Resp Care
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Randomized Controlled Trial
Automated oxygen flow titration to maintain constant oxygenation.
One century after the introduction of the oxygen flow meter into clinical practice, we have developed a device, FreeO(2), that automatically titrates the oxygen flow delivered to spontaneously breathing patients, with the aim of maintaining a stable S(pO(2)). We evaluated this system in healthy subjects during induced hypoxemia. ⋯ In this model of induced hypoxemia, the FreeO(2) system that automatically titrates the oxygen flow was more efficient at maintaining the S(pO(2)) target, while ensuring a statistically significant reduction in the rates of severe hypoxemia and hyperoxia, in comparison with air or constant oxygen flow. These beneficial results were obtained with less oxygen, in comparison to a constant oxygen flow.
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Editorial Comment
Is it asthma, COPD, or something in between, and does it matter?
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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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Evidence-based medicine has assumed a major place in establishing the standard of care for many diseases. Yet practices based largely on clinical experience have often been difficult to change, even when clearly associated with patient harm. In this paper, based on the 27th Philip Kittredge Memorial Lecture, we highlight respiratory care practices that have clearly failed the tests of time and evidence yet sometimes tenaciously persist. We also discuss the appropriate use and potential abuse of evidence-based medicine.