Respiratory care
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Comparative Study
Evaluation of Functional Characteristics of 4 Oscillatory Positive Pressure Devices in a Simulated Cystic Fibrosis Model.
Oscillatory positive expiratory pressure (OPEP) is an airway clearance therapy that delivers positive pressure and air-flow oscillations during exhalation. This study described functional characteristic differences of 4 OPEP devices during an active exhalation in a simulated model. We hypothesized peak pressure (Ppeak), positive expiratory pressure (PEP), oscillatory frequency (f), and pressure amplitude will differ, depending upon the device used, device resistance setting, and time (repeated consecutive active exhalations through the device). ⋯ Statistically significant and clinically relevant variations in Ppeak, PEP, and pressure amplitude occurred between devices and within a device, as the resistance setting changed. The combination of device, time, and resistance settings affects OPEP device output for pressure, amplitude, and oscillatory frequency. Functional variations may impact therapeutic effectiveness, warranting additional study to determine clinical impact.
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Recent findings suggest that using alveolar PCO2 (PACO2 ) estimated by volumetric capnography in the Bohr equation instead of PaCO2 (Enghoff modification) could be appropriate for the calculation of physiological dead space to tidal volume ratio (VD/VT Bohr and VD/VT Enghoff, respectively). We aimed to describe the relationship between these 2 measurements in mechanically ventilated children and their significance in cases of ARDS. ⋯ This study suggests that VD/VT Bohr and VD/VT Enghoff are not different when there is no hypoxemia (PaO2 /FIO2 > 300) except in the case of status asthmaticus. In subjects with a low PaO2 /FIO2 , the method to measure VD/VT must be reported, and results cannot be easily compared if the measurement methods are not the same.
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Early enteral nutrition is recommended for mechanically ventilated patients in several studies and guidelines. In contrast, the effects of early enteral nutrition on noninvasive ventilation (NIV) have not been investigated extensively. The lack of an established method of airway protection suggests that enteral nutrition administration to these patients could increase airway complications and worsen outcomes. ⋯ Among subjects receiving NIV, enteral nutrition was associated with increased risk of airway complications but did not affect mortality. Enteral nutrition should be carefully considered in these patients.
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Randomized Controlled Trial
Feasibility of Mid-Frequency Ventilation Among Infants With Respiratory Distress Syndrome.
Mid-frequency ventilation, a strategy of using conventional ventilators at high frequencies, may reduce lung injury but has had limited evaluation in neonates. Hence, a randomized crossover study was designed to assess the feasibility of using mid-frequency ventilation in preterm infants with respiratory distress syndrome. ⋯ Based on this small study, mid-frequency ventilation among preterm infants with respiratory distress syndrome is feasible. Further larger and longer duration trials are necessary to validate our findings. (ClinicalTrials.gov registration NCT01242462).