Respiratory care
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The ventilatory mechanics of patients with COPD and obesity-hypoventilation syndrome (OHS) are changed when there is air trapping and auto-PEEP, which increase respiratory effort. P0.1 measures the ventilatory drive and, indirectly, respiratory effort. The aim of the study was to measure P0.1 in subjects with COPD or OHS on treatment with positive pressure and to analyze their changes in P0.1 after treatment. ⋯ COPD and air trapping were associated with greater P0.1 as a marker of respiratory effort. A decrease in P0.1 indicates lower respiratory effort after treatment.
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The association between dyspnea and mortality has not been demonstrated in the ICU setting. We tested the hypothesis that dyspnea (self-reported respiratory discomfort) or its observational correlates (5-item intensive care Respiratory Distress Observation Scale [IC-RDOS]) assessed on ICU admission would be associated with ICU mortality. ⋯ IC-RDOS, an observational correlate of dyspnea, but not dyspnea itself, was associated with higher mortality in ICU subjects.
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Review Meta Analysis
Neurally adjusted ventilatory assist (NAVA) versus pressure support ventilation (PSV) during non-invasive ventilation (NIV): systematic review and meta-analysis.
Noninvasive ventilation (NIV) is increasingly used during ventilatory support. Neurally-adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that can improve patient-ventilator interaction. We conducted a meta-analysis to compare patient-ventilator interaction and clinical outcomes between NAVA and pressure support ventilation (PSV) in adult subjects during NIV. ⋯ NAVA has advantages in ventilator-patient interaction compared to PSV in NIV. Further research is needed in order to estimate effects on clinical outcomes.
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High-frequency percussive ventilation (HFPV) is an alternative mode of mechanical ventilation that has been shown to improve gas exchange in subjects with severe respiratory failure. We hypothesized that HFPV use would improve ventilation and oxygenation in intubated children with acute bronchiolitis. ⋯ HFPV was associated with significant improvement in ventilation and decreased exposure to high PIPs for mechanically ventilated children with bronchiolitis in our cohort and had a potential association with improved oxygenation. Our study shows that HFPV may be an effective alternative mode of ventilation in patients with bronchiolitis who have poor gas exchange on conventional invasive mechanical ventilation.