Resp Care
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Endotracheal suctioning is required but can have adverse effects, and could affect cardiorespiratory variables that are used to predict whether the patient is ready for extubation. ⋯ Post-suctioning changes in the measured variables persisted longer in these spontaneously breathing patients weaning from mechanical ventilation than in patients who are sedated and paralyzed. The effects of suctioning on cardiopulmonary function should be considered in practice and during the design of future studies on weaning and extubation prediction variables.
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Manual and mechanical cough-augmentation techniques can improve peak cough flow (PCF) in patients with respiratory insufficiency caused by neuromuscular disease. ⋯ In clinically stable patients with neuromuscular diseases, the effectiveness of cough-augmentation techniques can be predicted with measurements of maximum respiratory capacity. Patients with VC > 340 mL and MEP < 34 cm H(2)O would optimally benefit from the combination of breath-stacking plus manually assisted cough to improve PCF to > 180 L/min.
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Randomized Controlled Trial Comparative Study
A randomized multi-arm repeated-measures prospective study of several modalities of portable oxygen delivery during assessment of functional exercise capacity.
Ambulatory oxygen is an important component of long-term oxygen therapy. Pulse-dose technology conserves oxygen and thus increases the operation time of a portable oxygen system. ⋯ Between these 4 ambulatory oxygen systems there were no significant differences in S(pO(2)), walk time, or walk distance, and there was no evidence of inadequate oxygenation with the 2 systems that provide a lower oxygen concentration.
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Randomized Controlled Trial
Effectiveness and safety of hypertonic saline inhalation combined with exercise training in patients with chronic obstructive pulmonary disease: a randomized trial.
Inhaled hypertonic saline is used for bronchial challenge and sputum induction in patients with chronic obstructive pulmonary disease (COPD). We studied the effects of saline aerosol inhalation before each exercise session in an 8-week pulmonary rehabilitation program. ⋯ The improvement in 6-min walk distance was greater with normal saline than with hypertonic saline. Hypertonic saline was associated with adverse effects. It is unclear whether the only predictor of improved functional exercise capacity was exercise training. (ClinicalTrials.gov number, NCT00639236.).
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Comparative Study
Airway humidification during high-frequency percussive ventilation.
We were concerned about the risk of inadequate humidification during high-frequency percussive ventilation (HFPV). ⋯ HFPV's distinctive gas-flow mechanism may impair gas heating and humidification, so all humidification systems should be tested with HFPV prior to clinical use.