Respiratory care
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Review Meta Analysis
Community-Based Pulmonary Rehabilitation Programs in Individuals With COPD.
Community-based pulmonary rehabilitation (PR) programs can be offered to patients with COPD, but the literature on its effects is still not well summarized. Our purpose was to investigate the health-, physical-, and respiratory-related effects of community-based PR in individuals with COPD as compared to control groups. ⋯ Community-based PR tended to result in superior health-related quality of life and symptoms than control interventions, but the findings were inconsistent across outcomes and with very low certainty of evidence. Further studies are warranted for stronger conclusions.
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Review
Portable Handheld Point-of-Care Ultrasound for Detecting Unrecognized Esophageal Intubations.
Esophageal intubations are not an uncommon occurrence in prehospital settings, occurring as high as 17%. These "never events" are associated with significant morbidity and mortality especially when unrecognized or when there is delayed recognition. Here, we review the currently available techniques for confirming endotracheal tube intubation and their limitations, and present the case for the application of portable handheld point-of-care ultrasound as an emerging technology for detection of potentially unrecognized esophageal intubations such as during cardiac arrest. We also provide algorithms for confirmation of tracheal intubation.
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Randomized Controlled Trial
Patient-Ventilator Synchrony in Neurally-Adjusted Ventilatory Assist and Variable Pressure Support Ventilation.
Neurally-adjusted ventilatory assist (NAVA) improves patient-ventilator synchrony and reduces the risk of respiratory over-assistance. Variable pressure support ventilation (PSV) is a recently introduced mode of assisted ventilation that has also shown reduction in patient-ventilator asynchronies. We hypothesized that NAVA would reduce patient-ventilator asynchronies and inspiratory effort compared to variable PSV because breathing variability was intrinsically determined by the patient and not by the ventilator. This study aimed to evaluate patient-ventilator asynchronies and inspiratory effort pressure-time product (PTP) between NAVA and variable PSV in subjects with mild ARDS. ⋯ In this randomized controlled trial including subjects with mild ARDS, NAVA and variable PSV had comparable effects on patient-ventilator synchronies and PTP. However, variable PSV reduced the variability of VT and PS when compared with NAVA.
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An increase in respiratory work load and resistance to respiration cause a decrease in respiratory muscle endurance (RME) in patients with obesity hypoventilation syndrome (OHS). We aimed to evaluate and compare RME in subjects with OHS and a control group using an incremental load test and compare the RME of subjects with OHS in whom noninvasive ventilation (NIV) was and was not used. ⋯ RME was low in subjects with OHS but higher in those who used NIV. The incremental load test could be performed easily and safely in a clinic setting.
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The mask leak test used for modern noninvasive ventilators can detect the leak characteristics of masks that are not recommended by the manufacturer, but it has not yet been determined whether this method is acceptable. ⋯ The mask leak test had no effect on the ventilator performance when masks not recommended by the manufacturer were used, but tidal volume monitoring may be more accurate when some masks were used.