Respiratory care
-
Recruitment maneuvers in ARDS are used to improve oxygenation and lung mechanics by applying high airway pressures to reopen collapsed or obstructed peripheral airways and alveoli. In the early 1990s, recruitment maneuvers became a central feature of a variant form of lung-protective ventilation known as open-lung ventilation. This strategy is based on the belief that repetitive opening and closing of distal airspaces induces shear injury and therefore contributes both to ventilator-induced lung injury and ARDS-associated mortality. ⋯ We also review the radiologic, rheologic, and histopathologic evidence regarding the nature of lung injury and the phenomena of recruitment and de-recruitment as it informs our perceptions of recruitment potential in ARDS. Major lung-protective ventilation clinical trial data and other clinical data are also examined to assess the practical necessity of recruitment maneuvers in ARDS and whether a subset of cases might benefit from pursuing recruitment maneuver therapy. Finally, a less a radical approach to recruitment maneuvers is offered that might achieve the goals of recruitment maneuvers with less risk of harm.
-
Music therapy, as a non-drug therapy, is widely used in patients with COPD. However, the effects of music therapy on dyspnea, anxiety, depression and other physiological parameters has not been elucidated. Therefore, we sought to investigate the effects of passive music therapy (listening to music) and mixed music (combination of listening and singing) in adults with COPD. ⋯ Music therapy is effective in reducing dyspnea and anxiety in subjects with COPD. Additionally, music therapy may also improve sleep quality and physiological parameters of subjects with COPD. However, our conclusions need to be supported further by larger and longer well-designed trials.
-
Home noninvasive ventilation (NIV) improves disease courses of patients with respiratory insufficiency due to neuromuscular diseases. Data about appropriate ventilator settings for pediatric patients are missing. ⋯ Similar NIV settings fit all age groups of pediatric subjects with neuromuscular disease. Thus, we propose an expiratory positive airway pressure of 4-5 cm H2O, an inspiratory pressure delta of 8-10 cm H2O, and an age-oriented backup rate as a starting point for NIV titration. Patients with advanced disease stages might require slightly higher inspiratory positive airway pressures and backup rates.
-
Positive expiratory pressure (PEP) therapy imposes expiratory flow resistance to increase airway diameter and enhance mucus clearance. PEP is achieved several ways. Oscillatory PEP devices (OPEP) generate repeated occlusions that are known to reduce mucus viscosity. There are many marketed devices, but comparative performance is mostly unreported. The purpose of this study was to evaluate performance characteristics of many PEP/OPEP devices. For OPEP devices, we defined an optimal performance metric by creating an oscillation index that combines the OPEP performance characteristics. ⋯ PEP devices behaved similarly and as expected, with increased pressure with increased flow (flow resistors) or flow independence (threshold resistors). There was much greater variation in the performance of the OPEP devices. A higher oscillation index indicates better mechanical performance characteristics. Many devices have similar characteristics. However, the devices with the highest oscillation index have the highest flow amplitude and frequency, which may indicate better clinical performance.