Respiratory care
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Nebulized 7% hypertonic saline is used to treat patients with cystic fibrosis. Clinical trials supporting its use were conducted with breath-enhanced nebulizers (BEN). It is not uncommon for the specific nebulizer used in studies or prescribed by a physician to be unavailable to patients. The investigator compared the aerosol characteristics of hypertonic saline delivered by nebulizers of different operating principles. ⋯ Hypertonic saline aerosols generated with the BEN and BAN devices were similar, while that generated with the CON was different. Airway delivery was similar between the BEN devices, but higher than that observed with the BAN and CON devices.
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Patients with coronavirus disease 2019 (COVID-19) often develop acute hypoxemic respiratory failure and receive invasive mechanical ventilation. Much remains unknown about their respiratory mechanics, including the trajectories of pulmonary compliance and [Formula: see text]/[Formula: see text], the prognostic value of these parameters, and the effects of prone positioning. We described respiratory mechanics among subjects with COVID-19 who were intubated during the first month of hospitalization. ⋯ Respiratory mechanics of the subjects with COVID-19 who were on mechanical ventilation were characterized by persistently low respiratory system compliance and [Formula: see text]/[Formula: see text], similar to ARDS due to other etiologies. The [Formula: see text]/[Formula: see text] was more tightly associated with mortality than with compliance.
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Multicenter Study Observational Study
Driving Pressure is a Risk Factor for ARDS in Mechanically Ventilated Subjects Without ARDS.
Driving pressure (ΔP) has been described as a risk factor for mortality in patients with ARDS. However, the role of ΔP in the outcome of patients without ARDS and on mechanical ventilation has received less attention. Our objective was to evaluate the association between ΔP on the first day of mechanical ventilation with the development of ARDS. ⋯ In the subjects without ARDS, a higher level of ΔP on the first day of mechanical ventilation was associated with later development of ARDS. (ClinicalTrials.gov registration NCT02731898.).
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Bronchopulmonary dysplasia (BPD) is a chronic lung disease most commonly seen in preterm infants of low birthweight who required postnatal respiratory support. Although overall incidence rates have not changed, recent advancements in medical care have resulted in lower mortality rates, and those affected are beginning to live longer. As a result, the long-term repercussions of BPD are becoming more apparent. ⋯ This includes an increased risk for cerebral palsy and developmental delays, lower intelligence quotient (IQ) scores, impaired executive functioning, behavioral challenges, delays in expressive and receptive language development, and an increased risk of growth failure. In addition, the deficits of BPD have been found to influence much more than just physical health; BPD survivors have been noted to have higher rates of health care use, starting with the initial hospitalization and continuing with therapy and specialist follow-up, as well as impairments in quality of life, both physical and psychological, that continue into adulthood. The long-term consequences of BPD may best be addressed through future research, including better understanding of the pathophysiologic mechanisms leading to BPD, further comparisons between newborns with BPD and those without, and long-term assessment and management of BPD patients as adults.
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Pneumatic tube transport of blood gas samples is a common method of delivery within a facility. The effects of pneumatic tube transport on blood gas analysis has been studied. However, other analytes that are often assessed in blood gas analysis (eg, electrolytes, metabolites, and oximetry) are not typically included in these studies. We sought to investigate the impact of pneumatic tube transport on some of these other analytes. ⋯ Pneumatic tube transport of blood gas specimens is acceptable for blood gas and supplementary analytes, as evidenced by multiple points of evaluation, including statistical analysis, clinical judgment, and concordance with regulatory guidelines.