Respiratory care
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Cardiopulmonary exercise testing is an increasingly common test and is considered the accepted standard for assessing exercise capacity. Quantifying variability is important to assess the instrument for quality control purposes. Though guidelines recommend biologic control testing, there are minimal data on how to do it. We sought to describe variability for oxygen consumption (V̇O2 ), carbon dioxide production (V̇CO2 ), and minute ventilation (V̇E) at various work rates under steady-state conditions in multiple subjects over a 1-y period to provide a practical approach to assess and perform biologic control testing. ⋯ We report long-term variability for steady-state measurement of V̇O2 , V̇CO2 , and V̇E obtained during biocontrol testing. Utilizing ± 1.96 z-scores allows one to determine if a result exceeds expected variability, which may warrant investigation of the instrument.
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Observational Study
Clinical Findings and Outcomes From Subjects With COVID-19 Pneumonia in an Intermediate Respiratory Care Unit.
Many patients with COVID-19 require respiratory support and close monitoring. Intermediate respiratory care units (IRCU) may be valuable to optimally and adequately implement noninvasive respiratory support (NRS) to decrease clinical failure. We aimed at describing intubation and mortality in a novel facility entirely dedicated to COVID-19 and to establish their outcomes. ⋯ The IRCU was a valuable option to manage subjects with COVID-19 requiring NRS, thus reducing ICU overload. Male sex, gas exchange, and blood chemistry at admission were associated with worse prognosis, whereas older age, gas exchange, and blood chemistry were associated with 30-d mortality. These findings may provide a basis for better understanding outcomes and to improve management of noninvasively ventilated patients with COVID-19.
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Continuous monitoring of SpO2 throughout the 6-min walk test (6MWT) unveiled that some patients with respiratory diseases may present values across the test lower than SpO2 measured at the end of the test. Nevertheless, it remains unclear whether this approach improves the yield of walk-induced desaturation detection in predicting mortality and hospitalizations in patients with COPD. ⋯ O2 desaturation missed by end-exercise SpO2 but exposed by measurements during the test was independently associated with all-cause mortality and hospitalizations in subjects with COPD.
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Because some disease processes produce radiographic abnormalities that occur in characteristic distributions in the chest, classifying the position and appearance of these suggestive features and the underlying diseases provides a tool by which diagnostic accuracy might be improved. The goal of this review is to offer to the chest clinician a taxonomy of these disease entities that can produce characteristic chest radiographic distributions. ⋯ This taxonomy includes 3 distributional categories: (1) upper versus lower lung zone-predominant processes, (2) central versus peripheral processes, and (3) processes with distinctive focal locations, eg, "photonegative appearance" as in chronic eosinophilic pneumonia. It is hoped that this taxonomy aids the chest clinician in generating and streamlining a differential diagnosis and in ascertaining the specific cause of diseases with radiographic abnormalities.