Respiratory care
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According to Taiwan's integrated delivery system policy, ventilator-dependent patients are successfully liberated from mechanical ventilation in accordance with step-down care. However, premature discharge affects the 14-d readmission quality index. Therefore, we explored the risk and related factors of subjects liberated from mechanical ventilation who were re-intubated within 14 d. ⋯ Factors associated with re-intubation within 14 d after ventilator liberation are related to the level and quality of the care setting; thus, to prevent re-intubation, more attention should be paid to higher-risk ventilator-dependent subjects after they are liberated from mechanical ventilation.
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Measured maximum voluntary ventilation (MVV) correlates with maximum ventilatory capacity during exercise. As a shortcut, MVV is often estimated by multiplying measured FEV1 times 35 or 40, but this index varies with altitude due to reduced air density. The objective was to describe MVV in healthy individuals residing at 2,240 m above sea level and compare it with the reference values customarily employed. ⋯ At an altitude of 2,240 m, MVV is about 45 times the measured FEV1, and it can be estimated for other altitudes. The best predicting equations for MVV were calculated separately for females and males and included the following predictors: age, age2, and measured FEV1. The study found that reference values for MVV from studies conducted at sea level are inaccurate at this altitude.
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Widespread access to medical oxygen would reduce global pneumonia mortality. Oxygen concentrators are one proposed solution, but they have limitations, in particular vulnerability to electricity fluctuations and failure during blackouts. The low-pressure oxygen storage system addresses these limitations in low-resource settings. This study reports testing of the system in Melbourne, Australia, and nonclinical field testing in Mbarara, Uganda. ⋯ The low-pressure oxygen storage system was robust and durable, with accelerated testing equivalent to at least 2 y of operation revealing no visible signs of imminent failure. Despite power cuts, the system continuously provided oxygen, equivalent to the treatment of one child, for 30 d under typical power conditions for sub-Saharan Africa. The low-pressure oxygen storage system is ready for clinical field trials.
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Diaphragm excursion is limited during respiratory maneuvers after a stroke. How the diaphragm is limited during reflexive coughs and affects the effectiveness of cough in stroke patients is unclear. This study aimed to measure reflexive cough strength by cough peak flow (CPF) induced by citric acid nebulization (2.8 mol/L), record diaphragm excursions during reflexive coughs in stroke subjects at risk of silent aspiration, and compare these values with those of stroke subjects without risk of aspiration or dysphagia. ⋯ Stroke subjects at risk of silent aspiration showed reduced CPF and more limited diaphragm excursion during the citric acid-induced reflexive cough test. (ClinicalTrials.gov registration NCT02080988.).
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Editorial Comment
Optimizing Mechanical Ventilation in the Neonatal ICU.