Respiratory care
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Bronchiectasis is a chronic debilitating suppurative disease that significantly impacts quality of life. Clinical outcomes like exacerbations, are usually physician centered; however, the patients' experience, health-related behaviors, and expectations have frequently been neglected. In addition, patients' health perceptions may be influenced by their culture. ⋯ The diverse symptom perception and health-related behaviors highlighted the need for evaluation and intervention in bronchiectasis. These findings will provide rationales for refining future health care through comprehensive (particularly psychological) interventions worldwide.
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Positive expiratory pressure (PEP) devices are widely used in clinical settings, yet the performance characteristics of these devices remain relatively unknown. This study compared the performance characteristics of 6 airway clearance devices by varying resistance and flow. ⋯ PEP devices produced small but statistically significant variations in performance characteristics across a range of flows and resistance settings. There appear to be flow-dependent and non-flow-dependent devices. Varying flow or resistance typically maintained or increased the production of mean, peak, and amplitude PEP and oscillation frequency.
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The 2009 H1N1 influenza epidemic saw a rise in the use of extracorporeal membrane oxygenation (ECMO) as a supportive therapy for refractory ARDS. We sought to determine whether ECMO utilization follows a seasonal pattern that matches the influenza season, and whether it can further be explained by the incidence of each influenza subtype. ⋯ Non-cardiac and cardiac ECMO use in the United States were significantly associated with influenza incidence. The influenza A, H1N1 2009, subtype had the strongest association.
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Endotracheal tube (ETT) depth in premature infants is of critical importance because potentially life-threatening adverse events can occur if the tube is malpositioned. Analysis of current data indicates that the accuracy of current resuscitation guidelines for infants <1 kg is poor. We hypothesized that a weight-based formula that is used clinically in our institution would accurately predict appropriate ETT placement in infants weighing < 1 kg. ⋯ Our weight-based, institutional formula had a low sensitivity for predicting proper ETT depth. Weight-based formulas may have clinical utility; however, analysis of current data did not support use in infants < 1 kg. Rapid radiologic assessment of ETT placement is required for this patient population.