Respiratory care
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The extubation period is one of the most challenging aspects for intensive care teams. Timely recognition of the return to spontaneous ventilation is essential for reducing costs, morbidity, and mortality. Several weaning predictors were studied in an attempt to evaluate the outcome of removing ventilatory support. The purpose of this study was to analyze the predictive performance of the modified integrative weaning index (IWI) in the extubation process. ⋯ We concluded that modified IWI, similar to other extubation predictors, does not accurately predict extubation failure.
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The primary aim of the disease management program (DMP) for patients with COPD is to improve health outcomes and thereby to reduce overall costs. Six years after its introduction in Germany, no consensus has yet been reached as to whether the DMP has been effective in reaching these goals. The objective of the study was an evaluation of the DMP for COPD in Bavaria using routinely collected subject medical records. ⋯ Summarizing all results leads to the suggestion that the German DMP for COPD has been effective in enhancing the quality of care in regard to an improved adherence to guidelines, pharmacotherapy, exacerbations, and self-management education. However, the DMP was not able to prevent an increase in emergency hospital admissions for the stable population in the cohort.
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Patients with congestive heart failure or COPD may share an increased response in minute ventilation (V̇E) to carbon dioxide output (V̇CO2 ) during exercise. The goal of this study was to ascertain whether the V̇E/V̇CO2 slope and V̇E/V̇CO2 intercept can discriminate between subjects with congestive heart failure and those with COPD at equal peak oxygen uptake (V̇O2 ). ⋯ The ventilatory response to V̇CO2 during exercise was significantly different between subjects with congestive heart failure and those with COPD in terms of the V̇E/V̇CO2 slope with moderate-to-severe reduction in exercise capacity and in terms of the V̇E/V̇CO2 intercept regardless of exercise capacity.
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The aim of the present study was to assess how volume-oriented incentive spirometry applied to patients after a stroke modifies the total and compartmental chest wall volume variations, including both the right and left hemithoraces, compared with controls. ⋯ Incentive spirometry promotes increased expansion in all compartments of the chest wall and reduces asymmetric expansion between the right and left parts of the pulmonary rib cage; therefore, it should be considered as a tool for rehabilitation.
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Fatigue is a frequent symptom of patients with sarcoidosis. The origin of fatigue associated with sarcoidosis is unclear. The aim of this study was to assess the impact of affected organs, medication, and comorbidity on fatigue related to sarcoidosis. ⋯ It is important to consider that multiple clinical factors, especially comorbidities, contribute to the high degrees of fatigue in sarcoidosis.