Respiratory care
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Randomized Controlled Trial Multicenter Study
Comparison of Two Extubation Techniques in Critically Ill Adult Subjects: The ExtubAR Randomized Clinical Trial.
Two orotracheal extubation techniques are described in the literature: the traditional technique and the positive-pressure technique. Although prior studies reported better clinical outcomes with the positive-pressure extubation technique, its superiority has not been extensively studied yet. This study was to determine whether the positive-pressure orotracheal extubation technique, compared with the traditional orotracheal extubation technique, reduces the incidence of major postextubation complications (up to 60 min) in critically ill adult subjects. ⋯ Despite the trend toward the positive-pressure group, no statistically significant differences were observed. Our findings agree with the literature in that positive-pressure extubation is a safe procedure; therefore, both techniques may be used during extubation in critically ill adult patients.
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Multicenter Study Observational Study
Lung Ultrasound Findings Associated With COVID-19 ARDS, ICU Admission, and All-Cause Mortality.
As lung ultrasound (LUS) has emerged as a diagnostic tool in patients with COVID-19, we sought to investigate the association between LUS findings and the composite in-hospital outcome of ARDS incidence, ICU admission, and all-cause mortality. ⋯ Pathologic findings on LUS were common a median of 3 d after admission in this cohort of non-ICU hospitalized subjects with COVID-19 and did not differ among subjects who experienced the composite outcome of incident ARDS, ICU admission, and all-cause mortality compared to subjects who did not. These findings should be confirmed in future investigations. The study is registered at Clinicaltrials.gov (NCT04377035).
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Although noninvasive ventilation (NIV) is administered to manage respiratory failure due to various causes, safety and effectiveness issues associated with the use of NIV masks have been reported. The present article aims to provide health professionals with a comprehensive review of the ergonomic considerations of NIV masks in terms of design, evaluation, and personalization. ⋯ The comprehensive information presented in this review provides ergonomic perspectives to identify and prevent safety and usability problems associated with the use of NIV masks. Ergonomic improvement and personalization are important goals in order to facilitate the success of NIV treatment.
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Pediatric patients require tracheostomy tube placement as a last resort for critical airway management. Around-the-clock care is needed at discharge because of the high risk of morbidity and mortality associated with a tracheostomy. The potential for catastrophic sequalae can create a high stress home environment. A simulation program that used a high-fidelity manikin was implemented to reduce complications, morbidity and mortality, and improve skills for real-life medical scenarios. ⋯ Caregiver knowledge, confidence, and comfort levels were increased after participation. Pediatric patients with a tracheostomy are medically fragile, therefore, it is important for caregivers to be aware of and prepared for common tracheostomy emergencies and to "experience" emergency situations firsthand.