Respiratory care
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Chronic heart failure is commonly associated with inspiratory muscle weakness. However, few studies have investigated the risk factors for inspiratory muscle weakness in individuals with chronic heart failure and systolic dysfunction (left-ventricular ejection fraction [LVEF] <40%). ⋯ The combination of lower LVEF, lower systolic blood pressure, and smoking history predicted inspiratory muscle weakness. Patients with suspected inspiratory muscle weakness should be examined and, if inspiratory muscle weakness exists, then inspiratory muscle training should be provided. Reducing inspiratory muscle weakness has the potential to improve many of the deleterious effects of chronic heart failure.
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Editorial Comment
Management of Severe ARDS: New Strategies and Ongoing Challenges.
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Severe exertional dyspnea is a commonly reported symptom in patients with COPD, especially in the advanced stages. Our objective was to assess the preliminary impact of comprehensive, individualized management provided by a specialized tertiary center clinic on exertional dyspnea and patient-centered outcomes in patients with advanced COPD. ⋯ Although the impact of our specialized advanced dyspnea clinic was variable, as evaluated by the ESAS-r, it provided measurable additional clinically important benefit to almost half of the subjects with advanced COPD and severe refractory dyspnea.
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We sought to evaluate the effect of an integrated prospective payment program (IPP) on knowledge of hospice care and willingness to participate in hospice care among family members of patients on prolonged mechanical ventilation (PMV). ⋯ High levels of hospice care knowledge were unrelated to willingness to participate. HPCA knowledge was greater in the IPP group than in the non-IPP group; however, there was no significant difference in the willingness to agree to hospice care. It is recommended that individuals be encouraged to express their medical decisions.
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Lung-protective ventilation targeting low tidal volumes and plateau pressures is the mainstay of therapy in patients with ARDS. This ventilation strategy limits pulmonary strain, inflammation, and injury, but it may be associated with profound hypercapnic acidosis. In such conditions, extracorporeal CO2 removal can attenuate or normalize hypercapnia and may even facilitate ultraprotective ventilation. ⋯ Systems adapted from conventional renal replacement platforms with blood flows < 500 mL/min can achieve significant CO2 elimination. Therefore, incorporating low-flow extracorporeal CO2 removal in a continuous renal replacement therapy circuit is an attractive therapeutic option. We reviewed the relevant literature on combining extracorporeal CO2 removal with continuous renal replacement therapy.