Respiratory care
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Multicenter Study Clinical Trial Observational Study
Predictors of Extubation Failure Related to Aspiration and/or Excessive Upper Airway Secretions.
Extubation failure may have several causes, including swallowing dysfunction, aspiration, and excessive upper airway secretions. We hypothesized that a bedside global swallowing pattern assessment including 9 criteria (volume of pharyngeal secretions, 5 swallowing motor items, swallowing reflex, and 2 gag reflexes) performed prior to extubation could identify patients at risk of extubation failure. ⋯ In subjects with prolonged ventilation, the presence of one or both gag reflexes could predict a reduction in extubation failure related to aspiration or excessive upper airway secretions. (Clinical trials.gov registration NCT00780078.).
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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.
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Children are most affected by passive smoke and least able to avoid it. The Tobacco Dependence Program was developed to help reduce first-, second-, and thirdhand smoke exposure to our patients while they are in the hospital. ⋯ The Tobacco Dependence Program offers support to families as they begin the cessation process and provide the tools to continue a smoke-free lifestyle after discharge. The program is feasible and welcomed to assist patients and families in this process.
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A lung-protective mechanical ventilation strategy has become the hallmark of ventilation management for patients with acute respiratory failure. However, some patients progress to more severe forms of acute respiratory failure with refractory hypoxemia. In such circumstances, individualized titration of mechanical ventilation according to the patient's specific respiratory and cardiovascular pathophysiology is desirable. A lung rescue team (LRT) was recently established at our institution to improve the medical care of patients with acute respiratory failure when conventional treatment fails. The aim of this report is to describe the consultation processes, the cardiopulmonary assessment, and the procedures of the LRT. ⋯ The LRT individualized the management of severe acute respiratory failure. The LRT consultations were shown to be effective, safe, and efficient, with an impact on decision-making in the ICU.
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Lung function parameters are used as signs in the diagnosis and evaluation of asthma; however, their sensitivity and specificity are not ideal. We calculated and combined angle β with lung function parameters to identify the ideal indicator. ⋯ Angle β was a useful indicator for assessing airway obstruction. Furthermore, angle β combined with FEV1, FEV1/FVC%, FEF25%, FEF50%, and FEF75% can enhance the sensitivity and specificity of airway obstruction evaluations.