume changes during neuliorn me-
37iI0l:ll53
chanical ventilation: a bench vlud\ |l.euis|
research article
&
postal survey [Kirkpatrick et al|
37(11): 1256 research
Feasibility
of applying
tlow-.synchronized
very low birthweight infants [Servant
\emilalion
et al|
to
37(31:249
research article
article
provide high fiei|uency
jet veiiiilalioii
port of neonates [Scuderi et al|
uiilion
1 1 ):
[
eter [Hart
Knd-Tldal Pco:: .SV( Blood (;ases/|)H
Environmental Intluences on Health
cart to
ventilation
(Kacmarekl
(inference proceedings
proceedings
KqiiipmenI
37(
|
Essentials for \entilator-alarm systems [Maclntyre
Thoracic trauma [Hurst
Airvva>
et al
gas delivery features of mechanical ventilators
Essential
professionals |llapoiiik[
1460
printers [Hast et al|
new nebulizer
Effect of a
system [Miller
A
/cf/cr
communication between ICT'
37(41:357 research article
mining the mechanism of forward hlood flow during
An
for a "spider in the airway?" [The-
37(8):950
Digital electronic
&
venti-
East. Marini.
et al]
|
37(2):
[East[
Consensus statement on the essentials of mechanical
The
role ol the respiratory therapist in
marek
The
the
37(61:582 conference />roceedings
The
in
ing mechanical ventilation: a bench studv
&
a neo-
Harwiiod]
ence proceedings
conference proceedings jcorrcclion on 37(10):! 195]
Neonatal
&
bench study [Rau
Could you be the reason
ed patients [Bran.son[
1:
1
Computers
lators
37(12): 1414 device evaluation
al[
techniques
ventihition
[Barnes]
I
metered dose inhaler (MDI) use by
for
asthmatics [Chipps et
Emergency
37(9):
Equation
to
37(11):1273I
Clinical comparison of Gentle-Haler actuator and Aero-
37(
37(6(:551 conference proceedings
Emergency
mechanical ventilators (Chatbum[
Cla.ssificalion of
chamber spacer
37( 6 1:564 conference proceedini^s
[Stoller]
37 (1992)
ence proceedings
RiPAP
1
during trans-
37(2):I29 device eval-
The high-frequenc\ pneumatic How
Interrupter: eflecis
difterent ventilaloiy strategies [Cordero et al)
\\<i
37(4):348
research article
92 Vol 37
No
12
High
vcmilcilioii:
trci|iit-'M(.'y
flow inlcrriipler
&
olcclroiiR-
Foreign Bodies
oscillaioi IC'iialem el
Could you be
coiii|ians(m
new pneumatic
a
ol
;in
Bug? Yes.
37(<J):1070 conjereme
Inspired gas conditioning |Shellyi
An
pnnccdintis
Inlrahospilal transport ot critically
ed patients |Branson|
ill.
I
Durbin
In-vivo
piro]
37( 2
|
1
) :
nioiiiloring
37( 2 ): 165
&
Laboratory
ol
blood gases
arterial
pH
&
|Slia-
&
37(
1
&
journal feature
— Kittredge's
all
Campbell]
950
&
kinetic bed therapy
(Hess
et
(
&
classification of
&
Chatbuni[
&
modes of
]
&
Dziodzioj
37
subglottic presal]
37
Ic
interrupter: effects of
37(4):348
) :
1
wrong with
& CO:
et
volume with portable transport
al]
this
fit.
young
Arterial blood gas sampling
ventilators
37(3):233 research article [correc-
five
metered dose inhalers
37
&
37(5):444
three levels of fullness [Hess et all
jAARC]
Consensus statement on
re-
lators
Statements
[AARC]
37(8):913 clinical
tice guideliiu-
search article
mechan-
— 1942
Maclnly
I
the essentials of mechanical venti-
Branson. Brougher. Chatburn. East. Marini.
re]
Exercise testing for evaluation of hypoxemia &/or desat-
37(9): 1098 conference pro-
ceedings
|AARC|
uration
Exercise Testin;;
37(8):907 ,liuical practice guideline
[correction on 37(10):! 1951
Humidification during mechanical ventilation
in
a 3.''-year-old
man
37
]AARC]
37(8):898 diiiical prac-
tice guideline
[Kelleyl
37( 11 1:1 266 PfrCwvK^r
What is wrong with this fit. young cyclist' Kratt et al]
37(12):1432PFrO>™<'y
Extended Care Facility
Oxygen therapy in the home or extended care facility
Oxygen
therapy
[AARC]
|
tion
in
the
home
or extended
care
facility
37(8):918 clinical prcu-tice guideline Icorrec-
on 37(10): 1195]
Patient- ventilator system checks
[AARC]
37(8):882 clin-
ical practice guideliiu-
on 37(10):! 195]
[AARC]
(8):887 clinical practice guideline
on 37(10):! 195]
Results of exercise testing
cyclist? ]Kraft et al]
practice guideline
ventilation' [Marmi]
IVOX
PFT Corner
Guidelines, Recommendations.
in tidal
removal device:
37(7):720 coitference proceedings
on 37(5):431]
[AARCI
Kacmarek]
Hyperbaric treatment of respiratory emergencies [Weaver]
The volume of gas emitted from
tion
]
lecture
Gas Gangrene
proceedings
What derived
is
37( 2
]
{12):\432
[McGough
Durbi n
What
[Blanchelte
tion
101:1166 research arlu
ventilator
[corrections on 37(5): 4.M]
uration
the role of
37(10): 1175
Miller]
different ventilatory strategies (Cordero et al]
proceedings
Transcutaneous Pco:
ical
37
research article
operation [Branson
at
Program Committee
The high-frequency pneumatic tlow
37(8):
Technical description
tions
&
Gas E.xchange
The effect of partial upper-airway bypass on
37(5):
letter
Variations
in the ICU'.' |Picrsoii]
sure during acute lung injury in sheep [Kollef et
related to the sigh [Rendell-Bakerl
history
Horizons VII: what's new
(3):264
Some
ventilators
review article
editorial
37(2):
37(9): 11 13 confer-
Respiratory care practitioner: carpc diem'
Corner: technical as-
&
plague'.' [East]
printers [East et al]
inhaled nitric oxide gas [Miller
pects of respiratory care [Branson
boy [Pursley
Pulmonary vascular smooth-muscle regulation:
37(7):739
Eilell
ventilation [Tobin)
A new
&
letter
I
(2):144 symposium proceedings
Monitoring of pressure, flow.
):12l
communication between ICU
&
[Kacmarek]
):29 device
able [Sassoon]
1
Essential gas delivery features of mechanical, ventilators
function; the trigger vari-
ICU: panacea or
in the
computers
New
Mechanical ventilator design
1
a l.Vyear-old
ence proceedings
Impact Uni-Vent
ventilator [Campbell et alj
.<7(
in
37( 12): 1437 Test y<nir Radiologic Skill
Digital electronic
&
/<7fc7
[Picrson]
clinical evaluation of the
750 portable
IVOX
evalualion
422
Tesmerl
Computers
remoxal dc\icc;
No
Future
37(7):775 cdiift'irmi' proccctl-
& CO:
37(8):950
Insect?
&
iiicchaiiically ventilat-
i)i};s
the reason for a "spider in the airway ?" [The-
rouxetal]
37(11):1241 cIcvUc evaluation
all
37 (1992)
[AARC]
37(8):891
"92 Vol 37
No
12
1461
Oxygen
Hazards
|AARC|
Bronchial pn)\ ocation
rouxetail
37(8):95()
Exercise testing for e\akuilion of hypoxemia and/or desaturation
[AARC]
Brougher)
[AARCj
or extended
37(8):918 clinical practice
care
ftitideline
facility
(correc-
[AARC]
37(8):882
bed
kinetic
(Hess
tlierap\
|AARC]
trigger var-
37(8):907 clinical practice guideline
& CO;
ings
(AARCj
37(8):891
&
inhalation injury:
some
&
Infection t'onlrol
samplmg [AARC]
Artcnal blood gas
37(8):913 clinical
practice guideline
during trans-
37(2): 129 device eval-
port of neonates [Scuderi et al]
ings
|Stollcr|
Infection
jet ventilation
kinetic bed therapy ]Hess et
37(2):181 sym/yosium proceedings
al[
Smoke
frequency
IVOX
removal device:
37(2): 147
professionals [HaponikI
[AARC]
uation
37(S):9()2 clinical prac-
tice guideline
different ventilatory strategies [Cordero ei al]
Exercise testing for evaluation of hypoxemia &/or desat-
37(4):348
High frci|ucncs
ventilation:
&
comparison of an electronic
How
interrupter
al]
a
new pneumatic
[contributed by Brougher]
tice
37(
1 1 ):
in
1S^)8
therapy
[AARC|
Listening to the chest in the I93()s [contributed by Boiler]
tion
[AARC]
in
the
home
or
extended care
[.AARCj
37(8):882
Uf*r
Selection of aero.sol delivery
'\y>^
device |.\.\RC']
JAMA
100 years ago]
37(8):938 Historical
Notes
37iSl:.S91
&
consumption
in
1903 [contributed
A
critical carol:
Home Care
features
of mechanical
\cntilalors
star-
37(12):1424 classic reprints
[Barnes
Essential gas delivery
being an cssav on anemia, suffocation,
of Dickens [Banlett]
.ACLS
ti^f'
Intensive Care
vation,
Treatments for asthma
clin-
looJif
letter
toxic effect of tobacco vapor, with rcpori of cases [a re-
facilitv
on 37{!U): 1 195]
ical practice giddeline
37(8):
rected version on 37(6):634]
history related to the sigh (Rendcll-Baker[
37
guideline
Oxygen
1270 Historical Notes
37(3):270 Historical Notes [lllustratums omitted. Cor-
[AARC]
'Applied plusiolog)' lor primarv school children
[Kacniarek]
oscillator ]Cordero et
History of Respiratory Care
byDunlevy]
[AARC[
uration
[correction on 37( !()):!! 95]
research article
1462
[A.\RC|
Positioning. lung function.
High-Frequency Ventilation
in
tlie
Hypoxemia
[Durbin[
37
port
function:
Near-drowning [Nemiroff[ 37(6):600 conference proceed-
blood gas analysis
arterial
clinical practice i;iiidcline
&
&
[correction on 37(!0):!!95]
Hemoptysis
950
1
el
37(2):181 symposium proceedintis
The
37( 9 ) :
[
&
Some
Sassoon
&
Hypoxia
clin-
ical practice guideline
A
[
uration
Diagnosis
|
Hvpcrbaric iieatment of respiratory emergencies [Weaver]
on 37(10):! 1951
Sampling for
37
home
the
in
alj
iable
letter
Oxygen therapy
tion
[AARC[
Hyperbaric Medicine
tice îiiileliite
lAARC]
East. Marini.
proceedings
Objections to postural drainage therapy guideline |Kigin|
i7{U)):l2a9
Humidification
[AARC]
I
&
37(8):855 editorial
facility
Inspired gas conditioning [Shelly
IHess
what'.'
niu'.
care
— 1992 [Branson. Brougher. Chatbum.
