Respiratory care
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Normal values of the 6-min walk distance (6MWD) for children have not been well demonstrated. This limits the interpretation of the 6MWD in children. ⋯ The 6MWD does not increase in a straight linear fashion from the age of 12 until adulthood. Correlation of the 6MWD with anthropometric features is very weak, so in evaluating the 6MWD, the standard curves should be used.
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The clinical implications of fractional exhaled nitric oxide (F(ENO)) measurements in childhood asthma are unclear. We aimed to evaluate the relationship between the level of exhaled nitric oxide and pre-bronchodilator FEV1 and the change in FEV1 after bronchodilator in children with asthma. ⋯ Our results suggest a need to measure F(ENO) before as well as after spirometry. Consequently, in children with asthma with bronchial obstruction, we suggest assessing F(ENO) after short-acting β2 agonists as well. (ClinicalTrials.gov registration NCT00815984.).
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Observational Study
Inter-Observer Agreement of Spontaneous Breathing Trial Outcome.
Spontaneous breathing trials (SBTs) are a very important test in the weaning process. The trial involves evaluation of multiple objective and subjective variables. These characteristics could lead to variability in interpreting outcomes with important clinical implications. We aimed to measure the inter-observer agreement between respiratory therapists when analyzing SBT outcomes. ⋯ Within a respiratory therapist-driven weaning protocol, we found a near 90% inter-observer agreement in the interpretation of SBT outcomes. Our findings illustrate the complexity of interpreting fluctuating subjective and objective variables and their integration into one result: SBT success versus failure. Refining the definitions of variables and their limits for failure along with education might reduce this variability.
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Observational Study
Evaluation of Adherence to Ambulatory Liquid Oxygen Treatment: Are Commercialized Dual-Pressure Transducers Helpful?
Treatment adherence is widely recognized as a critical problem in long-term oxygen therapy, particularly in ambulatory liquid oxygen (LOX) systems. Adherence-monitoring strategies may be helpful in managing patients. We evaluated subjects' adherence to LOX using VisionOx and compared these results with the subjects' own adherence diaries and self-reported perceptions of use. ⋯ Subjects overestimated adherence to LOX therapy (when measuring percent of days of use) compared to adherence diary and objective adherence monitoring. Because no significant difference was found comparing the diaries and VisionOx use, either may be helpful in clinical practice.
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Septic shock presents as a continuum of infectious events, generating tissue hypoxia and hypovolemia, and increased oxidative stress. Chest physiotherapy helps reduce secretion, improving dynamic and static compliance, as well as improving secretion clearance and preventing pulmonary complications. The purpose of this study was to evaluate the immediate effect of chest physiotherapy on hemodynamic, metabolic, inflammatory, and oxidative stress parameters in subjects in septic shock. ⋯ The results indicate that chest physiotherapy has immediate effects, improving oxygenation and reducing lactate and oxidative damage in subjects in septic shock. However, it does not cause alterations in the inflammatory and hemodynamic parameters.