Resp Care
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To determine the outcomes of noninvasive ventilation (NIV) and the factors associated with NIV failure in patients with acute hypoxemic respiratory failure (AHRF). ⋯ NIV should be judiciously used in patients with AHRF. A low baseline P(aO2)/F(IO2) ratio was associated with NIV failure.
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A North American survey of respiratory therapist and physician tracheostomy decannulation practices.
Tracheostomy is a common surgical procedure performed on critically ill patients. However, little is known about how clinicians make decisions to decannulate patients, and whether similar decisions are made by respiratory therapists (RTs) and physicians. ⋯ Important differences exist in the decannulation practices of North American RTs and physicians. Evidence-based tracheostomy guidelines are needed to facilitate the safe and effective management of patients with tracheostomies.
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Editorial Comment
Toward leaner tracheostomy care: first observe, then improve.
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Randomized Controlled Trial
The addition of mechanical insufflation/exsufflation shortens airway-clearance sessions in neuromuscular patients with chest infection.
Mechanical insufflation/exsufflation (in-exsufflation) increases peak cough flow and may improve sputum clearance. No studies have compared current respiratory physiotherapy practice (manual percussion, shaking, and assisted cough) plus mechanical in-exsufflation to current physiotherapy practice without in-exsufflation in noninvasive-ventilation (NIV) dependent neuromuscular patients with an acute respiratory-tract infection. We hypothesized that airway clearance in these patients would be more effective with in-exsufflation, compared to without in-exsufflation. ⋯ This is a short-term study of the use of in-exsufflation as a supplement to standard NIV plus physiotherapy in a small group of patients with neuromuscular disease. The addition of mechanical in-exsufflation shortened airway-clearance sessions. The device appeared to be safe and well tolerated, and may provide additional benefit to patients with neuromuscular disease and upper-respiratory-tract infection; further studies are indicated.