Resp Care
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Evaluate the effects of continuous positive airway pressure (CPAP)/positive end-expiratory pressure (PEEP) and pressure support ventilation (PSV) on work of breathing (WOB). ⋯ WOB(T) increased as CPAP/PEEP was increased, and PSV lowered WOB(T.) We hypothesize that in a healthy animal model increased CPAP/PEEP may cause alveolar overdistention.
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Multicenter Study
Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece.
Ventilator-associated pneumonia (VAP) is the most common nosocomial infection among intensive care unit (ICU) patients. ⋯ VAP is a common infection and certain interventions might affect the incidence of VAP. ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP and modifying patient care to minimize the risk of VAP, such as avoiding unnecessary bronchoscopy or modulating enteral feeding.
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A recent survey of respiratory intensive care units (RICU) in Italy showed that RICUs in Italy are mainly (85%) located in acute care hospitals. Forty-seven percent of the patients are admitted from emergency departments, and only 18% are admitted from intensive care units (ICU), so the percentage of patients admitted for difficulty in weaning is low (8%). Patient demographics and admission patterns in RICUs located outside acute care hospitals have not been previously described. ⋯ The admission pattern at our RICU in a rehabilitation center is quite different from that of an RICU in an acute care hospital. Most of our patients are admitted from ICU because of difficulty with weaning. This may be the consequence of the institutional philosophy of rehabilitation centers, which strive to achieve greater patient independence.
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of a new desktop spirometer (Spirospec) with a laboratory spirometer in a respiratory out-patient clinic.
The performance of spirometers is often evaluated under ideal conditions with computer-generated waveforms or in vivo testing with healthy subjects. Real-life conditions are less ideal because of comorbidities, age of the subjects, and a variety of air flow limitations. Evaluation of new spirometry equipment can also be performed under these less favorable conditions. The Spirospec is a new desktop spirometer that is commercially available, but its accuracy has not been evaluated in a clinical setting. ⋯ The Spirospec is comparable to the Masterlab 4.0, with high accuracy for FEV(1) and forced vital capacity and clinically acceptable differences in the measured flow variables.
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Modern clinical use of supplemental oxygen supposes that: (1) exposure to F(IO)(2) < or = 60% is without adverse effects, (2) an individual at risk of developing arterial hypoxemia can be protected by administering high F(IO)(2), and (3) routine administration of supplemental oxygen is useful, harmless, and clinically indicated. There is now substantial evidence that none of those 3 suppositions are correct, and, on the contrary, supplemental oxygen is actually detrimental to many of the patients who receive it. Supplemental oxygen is much overused and its use should be limited to the few conditions and situations in which it is truly effective, useful, and non-detrimental.