Respiratory care
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Manual and mechanical cough augmentation techniques are used for airway clearance when cough effort is ineffective. Mechanical insufflation-exsufflation (MI-E) has been a mainstay for respiratory complications of neuromuscular disorders, but its use has expanded to other conditions that result in respiratory muscle weakness and impaired cough, such as intubation and mechanical ventilation. Mechanical in-exsufflation has been used for cough augmentation in both adults and children but has been more widely evaluated in adults. ⋯ Electrical impedance tomography has been used for monitoring during mechanical ventilation and may have a role in assessing the effectiveness of MI-E. Much of the literature that supports MI-E is derived from small, single-center studies of adult populations. Future study is warranted for efficacy and optimization of MI-E therapy in various clinical applications.
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Driving pressure (ΔP) and mechanical power (MP) may be important mediators of lung injury in ARDS; however, there is little evidence for strategies directed at reducing these parameters. We applied predictive modeling to estimate the effects of modifying ventilator parameters on ΔP and MP. ⋯ This novel conditional modeling confirmed expected response patterns for ΔP, with the response to adjustments depending on subjects' lung mechanics. Furthermore, a VT-driven approach should be favored over a breathing frequency-driven approach when aiming to reduce MP.
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During continuous flow CPAP for noninvasive respiratory support, a high flow (eg, 60-90 L/min) of gas with FIO2 titratable up to 1.0 is provided within a helmet or face mask, while a PEEP valve maintains the set pressure. A large amount of oxygen is wasted, whereas only a minimal amount is consumed. We describe a recirculation circuit designed to reuse the exhaust gas and save oxygen. ⋯ The recirculation system allowed a 80% reduction of oxygen consumption during simulated helmet CPAP therapy, whereas CO2 removal was effective for > 10 h. Recirculation minimally affected pneumatic performance of the CPAP continuous flow system, while improving gas conditioning as compared to the standard system.
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Spinal muscular atrophy (SMA) is a neurodegenerative disease that results in progressive muscular atrophy and weakness. The primary cause of morbidity and mortality in these children is pulmonary disease due to poor airway clearance that leads to acute respiratory failure. There is a paucity of literature on the treatment of children with SMA and acute respiratory failure. ⋯ The subjects with SMA types I or II can be treated successfully with NIV and aggressive airway clearance during acute respiratory failure. Similarly, when intubation is required, successful extubation can be achieved with NIV transitional support combined with aggressive airway clearance maneuvers.