Respiratory care
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Aspiration of colonized oropharyngeal secretions is a major factor in the pathogenesis of ventilator-associated pneumonia (VAP). A tapered-cuff endotracheal tube (ETT) has been demonstrated to reduce aspiration around the cuff. Whether these properties are efficacious in reducing VAP is not known. ⋯ In the setting of a VAP rate very near the average of ICUs in the United States, and where there was high adherence to a VAP prevention bundle, the use of a tapered-cuff ETT was not associated with a reduction in the VAP rate.
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Randomized Controlled Trial Multicenter Study
Are oxygen-conserving devices effective for correcting exercise hypoxemia?
Correction of exercise hypoxemia in advanced lung diseases is crucial and often challenging. However, oxygen-conserving devices have been introduced in the market with limited evidence of effectiveness. In the present study the efficacy of 2 oxygen-conserving devices, a pulse demand oxygen delivery (DOD) system and pendant reservoir cannula (PRC), were evaluated in subjects with COPD and interstitial lung disease (ILD). ⋯ Although these oxygen-conserving devices corrected exercise hypoxemia in most COPD and ILD subjects, correction was not achieved in about 20% of the severe COPD subjects, regardless of the device, and in nearly 40% of the ILD subjects with the DOD device. These findings underscore that individualized adjustment of oxygen flow is needed for optimal correction of exercise hypoxemia, especially with a DOD in an ILD patient. (ClinicalTrials.gov NCT01086891).
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Randomized Controlled Trial Comparative Study
A comparative study of 3 portable oxygen concentrators during a 6-minute walk test in patients with chronic lung disease.
The purpose of this study was to compare the ability of 3 portable oxygen concentrators (POCs) to maintain S(pO2) ≥ 90% during exercise in patients with chronic lung disease. ⋯ The Eclipse 3 was best at meeting the subjects' clinical needs. POC users should be appropriately tested during all activities of daily living, to ensure adequate oxygenation. The healthcare provider should provide information and help to direct the subject toward the most clinically appropriate oxygen system, while being mindful of the patient's preferences and lifestyle. (Clinicaltrials.gov NCT01653730).
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Randomized Controlled Trial
Pressures delivered by nasal high flow oxygen during all phases of the respiratory cycle.
Nasal high flow (NHF) oxygen therapy and CPAP are modes of noninvasive respiratory support used to improve respiratory function in multiple patient groups. Both therapies provide positive pressure, although this varies during the respiratory cycle. The purpose of this study was to measure and compare the airway pressure generated during different phases of the respiratory cycle in patients receiving NHF at various gas flows. ⋯ The expiratory pressure during NHF was higher than the mean pressure previously reported for NHF. This may account in part for the disproportional clinical effects seen with NHF. (Australian Clinical Trials Registry www.anzctr.org.au ACTRN12609000305224).