Resp Care
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Office spirometers are now widely used to detect obstructive lung diseases. To test the technical characteristics of these devices, simulation of different forced expiratory maneuvers is performed, using computer generated waveforms. However, the tests with human subjects are also useful to detect technical flaws. The procedure used by some authors to test the accuracy of office spirometers is to compare measurements made by 2 spirometers connected in series. ⋯ Connecting the spirometers in series gives variable results, depending on the position of the spirometer in the assembly. Individual tests are therefore essential, as results are not interchangeable.
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Randomized Controlled Trial
Response to albuterol MDI delivered through an anti-static chamber during nocturnal bronchospasm.
Decreasing electrostatic charge on valved holding chambers increases the amount of drug delivered. However, there are no data demonstrating that this increases bronchodilatation. ⋯ Delivery of albuterol through an anti-static chamber provides a clinically relevant improvement in bronchodilator response during acute, reversible bronchospasm such as nocturnal bronchospasm.
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Randomized Controlled Trial Multicenter Study
Findings from the MATREX study: a treatment protocol for the delivery of manual chest therapy in respiratory care.
One of the difficulties in comparing the numerous studies on manual chest therapy (MCT) is the wide variety of techniques used and terms employed to describe the intervention. This lack of consistency in therapeutic approach and the absence of defined tools for evaluation have led to a continued air of skepticism about its true value. This paper presents a treatment protocol used in a large randomized controlled trial examining the efficacy and cost effectiveness of MCT for patients hospitalized with exacerbations of COPD. ⋯ With respect to the essential elements of MCT, the treatment protocol used in the MATREX trial offers sufficient flexibility to the therapist, while being robust enough to maintain clinical trial integrity. The level of adherence by therapists indicates its professional acceptability with respect to delivering and evaluating this therapy.
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Randomized Controlled Trial Comparative Study
A prospective, comparative trial of standard and breath-actuated nebulizer: efficacy, safety, and satisfaction.
Nebulized drug delivery is a cornerstone of therapy for obstructive lung disease, but the ideal nebulizer design is uncertain. The breath-actuated nebulizer (BAN) may be superior to conventional nebulizers. This study compared the BAN to standard nebulizer with regard to efficacy, safety, and patient and respiratory therapist (RT) satisfaction. ⋯ Patients and RTs expressed greater satisfaction with the BAN, compared with standard nebulizer. Pre- and post-treatment vital signs did not differ between groups, but use of the BAN was associated with a shorter duration and a lower occurrence of adverse events. Taken together, these data support the use of the BAN for nebulized medication delivery.
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Review Case Reports
Severe acute respiratory failure secondary to acute fibrinous and organizing pneumonia requiring mechanical ventilation: a case report and literature review.
A 27-year-old woman was admitted to our ICU with acute hypoxemic respiratory failure and criteria for ARDS. Despite an F(IO(2)) of 1.0 and a lung protective strategy, the patient died on day 15 without any improvement. The relatives gave consent for post-mortem analysis. ⋯ There is little information regarding the pathophysiology of this illness. Important questions remain regarding this disease, including predisposing factors and management. Patients who require mechanical ventilation have poor outcomes.