Resp Care
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Multicenter Study
Performance of maximum inspiratory pressure tests and maximum inspiratory pressure reference equations for 4 race/ethnic groups.
Maximum inspiratory pressure (MIP) is an important and noninvasive index of diaphragm strength and an independent predictor of all-cause mortality. The ability of adults over a wide age range and multiple race/ethnicities to perform MIP tests has previously not been evaluated. ⋯ Race-specific reference equations for MIP are unnecessary in the United States. More than 80% of adults can be successfully coached for 5 maneuvers, with repeatability within 10 cm H2O.
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The utilization of noninvasive ventilation (NIV) in the Veterans Affairs health-care system is not well characterized. A survey of physicians and respiratory therapists was conducted to better understand its use. ⋯ The perception of NIV use in the Veterans Affairs hospitals varies significantly. This survey revealed a wide range of training and experience, location of use, presence of written guidelines, and methods of delivery. Notable perceptual differences exist between respiratory therapists and physicians. Underutilization of NIV and low rates of perceived efficacy are major findings.
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Comparative Study
Output and aerosol properties of 5 nebulizer/compressor systems with arformoterol inhalation solution.
Arformoterol, the (R,R) isomer of formoterol, is approved as an inhalation solution for the treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease. Multiple nebulizer systems are commercially available. Different nebulizers can differ significantly in drug output, which may impact drug delivery and clinical efficacy. This study compared the aerosol properties of arformoterol delivered via 5 commonly used nebulizer systems for the home-care market. ⋯ The results of this study demonstrate that the choice of nebulizer/compressor system can influence the aerosol properties of arformoterol inhalation solution and should be considered when prescribing nebulized medications.
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Case Reports
Airway pressure-release ventilation in pregnant patients with acute respiratory distress syndrome: a novel strategy.
Airway pressure-release ventilation (APRV) is a novel mode of positive-pressure ventilation that has several advantages over low-tidal-volume, assist-control ventilation in patients with acute respiratory distress syndrome, specifically, lower airway pressures, lower minute ventilation, minimal effects on cardio-circulatory function, ability to spontaneously breathe throughout the entire ventilatory cycle, and decreased sedation requirements. APRV is consistent with lung-protective strategies that aim to limit lung injury associated with mechanical ventilation. APRV utilization in obstetrical patients has not previously been reported. ⋯ APRV may have particular utility in pregnant patients with ARDS. We believe APRV was life-saving in our cases. APRV ventilation should be considered in pregnant patients with ARDS.
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To determine the frequency of, and barriers to, use of noninvasive ventilation (NIV) for adult patients with acute asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF) in academic emergency departments (EDs). ⋯ Consistent with available evidence, NIV use is more common in the ED for acute COPD and CHF than for acute asthma. Barriers to greater use of NIV in the ED include physician familiarity, availability of RT and equipment in the ED, and time required for NIV. For acute asthma, uncertainty about therapeutic benefits remains a challenge.