Respiratory care
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Ventilator management for children with hypoxemic respiratory failure may benefit from ventilator protocols, which rely on blood gases. Accurate noninvasive estimates for pH or P(aCO2) could allow frequent ventilator changes to optimize lung-protective ventilation strategies. If these models are highly accurate, they can facilitate the development of closed-loop ventilator systems. We sought to develop and test algorithms for estimating pH and P(aCO2) from measures of ventilator support, pulse oximetry, and end-tidal carbon dioxide pressure (P(ETCO2)). We also sought to determine whether surrogates for changes in dead space can improve prediction. ⋯ We have demonstrated a conceptual first step for predictive models that estimate pH and P(aCO2) to facilitate clinical decision making for children with lung injury. These models may have some applicability when incorporated in ventilator protocols to encourage practitioners to maintain permissive hypercapnia when using high ventilator support. Refinement with additional data may improve model accuracy.
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Positive airway pressure (PAP) in subjects with both obstructive sleep apnea and COPD reduces the risk of pulmonary hypertension, death, and hospitalizations from COPD exacerbations, but adherence to the intervention is low, similar to the experience with noninvasive ventilation in stable COPD. We sought to assess whether hyperinflation on chest radiographs contributes to low adherence to PAP therapy in the overlap syndrome. ⋯ Hyperinflation is associated with decreased adherence to PAP therapy in the overlap syndrome.
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Randomized Controlled Trial Comparative Study
A Pilot Study Comparing Two Oxygen Delivery Methods for Patients' Comfort and Administration of Oxygen.
The traditional oxygen delivery methods for oxygen therapy are continuous flow oxygen (CFO) and demand oxygen delivery (DOD); however, oxygen waste is considerable in CFO, while DOD is uncomfortable for patients. Synchronized DOD (SDOD), which was designed to overcome the drawbacks of both CFO and DOD, supplies oxygen according to the patient's breathing pattern and the desired oxygen saving. This study was conducted to examine the overall performance of SDOD in terms of oxygen saturation (SpO2 ), patients' comfort, and oxygen saving ratio (SR). ⋯ SDOD appears to be more suitable for oxygen therapy than CFO when considering SpO2 , patients' comfort, and SR.