Respiratory care
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The word "quality" refers to the features of a product or service to which a certain value is ascribed. When it comes to hospital-based practices, quality has often been considered to be specific to the care provided. However, this specific perspective is transitioning toward a broader concept after the evolution of quality-improvement projects and quality frameworks at the organizational level. ⋯ Therefore, it would be ideal to have a core team of respiratory therapists trained in quality management and to initiate quality-improvement processes at the departmental level. Every respiratory therapy department should have its own quality-improvement team to assist with the process of training, implementation, and analysis. Thus, this article aimed to discuss the role of respiratory therapists and respiratory therapy departments in quality-improvement processes and projects to set benchmarks and enhance outcomes.
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Randomized Controlled Trial
Effects of Mechanical Insufflation-Exsufflation on Sputum Volume in Mechanically Ventilated Critically Ill Subjects.
Mechanical insufflation-exsufflation (MI-E) is a noninvasive technique performed to simulate cough and remove sputum from proximal airways. To date, the effects of MI-E on critically ill patients on invasive mechanical ventilation are not fully elucidated. In this randomized crossover trial, we evaluated the efficacy and safety of MI-E combined to expiratory rib cage compressions (ERCC). ⋯ In mechanically ventilated subjects, MI-E combined with ERCC increased the sputum volume cleared without causing clinically important hemodynamic changes or adverse events. (ClinicalTrials.gov registration: NCT03316079.).
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A recent paper reported that low muscle mass in the erector spinae muscles (ESM) was strongly associated with poor prognosis and declining muscle mass over time in subjects with COPD. However, effects of pulmonary rehabilitation (PR), if any, on ESM mass have not been reported. We hypothesized that PR reduces the annual decline in ESM mass. ⋯ ESM mass was shown to decline yearly in subjects with COPD. The annual decline in muscle mass was reduced by PR.
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ARDS in patients with coronavirus disease 2019 (COVID-19) is characterized by microcirculatory alterations in the pulmonary vascular bed, which could increase dead-space ventilation more than in non-COVID-19 ARDS. We aimed to establish if dead-space ventilation is different in patients with COVID-19 ARDS when compared with patients with non-COVID-19 ARDS. ⋯ Indirect measurements of dead space were higher in subjects with COVID-19 ARDS compared with subjects with non-COVID-19 ARDS. The best compliance of the respiratory system was similar in both ARDS forms provided that different PEEPs were applied. A wide range of compliance is present in every ARDS type; therefore, the setting of mechanical ventilation should be individualized patient by patient and not based on the etiology of ARDS.
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Observational Study
ACUTE RESPIRATORY DISTRESS SYNDROME OUTCOMES IN NON-RESEARCH SUBJECTS ASSESSED BY GENERALIZED PROSPECTIVE TRIAL ELIGIBILITY CRITERIA AND ADHERANCE TO LUNG-PROTECTIVE VENTILATION.
ARDS mortality is lower among subjects participating in randomized controlled trials (RCTs) compared to subjects in observational studies. Excluding potential subjects with inordinately high mortality risk is necessary to prevent masking the impact of potentially effective treatments. We inquired whether observed mortality differed between RCT-eligible and RCT-ineligible subjects managed with varying degrees of lung-protective ventilation in a non-research setting. ⋯ Mortality in non-research, RCT-eligible subjects was substantially lower compared to RCT-ineligible subjects. Managing non-research patients with ARDS by keeping plateau pressure ≤ 30 cm H2O and formal use of a lung-protective ventilation protocol significantly reduces mortality risk.