Respiratory care
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Manual rib cage compression is a chest physiotherapy technique routinely used in clinical practice. However, scientific evidence remains scarce on the effects of manual rib cage compression on airway clearance and oxygenation in mechanically ventilated patients. ⋯ Our findings indicated that hard and brief manual rib cage compression combined with closed suctioning was safe and led to improvement of mucus clearance; however, no effectiveness was confirmed with regard to oxygenation and ventilation.
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Observational Study
The Impact of High-Flow Nasal Cannula on Olfactory Function.
Oxygen therapy provided via high-flow nasal cannula (HFNC) improves gas exchange lung compliance and results in increased lung expiratory volumes. Previous data indicate that hyperbaric and humid states improve the olfactory thresholds compared to hypobaric and dry conditions. This prospective, observational study aimed to determine the impact of oxygen delivery through HFNC on olfactory function in subjects admitted to the ICU for acute respiratory failure (ARF). ⋯ Our results indicate that subjects with ARF had relative olfactory dysfunction compared to healthy controls. These results also suggest that implementation of HFNC to relieve hypoxemia in subjects presenting with ARF can lead to a significant improvement in olfactory function.
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More children are discharged from ICUs on prolonged mechanical ventilation (PMV) via tracheostomy than ever before. These patients have long hospitalizations with high resource expenditure. Our objective was to describe the characteristics of these resource-intensive patients and to evaluate their costs of care. We hypothesized that subjects requiring PMV for neurologic diagnoses would have higher costs, longer hospital length of stay (LOS), and worse outcomes than those with primarily respiratory diagnoses. ⋯ This descriptive study evaluated the social and medical characteristics of subjects being discharged from the pediatric ICU with PMV via tracheostomy, as well as quantified the financial impact of their care. Those requiring PMV for neurologic diagnoses had shorter hospital LOS and lower hospital costs than those with respiratory diagnoses. No definitive differences in outcomes were found.
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Survivors of prolonged ICU admissions are bedridden and immobilized for an extended period of time. These patients often are discharged to long-term acute care hospitals (LTACHs) for continued medical care and rehabilitation. Early ambulation has been associated with improved functional outcomes and lower readmission rates in hospitalized patients. The aim of this study was to determine the association between ambulatory status and discharge disposition in survivors of prolonged ICU stays who were admitted to an LTACH. ⋯ The ability to ambulate was associated with a greater likelihood of being discharged home in survivors of prolonged ICU stays who were admitted to an LTACH. These results suggest that mobility training for survivors of prolonged ICU stays in LTACH facilities should be strongly emphasized to improve their likelihood of being discharged home.
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Individuals who share the same comorbidity profile are usually similar with regard to their disease severity, use of health care, and clinical outcomes. The identification of comorbidity clusters therefore bears prognostic information. The objective of this study was to identify and characterize comorbidity clusters in individuals with COPD in Denmark. ⋯ The presence of heart disease in individuals with COPD is a strong prognostic factor for socioeconomic and health vulnerability.