Respiratory care
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High-dose (≥ 80 ppm) inhaled nitric oxide (INO) has antimicrobial effects. We designed a trial to test the preventive effects of high-dose NO on coronavirus disease 2019 (COVID-19) in health care providers working with patients with COVID-19. The study was interrupted prematurely due to the introduction of COVID-19 vaccines for health care professionals. We thereby present data on safety and feasibility of breathing 160 ppm NO using 2 different NO sources, namely pressurized nitrogen/NO cylinders (INO) and electric NO (eNO) generators. ⋯ This pilot study testing high-dose INO (160 ppm) for 15 min twice daily using eNO seems feasible and similarly safe when compared with INO.
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Editorial Comment
Pandemic Surge, Well-Intended Responses, and Unintended Consequences.
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Ventilator-induced lung injury (VILI) requires repetitive transfer of energy from the ventilator to the compromised lung. To understand this phenomenon, 2 sets of equations have been developed to partition total inflation energy into harmless and hazardous components using an arbitrary level of alveolar pressure as a threshold beyond which further energy increments may become damaging. One set of equations uses premeasured resistance and compliance as inputs to predict the energy that would be delivered by typical ventilator settings, whereas the other equation set uses observed output values for end-inspiratory peak and plateau pressure of an already completed inflation. ⋯ This validation of threshold-partitioned energy equations suggests their potential utility for implementing practical strategies for VILI avoidance.
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Patients who are obese are at risk for developing high pleural pressure, which leads to alveolar collapse. Esophageal pressure (Pes) can be used as a surrogate for pleural pressure and can be used to guide PEEP titration. Although recent clinical data on Pes-guided PEEP has shown no benefit, its utility in the subgroup of patients who are obese has not been studied. ⋯ Individualization of PEEP with Pes guidance may have a role in patients who are obese.
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Humidification of inspiratory gases is mandatory in all mechanically ventilated patients in ICUs, either with heated humidifiers (HHs) or with heat and moisture exchangers (HMEs). In patients with COVID-19, the choice of the humidification device may have relevant impact on patients' management as demonstrated in recent studies. We reported data from 2 ICUs using either HME or HH. ⋯ The choice of the humidification device used in subjects with COVID-19 had a relevant impact on ventilation efficiency (increased CO2 removal with lower dead space) and on complications related to low humidity, including ETOs that may be present with heated-wire HHs when used with high ambient temperatures.