Respiratory care
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Review Meta Analysis
Positive Airway Pressure and Metabolic Markers in Children With Obstructive Sleep Apnea.
Increasing evidence suggests an association between childhood obstructive sleep apnea (OSA) and metabolic syndrome, with more research available on the potential impacts of positive airway pressure (PAP) on metabolic markers in children. The purpose of this systematic review is to provide a systematic synthesis of the evidence on the effect of PAP use on metabolic markers in children with OSA. ⋯ Although evidence on effects of PAP on metabolic markers in children with OSA is encouraging, available literature is limited. Longitudinal studies are still required to further assess the long-term influence of PAP on metabolic and inflammatory markers, particularly in children with obesity.
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Tracheostomized children have higher mortality compared to adults due to smaller airway anatomy and greater medical complexity and are at high risk for life-threatening complications. Following new tracheostomy placement, caregivers are required to successfully complete extensive training before discharge home. Training for tracheostomy emergencies such as tube obstruction and accidental decannulation is challenging without real-life, hands-on experience, but simulation training has shown promising effects on improving caregiver knowledge and comfort in preparing for emergency situations. ⋯ However, guidelines for standardized management of tracheostomy-related respiratory illness are not available. Although standardized decannulation protocols are utilized, evidence-based guidelines are lacking, and the role of routine polysomnogram prior to decannulation is unresolved. Several knowledge gaps in management of pediatric tracheostomy present the opportunity for future research to improve patient outcomes.
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Pulse oximetry is arguably the most impactful monitor ever introduced into respiratory care practice. Recently there has been increased attention to the problem of occult hypoxemia in which patients are hypoxemic despite an acceptable SpO2 Although occult hypoxemia might be greater in Black patients than white patients, it is not insignificant in whites. In a given population of patients, the bias between SpO2 and arterial oxygen saturation (SaO2 ) might be close to zero. ⋯ Manufactures report accuracy of SpO2 derived from normal individuals, which might differ from that in the clinical setting. That SpO2 overestimates SaO2 in an important number of individuals has caused some to recommend higher SpO2 targets to avoid occult hypoxemia. There is also evidence that suggests that SpO2 might not accurately trend SaO2 Additional research is needed to investigate strategies to mitigate the bias between SpO2 and SaO2 Clinicians must be cognizant of the limitations of pulse oximetry when clinically using SpO2 The aim of this paper is to provide an update on pulse oximetry.
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Randomized Controlled Trial
Direct Health Care Costs Associated With a Multicomponent COPD Exacerbation Intervention.
Health care costs attributed to COPD have been estimated at $4.7 trillion globally in the next 30 years. With the global burden of COPD rising, identification of interventions that might lead to health care cost savings is an imperative. Although many studies report the effect of COPD self-management interventions on subject outcomes and health care utilization, few data describe their effect on health care costs. ⋯ Controlling for important confounders, we found lower public community health care costs but no difference in acute health care costs with our multicomponent COPD exacerbation prevention management intervention compared to usual care. Community health care costs were almost double those incurred compared to acute health care costs. Given this finding, although most COPD exacerbation management interventions generally focus on reducing the use of acute care, interventions that enable health care cost savings in the community require further exploration.