Respiratory care
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Editorial Comparative Study Observational Study
Comparison of Interfaces for the Delivery of Noninvasive Respiratory Support to Low Birthweight Infants.
Bench and clinical data indicate that techniques for applying noninvasive respiratory support may vary in terms of effectiveness, application, and tolerability. We implemented a new nasal interface and flow-generation system for the delivery of noninvasive respiratory support (NRS) to replace previously used systems. Our goal was to determine whether there were significant differences in clinically relevant outcomes between our new method and conventional systems. ⋯ The ability to apply continuous distending pressure through consistent application of NRS with the RAM cannula attached to a ventilator may improve clinical outcomes, including the duration of respiratory support and pressure-ulcer rates. The influence of this system on the development of bronchopulmonary dysplasia and the significantly increased retinopathy of prematurity requires further study.
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Inspiratory muscle strength has been considered an important marker of ventilatory capacity and a predictor of global performance. A new tool has become available for dynamically evaluating the maximum inspiratory pressure (the S-Index). However, the proper assessment of this parameter needs to be determined. Thus, the aim of the present study was to investigate the number of inspiratory maneuvers necessary to reach a maximum and reliable S-Index and the influence of inspiratory muscle warm-up on this assessment. ⋯ Eight maneuvers were necessary to reach maximum and reliable values of the S-Index preceding inspiratory muscle warm-up or sham. Moreover, inspiratory muscle warm-up preceding S-Index assessment improved inspiratory muscle performance.
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Recommendations regarding ventilation during cardiopulmonary resuscitation (CPR) are based on a low level of scientific evidence. We hypothesized that practices about ventilation during CPR might be heterogeneous and may differ worldwide. To address this question, we surveyed physicians from several countries on their practices during CPR. ⋯ Physicians indicated heterogeneous practices that often differ significantly from international CPR guidelines. This may reflect the low level of evidence and a lack of detailed recommendations concerning ventilation during CPR.
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During extracorporeal membrane oxygenation for ARDS, a range of 1-4 mL/kg predicted body weight tidal volume (VT) is commonly used. We explored whether such a low VT could be adequately delivered by ICU ventilators, and whether such low VTs prevent the heated humidifier (HH) from reaching the recommended target of 33 mg/L absolute humidity (AH). ⋯ Low VT was systematically under-delivered by modern ICU ventilators by roughly 7-9%. To meet the recommended target of 33 mg/L AH, adult circuit at f30 should be used.