Maclntyre]
37
iîdilelinc
guidelines;
practice
or extended
[correction on 37111)):! 195]
Humidification during mechanical \enlila(ion
clinical
lators
37(S):9(I7 clinical practice f>ui<Jeline
(8):887 clinical practice
&
Humidity, Humidifiers.
/<•«<'/
home
the
in
37(8):918 clinical practice guideline (correc-
on 37(IOl:! 1951
tion
for a "spider in the airway?" jThe-
therapy
[AARC]
37(81:902 clinical prac-
tice siuiilcHne
Could you be ihe reason
More
37 (1992)
&
Durhin|
time for a mandate
37(6):5I6 editorial
Airway management options jRcines]
37(7):695 confer-
ence proceedings
RESPIR.XTORY CARE • DECEMBER
"92 Vol 37
No
12
-N
Computers
ICU: panacea or plague? [East]
in the
&
computers
[Campbell
&
A new
ventilators
a sigh breath
improve oxygenation
[Bruce
et
Campbelll
37(12): 1409 re-
& CO:
removal device:
IVOX
& pH
|Shapiro|
&
Rutherford]
ICU?
in the
37
[Pierson]
&
kinetic bed therapy [Hess et
37(5):458 Test Your Ra-
Skill
bypass on subglottic pres-
The
inhalation injury:
some
}7(6):(>(i')
conference proceed-
on subglottic pres-
effect of partial upper-airway bypass
37(7):695 confer-
Factors affecting lung volume changes during newborn mechanical ventilation: a bench study [Lewis]
Does a sigh breath improve oxygenation
CPAP"!" [Bruce
tient receiving
et
in the
intubated pa-
37(12):1409
ul|
Management, Administrative
re-
[Burns]
37(8):947
"beggars" should be "baggers
'
letter [cor-
Cadson]
37(10):12I1]
37(
al]
1
among
gevity
&
Eitel]
placement [Day
The
to assess
endotracheal tube
&
CO: removal
device:
IVOX
37(4):343 research
Application form items as predictors of pert'omiance
What
&
&
Melaney]
constitutes an order for mechanical ventilation.
should give the order? [Pierson]
lon-
37(2): 137 research
lation
BiPAP
Job Satisfaction
&
A
intent of respiratory
in the acute care setting
1:46 research article
37(8):948
37(2):129 device eval-
[Chatbum]
&
kinetic bed therapy [Hess et
Comparison of nebulizer
deliver)
•
O: enrichment: what
DECEMBER
'92 Vol 37
No
37(9i:
to Ei/uation
I
37(11): 1273]
Kittredge's Corner
provide temporary
letter
uation
Kinetic Bed Therapy
RESPIRATORY CARE
[McGarry]
cart to provide high frequency jet ventilation during trans-
port of neonates [Scuderi et all
& who
Mechanical Ventilation: Also see High Frequency Venti-
article
37
proceedings
37(5):448 point of view paper
(3):264 Program Committee lecture
ventilators
et al|
a
arterial
Respiratory care practitioner: carpe diem! [Kacmarck]
Job Performance
1
management of
Patient-focused hospitals: an opportunity for respiratory care
37(
37(2): 137 research
effect of respiratory care department
IVOX
among
Melaney]
article
37(61:533 conference
proceedings
gevity
&
et al]
lon-
article
37(7):739
conference proceedings [correction on 37(10):1I95]
Rapid analysis of exhaled CO:
&
Skill
[Durbin]
&
& ACLS
37(10):1153
research article
search article
&
37
al]
ence proceedings
[Douglas
37
al]
1
Lung Volumes
Airway management options [Reines]
a
&
was
37(5):478 letter
rection:
I
ings
Intubation of the Airway
How
10):
ings
al]
&
effect of partial upper-airway
Smoke
diologic Skill
al]
Table
(
ICU [Copeman]
this
I
Injury
The
Emergency care
37
Campbell]
.\bsccss
Lung
Is
&
37(51:462 Kittredge's Corner
37(2): 154 symposiiun proceedings
in the
Corner: technical as-
[Branson
Foul-smelling sputum, malaise.
Stumped
care
Professional literacy revisited [Barlel]
Lun^
37(2 ): 165 symposium proceedings
al]
— Kittredge's
Literacy
In-\i\o monitoring of arterial blood gases
(2):
button?
omitted: table on 37(6):634]
New
journal feature
suction
lOO'i
the
37(8):933 Kittredge's Corner
Sighs: wasted breath or breath of fresh air? [Branson
the intubated pa-
in
al|
search article
[Durbinj
press
Branson|
(51:422 editorial
CPAP?
tient receiving
&
pects of respiratory
37|9):1113 confer-
printers [East ei al|
ence proceeJiiifis
Does
when you
happens
37(2):
Digital electronic
37 (1992)
37(
12
1 1
methods through
bench study [Rau
&
a neo-
Harwood]
1463
Consensus
tilators
rini.
A
stateiiicnl
— 1992
and
of Dickens
&
computers
37( 12 »: 1424 classic reprints
|
ence proceedinfis
Effect of a
new
nebulizer position on aerosol delivery dur-
37
|
[Kacmarekl
of mechanical
features
\ennhil(irs
37(9):1045 coitference prnceediiiiis
Essentials for ventilator-alarm sysleins [Maclntyre
An
1
evaluation of
MDl
&
Day]
spacers
&
volume of medication [Eherl
el al]
37(8):862
chanical ventilation: a bench stud\ [Lewis]
37(10):1153
research article
ventilation
et al]
to
37(3):249
research article
interrupter: eflecis of
different ventilatory strategies [Cordero el al]
37(4):348
research article
ventilators provide
when you
&
temporary O; enrichment: what
press
Bianson|
100%
the
[AARC]
37
proceediniis
ed palienis [Branson]
ill.
ings
A:
function: the trigger var-
Monitoring of pressure, flow,
ventilation [Tobin]
&
editorial jcorrection
see Hansen letter
still
re
down?
[Burns]
37(8):
useful:
Fno:
estinialion [Keltelll
37
[AARC]
37(8):882
clin-
37(1):
Pressure-conlrol ventilation —another view (Rcvnolds]
1464
|\\ilsoii|
& who
37(9):1 124 conference
proceedings
variables should be monitored during mechan-
37(9):1()97 ctmference pro-
ventilation? [Marini]
ceedings
Mechanical Ventilators: Also see High Frequency \entila-
and Portable Nentilators
BiPAP m the acule cue setting [McGany] 37(8):948
letter
]Chatbum]
37(9):
to Ecjiiation
I
37(11): 1273]
Comparison of nebuli/er delivery methods through a neonatal endotracheal tube: a bench study [Rau A; Harwood]
lators
— 1992
]
Branson. Brougher. Chatburn. East. Marini.
Digital electronic comniunication
&
computers
&
between ICU ventilators
37(9):1113 confer-
printers [East et al|
ence proceedings
features of mechanical
gas deliver)
Essential
Kacmarek
I
37( 9
)
:
1
ventilators
045 onference proceedings
<
Essentials for ventilator-alarm systems [Maclntyre
1
&
Day)
Factors aftecting lung volume changes during newborn mechanical ventilation: a bench study [Lewis]
37(10):
1
153
research article
Feasibility
flow-synchronized
of applving
very low birthweight infants ]Servanl
The high-frequencv pneumatic flow
ventilation
el al]
lo
37(31:249
inteniipler: effects of
37
37(4):348
ventilators provide
happens
when you
&
temporary
press
Branson]
the
O: enrichment: what
100'7r
suction
button'
Humidification during mechanical ventilation ].A.ARC]
37
/('«('/•
el al]
research article
(Campbell
letter
marek]
are corrected on
What derived
How
barotrauma: a response to Chalburn [Jones]
(1):83
& 2A
dilTeivni ventilatory strategies [Cordero
The
in ventilated adults
research article
37(I2):1447J
(8):948/(;^'/
84
What
37(9):
37(9): 1056 conference proceeding's
iable [.Sassoon]
&
Pco:
Figures IB
Upper airway problems
[
Mechanical vcnlilalor design
PIP
&
Table 2
Maclntyre]
37(9):I070 conference
Intrahospital transport of criticallv
Nothing new but
in
37(8):933 Kiitredê's Corner
Inspired gas conditioning [Shelly]
857
jErrors
end-tidal
D/iodzio[
button'
(8):887 clinical practice iîideline
all
&
suction
On mythology &
&
Transcutaneous Pco:
1009 conference proceedings jcorrection
[Campbell
ings
tlon
flow-synchronized
of applying
very low birthweighl infants ].Ser\anl
happens
& classification of modes of ventilator
& Chatbum] 37(9):1026 conference
proceedings
ical
Factors affecting lung \olume changes during newborn me-
How
operation [Branson
research article
Feasibility
37(8):
proceedings
108 conference proceediniis
respirable
on 37(6):634l
37(5):43II
Essential gas deh\ery
37(9):
Hansen]
/,//<•;
&.
was
I
letter
[Blanchelte
about compliance measurement
in slalenienl
37(12):1447
950
[Branson
related to the sigh [Rendell-Baker]
history
ing mechanical ventilation: a bench study lQuinn|
Error
Some
air.'
37(5):462 Kittredge's Corner [Table
Campbell)
ventilators
37(9i:1113 confer-
printers [East el al)
Sighs: wasted hiealli or breath of tresh
imiitted: table
forms of intensive care, after the manner
Bartlett
Digital electronic
&
Ma-
being an essa\ on anemia. sutYocation. star-
oilier
1
mechanieal ven-
ol
37(9): 1000 confereiHe proccetlini^s
Maclntyrel
critieal earol:
vation,
on the essentials
[Branson. Brougher. Chatbum, East.
37 (1992)
emergency care |Kac-
Inspired gas conditioning [Shellv]
proceedings
92 Vol 37
No
12
transpml orcnlically
Inlraliospit.il
&
Laboratory
riiL'L'liaiiiL'alh
ill,
clinical cnakiation of the
750 portable
\L'nlllal-
37(71:775 cdiijirciice pi(Hffilini;s
ed patients |BraiiM)ii|
-^7(
1
):29 device
evuhuition
&
function: the trigger sari-
37(91:1056 coiijcrciuc proceedinf;s
able ISassoonJ
&
Monitoring of pressure, flow,
emperors: what are you doing
editorial [correclion
see Hansen letter
down? Burns]
37(8):882
clin-
[Branson
&
37(2): 165
37(8):
tice
& classification of modes of ventilator
& Chatburn] 37(9):1026 conference
37(3):233 research article /error
et al|
variables should be monitt)red during
mechan-
approach
to
metabolic acidosis for the respiratory care
Transcutaneous Pco:
(Blanchette
kinetic bed therapy (Hess et
&
&
Dziodzio]
[
&
Mar-
rini.
— 1992
[Branson, Brougher. Chatburn, East.
&
Mar-
&
method
&
Techniques
for delivery of ribavirin to
&
Steinberg]
Monitoring
non\en-
ford]
37(8):
[East]
computers
&
37(2):
printers ]East et alj
[Blanchette
ventilators
What
ical
a sigh breath improve oxygenation in the intubated pa-
CPAP'
(Bruce
et
37(7):739
Eitel]
&
oxygen
[Nelson
&
Ruther-
&
&
37(10):
et al]
1
end-tidal
Pco:
i'i
ventilated adults
Dziodzio[
derived variables should be monitored during mechan\entilation'.'
