Respiratory care
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Acute lower respiratory infections can impair muscle strength in patients with amyotrophic lateral sclerosis (ALS). When associated with an increase in load on the respiratory system, this situation may precipitate hypercapnic respiratory failure in non-ventilated patients with ALS. The aim of this study was to determine whether a clinical or functional parameter can predict the need for noninvasive ventilation (NIV) during an acute respiratory infection for medically stable, non-ventilated patients with ALS. ⋯ In medically stable, non-ventilated patients with ALS, measurement of percent-of-predicted FVC and peak cough flow can predict the need for NIV during an acute lower respiratory tract infection.
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Use of noninvasive ventilation (NIV) for the treatment of patients with acute respiratory failure (ARF) has greatly increased in the last decades. In contrast, the increasing knowledge of its effectiveness and physician confidence in managing this technique have been accompanied by a declining number of available ICU beds. As a consequence, the application of NIV outside the ICU has been reported as a growing phenomenon. Previously published surveys highlighted a great heterogeneity in NIV use, clinical indications, settings, and efficacy. Moreover, they revealed a marked heterogeneity with regard to staff training and technical and organizational aspects. We performed the first worldwide web-based survey focused on NIV use in general wards for ARF. ⋯ Use of NIV in general wards was reported as effective, common, and gradually increasing. Improvement in staff training and introduction of protocols could help to make this technique safer and more common when applied in general wards setting.
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A 79-y-old man with generalized tetanus was admitted to the ICU. A left-forearm wound was surgically debrided, and the wound was closed. On postoperative day 1, after the patient experienced opisthotonos and convulsions, endotracheal intubation was performed. ⋯ Edi monitoring revealed periodic amplitude change. The cause of the periodic breathing pattern in this patient could not be determined but may be attributable to side effects of the pharmacologic interventions or the natural history of the disease itself. NAVA mode improved patient-ventilator synchrony.
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Home mechanical ventilation (HMV) is a routine method of treatment for patients with chronic ventilatory failure. Over the last 20 y, a marked development in HMV has been noted in terms of its prevalence and the changing proportion of patients with various indications. However, data on HMV come exclusively from the developed countries of Europe and North America. Nowadays, we can see the emergence of HMV in less developed countries. This study aimed to describe the development of HMV in Poland. ⋯ The prescription pattern of HMV in Poland has evolved, and there is a clear shift from neuromuscular to respiratory diseases. The prevalence of ventilation via tracheostomy still remains very high in comparison with other European countries. The Polish experience could be useful for countries with emerging HMV care systems.
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Subjects who do not pass ventilator weaning parameters but whose ambient air oxyhemoglobin saturation can be normalized by mechanical insufflation-exsufflation (MIE) can be extubated to continuous noninvasive ventilatory support (CNVS) with MIE used to maintain extubation. Our aim was to study MIE-associated changes in breathing tolerance, pulse oximetry, and vital capacity (VC) for consecutive unweanable subjects. ⋯ Many unweanable subjects can be extubated to CNVS and MIE. The latter can normalize O2 saturation, increase VC, and facilitate extubation.