Respiratory care clinics of North America最新文献

{"title":"Humidification: measurement and requirements.","authors":"Klaus Züchner","doi":"10.1016/j.rcc.2006.03.005","DOIUrl":"https://doi.org/10.1016/j.rcc.2006.03.005","url":null,"abstract":"<p><p>Humidification measurement is now feasible, but it is cumbersome and costly for routine use. The user therefore may rely on data supplied with the humidification device and obtained according to ISO standards. For comparison purposes it would be extremely helpful if both standards used to describe humidification properties quoted performance values in the same manner, preferably as moisture loss measured as milligrams of water per liter at the maximum tidal volume. The acceptable water loss should be between 0 and 7 mg/L water depending on the specific situation of the patient.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 2","pages":"149-63"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26135640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Devices used to humidify respired gases.","authors":"Jörg Rathgeber","doi":"10.1016/j.rcc.2006.03.012","DOIUrl":"https://doi.org/10.1016/j.rcc.2006.03.012","url":null,"abstract":"<p><p>The efficiency of HMEs decreases with increasing tidal volumes. HMEs always result in an elevation of the inspiratory and expiratory airway resistances; this should be considered especially in cases that involve spontaneous respiration. The pressure drop across HMEs should be less than 2 hPa for a flow of 60 L/min, a level that also has been measured for cascade humidifiers.HMEs with a hygroscopic coating of CaCl2 should be given preference over LiCl-coated ones, especially because products of the same efficiency are available with CaCl2 coating. Lithium is a potentially toxic substance that can be taken up by way of bronchopulmonary resorption after accidental washing out [37]. Therefore, a possible safety hazard cannot be eliminated, especially in neonates and babies. Not least for these reasons HMEs must never be combined with active humidification systems or medication nebulizers. Even if the reduction in functional efficiency of the HME that is caused by washing off of the coating of hygroscopic substances is disregarded, the presence of medication aerosols in the HME, in particular, can result in a dangerous increase in resistance to gas flow. The internal volumes of HMEs should be as small as possible so that they do not increase the effective deadspace too much. A combination of HMEsand catheter mounts results in a further increase in the deadspace, and there-fore, must be considered critically, especially in cases that involve spontaneous respiration. If a catheter mount is necessary to add flexibility to the breathing system, the HME preferably should be connected directly onto the tracheal tube with the catheter mount behind it; otherwise, the humidification efficiency of the HME will be reduced by condensation in the catheter mount. Children should be ventilated with special HMEs that have a small internal volume. Caution is required in patients who have elevated sputum production, pulmonary trauma with bleeding, pulmonary edema, or a similar condition;in such patients a partial obstruction of the HME with a resulting elevation of the airway resistances might occur. In patients who have very viscous secretions (eg, as a result of a primary pulmonary disease or long-term dehydration therapy), heated humidifiers with a set temperature of greater than 370 degrees C should be given preference. Several recent investigations showed that not every device that is designated as an HME is appropriate for conditioning respiratory gases (ie, it effectively humidifies the inspiratory air). Most of the products that are available on the market are, at best, adequate for anesthetic ventilation or short-term postoperative follow-up ventilation. Generally, this is true of all HMEs that have not been coated with hygroscopic substances. CoatedHMEs have a much better humidification efficiency; however, here too, the existence of substantial differences in quality among the products prohibits an uncritical application.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 2","pages":"165-82"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26135641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Filtration of respired gases: theoretical aspects.","authors":"Ron J Thiessen","doi":"10.1016/j.rcc.2006.03.001","DOIUrl":"https://doi.org/10.1016/j.rcc.2006.03.001","url":null,"abstract":"<p><p>The filtration of aerosols and the behavior of aerosolized particles are less intuitive and more complex than commonly indicated in the medical literature, but once the basic principles are presented, they are not difficult to understand or apply. Particles with diameters close to the most penetrating particle size are clearly the particles of greatest concern, interest, and value in considering the performance of different filtration devices, and this size has been identified as the standard particle size for testing respirators and breathing system filters. Although almost every level of health care now mandates the N95 (NIOSH rating) as the minimum rating for medical respirators, there is no such mandate regarding minimum efficiencies of breathing system filters. At least in North America, it still falls to each individual purchaser to ensure that these standardized tests are performed, because manufacturers adhere to these standards only on a voluntary basis. Government regulations similar to NIOSH 42 CFR 84 are needed for breathing system filters and should include a rating system such as N95, N99, or N100. For breathing system filters, the BFE and VFE tests are misleading and should be abandoned (or even better, banned) in favor of internationally recognized sodium chloride tests. Until then, manufacturers will be hesitant to abandon their BFE and VFE data, which give the appearance of vastly better performance than does the sodium chloride test.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 2","pages":"183-201"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26135571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accreditation of sleep disorders programs.","authors":"Bonnie Robertson","doi":"10.1016/j.rcc.2005.11.005","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.11.005","url":null,"abstract":"<p><p>The accreditation of a sleep program ensures a high quality of care for the patient who has a sleep disorder. With more sleep laboratories becoming available, accreditation may be the best single way for a consumer to determine the adequacy of the facility. The process for accreditation requires the sleep program to develop policies and procedures that meet rigorous national and local standards. By adhering to protocols that have been proven to outline the optimal care for any given disorder associated with sleep, the provider of that care can assure the public that the program will deliver the appropriate treatment for these problems.