Resp Care
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Clinical Trial
A decremental PEEP trial identifies the PEEP level that maintains oxygenation after lung recruitment.
To assess the ability of a decremental trial of positive end-expiratory pressure (PEEP) to identify an optimal PEEP level that maintains oxygenation after a lung-recruitment maneuver. ⋯ A decremental PEEP trial identifies a PEEP setting that sustains for 4 h the oxygenation benefit of a 40-cm H2O, 40-s lung-recruitment maneuver.
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Multicenter Study
The long-term stability of portable spirometers used in a multinational study of the prevalence of chronic obstructive pulmonary disease.
We report the performance of an ultrasound-based portable spirometer (EasyOne) used in a population-based survey of the prevalence of chronic obstructive pulmonary disease, conducted in 5 Latin American cities: São Paulo, Brazil; México City, México; Montevideo, Uruguay; Santiago, Chile; and Caracas, Venezuela (the Latin American COPD Prevalence Study [PLATINO]). ⋯ In these 70 EasyOne spirometers neither calibration nor linearity changed during the study. Such calibration stability is a valuable feature in spirometry surveys and in the clinical setting.
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Airway inflammation in acute and chronic respiratory diseases is characterized in part by abnormal pH in airway-lining fluid. The pH of exhaled-breath condensate (EBC) is low (acidic) in various pulmonary inflammatory diseases, including asthma, chronic obstructive pulmonary disease, cystic fibrosis, pneumonia, and acute respiratory distress syndrome. Because the time course of pH changes in the airway is not yet clear, we aimed to develop a method for frequent and intensive EBC pH data collection in mechanically ventilated patients. ⋯ Continuous monitoring of EBC pH from the ventilator exhaust port is safely achievable and reliably provides data that may become useful in monitoring critically ill patients.
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To determine the prevalence of confirmatory use of spirometry in patients admitted to a tertiary-care facility with the diagnosis of chronic obstructive pulmonary disease (COPD), including those with respiratory failure, and compare that to the use of confirmatory 2-dimensional echocardiography (2-D echo) in patients admitted with the diagnosis of congestive heart failure (CHF), to determine preferential confirmatory testing practices. ⋯ A large proportion of patients hospitalized with the diagnosis of COPD have never had a confirmatory test, including those with presumably advanced disease. Compared to patients with CHF, patients with COPD are less likely to have had the confirmatory test performed, even when both conditions coexist. Many patients with the clinical diagnosis of COPD have an inconsistent physiologic diagnosis. To impact the increasingly important problem of COPD, we must raise awareness of the need to confirm its diagnosis and severity with spirometry.
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In the developed world, Guillain-Barré syndrome and myasthenia gravis account for the majority of cases of acute respiratory failure associated with neuromuscular disease. The 4 components that contribute to respiratory failure are upper-airway dysfunction, inspiratory-muscle weakness, expiratory-muscle weakness, and the pulmonary complications associated with these conditions. ⋯ The morbidity and mortality of patients who require mechanical ventilation are not insubstantial. This paper will review the mechanisms underlying acute respiratory failure, the clinical assessment of patients, the predictors of the need for mechanical ventilation, and the intensive-care-unit morbidity and mortality of patients with Guillain-Barré syndrome or myasthenia gravis.