The clinical respiratory journal
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Randomized Controlled Trial
A randomized double-blind controlled trial comparing three sedation regimens during flexible bronchoscopy: Dexmedetomidine, alfentanil and lidocaine.
No standardized sedation protocol is available for flexible bronchoscopy (FB). ⋯ No consistent differences were present between the three regimens; however, each was more appropriate in certain patient profiles. We consequently proposed a protocol as a first step towards standardizing sedation practice in FB in a patient-tailored manner. A more comprehensive and detailed protocol including other sedative agents with their corresponding doses should be developed.
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Randomized Controlled Trial
CPAP and EPAP elicit similar lung deflation in a non-equivalent mode in GOLD 3-4 COPD patients.
Lung hyperinflation is associated with inspiratory muscle strength reduction, nocturnal desaturation, dyspnea, altered cardiac function and poor exercise capacity in advanced COPD. ⋯ Twenty-one eligible COPD patients were studied (13 male/8 female, FEV1 % predicted of 36.5 ± 9.8). Both CPAP and EPAP demonstrated significant post-pre (Δ) changes for IC and PImax, with mean ΔIC for CPAP and EPAP of 200 ± 100 mL and 170 ± 105 mL (P = .001 for both) in 13 and 12 patients (responders) respectively. There were similar changes in % predicted IC and PImax (∼7%, P = .001 for both) for responders and poor responder/non-responder agreement depending on CPAP/EPAP mode (Kappa = .113, P = .604). There were no differences in CPAP and EPAP regarding intensity of lung deflation (P =.254) and no difference was measured regarding HR (P = .235) or SpO2 (P = .111). CONCLUSIONS: Both CPAP and EPAP presented a similar effect on lung deflation, without guaranteeing that the response to one modality would be predictive of the response to the other.
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Prone position ventilation (PPV) has been shown to improve oxygenation and decrease pulmonary vascular resistance and mortality in patients with severe acute respiratory distress syndrome (ARDS). Whether these benefits of PPV occur similarly in acute exacerbations of interstitial lung disease (ILD) is not clear. We retrospectively explored the use of PPV in acute exacerbation with ILD versus those with severe acute respiratory distress syndrome (severe ARDS). ⋯ Our findings suggest that PPV may improve oxygenation and partially improve hemodynamic parameters during acute exacerbations of ILD.