Respiratory care
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Randomized Controlled Trial Comparative Study
Neurally-Adjusted Ventilatory Assist for Noninvasive Ventilation via a Helmet in Subjects With COPD Exacerbation: A Physiologic Study.
In patients with COPD exacerbation, noninvasive ventilation (NIV) is strongly recommended. NIV is generally delivered by using patient triggered and flow-cycled pressure support through a face mask. A specific method to generate neurally-controlled pressure support has been shown to improve comfort and patient-ventilator interaction. In addition, the helmet interface was better tolerated by patients compared with a face mask. Herein, we compared neurally-controlled pressure support through a helmet with pressure support through a face mask with respect to subject comfort, breathing pattern, gas exchange, pressurization and triggering performance, and patient-ventilator synchrony. ⋯ In the subjects with COPD with exacerbation, NAVA through a helmet improved comfort, triggering performance, and patient-ventilator synchrony compared with pressure support through a face mask.
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Research in the area of adult invasive mechanical ventilation is rich and diverse. With more than 3,200 articles on mechanical ventilation published in 2018, isolating the most relevant literature is a challenge. Separated into 5 themes (ie, ventilatory support, hyperoxia, ventilator-associated events, prevention of events, and ventilator liberation), this article will describe the most important papers published on adult invasive mechanical ventilation in 2018.
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Randomized Controlled Trial
Visual Obstruction of Flow Indicator Increases Inspiratory Volumes in Incentive Spirometry.
Incentive spirometers were developed to facilitate sustained maximum inspiration. In addition to a slow-rising float that indicates volume displacement, the incentive spirometers includes a sensitive, rapid-fluttering flow indicator. Achieving the target inspiratory volume is believed to be the most important factor in successful incentive spirometers use. This investigation hypothesized that patients focus on the rapid fluttering of the flow indicator rather than volume float during incentive spirometers use. The effects of adjusting hand positioning to cover the flow indicator on inspiratory volumes were evaluated. ⋯ Covering the flow indicator during incentive spirometers significantly increased achieved inspiratory volumes. Increased volumes were generated, irrespective of flow indicator covering order, which strongly suggested that the covering effect was greater than any learning or condition order carry-over effects. Because achieving target inspiratory volumes is considered the most important factor in successful incentive spirometers use, these findings may have immediate applications for improving incentive spirometers protocols, patient education, and device design implications.
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Healthy individuals without respiratory symptoms can sometimes present with low FEV1/FVC. The objective of this study was to characterize and compare subjects without symptoms and with reduced FEV1/FVC but normal FEV1 with subjects with mild obstructive lung disease. ⋯ A reduced FEV1/FVC may be a normal finding in younger-to-middle age male subjects with an FVC% value above the mean predicted value, especially when terminal flow is within the normal range.
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Multicenter Study Observational Study
Lung Ultrasound Combined With Procalcitonin for a Diagnosis of Ventilator-Associated Pneumonia.
Lung ultrasound is a valuable imaging tool in the diagnosis of community-acquired pneumonia. However, its diagnostic accuracy in ventilator-associated pneumonia (VAP) has not been fully investigated. The aim of this study was to evaluate the diagnostic performance of the combination of a lung ultrasound with procalcitonin (PCT) in mechanically ventilated subjects with symptoms suggestive of pneumonia. ⋯ A combination of lung ultrasound and PCT was accurate in the diagnosis of VAP. Lung ultrasound is a useful lung-imaging tool to assist VAP diagnosis.