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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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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Diagnostic or therapeutic flexible bronchoscopy is often necessary in severely ill patients. These patients often have comorbidities that increase the risk of bronchoscopy-related complications. ⋯ Noninvasive ventilation may prevent hypoventilation in patients with obstructive sleep apnea and obesity hypoventilation syndrome who require bronchoscopy, and may assist in the bronchoscopic evaluation of patients with expiratory central-airway collapse. We describe the indications, contraindications, and technique of flexible bronchoscopy during noninvasive ventilation.
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Literature searches are essential to evidence-based respiratory care. To conduct literature searches, respiratory therapists rely on search engines to retrieve information, but there is a dearth of literature on the comparative efficiencies of search engines for researching clinical questions in respiratory care. ⋯ Our results suggest that PubMed searches with the Clinical Queries filter are more precise than with the Advanced Scholar Search in Google Scholar for respiratory care topics. PubMed appears to be more practical to conduct efficient, valid searches for informing evidence-based patient-care protocols, for guiding the care of individual patients, and for educational purposes.