Respiratory care
-
Scoring systems are frequently used to assess the severity of pediatric asthma exacerbations. The modified pulmonary index score (MPIS) has been found to be highly correlated with length of stay (LOS) in the pediatric intensive care unit (PICU). We sought to evaluate the use of the MPIS to predict hospital LOS for patients admitted to our PICU. ⋯ The MPIS thresholds used in our pathway appropriately predicted LOS in our cohort of subjects with asthma admitted to the PICU. Higher MPIS was associated with increased hospital LOS, PICU LOS, and time on continuous albuterol.
-
We sought to evaluate the acute effects of different inspiratory loads using nasal and oral interfaces on the volumes of the chest wall and its compartments, breathing pattern, and respiratory muscle activation in children with mouth-breathing syndrome. ⋯ The use of acute inspiratory loads improved the breathing pattern and increased lung volume and electrical activity of inspiratory muscles. This work brings new perspective to the investigation of using nasal interfaces during the application of inspiratory loads. The nasal interface was more effective compared to the oral interface commonly used in clinical practice.
-
Medication adherence in asthma and COPD is notoriously low. To intervene effectively, family physicians need to assess adherence accurately, which is a challenging endeavor. In collaboration family physicians and individuals with asthma or COPD, we aimed to explore the barriers and facilitators of assessing medication adherence in clinical practice (exploratory phase), and to develop a novel web-based tool (e-MEDRESP) that will allow physicians to monitor adherence using pharmacy claims data (development phase). ⋯ The e-MEDRESP tool has the potential to allow physicians to measure adherence objectively and to facilitate patient-physician communication concerning medication use. Future studies are needed to evaluate the feasibility of implementing e-MEDRESP in clinical practice. It would be relevant to develop strategies that could facilitate the sharing of information presented in e-MEDRESP among primary care health professionals.
-
Detection of diaphragmatic muscle activity during invasive ventilation may provide valuable information about patient-ventilator interactions. Transesophageal electromyography of the diaphragm ([Formula: see text]) is used in neurally adjusted ventilatory assist. This technique is invasive and can only be applied with one specific ventilator. Surface electromyography of the diaphragm ([Formula: see text]) is noninvasive and can potentially be applied with all types of ventilators. The primary objective of our study was to compare the ability of diaphragm activity detection between [Formula: see text] and [Formula: see text]. ⋯ Analysis of our results showed that [Formula: see text] was not reliable for breathing effort detection in subjects who were invasively ventilated compared with [Formula: see text]. In stable recordings, however, [Formula: see text] and [Formula: see text] had excellent temporal correlation and good agreement. With optimization of signal stability, [Formula: see text] may become a useful monitoring tool.
-
In the modern era, many devices exist to support patients with respiratory insufficiency. There is currently no way to depict changes in the degree of support a patient is receiving over time. ⋯ Elements of respiratory support can be automatically extracted and transformed into a numerical RSS for visualization of respiratory course. The RSS provides a clear visual depiction of respiratory care over time, particularly in subjects with a complex ICU course. The score also allows for the automated adjudication of meaningful end points, including timing of extubation and incidence of nonprocedural re-intubation.