Resp Care
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To determine the relationship between tracheostomy tube in place after intensive-care-unit (ICU) discharge and hospital mortality. ⋯ In our critical-care setting, lack of decannulation of conscious tracheostomized patients before ICU discharge to the general ward was associated with higher mortality.
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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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The Acapella is a respiratory rehabilitation device designed to aid sputum clearance. When the patient exhales through this device, continuous and oscillatory pressure levels are produced. The adequate practical use of the Acapella is critically dependent on the characteristics of the produced pressure, which include the production of a mean pressure>or=10 cm H2O and a matching of the oscillation frequency with the respiratory-system resonance frequency, and/or with the frequency of ciliary movement (approximately 13 Hz). The development of a dedicated software tool would contribute to optimize the clinical application of this device. Thus, the aim of this study was 2-fold: to characterize the mechanical behavior of the Acapella, and to develop a software tool to ease the practical use of this device. ⋯ The Acapella device may produce clinically adequate values of mean pressure and oscillation frequency. However, it depends on its use at optimized conditions. The user-friendly software proposed in this study could help the user to achieve these conditions.