Respiratory care
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The new Global definition of ARDS recently introduced a subgroup known as non-intubated ARDS. This study aimed to assess the risk of progression from noninvasive oxygen support to intubation and ARDS severity based on the SpO2 /FIO2 among non-intubated subjects with ARDS. ⋯ The non-intubated ARDS criteria encompassed a broader spectrum of subjects with lower in-hospital mortality compared to the Berlin criteria. The SpO2 /FIO2 and ARDS severity cutoff proposed in the new Global ARDS definition were valuable predictors of in-hospital mortality in these subjects.
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The global population is aging, and the proportion of elderly patients admitted to Intensive Care Units (ICUs) is increasing. In this scenario, achieving a balance between judicious utilization of a limited and high-cost resource and providing optimal intensity of care presents a challenge, given that in very elderly patients, the value of ICU care is uncertain. The aim of our study is to evaluate the survival of older patients admitted to ICU who require mechanical ventilation (MV) at different levels of treatment intensity. ⋯ Our data indicate that in older subjects using MV, higher intensity of treatment does not seem to translate into a survival benefit. This finding highlights the importance of considering individualized treatment plans for elderly patients in the ICU.
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Transnasal fiberoptic laryngoscopy (TFL) has revealed that laryngeal obstruction can hamper assisted ventilation. TFL may be considered invasive, and laryngeal ultrasound (US) could be a noninvasive alternative. The objective of this study was to investigate the feasibility of using laryngeal US to study laryngeal movements in healthy adult volunteers undergoing noninvasive ventilation (NIV) and to compare the observations with those of simultaneous TFL. ⋯ Laryngeal US emerged as a feasible method to describe laryngeal movements during NIV, providing high-quality observations and high concordance with TFL.
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Assessing respiratory mechanics in patients with acute hypoxemic respiratory failure who are not intubated could provide useful information about illness trajectory. Oscillometry is a respiratory function test used to measure total respiratory impedance during tidal breathing, which reveals resistive and elastic properties of the lung. This study assessed the feasibility of oscillometry in patients with acute hypoxemic respiratory failure and described their respiratory mechanics. ⋯ Respiratory mechanics in the participants with acute hypoxemic respiratory failure who were not intubated could be assessed by oscillometry in carefully selected cases.
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Mechanical insufflation-exsufflation (MI-E) is crucial to assist patients with impaired cough, especially those with neuromuscular diseases. Despite recent advancements that enable real-time display of peak expiratory flow (PEF) and inspiratory volume, accurately monitoring these parameters with MI-E devices during treatment can still present challenges. ⋯ Our study highlighted consistent underestimation of PEF and inspiratory volume across MI-E devices. Improving device monitoring is essential for guiding MI-E therapy and ensuring patient safety.