Resp Care
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Randomized Controlled Trial Comparative Study
A prospective randomized controlled trial on the efficacy of noninvasive ventilation in severe acute asthma.
Noninvasive ventilation (NIV) is an emerging modality in the management of patients with acute respiratory failure. However, its role in severe acute asthma is not well defined. ⋯ In patients with severe acute asthma, the addition of NIV to standard medical therapy probably accelerates the improvement in lung function, decreases the inhaled bronchodilator requirement, and shortens the ICU and hospital stay, but a larger study is required to settle this issue.
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Comparative Study
Relationship between functional residual capacity, respiratory compliance, and oxygenation in patients ventilated after cardiac surgery.
Measurement of functional residual capacity (FRC) is now possible at bedside, during mechanical ventilation. ⋯ Indexing the measured FRC values to the predicted supine and sitting FRC values does not improve the association between PaO2/F(I)O2 and respiratory-system compliance. In mechanically ventilated patients after cardiac surgery, FRC is influenced more by the ventilator settings than by physiologic variables (as in spontaneously breathing persons).
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Comparative Study
Prevalence of chronic obstructive pulmonary disease and tobacco use in veterans at Boise Veterans Affairs Medical Center.
Although its prevalence is still debated, chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States, and smoking cessation remains the only intervention that can significantly improve the prognosis of COPD. ⋯ The prevalence of COPD in patients at the Boise Veterans Affairs Medical Center was consistent with that in other United States surveys, although the underutilization of screening spirometry in those at risk for COPD may have caused underestimation of the prevalence. Smoking, age, and male sex were identified as significant risk factors for COPD, and the prevalence of active smoking remains high in this population of veterans.
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Unplanned extubation represents a threat to patient safety, and risk factors and prevention strategies for unplanned extubation have not been fully explored. ⋯ We identified perceived risk factors and defined "near misses" for unplanned extubation. Our findings should inform strategies for prevention of unplanned extubation.
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Randomized Controlled Trial Comparative Study
Comparison between automatic tube compensation and continuous positive airway pressure during spontaneous breathing trials.
Various methods to perform spontaneous breathing trials (SBTs) exist, but no one method has been shown to be superior. Automatic tube compensation (ATC) is a new and potentially advantageous ventilation mode to use during SBT. We compared ATC to continuous positive airway pressure (CPAP) during SBTs, to determine their efficacy in identifying patients ready to be liberated from mechanical ventilation. ⋯ When applied as part of a respiratory-therapist-driven weaning protocol in a general intensive-care population, SBTs with ATC were safe but did not hasten liberation from mechanical ventilation, when compared to CPAP.