Respiratory care
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Comparative Study
Comparison of Pediatric Tracheostomy Stoma Cleaning Solutions.
In the limited literature on cleaning tracheostomy stoma sites, there is no standard guideline for the cleaning solution. The objective of this study was to determine whether signs of stoma-site infection were different among a hospitalized pediatric population when using sterile water, sterile saline solution, or 0.25% acetic acid solution for tracheostomy stoma cleaning. ⋯ Analysis of our findings indicated that a 0.25% acetic acid solution used for stoma cleaning may be associated with fewer signs of infection than sterile water or sterile saline solution. More research is warranted toward establishing a standard practice.
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Oxygen has long been considered a vital and potentially life-saving component of emergency care. Given this, there is widespread and liberal use of supplemental oxygen in hospitals across the United States and throughout the world. Recent research, however, delineates serious deleterious effects at the cellular level, inducing damage to the cardiovascular system, the central nervous system, the pulmonary system, and beyond. ⋯ Current evidence suggests an association between hyperoxia and increased mortality after cardiac arrest, stroke, and traumatic brain injury, as well as in the setting of sepsis, although there is insufficient evidence to conclude concretely that hyperoxia effects clinical outcomes. As such, there exists a need for additional large-scale randomized controlled trials with well-defined parameters for the evaluation of clinical outcomes. Until the completion of such trials, titration of supplemental O2 to normoxia is advised to avoid the negative effects of both hyperoxia and hypoxia in acutely ill adult patients.
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The benefits of inspiratory muscle training (IMT) for patients with COPD are documented in the literature, but its isolated effect or association with other interventions, the best training methods, and what type of patient benefits the most are not clear. We sought to assess the effects of IMT on respiratory muscle strength, pulmonary function, dyspnea, functional capacity, and quality of life for subjects with COPD, considering IMT isolated or association with other interventions, presence of inspiratory muscle weakness, training load, and intervention time. ⋯ Isolated IMT improved inspiratory muscle strength, functional capacity, and pulmonary function, without changing dyspnea and quality of life. Associated IMT only increased inspiratory muscle strength. These results indicate that isolated IMT can be considered as an adjuvant intervention in patients with COPD.
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Secretion management in mechanically ventilated patients is a paramount task for clinicians. A better understanding of the mechanisms of flow bias and airway dynamic compression during airway clearance therapy may enable a more effective approach for this population. Ventilator hyperinflation, expiratory rib cage compression, a PEEP-ZEEP maneuver, and mechanical insufflation-exsufflation are examples of techniques that can be optimized according to such mechanisms. In addition, novel technologies, such as electric impedance tomography, may help improve airway clearance therapy by monitoring the consequences of regional secretion displacement on lung aeration and regional lung mechanics.
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We sought to longitudinally assess the efficacy of the patient-facing ASTHMAXcel mobile application in improving asthma knowledge and outcomes in adults with asthma. ⋯ ASTHMAXcel contributes to improved asthma knowledge and outcomes and to decreased health care utilization. ASTHMAXcel is an inexpensive, scalable aid for out-patient asthma management.