[Marini]
ceedings
37(12): 1409 re-
al]
Shapiro]
[corrections on 37(5):431J
37(9):1113 confer-
ence proceedings
tient receiving
venous
mixed
Transcutaneous PcO:
]
37(2):154 symposiiun proceedings
placement [Day
Digital electronic
pH
in the
&
ventilation ]Tobin]
tilated pediatric patients |Cefaratt
&
Monitoring during resuscitation (Hess
Monitoring of pressure, flow.
alternative
Ma-
Maclntyre]
37(2):I65 symposium proceedings
Methods, Procedures,
Murder Mysteries
search article
"Murder mystery"
on oxygen concentrations received from nasal cannulas ]Dunlevy & Tyl]
effect of oral versus nasal breathing
pulmonary phys-
&
37(10): 1197 mur-
iology calculations [Maron
Bosso]
der mystery [answers on 37( H):1274
et al]
&
murderer
re-
vealed on 37(1 2): 14451
Near-Drowning: See Drowning
arterial
Nebulizers, Inhalers,
37(4):343 research
&
&
Near-Drowning
Vaporizers
article
]Bames]
&
\ aporizers
Emergency
37(12):i447/(W/-
37(2): 181
al]
tilators
Metered Dose Inhalers (MDIs): See Nebulizers, Inhalers,
The
37
[Pierson]
Consensus statement on the essentials of mechanical ven-
Lethal infantile mitochondrial disease [Martinasek
The
ICU?
in the
Monitoring
37(9): 1097 conference pro-
]Marini]
Does
Lethal infantile mitochtmdnal disease [Martinasek
Metabolic .Acidosis
&
Rutherford]
Mitochondrial Disease
in
ceedings
Computers
&
Oral \s nasal breathing: effects on O; concentration received
tinasek
ical ventilation?
An
[AARC]
Conclusion section corrected on 37(5}:431]
tinasek]
]Shapiro|
[correction on 37(5):43l]
Variations in tidal \olume with portable transport \enlilators
What derived
& pH
guideline
proceedings
[McGough
IVOX
removal device:
letter
operation ]Branson
& CO2
IHughes]
history related to the sigh [Rendell-Bakerl
37(4):348
(2):144 symposium proceedings
on 37(6):634]
.An
37(2):I47 symposium proceedings
[Durbin]
New
air.'
37(5):462 Kittredge's Corner [Table omit-
Campbell]
950
flow
research article
[AARC]
to
37(3):249
research article
The high-frequency pneumatic
measurement:
37(I2):1447I
Sighs: wasted breath or breath of fresh
Some
\entilation
el al]
v\ith
37(8):
|
re coinpliuncc
ted: table
l'low-s\nchroni/cd
37(9): 1081 (inference proceedings
ventilation |Tobin|
On mythology & naked
all
of applying
different \entilatory strategies ]Cordero et al]
857
Feasibility
very low birthweight inlants ]Ser\ant
Impact Uni-Vent
\entilator |C'aniphell el all
37 (1992)
ventilation
techniques
&
related
equipment
RESPIRATORY CARE
•
DECEMBER
"92 Vol 37
et al]
37(1 ):6I re-
search article
No
12
1465
comparison
Clinical
chamber spacer
ot
asthmatics [Chipps
Gcntlc-Huler actuator and Aero-
mciered dose inhaler (MDl) use by
lor
et al]
natal endotracheal tube; a
&
bench studs jRau
a neo-
Harwimdl
new
nebulizer position on aerosol deli\cr> dur-
ing mechanical ventilation: a bench stud\
37
|Quinn|
MDl
evaluation of
spacers
& adapters:
on the
their effect
volume of meilication [Ebert
respirable
37(8):862
et al]
37(9):l()70 conference
|AARC|
37(S):8')I
The volume of gas emitted from
metered dose inhalers
five
three levels of fullness |Hess
et
37(5):444 re-
al|
Ic
A cart to provide
effect of oral
Evaluation
\
ersus nasal breathing on oxygen con-
high frequency
jet
entilation during trans-
\
al|
of
the
bench study [Rau
&
a neo-
Harwood]
Factors affecting lung volume changes during newborn me-
\ s
& CO2
of applying
flow-synchronized
theraps
37(10):
1
home
the
in
ventilation
receiving
CPAP'
37(101:1193 Test Your Radiologic
&
N4ar-
of
the
]Thompson
et al]
&
Miller]
37(101:1175
rcvieiv article
Syncoxy
the
breath-syn-
et al]
How
O; enrichment: what
100% suction button?
ventilators provide temporary
happens
when you
&
press
the
37(8):933 Kittredge 's Corner
Branson]
& CO:
IVOX
removal device:
monitoring of
37(2): 165
arterial
blood gases
& pH
]
Sha-
&
Ruther-
37(2):154 sxinposium proceedings
ford]
&
al]
37(2): 181
Smoke
inhalation
kinetic
bed therap) (Hess
injury: some priorities for
et
respiratory care
37|6):609 conference proceed-
ings
ings
Puhiionaiy \asciilar smooth-muscle regulation: the role of
inhaled nitric oxide gas
Nutrition
]
Miller
&
Miller]
37(10): 1175
review article
critical carol:
being an essay on aiicnua. suffocation, star-
and other forms of
Dickens
]Bartlett]
manner
iiueiisixe care, after the
37(121:1424
reprints
classic
FORIM
OPEN FoRUM 37(11): 1277
Author index for 1992 OPRN FORUM abstracts 37l
1372
A new look for Opfn Forum "93 with some pointers on
1
1
1:
—
'in
Thoracic trauma ]Hurst|
Mil ):70S conference proceedings
Patient Assessment
Emergency management of
Abstracts of 1992
fashion' ]Brougher]
Orders for Therapy
What constitutes an order
37(12):1405 editorial
\
entilation.
& who
37(9):l 124 conference
acute, severe
asthma [Fanta] 37
(6):551 conference proceedings
Emergency
[Barnes]
ventilation
techniques
&
related
equipment
Exercise testing for evaluation of hypoxemia and/or desaturation
for mechanical
should gi\e the order? ]Pierson)
proceedings
146(1
re-
Near-drowning ]Nemiroff| 37(6):600 conference proceed-
inhaled nitric oxide gas ]Miller
staying
37(12»:1409
al]
Pathophysiology
Oxide Gas
of
of
ability
professionals ]Haponik]
I'lihnonary vascular smooth-muscle regulation: the role of
Ol'KN
et
Monitoring mixed venous oxygenation ]Nelson
Carlson]
]Bruce
to
vation,
facility
chronized valve to provide adequate oxygen levels JSato
37(3):249
et al)
Lethal infantile mitochondrial disease (Martinasek
A
care
search article
Skill
Nitric
or extended
sigh breath improve oxygenation in the intubated pa-
tient
153
research article
&
O: concentration received
on 37ll0):1195]
tion
piro]
Neonatal
37
[Kettellj
37(12):1447/<'m'/-
|AARC]
In-vivo
very low birthweight infants (Servant
tinasek]
IVOX
removal device:
Fdo: estimation
useful:
still
nasal breathing: effects on
[Hughes]
]Durbin|
&
breath-syn-
(8):948/(W/-
research article
(Douglas
Syncoxy
the
]Durbin]
Intravenous iixygenation
a
Tyl]
]Campbell
chanical ventilation: a bench study |Lewis|
this
of
ability
Evaluation
uation
Is
&
chroni/ed \al\e to provide adequate oxygen levels [Sato
Does a
port of neonates [Scuderi et
Feasibility
37
j.^tlas]
Oxygenation
Neonatal Respiratory Care
1 1 ):
oxygen
centrations received from nasal cannulas JDunlevy
Oxygen
37(
The
Oral
proceedings
search anil
&
(5):477 letter
Nothing new but
research article
Inspired gas conditioning |Shelly|
at
Mechanical Ventilation
see
:
Calculating F[)0: for mixtures of air
et al]
An
Oxygen Therapy Also
37(1 1):1233 research article
Effect of a
37 (1992)
tion
on
37(8):907 clinical practice guideline [correc.171 lOl: I I9.>l
37(8):887
RESPIRATORY CARE
•
DECEMBER
92 Vol
.^7
No
12
&
Monitoring mixed venous oxygenation [Nelson
37(2): 154 symposium proceedings
ford]
Oxvgen therapy
in the
home
on 37
37(8):913 clinical
some
inhalation injury:
&
[Blanchette
&
end-tidal
Pco:
\enlilated adults
in
The
for delivery of ribavirin to
&
nonven-
Steinberg]
What
[Thompson
&
vocal cord dysfunction
&
[Wanger
syndrome:
Beam|
Problems with a bronchial challenge [Wanger
wrong with
this
37(10): 1187
&
Irvin]
37
man
young
fit.
[Kelleyl
cyclist? [Kraft et all
37
al]
al]
What
&
Rutherford]
pulmonary physi-
&
37(10):1197 mur-
Bosso]
&
murderer
re-
vealed on 37(I2):I4451
Neonatal
&
&
ology calculations [Maron
&
airway emergencies [Thompson
pediatric
ical
kinetic bed therapy (Hess et
et
&
kinetic
bed therap) (Hess
et
37(2): 181 symposium proceedings
derived variables should be monitored during mechanventilation' [Marini|
ceedings
37(2):181 symposiutn proceedings
Pulmonary Vascular Smooth Muscle
this
fit.
young
cyclist? [Kraft et al[
Pulmonary \ascular smooth-muscle regulation: the role of
37(10):1175
inhaled nitric oxide gas [Miller & Miller]
37
(12):1432PF7'0)/7!e/-
review article
Pneumothorax
&
who
der mystery [answers on 37(11):I274
[Kohr
&
"Murder mystery"
Pneumonia
Radiographic
37
Physical Therapy: See Chest Physical Therapy
Pneumonitis
V\'hat IS wrong with
cyclist? [Kraft et all
aiV.Un PFT Corner
al]
wrong with this fit. young
PFT Corner
Pulmonary Physiology
37( 11): 1266 PfrCorac'/is
is
review article
when
PFT Co/Tier
Results of exercise testing in a 33-year-old
What
Pulmonarv \ascular smooth-muscle regulation: the role of
37(10):1175
inhaled nitric oxide gas [Miller & Miller]
dis-
PFT Corner
8 ):929
[Kel-
proceedings
Features (brief case reports involving pul-
hysterical
man
et al[
cussion)
(
33-year-old
Pulmonary Hypertension
function tests, with questions, answers.
