Respiratory care
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ARDS in patients with coronavirus disease 2019 (COVID-19) is characterized by microcirculatory alterations in the pulmonary vascular bed, which could increase dead-space ventilation more than in non-COVID-19 ARDS. We aimed to establish if dead-space ventilation is different in patients with COVID-19 ARDS when compared with patients with non-COVID-19 ARDS. ⋯ Indirect measurements of dead space were higher in subjects with COVID-19 ARDS compared with subjects with non-COVID-19 ARDS. The best compliance of the respiratory system was similar in both ARDS forms provided that different PEEPs were applied. A wide range of compliance is present in every ARDS type; therefore, the setting of mechanical ventilation should be individualized patient by patient and not based on the etiology of ARDS.
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Observational Study
ACUTE RESPIRATORY DISTRESS SYNDROME OUTCOMES IN NON-RESEARCH SUBJECTS ASSESSED BY GENERALIZED PROSPECTIVE TRIAL ELIGIBILITY CRITERIA AND ADHERANCE TO LUNG-PROTECTIVE VENTILATION.
ARDS mortality is lower among subjects participating in randomized controlled trials (RCTs) compared to subjects in observational studies. Excluding potential subjects with inordinately high mortality risk is necessary to prevent masking the impact of potentially effective treatments. We inquired whether observed mortality differed between RCT-eligible and RCT-ineligible subjects managed with varying degrees of lung-protective ventilation in a non-research setting. ⋯ Mortality in non-research, RCT-eligible subjects was substantially lower compared to RCT-ineligible subjects. Managing non-research patients with ARDS by keeping plateau pressure ≤ 30 cm H2O and formal use of a lung-protective ventilation protocol significantly reduces mortality risk.
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User errors in managing heated humidifiers (HHs) have been suggested to be a source of nasal burns in newborns treated with nasal CPAP. This study evaluated the risk of burns by reproducing 3 typical errors concerning the use of HHs. ⋯ In case of misuse, 5 of the 6 tested devices presented a severe risk of inducing skin burns, whereas the MR950 presented a moderate risk.
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Aerosol therapy is commonly used by intensivists during invasive mechanical ventilation. More information is needed to optimize outcomes. The first aim of this study was to assess the deposition of salbutamol on components of a closed mechanical ventilation system, both in the presence and absence of biofilm generated by Acinetobacter baumannii. The second aim was to evaluate the deposition of salbutamol, using a single dose and a double dose, delivered via a jet nebulizer placed between the flexible tube and the heat and moisture exchanger. ⋯ Our findings indicate that an A. baumannii biofilm had no impact on the extent of salbutamol deposition. Salbutamol deposition was comparatively low and could be delivered without removal of the heat and moisture exchanger.