Respiratory care
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Background: To test the ability of a low-pressure, low-flow, Heliox-based rebreathing system to reduce work of breathing and conserve gas while preserving CO2 concentration, temperature, and humidity at physiological levels in a bench study. Methods: We performed a bench study of a novel low-pressure, low-flow, noninvasive Heliox rebreathing system with CO2 scrubber that was connected to an artificial lung simulator with careful monitoring of flow, pressure, work of breathing, oxygen (O2), carbon-dioxide (CO2), temperature, and humidity levels. Multiple runs of breathing were performed while manipulating levels of resistance (5 - 30 cm H2O/L/sec), gas mixtures (room air, 79% Helium 21% O2, and 70% Helium and 30% O2), and leak levels (ultra-low, low, and high). ⋯ Gas wastage was reduced by 10- to 54-fold while the end-tidal CO2 concentration, humidity, and temperature were maintained by the device at physiological levels. Conclusions: In a bench-test, a low-pressure, low-flow, noninvasive Heliox rebreathing system with CO2 scrubber reduced work of breathing and conserved gas while preserving CO2 concentration, temperature, and humidity at physiological levels. Future studies in human subjects need to be performed to determine whether reduction of work of breathing and gas conservation can be achieved.
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Aerosol therapy is commonly used during treatment with high-flow nasal cannula (HFNC) in the intensive care unit (ICU). Heated humidification inside the HFNC tubing circuit leads to unwanted condensation, which may greatly limit the efficiency of drug delivery. In this study, we aimed to investigate whether a novel humidification system, which decouples temperature and humidity control, can improve the delivered dose. ⋯ In this bench study, we found that the delivered dose for an infant HFNC nebulization setup could be improved significantly by decoupling temperature and humidity control inside the HFNC circuit, as it reduced drug deposition inside the breathing circuit.
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A protocolized extubation readiness test (ERT), including a spontaneous breathing trial (SBT), is recommended for patients who are intubated. This quality-improvement project aimed to improve peri-extubation outcomes by using a high-risk ERT protocol in intubated cardiac patients in addition to a standard-risk protocol. ⋯ In this quality-improvement project, a high-risk ERT protocol was implemented with improvement in peri-extubation outcomes among cardiac subjects.
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When treating acute respiratory failure, both hypoxemia and hyperoxemia should be avoided. SpO2 should be monitored closely and O2 flows adjusted accordingly. Achieving this goal might be easier with automated O2 titration compared with manual titration of fixed-flow O2. We evaluated the feasibility of using an automated O2 titration device in subjects treated for acute hypoxemic respiratory failure in a tertiary care hospital. ⋯ Automated O2 titration could be successfully implemented in hospitalized subjects with hypoxemic respiratory failure from various causes. This experience should foster further improvement of the device and recommendations for an optimized utilization.
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Review Meta Analysis
A network meta-analysis on the effects of different exercise types on COPD patients.
This study aimed to compare and rank the effects of aerobic exercise, resistance training, endurance training, and high-intensity interval training in COPD by network meta-analysis. ⋯ The findings of this study suggest that high-intensity interval training may be more effective than endurance exercise, resistance exercise, and aerobic exercise in improving the 6-min walk distance, FEV1, FEV1/FVC, and St. George Respiratory Questionnaire scores in patients with COPD. In addition, endurance training may be better than resistance exercise, aerobic exercise, and high-intensity interval training in improving FVC in patients with COPD. However, due to the limited number of studies conducted on high-intensity interval training, more high-quality randomized controlled trials are required to verify these conclusions.