is
a
in
wheezing
37
Irvin]
Protocols
37(8):
evaliuition
the
&
(12):U32
tilatcd pediatric patients [Cefaratt
&
testing
marek]
What
method
[Wanger
37{n):n66 PFT Comer
ley]
proceedings
alternative
a bronchial challenge
Results of exercise
Dziodzio]
Pediatric Respiratory Care
Asthma
37(10):
letter
Problems with
[correction on 37(5):431]
"PFT Corner"
Objections to postural drainage guideline |Kigin|
m:929 PFT Corner
877 device
renaming
PFT Corner
31{(t):6W conference proceed-
ings
Transcutaneous Pco:
&
a redefinition
Pulmonary Function & Pulmonary Function Testing
Asthma & the \ocal cord dysfunction svndrome: when
37(10):1187
wheezing is hysterical [Wanger & Beam]
37(8):891 clinical
practice guideline
et
a
1209
practice guideline
bed therapy [Hess
kinetic
37(5):419 editorial
[Lewis]
for arterial blood gas analysis
&
Chest physical therapy: time for
monary
portable transport ventilators
Postural Drainage Therapy
three cases |Angelillo|
&
iih
37(3):233 research article Icorreciion
37(2): 181
all
Reaetise airway dysfunction svndrome (RADS): a report of
Neonatal
\olume w
et al|
Positioning, lung function,
tice guideline
An
37(1):29 device
|
on37<5):43I\
37(81:882 clinical prac-
Smoke
et al
Positioning of Patients
(10): 1 1951
marek)
Impact Uni-Vent
clinical e\aluation of the
in tidal
[McGough
37
facility
(81:918 clinical practice guideline (correction
Sampling
&
evaluation
f;uiile-
Variations
or extended care
iyy2)
750 portable ventilator (Campbell
line
The
(
Laboratory
Ruthcr-
37(8):898 clinical practice
Nasotracheal suetioning
37
findings
following
feeding-tube
Radiography. Diagnostic
placement
Abnomial radiograph
Clevenger]
cer, radiotherapv
Skill
RESPIRATORY CARE
ill,
Bilateral hilar
•
DECEMBER
"92 Vol 37
No
gelillo)
12
in a patient
&
working
with a history of lung canin
[Chauhan
a quarry
&
Brandsburgl
Portable Ventilators
.
masses
37(
1
in a
):79 Test
32-year-old
man?
Your Radiologic
[Klaas
&
An-
Skill
1467
SUBJECT INDFA' TO VOLUME
&
&
IDougias
Carlson]
37(
1(():
1
More on ACLS
syndrome?
distress
857 editorial Icorrection
&
[Kohr
following
findings
placement
feeding-lube
37(5):458 Test Yciir Ra-
ICL' |C"opeman|
in the
37(51:478
Respiratory care practitioner: carpe diem
|
37|7):708 conference proceed-
Hurst]
The
See RcactJM' \ir«a\
Smoke
SMulrome
l)\sl'iiiicti<)n
what
hyperrcsponsi\eness:
RADS'
IWitek
&
can
we
What
some
inhalation injury:
should gi\e the order? [Pierson]
&
Respiratory Distress Syndrome
Factors affecting lung volume changes during newborn me-
.Statements
chanical ventilation: a bench study JLewis]
Research
Program Committee
department's experience ]Bearden]
37(8):945
[Douglas
letter
|Horn|
Resuscitation
time for a mandate
&
in
14^)1
MO ):795 conference
|Jelfs|
ACLS
ACLS
proceedings
&
Resuscitation Devices
&.
&
[Henson]
]
Supplies
37(8):945
[Horn]
time for a mandate
37(S):946 letter
37(8»:947 letter [cor-
Burns]
"beggars" should be "baggers"
Emergency
&
techniques
ventilation
37(10):1211]
equipment
related
lon-
Melancy]
& ACLS
& ACLS
Emergency care
[Barnes]
&
Your Radiologic
37(6):516 editorial
Durbin)
Dinosaurs. RCPs,
rection:
analysis (Gurza-Dully
&
37(1 ):46 research article
among
&
37i in i: 11 93 Test
]
[Barnes
Carlson
letter
37(6):516 cditurinl
Durbni]
&
Skill
37(8):945
letter
IVOX
a
this
Is
removal device:
37(2): 147
[Durbin]
Respiratory Care Practitioners
ACLS —one
& CO:
Intru\enous oxygenation
lecture
37(10):1153
research article
37
Respiratory care practitioner: carpe diem! [Kacmarek]
gevity
& who
proceedings
37(31:254 case report
Recommendations: See Guidelines. Recommendations,
[Barnes
37
ings
from
learn
37|3):231 editorial
Schachler]
Reacti\e airway dysfunction syndrome (RADS): a report of
(3):264
letter
IKacmarck]
37( 6 ):523 conference proceedings
]
Airway Dyst'unctiun Syndrome (RADS)
Airway
I
marek
ini;s
al]
yi[S\:XVi point of view paper
(3):264 Program Committee lecture
Thoracic trauma
ACLS
37(I2):1447}
dinloific Skill
Reuctivi'
37(8):
Professional literacy revisited [Bartel]
Stumped
ACLS
letter
re
Patient-focused hospitals: an opportunity for respiratory care
37(2):198 Test Your Rculiolofiic
Clcvengerj
Skill
RADS:
Hansen
see
Skill
Radiographic
numbers you're writing down'? [Burns]
those
all
193 Test Your Radiolofiic
37(8):945 letter
training JGallo]
&
On mythology
Skill
simple case of respirator)
a
this
Is
night sweats |C'hauhan)
37 (1992)
37(2):137 research
An
evaluation of the resistance to
How through
the patient
valves of tv\el\e adult manual resuscitators [Hess
&
Sim-
article
An
mons]
In
support
ACLS
oi'
certification
37(12):1446
]Shaffer]
letter
Could you be
roux
et al
]
the reason for a "spider in the airway'.'" |The-
37(8):95() letter
Dinosaurs, RCPs,
The
& ACLS
blood gas analy/er on
37(8):946 later
More on ACLS
the
appropriateness of arterial
et al]
37(4):343 research
article
Emergency
rection:
The
& ACLS
[Burns]
37(8):947
letter
I cor-
"beggars" should he "baggers" 37(10):I2I I j
future educational needs of respiratory care practition-
ers: a
Delphi study ]0"Daniel
ct al]
37(
1
):65 special ar-
ticle
er]
ings
Neonatal
The
pediatric
airway
emergencies [Thompson
marck]
The
&
ACLS
certification
]Shaffer]
37(12): 1446
et
role
emergency care IKac-
of
inining the
transesophageal
echocardiography
mechanism of forward blood
ct al]
in
deter-
flow during car-
37(7):769 con-
ference proceedings
Smoke
letter
1468
training [Gallo] 37(81:945 letter
diopulmonary resuscitation IPorler
Hyperbaric treatment of respiratory emergencies [Weav-
In support of
37(71:739
Near-drowning ]Nemiroff| 37(6):6()0 conference proceed-
al]
care
<k Eitel]
conference proceedings /correction on 37(10): 1 1951
[Henson]
Monitoring during resuscitation ]Hcss
inhalation injur\
:
some
prolcssionals jHaponik]
ings
RESFiR.MORI CARE • DECEMBER
'92 Vol 37
No
12
1
SulTocation
Retention
A
37
carpe diem! (Kaciiiaick|
Respir;itiir\ care praclilioner:
(3l:264 I'roiiidin Cmninillcc lecliin-
critical carol:
method
alternative
of ribavirin to non-
for delivery
ventilated pediatric patients [Cefaratt
&
37
Steinberg)
37(
in
IWl
— 1992
3n[l):l')6 conference
|Jefls|
tilators
proceedings
rini.
method
alternative
&
acuum
&
&
CPAP?
[Bruce
et
cer,
Bilateral
search article
Sighs: wasted breath or breath of fresh air? [Branson
37(5):463 Kiilredge's Corner [Table
Campbell[
ted; table
Some
Smoke
&
37(8):
Inhalation
some
inhalation injury:
of Tobacco
[Chauhan
masses
in
a
32-year-old
&
Skill
man?
[Klaas
&
&
Cadson]
following
findings
feeding-tube
placement
37{2):198 Test Your Radiologic
Clevengerl
JAMA
in
100 years ago]
37(8):938 Historical
An
this
fit,
young
vation,
carol:
37(12):1424
[Bartlett]
&
State-
A
Subglottic Pressure
effect of partial upper-airway bypass
10):
1
&
Mahutte]
ventilators
happens
&
37(
1
):
&
Branson]
press
the
Laboratory
suction
The
button?
ill.
clinical
evaluation of the Impact Uni-Vent
ventilator
[Campbell
et al]
marck
37(1 ):29 device
[
guideline
37(8):898 cliniccd prac-
during trans-
evaluation
[AARC]
&
750 portable
O: enrichment: what
100%
jet ventilation
al]
ings
Supplies
provide temporary
when you
ICampbell
frequency
37
et al]
Evaluation of a closed-system, directional-tip suction catheter [Hart
Suction Devices
ilil ):796 conference
uation
on subglottic pres-
sheep [Kollef
injury in
&
Skill
37(7):695 confer-
[Reines]
1991 [Jeffs]
in
port of neonates JScuderi et
Suction, Suctioning,
Your Radiologic
proceedings
ments
durmg acute lung
a 13-year-old boy [Parsley
reprints
classic
Statements: See Guidelines, Recommendations,
sure
in
37( 12): 1437 Test
Transcutaneous P02 or Pcoi' See Blood Gases/pH
Transport of Patients
star-
Dickens
37(5):458 Test Your
ence proceedings
Starvation
A critical
Tesmer]
Tracheotomy & Tracheostomy
Airway management options
37
cyclist? [Kraft et al]
ICU [Copeman|
&
wrong with
is
the
in
Radiologic Skill
il2):UMPFT Comer
tice
&
&
Stumped
Sports Medicine
How
a quarry
Skill
port
(
a history of lung can-
ith
in
a
[Kohr
Notes
The
working
Radiographic
toxic effect of tobacco vapor, with report of cases [a re-
of
a patient
Skill
ings
Smoking
What
this
Is
[Douglas
The
(brief case
letter
Smoke
w
in
&
omit-
I
hilar
Angelillo]
on 37(6):634]
history related to the sigh jRendell-Bakerl
950
radiotherapy.
Brandsburg]
37(12): 1409 re-
al]
(TYRS) Features
discussion)
Abnormal radiograph
letter
sigh breath improve oxygenation in the intubated pa-
tient receiving
Skill"
reports, including radiographs, with questions, answers,
37(8):952
Your Radiologic
"Test
Sigh Breaths
Does a
& classificatiim of modes of ventilator
& Chatbum| 37(9): 1026 conference
proceedings
unit scav-
enging system for ribavirin administration [Kacinarek
Ma-
Maclntyre]
37
Steinberg]
(8):877 device evaluation
"Bye sigh [Branson]
1
the essentials of mechanical ven-
Branson, Brougher, Chatbum, East.
operation [Branson
Evaluation of a double-enclosure. double-\
Kratohvil]
J
of ribavirin to non-
for delivery
ventilated pediatric patients [Cefaratt
37(9):
Equation
to
37(I1):I273I
Safety of Personnel
& Symposium
Classification of mechanical ventilators IChalburn]
&
):37 device evaluation
I
37(12):1424 classic reprints
Terminology
enging system for ribavirin administration [Kacmarck
j
star-
manner
IVoceedings
(8):877 (Icvicf evaliiaiion
Kratohvil
e care, after the
Symposium Proceedings: See Conference
Evaluation of a double-enclosure, double-vacuum unit scav-
An
and other forms of intensi\
vation,
Ribavirin
An
37 (1992)
ings
"92 Vol 37
No
12
1469
Variations in tidal volume with portable transport ventilators
[McGough
37(31:233 research ankle Icorrection
CI all
on 37(5):431l
placement [Day
37(7):695 confer-
inhaled nitric oxide gas [Miller
ence proceedings
Hyperbaric treatment of respiratory
37( 2 ): 147
monitoring of
In-vivo
37(2): 165
piro!
