Respiratory care
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Nocturnal noninvasive ventilation is recommended for patients with hypercapnic COPD. Long-term oxygen therapy improves survival in patients with hypoxemic disease. However, leaks during noninvasive ventilation are likely to reduce the fraction of inspired oxygen. ⋯ The nighttime inspired O2 fraction decreased with a modern noninvasive ventilation pattern, pressure target, and intentional leaks. This partial lack of O2 therapy is likely to be harmful. It might explain the poor results in all but 2 randomized controlled trials on long-term noninvasive ventilation in COPD. (ClinicalTrials.gov registration NCT02599246.).
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Mechanical ventilation is a life-support therapy that can be associated with respiratory muscle dysfunction that may perturb the weaning process. The timed inspiratory effort (TIE) index is a recently proposed weaning index that has been reported to be effective in predicting successful weaning. We sought to analyze the respiratory muscle groups involved with the TIE index measurement utilizing the surface electromyography (sEMG). ⋯ Subjects succeeding in a weaning trial had higher muscle strength, confirmed in the pooled and the individual sEMG analysis. A vigorous diaphragm with low fatigue potential seems essential for successful weaning; the sternocleidomastoid may also be of importance in this regard.
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Automatic tube compensation (ATC) unloads endotracheal tube (ETT) resistance. We conducted a bench assessment of ATC functionality in ICU ventilators to improve clinical management. ⋯ ATC is used more frequently in clinical practice than expected. In addition, VT delivery by ATC differed slightly though significantly between ventilators.
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Editorial Comment
The Current State of Home Mechanical Ventilation in Children.