Respiratory care
-
Oxygen titration is recommended to avoid hyperoxemia and hypoxemia. Automated titration, as well as the [Formula: see text] target, may have an impact on oxygen utilization, with potential logistical effects in emergency and military transportation. We sought to assess the oxygen flow required for different [Formula: see text] targets in spontaneously breathing subjects, and to evaluate individualized automated oxygen titration to maintain stable oxygenation in subjects with COPD and healthy subjects with induced hypoxemia. ⋯ Significant reductions in the amount of oxygen delivered could be obtained with optimized [Formula: see text] targets. Oxygen delivery through a gas mask to correct hypoxemia is feasible, and automated oxygen titration may help individualize oxygen administration and reduce oxygen utilization. (ClinicalTrials.gov registration: NCT02782936, NCT02809807.).
-
Respiratory monitoring in patients receiving oxygen therapy for acute care is mandatory at the initial stage of in-hospital management given the potential risk of clinical worsening. Although some patients benefit from close monitoring in the ICU, the vast majority of them are managed in general wards with reduced staff and clinical supervision. The objective of monitoring is to detect early clinical deterioration, which may help prevent in-hospital cardiac arrest. ⋯ Automated and continuous monitoring, in addition to clinical evaluation and arterial blood gases analysis, which remain necessary, may improve the detection of clinical worsening in specific patients. Devices that automatically titrate and wean oxygen flow on the basis of [Formula: see text] enable measurement of several major cardiorespiratory parameters (eg, [Formula: see text], oxygen flow, heart rate, breathing frequency, and heart rate variability). The combination of these parameters into new scores is at least as accurate and well-evaluated, and recommended early warning scores and may be useful in monitoring patients receiving oxygen therapy.
-
Randomized Controlled Trial
Clinical Efficacy of Vibrating Mesh and Jet Nebulizers With Different Interfaces in Pediatric Subjects With Asthma.
Nebulizers are commonly used in emergency departments to deliver bronchodilators to children with asthma exacerbations. However, no clinical study comparing a vibrating mesh nebulizer with a jet nebulizer is available in this patient population. The purpose of this study was to compare the clinical efficacy of a vibrating mesh nebulizer to a jet nebulizer combined with a mouthpiece or mask in children with asthma exacerbations admitted to the emergency department. ⋯ Subjects treated with a vibrating mesh nebulizer required significantly fewer treatments and less time to achieve a mild asthma score. In subjects with a mask interface, the vibrating mesh nebulizer significantly reduced the probability of admission compared to jet nebulizer. (ClinicalTrials.gov registration NCT02774941.).
-
Some patients with acute heart failure (AHF) who are treated initially with noninvasive ventilation (NIV) will require endotracheal intubation, which indicates NIV failure. The incidence and prognosis of NIV failure in patients with AHF are not well characterized. ⋯ Intubation after initial NIV treatment was required in 1.5% of subjects hospitalized with AHF and treated with NIV, and was associated with high in-hospital mortality. These findings can guide future prospective interventional trials and quality improvement ventures.
-
Intravenous formulations of epoprostenol are frequently delivered via nebulizer to treat pulmonary hypertension in acutely ill patients. Although their efficacy as pulmonary vasodilators has been shown to be comparable to inhaled nitric oxide, the local effects of these formulations within the airways have not been determined. We hypothesized that the alkaline diluents of these compounds would lead to increased airway epithelial cell death and ciliary cessation. ⋯ Exposure to intravenous formulations of epoprostenol in glycine and arginine caused increased cell death and ciliary cessation in bronchial epithelial cells. These findings suggest that undesired local effects may occur when these compounds are delivered as inhaled aerosols to patients.