Respiratory care
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Editorial Comment
Preventing Colonization by Lung Isolation: Primum Non Nocere.
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Review Meta Analysis
Effects of Transitional Care on Hospital Readmission and Mortality Rate in Subjects With COPD: A Systematic Review and Meta-Analysis.
Studies on the effect of transitional care on hospital readmissions have reported inconsistent findings, and the effect on mortality has not been reviewed systematically. This systematic review and meta-analysis of randomized controlled trials aims to examine the effect of transitional care interventions on COPD-related readmissions, all-cause hospital readmissions, and all-cause mortality rates in subjects with COPD. ⋯ There was a significant effect of transitional care on both COPD-related and all-cause hospital readmissions in subjects with COPD. Duration of interventions, type of care providers, and use of telephone follow-up appeared to moderate the beneficial effects of transitional care.
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Randomized Controlled Trial
Impact of Gas Masks on the Work of Breathing and Breathing Pattern in Subjects With Stable COPD.
The gas mask constitutes the main respiratory protective equipment in a chemical, biological, radiological, or nuclear environment. The aim of the study was to evaluate the impact of the gas mask on respiratory pattern, gas exchange, and indexes of respiratory effort in patients with moderate to severe stable COPD. ⋯ Indexes of respiratory effort increased slightly in subjects with stable COPD while using a gas mask. This effect was likely related to increased inspiratory resistance when the mask was worn. These data are reassuring for the potential short-duration use of such protection for patients with moderate to severe COPD.
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Multicenter Study Clinical Trial
Effects of Changes in Apnea Time on the Clinical Status of Neonates on NIV-NAVA.
Apnea time allows the clinician to set a minimum spontaneous respiratory frequency when using noninvasive neurally-adjusted ventilatory assist (NIV-NAVA). Short apnea times may provide backup ventilation during periods of physiologic variability causing overventilation and suppression of spontaneous respiratory drive. Longer apnea times may allow more spontaneous ventilation but can result in insufficient respiratory support. The purpose of this study was to evaluate various apnea times in neonates on NIV-NAVA. ⋯ Short apnea times resulted in more switches into backup ventilation and longer time in backup ventilation but promoted clinical stability with fewer clinically important events in neonates ventilated with NIV-NAVA.
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The optimization of ventilation during cardiopulmonary resuscitation (CPR) is a broad field of research. Recent physiological observations in this field challenge the current understanding of respiratory and circulatory interactions. Thanks to different models available (bench, animal, human), the understanding of physiological phenomena occurring during CPR has progressed. ⋯ We summarize the clinical and animal observations supporting these concepts. We then discuss the different contributions of bench, animal, and human models to the understanding of airway closure and their impact on intrathoracic pressure, airway closure, and hemodynamics generated by chest compression. The limitation of airway pressure and ventilation, resulting from airway closure reproducible in models, may play a major role in ventilation and gas exchange impairment observed during prolonged resuscitation.