37(2): 154
& CO:
arterial
removal
Vocal Cord Dysfunction
blood gases
.Asthma
& pH
Rutherford]
&
37
[Pierson]
kinetic
bed therapy [Hess
1470
methods through
endotracheal tube: a bench study
37(
1 1 ): 1
\ocal
the
233
&
Beam]
37(10»:1187
is
when
cord dysfunction syndrome:
hysterical ]\Vanger c^
Beam]
37(10i:I187
ork of Breathing
able ]Sassoon]
delivery
[Wanger
et
Tubes. Kndotracheal
wood]
&
wheezing
\\
Comparison of nebulizer
when
cord dysfunction syndrome:
hysterical
PFT Corner
is
Wheezing
.Asthma
ICU?
vocal
the
PFT Comer
&
in the
&
wheezing
(Sha-
natal
the role of
37(10):1175
37(5):473 video review
IVOX
de\ice;
al]
Miller]
Chairobics Video Exercise Program (Spessert) JDunlevyl
(2):
&
Video Reviews
emergencies [Weav-
New
37(2):
[Hast]
]
161 researcli article
revien- article
Computers in the ICU; panacea or plague?
Durbin
1
Pulmonary vascular smooth-muscle regulation:
Airway management options [Reines]
I
37( 10):
et al]
Va.sodilators
Trauma Care
er]
37 (1992)
researcli ariicle
]Rau
a neo-
&
Har-
What derived
ical
&
function: the trigger vari-
ventilation? ]Marim|
mechan-
ceedings
"92 Vol 37
No
12
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No
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PRIMEDICA
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NEW YORK
NEW YORK
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RESPIRATORY THERAPISTS
Si.
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Responsibilities include
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CONNECTICUT
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For immcdiaic consideration, please contact:
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r^P
CKiidrcn't
^^
lH^l>'
Our progressive
Department
features stalc-of -the art lechnology and the opportunity for t'ulfilling. dynamic interaction with our
staff of ten pulmonary physicians. As a member
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monitor continuous ventilatory support to our
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offering our staff of forty respiratory care practitioners the opportunity to work in hyperbaric
medicine, participate in sleep disturbance studies, and assist witli bronchoscopies
EVENING SinFT SUPERVISOR
"'"l-*
.,
,.^,
,..„,.„
FLORIDA
THERAPISTS
Wo have
positions
on evening and
night shifts and limited opportunities
for those
who wish
to
work
provide care in accordance with
physician orders and professional
will
practices in
all clinical
hospital Candidates
ratory care.
for
CRTT
credentials,
Maryland
R
M
E
THE
E
F
B
.\1
E
E
L
E
R
I
N
G
all shifts
on weekends as-needed. Associates
or
areas of the
must have RRT
and application
We're All Children's Hospital.
Please send statement of qualifica-
Tampa
Bay's
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Here, you'll find a slate-of-lhe-art
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We
State liccasure.
DEVELOPMENT COORDINATOR
BS
**" CliilJ.™. Unt, Nc.tfotk.VA23»-
RESPIRATORY
RRT, with previous supervisory experience, and
knowledge in adult, pediatric and neonatal respi-
ST,\FF
Human Resouita
Hoipit^ of
^_^j
to children's health care
cnuTcntJy have these
opportimities availaiilc
Registered Respirator)- Therapist
Respiratory Care, RRT, experience with
Didactic and Clinical teaching.
tions or telephone, (301) 905-1105, to
Certified Respirator)' Therapist
request our application between 8,im
Polysomnographic Technologist
Our
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staff of skilled professional respiratory care
practitioners are valued members of a team of
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Norwalk Hospital, your opinions are not i^nly
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RT's are encouraged to apply by submitting a
resume or by calling Mr JiKcph Pereira. Manger
of Employment. Norwalk Hospital, Maple Street.
highly
CT 06856. Wc are an c<]ual opportunity
employer. M/F/H/V. Principals only.
Norwalk,
K
Norwalk Hospital
The Center For Advanced Medicine
C)ur Respiratcin rherajiy
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Dqiartment
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Children^ hospital^
RESPIRATORY CARE • December '92 VOL
37
No
12
FLORIDA
GEORGIA
FLORIDA
Atlanta Georgia
Home of the
Join
one of the highly respected
names
Shands
RESPIRATORY THERAPIST
Department
health care
in
Hospital of
ol Reipiralory
a
is
in
548-bed teacfiing
facility at tfie
University of Florida witfi a 20-bed tertiary level
University's Division of Pediatric Surgery
in
NICU
and Neonatology, seeks the
followiing
will
(C.R.T.T, or
We
provnde an excellent opportunity with-
all
nursery The qualified can-
skills,
Crawford Long Hospital, o 583*bed leoching
dynamic Individual experienced
components
hospital
lo-
cated in Atlanta, offers starling salary commensurate
ECMO
in
to;
with experience
Coordinate
III
be a credentioled Respirotory Therapist
R.R.T] and possess solid decision moking cap-
and good communication
abilities
ECMO COORDINATOR
Exciting position for
Crawford Long
a diverse respiratory core department with 5 intensive
didote
professional to join the progressive health care team:
at
University seeks experienced respiro-
care units including o Level
conjunction with the
Therapy
Emory
tory therapist
Hospital, a leading referral center for the soutfieastern United States,
and high nsk pennatal center The Respiratory Care Department,
1996 Olympics
of a growing neonatal Extra Corporeal
Membrane
ond an outstanding
package with
benefit
continuing education benefits For more information con-
Oxygenation Program
tact
Evelyn Roper
(I
[800)
843-5759) or send resume
to
Provide clinical supervision and direct patient care
Crawford Long Hospital
Develop and implement staff training and educational programs
Contnbute to quality assurance programs and participate
in
research
of
practice
in Florida,
with a
minimum
of two years' neonatal
year of demonstrated supervisory/program
Bachelor's degree
The
ECMO team
is
in
ECMO
experience and one
management expenence.
Emory
University
550 Peachiree Screei
Atlanta, GA 30365
Ann: Personnel
FOE
The successful candidate must be credentialed as RN or RRT. or CCP, and licensed to
Position requires
nursing or other clinical specialty.
composed
of
27 RNs and RRTs and provides
approximately 20 patients each year. Future plans
and pediatric support. Located
in
for
the
ECMO
quality care to
program include cardiac
north central Florida and readily accessible to
Shands Hospital sets a standard
and benefits programs. Submit resume or call:
Florida's amenities.
for highly
all
OHIO
of
competitive compensation
^ — w '^f^^^^^^^^^^^^'^^'^w ^ w
Employment Coordinator
Shands Hospital at the University of Florida
PC Box 100337. Gainesville. FL 32610-0337
Joel Young,
904/39S<>441 or 800/325^367
EOE
'^ '^
^^^r™*^"^^""^
CHARGE
THERAPIST
^
SHANDS HOSPITAL
bed
at the University of Florida
Medical Center, a 417
located in Noi thwest
has an opportunity for a
Rita's
St.
facility
Ohio,
i
night
shift
be
Therapist. This position will
REGISTERED
^
RESPIRATORY THERAPISTS
A
I
Mariners Hospital,
opening for a
Some
Call It Paradise,
Other Call It Home
time
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ence
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RRT
with a Flori-
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clinical
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I
must be
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RRT's
,.
AAAA approved program
years
clinical
an
of
with 3
experience. Neonatal
and supervisory ex-
' resuscitation
perience is preferred.
»'
''
»'
St.
Rita's offers
'
commensuand an excel-
salary
''
rale with experience
lent flexible benefits
package.
To apply, send resume
Employment
resume or contact:
to:
Specialist
Personnel Director
MARINERS
HOSPITAL
Memorial
50 High Point Road
000 36th
Vero
mance
i-un-Boni
Send
including $1500 Sign-On-Bonus.
Indian
River
Street
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"°^
tivities,
,.
competitive with the South Florida area
Hospital
1
re-
sponsible for the direct supervision yl
and coordination of night shift ac-
>;
'*
We
^
Rorida Keys has an
da license. Must be able to function inde-
but Vero Beach can be both 'o you
when you join IfWvMH, a 347-bed acute
care Faciliry in beautiful Vero Beach,
-^
*
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a
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Tavemier,
^
^
RESPIRATORY CARE • December
'92
(305) 852-9222, Ext. 243
DRl'G FREE/SMOKE FREE
VOL 37 No
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WORKPLACE
Medical Center
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Lima, Ohio 45801
St. Rita's
FL 33070
1
i
(11PM-7AM) Charge
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RESPIRATORY CARE
I
Development
and
Growth
Pulmonarv Services Department
the
of
is
REGISTERED
,
offering
The University of Texas
Medical Branch at Galveston
<
and
full
CLINICAL
SPECIALISTS
J
part time job opportunities for
professionally motivated registered and
new
TEXAS
INDIANA
OHIO
POLySOMNOGRAPHIC
>
has the following opporiuni-
'
ties available
'
registtv-eligible licensed ttietapists^
The Pulmonary Services Department
a progressive and
assertive
TECHNOLOGIST
offers
to
Our career-minded
Respiratory Care,
Respiratory Therapists are integral members of the health care team with respon-
for
At MidWest Medical Center
currently
that include patient assessments
sibilities
determination of appropriateness of
all aspects of airway
Ic ion
assertive
mechanical
venti-
We
sure to diagnostics inclusive of metabolic
Intensive
in
Care
the
a Resistered
preferred
BENEFITS
• Premium Sharing • Teacher
Retirement System • Redirection Accounts (ask us about
these) • Tuition Reimbursement • Three weeks vacation + holidays • NO
are seeking a Registered
Polysomnographic Technologist
wtio IS also a Respiratory Care
Practitioner Must be experienced
new programs in hyperbaric
medicine and sleep disorder testing plus
monitoring,
program (Mobile
Requirements include RRT
and 5 years ICU experience
A Bachelor's degree, CPFT.
and supervisory experience
are"_
Center,
management and weaning, expo-
opportunities to participate
seekms
we
Polysomnosraphic Technolo3ist to
work primarily day shift in our
accredited Sleep/Wake Disorders
respiratory care,
monagement,
12-HOUR DAY/
NIGHT POSITIONS
SLEEP/WAKE
DISORDERS CENTER
^
approach
'
iifestar
in
Unit)
the use and maintenance of
equipment
communication and correspondence skills are necessary
Knowledge of computerized data
highfy technical sleep
We
are
71
We
and
a competitive wage and
bcated
offer
5 minutes from
1-77
Excellent
I-
package, including tuition
reimbursement for part and full time
employees, paid A. ARC, membership
flexible benefit
systems
Respiratory
write to
necessary
commensurate with experience We offer a comprehensive
benefit package including medical
and dental insurance and tuition
Care Seminar provides
free CRCE credit for staff. Interested candidates should call (2)6) 363-2544 and/or
submit a resume
For further information, call
(409) 772-8189 Collect, or
THE UNIVERSITY
OF TEXAS IWEDICAL
BRANCH, E-90, Galveston.