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 1","pages":"121-4, ix-x"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25900099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of medication on sleep.","authors":"W David Brown","doi":"10.1016/j.rcc.2005.11.008","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.11.008","url":null,"abstract":"<p><p>Understanding the role that medication has on sleep is difficult for many reasons. Most medications have not been sufficiently studied to determine their primary effects on sleep and waking behavior. Because of the increased awareness of the importance of sleep to health and well being, the effects of a new drug on sleep and waking behavior should be a mandatory element of the clinical trials process. Even when the effects of a drug are known, the medication may act differently in normal individuals and individuals who are ill. The interaction of many medications would be difficult to predict,and acute effects may be quite different from chronic use. Even a general idea about the effects of a medication will help the sleep medicine specialist understand and interpret the polysomnogram and MSLT accurately.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 1","pages":"81-99, ix"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25900096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety in the sleep laboratory.","authors":"Mary Kay Hobby","doi":"10.1016/j.rcc.2006.02.001","DOIUrl":"https://doi.org/10.1016/j.rcc.2006.02.001","url":null,"abstract":"<p><p>The importance of workplace safety cannot be understated. The safety of employees affects morale, attendance, and workman's compensation. Federal organizations and agencies have provided guidelines to help ensure the health and safety of the technician and the patients who visit the sleep center. This article discusses commonly encountered hazards and ways to address them.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 1","pages":"101-10, ix"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25900097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric and neurologic disorders that affect sleep.","authors":"Jeremy Dozier","doi":"10.1016/j.rcc.2005.11.007","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.11.007","url":null,"abstract":"<p><p>Neurologic and psychiatric disorders that affect sleep are linked by a common symptom: insomnia. For this reason the overnight attended polysomnogram is a vital diagnostic tool for the clinician who wishes to determine the cause of the sleep disturbance. The role of a well-trained and competent polysomnographer is vital to the collection of reliable diagnostic data. Understanding the symptoms and clinical manifestations of these disorders helps the polysomnographer recognize and address the challenges that can arise during the overnight polysomnographic record collection and ensure an accurate diagnosis.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 1","pages":"71-80, viii"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25900095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple sleep latency test and maintenance of wakefulness test.","authors":"Jill M Slinkard","doi":"10.1016/j.rcc.2005.11.012","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.11.012","url":null,"abstract":"<p><p>In addition to overnight polysomnography, there are two special tests with which every sleep technologist should be familiar: the multiple sleep latency test and the maintenance of wakefulness test. These two tests classify excessive daytime sleepiness using objective data. The role of the sleep technologist is to understand and perform an accurate test so that sleep clinicians can use that data in diagnosing and treating their patients. This article provides step-by-step directions for performing these tests.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 1","pages":"17-22, viii"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25900233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep medicine management: clinic-based, laboratory testing, and durable medical equipment.","authors":"Bonnie Robertson","doi":"10.1016/j.rcc.2005.11.006","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.11.006","url":null,"abstract":"<p><p>The patient who is suffering from a sleep disorder is seeking help for one of the basic necessities of life: a good night's sleep. For all those who have developed a problem in sleeping, whether it is physiologic or psychologic, the sleep medicine profession can be literally a lifesaver.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 1","pages":"111-9, ix"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25900098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actigraphy.","authors":"Christine Acebo,&nbsp;Monique K LeBourgeois","doi":"10.1016/j.rcc.2005.11.010","DOIUrl":"https://doi.org/10.1016/j.rcc.2005.11.010","url":null,"abstract":"<p><p>Actigraphy is a methodology for recording and analyzing activity (movement) from small, computerized devices worn on the body. Published reports on the reliability and validity of actigraph measures, although not comprehensive, generally indicate that sleep estimated by scoring algorithms is relatively consistent with PSG-scored sleep for normal individuals across the lifespan and for some patient groups. Accuracy is often greatly decreased when sleep is disordered or disrupted. Although actigraphy maybe suitable for documenting and evaluating some sleep disorders, its role in clinical diagnosis is limited. Actigraphy is a useful methodology for investigating group differences, sleep-pattern variations over time, and the effects of behavioral or treatment interventions. Controlling artifacts is extremely important, and using some form of daily log is essential for documenting events. The recording period should be long enough to provide reliable measures and to capture important variations across time.</p>","PeriodicalId":79530,"journal":{"name":"Respiratory care clinics of North America","volume":"12 1","pages":"23-30, viii"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25900092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}