Respiratory care
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Randomized Controlled Trial Comparative Study
Short-Term Effects of an Active Heat-and-Moisture Exchanger During Invasive Ventilation.
Humidification is a standard of care during invasive mechanical ventilation. Two types of devices are used for this purpose: heated humidifiers and heat-and-moisture exchangers (HME). ⋯ This study indicated that, compared with the heated humidifiers, the use of the active HME or the HME increased inspiratory effort, PaCO2 , pH, and dyspnea in stable subjects who were tracheostomized and ventilator-dependent. (ClinicalTrials.gov registration NCT02499796.).
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Comparative Study Observational Study
Comparison of End-Tidal, Arterial, Venous, and Transcutaneous PCO2.
We investigated the measurement of end-tidal partial pressure of carbon dioxide (PETCO2 ) with a capnometer in patients with respiratory failure, and we determined whether this technique could provide an alternative to measurement of PaCO2 using arterial blood gas analysis in the clinical setting. ⋯ PETCO2 can be measured simply using a capnometer, and PETCO2 measurements can estimate PaCO2 . However, the limits of agreement were wide. Therefore, care providers must pay attention to the characteristics and errors of these devices. These results suggest that measurement of PETCO2 might be useful for screening for hypercarbic respiratory failure in the clinical setting.
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Editorial Randomized Controlled Trial Comparative Study
A Randomized Controlled Trial Comparing Two Lung Expansion Therapies After Upper Abdominal Surgery.
Lung expansion therapy is often ordered after surgery to improve alveolar ventilation and reduce risks of postoperative pulmonary complications. The impact of lung expansion therapy at altering ventilation in patients who are not intubated has not been described. The primary purpose of this study was to determine if there is a difference in dorsal redistribution of ventilation and incidences of postoperative pulmonary complications when comparing incentive spirometry (IS) with EzPAP lung expansion therapy after upper abdominal surgery. Our a priori null hypothesis was that there are no differences. ⋯ There was no significant post-lung expansion therapy dorsal ΔEELI% or postoperative pulmonary complications among the adults who received IS or EzPAP 3 times a day after upper abdominal surgery. (ClinicalTrials.gov registration NCT02892773.).
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Oxygen is the most commonly used drug in critical care. However, because it is a gas, most clinicians and most patients do not regard it as a drug. For this reason, the use of medical oxygen over the past century has been driven by custom, practice, and "precautionary principles" rather than by scientific principles. ⋯ It has been known for many decades that the administration of supplemental oxygen is hazardous for some patients with COPD and other patients who are vulnerable to retention of carbon dioxide (ie, hypercapnia). It has been recognized more recently that excessive oxygen therapy is associated with significantly increased mortality in critically ill patients, even in the absence of risk factors for hypercapnia. This paper provides a critical overview of past and present oxygen use for critically ill patients and will provide guidance for safer oxygen use in the future.
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Mechanical ventilation alarms and alerts, both audible and visual, provide the clinician with vital information about the patient's physiologic condition and the status of the machine's function. Not all alarms generated by the mechanical ventilator provide actionable information. ⋯ To date, mechanical ventilator alarm settings do not have standardized nomenclature. The aim of this review was to examine and report on the literature that pertains to mechanical ventilation alarms and alarm fatigue and to propose recommendations for future research that may lead to safer mechanical ventilation alarm practices.