Texas 77555-0890, UTMB
IS an equal opportunity/affirmative action employer
;
reimbursement.
For consideration, please send
to:.
Pulmonary Care
Services.
Salary
dues, paid licensure fees, free parl<ing and
uniforms. Attendance of out annual SVCH
& HC
is
STATE INCOME TAX
.
'
m/t/dA/ UTMB IS a smoke-free,
drug-free workplace UTMB
employs only individuals
resume to Jeff Moliere, Director,
Pulmonary Services, MidWest
Medical Center, 3232 North
eligible to
work
in
the U.S.
Meridian Street, Indianapolis, IN
call (317) 927-2336 or
(800) 962-5819. An Equal
46208. Or
Mrs, Pa\
Human
SImmerman
Resources Department
Saint Vincent Charity
Hospital
&
Healtti
Center
2351 East 22nd street
Cleveland. OH 441 15
Equal Oppofturntv Employ»r M/F,'H
^-
t
toll free
Opportunity Employer
KENTUCKY
t^^-
v
^
^
^
^
MIDWEST
'
Alluint Allied Health Services, a leading;
t
Respiratory Care in the
area Is currently needing
RCP's, CRTT's, or RRT's u> staff long term
provider
.•i»
•« «-
.<i»
,•-
-
»ii'
•.•
^
»^'
»•
Lciuisville.
(if
KV
care facilities in (he metro area
range of benefits,
Alliant offers a full
including medical, paid denial and
insurance.
We
also
offer
salaries along with a flexible
life
competitive
paid time off
system.
If
interested please respond with
resume
to:
EARN CONTINUING
RESPIRATORY CARE
EDUCATION CREDIT
WITH AARC
VIDEOCONFERENCES
CALLai4)830-0061
D
Allin
Alliant Allied Health
224
E.
Broadway
KY 40202
Louisville,
or call (502)629-8292
or (502) 629-8294
Alliant
licallh Svslciii
RESPIRA TORY CARE • December '92 VOL
37
No
12
—
,
Calendar
of Events
Nol-for-profii organizations arc offered a free advertisement of up to eight lines to appear, on a space-available basis, in Calendar of
Events
in
RtSPlRATORY Carh Ads
meetings ure priced
for other
at S5.5()
per line and require an insertion order. Deadline
is
the
20th of the month two months preceding the month in which you wish the ad to run. Submit copy and insertion orders to Calendar
RESPIRATORY CARE. 1030 Abies Lane.
of Events.
1
Dallas
TX
75229-4593.
AARC & AFFILIATES
Lyon Cedcx
,
04. France. Call (33) 78 39 08 43. fax (33)
78 29 98 94.
December 12-15
presents
in
AARC
San Antonio, Texas. The
38th Annual C(in\eniion and Exhibition
its
March
Antonio Con\eniion Center. The e\ent features
the -San
four days of meetings and lectures covering
respiratory care.
The Exhibit
300 companies exhibiting
in
all
Hall showcases
Annual Big
It
Pulmonary Ski Conference. Contact
,Sk\
American Lung
facets of
more than
o\er .500 booths.
24-27. 1993 In Helena, Montana. The AmerLung Association of Montana presents the Twelfth
ican
at
MT
Ave. Helena
prom-
.'\ssociation
59601. (406) 442-6556.
11030
Department.
ventions
AARC
Abies
Ln.
Con-
Dallas
Topics presented include molecular biology
ease, cells involved in asthma,
January 27-29
Clackamas. Oregon. The OSRC
Monarch
in
asthma.
.Annual Education Conference at the
its
February 16-19
in
Reno, Nevada. The American Lung
Care present the 12th Annual High Sierra
Care Conference
issues.
AARC
VHA
PO Box 7056. Reno
AM-3 PM PST).
Nevada.
(9
NV
currently
being
accepted.
For
PA
19103. (800) 223-3855.
Videoconference Dates
AARC
Videoconference. The AARC, in conjunction with
Network, presents "Application of Positive Airway Pressure without Intubation," one in series of live satellite videoconferences
titled "Professor's Rounds in Respiratory Care." Featured presenters
are Robert M Kacmarek PhD RRT and David J Pierson MD. Site registration for entire staff is S275 for AARC members. Call (214) 830-0061
March 30
critical care
Contact Donna Turner. American Lung Associa-
829-5864
lung dis-
Crit-
the Peppermill Hotel Casino.
at
Topics include adult, pediatric, and neonatal
are
Suite 946, Philadelphia
Association of Nevada and The Nevada Society for Respiratory
Abstracts
in
and house dust mite and
more information, contact Gil-Kenes. 1617 JFK Blvd.
Motor Hotel. Featured speakers include Neil Maclntyre
MD. John Luce MD. Ed Abraham MD. and Sam Giordano MBA RRT. Contact Mike Taylor at (503) 2804796 for further information.
tion of
(406)
October 24-29, 1993. in Jerusalem, Israel. The XlVih
World Congress of Asihmalogy convenes in Jerusalem.
TX
75229-4593. (214) 24.3-2272, fax (214) 484-2720.
ical
FAX:
442-2346.
be ;Fantastico! For details, refer to the Conven-
ises to
tion information in this issue or contact the
hosts
the
of Montana. 825 Helena
89510. (702)
Satellite
AARC
Videoconference. The AARC. in coniunction with VHA
Network, presents "Therapist-Driven Protocols," one in series
of live satellite videoconferences titled "Professors Rounds in Respiratory Care" Featured presenters are George G Burton MD and Sam
P Giordano MBA RRT. Site registration for entire staff is S275 for AARC
members Call (214) 830-0061
r/lay
13
Satellite
OTHER MEETINGS
January
8-10, 1993 in Naples, Florida.
Association of
EMS
Physicians holds
in
EMS
The National
education
and
Videoconference. The AARC, in conjunction with VHA
Network, presents "Monitoring Oxygenation in the Cntically III
Patient," one in series of live satellite videoconferences titled "Professors Rounds in Respiratory Care." Featured presenters are Leonard
D Hudson MD and David J Pierson MD. Site registration for entire staff
controversies
in
Satellite
chalpre-
IS
hospital therapeutics. For further information, contact
Kathleen Stage-Kern.
NAEMSP
Executive Director,
S275
with
1993 in Lyon, France. The Journees
VHA
national Conference on
Home
(SRMAR)
93,
is
(French/English)
December
Grande Rue de
RESPIRATORY CARE •
Why,
and
Videoconference. The AARC. in conjunction
Network, presents "Pulmonary Function Testing
What'"
one
in
senes
of
live
satellite
video-
titled
Mechanical Ventilation.
March 30
VHA
cation sessions, and poster presentations and exhibits.
Deadline for abstracts
830-0061
"Professors Rounds in Respiratory Care," Featured
presenters are Charles G Irvin PhD and David J Pierson MD, Site registration for entire staff is S275 for AARC members. Call (214) 830-0061.
scientific sessions, practical edu-
Simultaneous translation
Call (214)
AARC
Satellite
conferences
Inter-
nationales de Ventilation a Domicile presents the Inter-
The meeting includes
AARC members.
September 30
When,
3-5.
for
at
(412)578-3222.
March
AARC
July 29
Winter Meet-
The meeting addresses
ing at the Ritz Carlton.
lenges
its
la
is
JIVD
Croix-Rousse, 69317
DECEMBER
92 Vol 37
No
Videoconference. The AARC. in conjunction with
Network, presents "Unconventional Methods for Adult
Oxygenation and Ventilation Support," one in series of live satellite videoconferences titled "Professor's Rounds in Respiratory Care," Featured presenters are James K Stoller MD and David J Pierson MD, Site
registration for entire staff is $275 for AARC members. Call (214) 830-
offered.
1992. Write:
AARC
Satellite
0061,
12
1471
—
—
)
Notices of compeiiuons. scholarships, fellowships, examination dates,
new
educational programs, and the Like will be listed here free of
charge. Items for the Notices section must reach the Journal 60 days before the desired
issue. February
Notices
1
I
for the April issue, etc). Include
1030 Abies Lane. Dallas
TX
month of publication (January
pertincni informaiiun and mail notices to
all
1
for the
RESP1R.MORY CARE Notices
March
Dept.
75229-4593.
The American Respiratory Care Foundation .Announces
Literary Awards for 1992
1992
.\llen
&
Hanburys
.\
OPEy Forlm
Best Papers Submitted by 1992
wards
Never Published as
Best Original Paper Acceplecl Jor Fiiblu uliaii Jriim
through October 1992 lS20()0)
Evaluation of
MDI
Spacers and Adapters: Their Eftecl on Ihe Res-
pirable Voluine of Medication
—
Jerrj'
Participants Wlu>
Have
Author ($500 each)
Deiemher 1991
(
An
First
Eben. Alexander B Adams,
&
Tracheostomy
1
Discontinuation:
Impact of Tracheostomy
Tube
Selection on Airways Resistance during Tracheostomy Occlusion
Barry Beard and Frank
J
Monaco
Beth Green-Eide (Respir Care 1992;37:862-868)
5 Best Papers Based on any Open Forum presentation ($1000 each)
(2)
A New
Mathematical Method for Predicting the Expiratory Time
Necessary To Achieve a Desired
Laboratory and Clinical Evaluation of the Impact Uni-Vent 750
Roben S Campbell. Kenneth Davis Jr. Daniel J
Portable Ventilator
(1)
—
Johnson.
(2)
&
John
R Rimes
Transcutaneous Pco: and End-Tidal Pco2 in Ventilated Adults
Blanchette
John Dziodzio (Respir Care 1992:37:240-248)
Radiometer
&
The Effect of Respirator.- Care Department Management of a
Blood Gas Analyzer on the Appropriateness of Arterial Blood Gas
Darin. & Charles G Durbin
Utilization
Kathryn E Beasley. James
Jr (Respir Care 1992:37:343-347)
(3)
—
The
tion Received from Nasal Cannulas
Tyl( Respir Care 1992:37:357-3601
of a
.\
Test Your Radiologic Skill
sistent
Cough—Gary
wards for Best Features
—
.Acute Exacerbation of
Schroeder (Respir Care 1991
Asthma » ith
:.^6:
Per-
1428- 14.301
M
Oxygen ConcentraL Dunlevy & Sylvia E
Effect of Oral versus Nasal Breathing on
(5) Effect
PEEP Level and Total AlveR Jones. Paul B Blanch, and
Intrinsic
— Michael
David Porembka (Respir Care 1992:37:29-361
Tim
(4)
olar End-Expiratory Pressure
New
—
Crystal
Nebulizer Position on .Aerosol Delivery during
Mechanical Ventilation:
Care 1992;37:423-431)
A Bench
Study
— William W Quinn
(Respir
PFT Comer #43
Kenneth J McKay
—Can't
&
Breathe
Robert
D
or
Won't Breathe Revisited
Schreiner (Respir Care I991;36:1431-
14.341
Test
'^'iiur
Radiologic Skill
ing-Tube Placement
—Joan
— Radiographic
Kohr
&
Findings following Feed-
Frederick
W
Clevenger (Respir
Care 1992:37:198-202)
THE NATION.AL BOARD FOR RESPIRATORY CARE— 1992
Examination and Fee Schedule
RE/PIR/VTORy QiRE
Manuscript-Preparation Instructions for
Authors and Typists
General Information
advisable to consult the Editor before writing or suhinitting
such a paper.
