Respiratory care
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Pulmonary function testing parameters predict cardiovascular and mortality outcomes. Previously, risk scores were created using the basic metabolic profile and complete blood count, including the Intermountain Risk Score (IMRS). This study sought to develop similar pulmonary-specific risk scores for mortality prediction. ⋯ Pulmonary-specific IMRS and pulmonary-specific basic metabolic profile risk score provided excellent discrimination of mortality among pulmonary subjects. These risk stratification tools combine familiar, relatively inexpensive, commonly-measured, standardized laboratory parameters with spirometry data. They may be electronically calculated and delivered at the point of care, providing meaningful risk information to assist clinicians in patient evaluations.
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Comparative Study
Performance and Acceptability of Two Self-Inflating Bag-Mask Neonatal Resuscitator Designs.
A self-inflating bag-mask device is specified by international policy guidelines as standard prototype of care for newborn resuscitation. Our hypothesis is that a new bag-mask design would be as effective and easy to use as a standard, self-inflating resuscitation bag-mask. ⋯ The performance and acceptability of the Upright device in this user population suggest that the device may be suitable for effective ventilation by infrequent users in low-resource settings. The Upright device should be tested in such a setting.
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Computerized respiratory sounds have shown potential in monitoring respiratory status in patients with COPD. However, the variability and reliability of this promising marker in COPD are unknown. Therefore, this study assessed the variability and reliability of respiratory sounds at distinct air flows and standardized anatomic locations in subjects with COPD. ⋯ Respiratory sound parameters are more reliable at an air flow of 0.4-0.6 L/s and are reliable overall at all anatomic locations. This should be considered in future studies using computerized auscultation.
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During the last few decades, attention has increasingly focused on noninvasive ventilation (NIV) in the treatment of chronic respiratory failure. The University of Leuven and the University Hospitals Leuven therefore chose this topic for a 2-day working group session during their International Symposium on Sleep-Disordered Breathing. Numerous European experts took part in this session and discussed (1) NIV in amyotrophic lateral sclerosis (when to start NIV, NIV and sleep, secretion management, and what to do when NIV fails), (2) recent insights in NIV and COPD (high-intensity NIV, NIV in addition to exercise training, and NIV during exercise training), (3) monitoring of NIV (monitoring devices, built-in ventilator software, leaks, and asynchronies) and identifying events during NIV; and (4) recent and future developments in NIV (target-volume NIV, electromyography-triggered NIV, and autoregulating algorithms).
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Case Reports
High-Flow Nasal Cannula and Aerosolized β Agonists for Rescue Therapy in Children With Bronchiolitis: A Case Series.
Asthma and bronchiolitis are episodic obstructive pulmonary diseases characterized by bronchoconstriction, airway wall inflammation, increased mucus production, and air-flow obstruction. We present the cases of 5 infants treated for acute bronchiolitis with respiratory distress using a combination of high-flow nasal cannula oxygen (HFNC) and an Aerogen nebulizer to deliver aerosolized β-agonist therapy. In all infants, we found that HFNC resulted in a greater heart rate increase than delivery via a facemask. We also found that patients tolerated inhaled therapy better with HFNC than a facemask.