Rkspiratorv Cark welconics
respirator\' care
Perfection
and prepared according
Editorial:
lo these Instructions.
Computer
A
paper drawing attention to a pertinent concern;
ma\ present an opposing opinion,
not required, but efforts in that direction are
is
appreciated.
original nuinuscripts related to
problem
diskette submissions are encouraged
Letter:
and may reduce processing and review time. See requirements
into focus.
A
signed communication about prior publications
this journal, or
in
these Instructions.
tions
Editorial consultation
available by telephone or letter
is
any stage of planning or writing. Specific guidance
(in
may
at
a case report, an evaluation, a re\ lew. overview, or update or a
cussion.
book re\iew;
PFT
of journal
is
name
TX
and for
in-
model manuscript,
list
units;
or
for clarity
and
case report in\()l\ing
questions,
answers, dis-
pul-
pulmonary medicine radiography and including one
more radiographs, may involve imaging techniques other
Review of Book. Film. Tape, or Software:
ical re\'iew
authors receive galleys to proofread
style;
— with
than conventional chest radiography.
a dou-
manuscnpts may be copyedited
ble-blind manner. .Accepted
.A bricl. instructi\e
blood data
in\()l\ing
7.i229-459.\ or call (214) 243-2272.
in
care
Test ^'our Radiologic Skill: Like Blood Gas Comer, but
Respiratory Care, 11030 Abies Lane,
Manuscripts are reviewed by authoritati\e referees
title,
Corner: Like Blood Gas Corner, but invohing
monary function tests.
abbreviations, and copy of these Instructions
available. Write to
Dallas
and from SI
typists, a
in
illustra-
be included. Type double-spaced, supply a
Blood Gas Corner;
pnnted
respiratory
for con\erting to
about other pertinent topics. Tables and
mark "For publication."
form) will be provided on request for writing a research paper,
house manuscript review. For
it
clarify a position, or bring a
A
balanced,
crit-
of a recent release.
before publication. Published papers are copyrighted by the
publisher and
may
Considerations
not be published elsewhere without per-
mission.
Prior and Duplicate Publication:
Publication Categories
Research
A
.\rticle:
report of an
In
investigation (a
original
ork that has been piib-
may
consider such material,
to publish is
given by the author and
special instances, the Editor
provided that permission
study).
\\
accepted elsewhere usually should not be submitted.
lishi'd or
other publisher. Please consult the Editor before submitting
Evaluation of Device/Method/Technique:
evaluation of an old or ne^\
description and
.A
such work.
device, method, technique, or
modification.
Case Report:
was treated in
.Authorship: All persons listed as authors should have par-
A
a
report of a clinical case that
new way. or
is
is
uncommon,
exceptionally instructive. All
authors must have been associated with the case.
managing physician must
ticipated in the reported
or
A
script; all
case-
all
either be an author or furnish a letter
Article:
A
comprehensive,
critical
review of the
summarv of a pertinent
least 40 published research
A
is
has been the subject of
articles.
not justified solely on the basis of solicitation of funding,
collection or analysis of data, provision of advice, or similar
services. Persons performing such ancillary services
recognized
not
A
critical
A
lo merit a
Review
points of view, or editorial are asked to disclose on the
report of subsequent developments in a topic that
View Paper: A paper
stantiated opinions
on
Special Article:
A
going categories
may
may be
.Acknow ledgmenls section.
Conflict of Interest: Authors of research or e\ aluation papers,
.Article.
script's title
has been critically reviewed in this journal or elsewhere.
Point of
in the
review of a pertinent topic about which
enough has been published
Update:
paper with collective (corporate) authorship must
lit-
topic that
Overview:
manu-
specify the key persons responsible for the article. Authorship
erature and state-of-the-art
at
the shaping of the
should be able to publicly discuss and defend the paper's
content.
approving the manuscript.
Review
work and
should have proofread the submitted manuscript: and
a pertinent
whose product
figures in the submitted manuscript or with the manufacturer
and controversial
or distributor of a competing product. (Such arrangements will
DECEMBER
topic.
one of the
be acceptable as a Special
•
with a manufacturer or distributor
expressing personal but sub-
pertinent paper not fitting
RESPIRATORY CARE
may have
manu-
page any liaison or financial arrangement they
not disqualify a paper from consideration and will not be dis-
fore-
.Article.
'92 Vol 37
It
closed to reviewers.)
is
No
12
147.3
INSTRICTIONS FOR Al'THORS & T^'PISTS
Details about Sections:
Preparation or the Manuscript
ihcsc Inslaictions. authors and
Note:
in addiliim
typists
can benefit from inspeelinj; papers recently published
to rcailing
Respiratory Cark and using them
in
Title:
as
Make
the paper's
General Specifications
titles,
margins of
11 in.) with
mm
bond paper. 216 x 279
at least
mm (1
25
on
in.)
all
(8 in.
x
sides of the
page. Double-space the entire manuscript (three lines per vertical
Number
inch).
paragraphs
.S
pages
all
spaces.
Do
headings, or other words.
identification
in
upper-right corners. Indent
not justify.
Do
Do
not underline
not type authors' names
anywhere except on the
title
t)r
titles,
other
page. Repeat
title
only (no authors) on the abstract page. Begin each of the fol-
lowing on a new page:
sources
list,
appendix,
page, abstract, text,
title
acknowledgments, reference
list
each table, each
and
full
letters,
names of
all
professional
name, address (include
institutional affiliations: (c)
room number for courier service), telephone
number, and Fax number of corresponding author: (d) name
building and/or
and address for
reprint requests: (e) sources of support such as
and supplies;
grants, equipment, drugs,
and date of any meeting
tion, location,
the paper has
(f)
at
name of
which
organiza-
a version of
been presented; (g) disclosure of financial
rela-
tions of any author with
commercial products or
nected with the paper
or with competing products or inter-
ests; (h)
name,
any: and
(i)
—
and
title,
disclaimers,
of
affiliation
if
interests con-
statistical consultant, if
any.
of figure legends. Use standard English. Employ
the first person and active voice (eg.
lly") rather than the 'obscure person"
is
list,
product-
of the paper: (b)
title
with academic and credential
authors,
side ot white
and yet as short
as specific, clear,
as models.
Title Page: List (a)
Type on one
title
you can.
believed that pigs can fly")
"We
believe that pigs can
and passive voice
— because the
latter
(eg. "It
obscures the
Abstract: (required only for research articles and evaluations
of devices/ methods/techniques). The abstract must summarize
what was studied; why and how
it
was
studied; the results,
including important data and statistical significance: and con-
identity of the responsible party (the believer).
clusions draw n from the results. All infomiation in the abstract
Headings
main
in Text: Ceniei
and type ihem
in capital
section headings on the page
and small
letters leg.
Introduction.
Methods. Results. Discussion). Begin subheadings
margin and type them
Equipment.
in capital
and small
Statistical Analysis).
Do
the left
at
letters (eg. Patients.
not underline or darken
must also appear
the abstract.
not cite references in
for
colons:
BACK-
.methods, results. CONCIA SIONS. The
a
include
paper evaluating
following
the
device/method/icchmque
a
headings:
B.ACKCIROl'N'D.
DESCRIPTION OF DEVICE, EVALUATION METHODS. EVALl ATION RESULTS. CONCLUSIONS. The
Manuscript Structure
Most kinds of papers have standard parts in a standard order.
as shown hereafter. However, papers can vary indi\iduall).
all
Do
placed within the abstract and follov\ed b\
(;R()LN1),
should
and not
itself.
abstract for a research article should include
the following headings (in all capital letters), appropriately
abstract
section headings or subheadings.
paper
in the
The
papers will ha\e
all
the
pans
abstract should be
case
lisicil
one paragraph, not indented, and not
all
longer than 250 words. Center
letters,
title,
typed
in capital
and lower
over abstract.
here.
Introduction: Briefl) describe the background of the work or
Research Article:
ods.
Discussion.
Results.
Introduction.
Title Page. Abstract.
Conclusions.
Product
Meth-
Sources,
Acknowledgments. References. Tables, Appendices, Figure
Legends.
the paper. Cite oiils pertinent references,
subject extensively.
the
work reported
Do
in
and do not
re\ iew the
not include data or conclusions from
your paper. In a research paper, end
this
section with a clear statement of the research question(s) or
hypolhesis(es).
Evaluation of I)e>ice/Method/Techniquo:
stract. Inlroduction.
fule Page. .Ab-
Description of Device/Methodn"echnique,
Evaluation Methods. Evaluation Results, Discussion. Conclusions,
Product
Sources,
Acknowledgments,
References,
Tables. Appendices. Figure Legends.
Case Report:
Methods Section
(in a
ol patients, controls,
research paper): Describe the selection
or laboratory animals. Give details about
randomization. Describe methods for blinding of observations.
Give numbers of observations. Report losses to observation
(eg. dropouts or disqualified subjects), listing numbers of sub-
Title Page. Introduction.
Case Summary. Dis-
jects or data sets lost,
w hen
lost,
and why
lost.
Describe meth-
cussion. Rctercnces, Tables. Figure Legends.
ods
Review
work. Give references to established methods; provide references and brief descriptions for methods that have been pub-
.\rticle:
litle
Page. Table of Contents. Introduction.
Reviev\ of the Literature. State-of-thc-Art
Summary. Acknowl-
edgments. References. Tables, appendices, and
may
be included. Other formats
may be
illu'-lralions
suitable.
Point of View Paper: Title Page. Text. References. Tables
and
illustrations
1474
may be
included.
in sufficient detail to
lished but are not well
allow other workers to replicate your
known: describe new or
substantiallv
modified methods, give reasons for using them, and evaluate
their limitations. Report calibration of
Drugs
—
Identifv precisely
»ill
measuring devices.
drugs and chemicals used, giving
generic names, doses, and routes of administration.
If
desired.
'92 Vol 37
No
12
INSTRUCTIONS FOR AUTHORS & TYPISTS
brand names
may be
Commereial
given
Produets
—
number
(including model
in
parentheses after generic names.
applicable) the
if
name.
tioned, giving the manufacturer's
try
—
parentheses
in
mentioned, do not
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are
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References
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in
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cussion section.
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Do
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articles
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to
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more than
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cases but are essential
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citing
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rial
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in
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It
may be
do not repeat
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useful to restate the research
in detail the
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communications
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work. Link the conclusions with the goals of your work, but
as "unpublished observations."
avoid unqualified statements and conclusions not completely
Citing References in
supported by your data. Avoid claiming priority and alluding
to
work
that has not
Reference
been completed. State new hypotheses
cussion section or
in a separate
—
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Conclusions
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of a reference, use
when warranted, but clearly label them as such. Recommendations, when appropriate, may be included. Provide a clear
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number
if
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After the
you
cite
first
it
is
citation
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Cite references by superscript, full-size, arable
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its
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Reference
in the paper.
numerals.
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tlie
is
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•
if
Avoid
citing references at the
and
states or countries
tence;
after the text.
For each kind of
phrase or sentence.
cities,
DECEMBER
'92 Vol 37
No
12
instead, cite
them
at
the
end of a phrase or sen-
pertinent places within
the
1475
:
.
Listing References: Starling on a
the references in numerical order.
new page after the text, list
Do not employ "op cit" or
Tvpe references double-spaced, using
"ibid."
examples given hereafter.
the styles of the
Index Medicus.
names of
torial,
or
item's
Do
letter, identify
it
Provide both
title.
not leave spaces
bers.
If
less well
known
the cited item
or nonindexed
and
first
last
with
nebulised
Re\ersible bron-
pentamidine
(letter).
Lancet 1988:2:905.
Paper accepted but not
yet published:
an abstract, edi-
is
as such in parentheses following the
9.
Hess D.
New
therapies for asthma. Respir Care (year, in
press).
complete page numbers.
between dates and volume and page num-
Obtain authors" names,
books, not from other
dates,
and
Personal author book: (Specific pages should be cited when-
the original cited articles
and
ever possible.)
article
volume and page numbers from
and book
articles" reference lists,
Examples of correct reference
inaccurate.
in
Smith DE. Herd D. Gazzard EG.
choconslriction
words and
first
proper names. Abbreviate journal names as
Spell out in full the
8.
List all authors (do not use "et al").
In titles of articles and books, capitalize only
journals and periodicals
Letter in journal:
titles,
which often are
follow (these
listings
are single-spaced here but must be double-spaced in a
10.
Nunn
JF.
Applied respiratory physiology.
New
York:
.Appleton-Century Crofts. 1969.
manu-
script).
Note:
To
specify pages in a book, place a colon after the year
Article in a journal carrying pagination throughout
and then
volume:
1969:85-95 (series of contiguous pages), 1969:85,95 (separ-
list
Examples:
page(s).
the
1969:85 (one page).
ated pages).
1
Shepherd KE, Johnson DE. Bronchodilator
testing: an
analysis of paradoxical responses. Respir Care
1988:
33:667-671.
Article in publication that
numbers every
Corporate author book: (Specific pages should be
whcncscr possible.)
issue beginning
11.
with Page
2.
I
.American Medical .Association Department of Drugs.
AMA drug evaluations.
Bunch D. Establishing a national database
AARC Times 1991:L'i(Mar):6l.62.64.
for
cited
3id ed. Littleton
CO: Publishing
Sciences Group. 1977.
home
care.
Book with
Corporate author journal
3.
article:
establishing
units
for Respiratory Care. Criteria for
12.
for
editor(s): (Specific pages should be cited
when-
ever possible.)
ventilator-dependent
chronic
Guenter CA. Welch
Philadelphia:
JB
MH.
editors.
Pulmonary medicine.
Lippincott. 1977.
patients in hospitals. Respir Care 1988:33: 1044-1046.
Article in journal supplement: (Journals differ
in
then meth-
ods of numbering and identifying supplements. Supply suf-
Chapter
ficient information lo allow retrieval.)
13.
4.
Reynolds H\'. Idiopathic
pulmonary
interstitial
fibrosis.
Chest 1986:89(3. Suppl): 139s- 143s.
Abstract
in journal:
(.Abstracts
are
not strong references.
Abstracts more than 3 years old should not be cited.
cited, abstracts
book: (Specific pages should be cited whenever
in
possible.)
AK. Acute respiratory failure. In: Guenter CA.
Welch MH. editors. Pulmonary medicine. Phildelphia:
JB Lippincott. 1977:171-223.
Pierce
Newspaper
article:
When
should be identified as such.)
14.
Rensberger B. Specter B.
natural process.
5.
Stevens DP. Scavenging riba\irin from an oxygen hood
to
reduce environmental exposure
(abstract).
A:2(Col
15.
Does
5).
Dictionary or similar reference:
Editorial in journal:
Rochester DF.
be destroyed by
Respir
Care 1990:35:1087-1088.
6.
CFCs may
The Washington Post 1988 Aug 7:Sect
respiratory
muscle
fatigue or incipient fatigue'.' (editorial).
Am
rest
Pneumohemopericardium. Dorland"s
dictionary. 26th ed. Philadelphia:
relieve
medical
illustrated
WB
Saunders. 1981:
1038.
Rev Respir
Dis 1988;138:516-517.
Tables: Use tables
show
Editorial with no author given:
7.
High frequency
1:706-708.
1476
ventilation
(editorial).
Lancet
1991:
trends. Start
struct a table with
to display information,
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data, or
Do
not con-
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fewer than four lines (rows) of data (instead,
put the data in the text).
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Avoid more than 8 columns
DECEMBER
"92 Vol 37
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12
Number
tables as Table
order of their
descriptive
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Table
1,
mention
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2. etc.
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To key
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Give temperatures
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mmHg). pH
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the
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must be of professional qual-
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1988) and 1989;34:I45 (Feb 1989).
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ues—for example. "PEEP. 10 cm H:0 [0.981 kPa]." For con-
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matter that would clutter the
(mm
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"92 Vol 37
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MONITOR INTERFACE.
to
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Space-
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MDI AEROSOL CHAMBER. The
design of the ACE MDI aerosol
chamber allow s
tilator
it
to
be used
ven-
in a
with an endotracheal
circuit,
airway, manual resuscitator. or incen-
admin-
tive spirometer, or for routine
A
istration.
plastic
crystal
advantage
"clear"
is
permits the
that
the
cli-
nician to see the canister dispensing
According
the dose into the spacer.
manufacturer,
the
designed
to
respirable
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the
increase the
drug
to
is
unit-dose solution
provide
coaching adaptor signals for excessive inspiratory tlowrates. and allow
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is
A
draw-string bag
provided for storage between
DHD — Diemolding
ments.
care Division. Dept
St.
Canastola
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treat-
Health-
RC, 125 Rasbach
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VENTOLIN NEB-
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as
ULES. The preservative-free solution
is
said to eliminate the risk of pre-
servative-induced
bronchospasm. a
possible side effect of beta-agonist
The
solutions that contain sulfites.
ncbules are packaged in a
foil
pouch
(25/pouch), each in a clear, unit-dose
tamper-evident
Hanburys.
2221. Fax (315) 697-8083.
Albu
as a preservative-free, sterile,
terol
amount of
delivered,
UNIT-DOSE ALBUTEROL.
container.
Dept
Allen
&
RC. Five Moore
Drive, Research Triangle Park
NC
27709.
VACUUM-LINE FILTERS.
The
Teflon micioporous membranes that
comprise
CONTAIN
filters
stop and
control the spread of infectious mate-
vacare's
Passport
nebulizer-com-
pressor (Model IRC-1190)
weight,
portable
therapy.
The
of the
In
device
is
for
a lightaerasol
sleek non-medical look
Passport
makes
it
ideal
for
today's active lifestyles, according to
the manufacturer.
lb.
The
unit
weighs 5.5
and the compressor has a 5-year
RESPIRATORY CARE
•
DECEMBER
The 1992
AHA
Com-
medical \acuuni systems and
plete Catalog offers an authoritative
are used in suction, aspiration, and
and comprehensive (over 300) col-
rials b\
NEBULIZER-COMPRESSOR.
CATALOG.
laser
lection of books, periodicals, special
the
publications,
plume evacuation, according to
manufacturer. The filters stop aer-
osols,
isms
pass
particulates,
—even
easily
and microorgan-
aqueous
through
solutions
other
that
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Arbor Medical. Dept RC. 3728 Plaza
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"92 Vol 37
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video
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DALLAS, TX
PERMIT NO. 2480
POSTAGE WILL BE PAID BY ADDRESSEE
DAEDALUS ENTERPRISES INC
P.O. BOX 29686
DALLAS,
TX
75229-9691
Il„.l.l.l...l.l..l.ll.l..l.l.nll.<lil
IIIIihI
NO POSTAGE
NECESSARY
MAILED
IF
IN
THE
UNITED STATES
BUSINESS REPLY CARD
FIRST CLASS
PERMIT NO. 604
RIVERTON, NJ
AARC PUBLICATIONS
P.O. BOX 1856
RIVERTON, NJ 08077-9456
l„,l..l.ll...l...ll...ll.l...l..l.l.l..ll...l..ll
NO POSTAGE
NECESSARY
IF
MAILED
IN
THE
UNITED STATES
BUSINESS REPLY CARD
FIRST CLASS
PERMIT NO. 604
RIVERTON, NJ
AARC PUBLICATIONS
P.O. BOX 1856
RIVERTON, NJ 08077-9456
III...
I.
.1.11. ..I.
nil. ..II. I...
I.
.1.1.1.. II...
I. .11
Compare Unl-Vent
PRESENTING
THE FIRST
PORTABLE
VENTILATOR
THAT
DOESN'T
HAVE TO
APOLOGIZE
FOR BEING
PORTABLE!
ventilator
to
and you
the Model 750
any other portable
will
is in
quickly see why
a class by
itself.*
ALARM STATUS
"-'"'^CONNECT
PEEP NOT
SE^r
APNEA
•Respiratory Care Magazine,
January 1992, Vol. 37, No. 1.
'^
Blender
60
50
I
70
/
vv^^
• Control, Assist-Control and SIMV operating modes,
optional electronic demand valve - all PEEP compensable!
• Comprehensive alarm system and automatic continuous system
self-checks for
maximum
safety!
• Easy-to-operate, logical control groupings, simplify personnel trainingi
• Operates from internal battery or external power
• High-reliability, electronic circuitry
is
-
unaffected by changes
For more information on the Uni-Vent^"^ Model 750, or the name of your local Representative,
IMPACT Instrumentation, Inc., 27 Fairfield Place, P.O. Box 508, West Caldwell, NJ 07006
Circle 116
consumes no gas!
call
I
in altitude!
Impact today!
1-800/969-0750
VOLDYNE
Volumetric Incentive Deep-Breathing Exerciser
The accuracy
of Voldyne.
patients
and
Voldyne 2500
...
A smaller
in
new
a
size,
matched
to geriatric
patients with smaller lung capacities.
lighter flow
cup reduces the work of breathing, thus
improving patient performance and progress
Every unit
reliability
is
individually tested
and superior accuracy
and calibrated for performance,
volume
ot inhaled lung
Volume incentive spirometry Improves assessment of patient
progress by eliminating the guesswork associated with spirometers
that only measure flow.
Graduations printed on both sides of the unit allow the therapist to
conveniently observe volumes while instructing and encouraging
the patient.
For further information, contact
Representative or
call:
ifour
Sherwood
OR
/Critical
Care
„__ ,tc T/i-n
1-800-32
5-7472
loutsideMissouril
1-800-392-7318
(inw issouril
.
A Sheriuaod
^^_
MeOICHL
©1991 Sherwood Medical Company
Circle 155
®

Respiratory care : the official journal of the American Association for

Transcription

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