Respiratory care
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High electrode temperature during transcutaneous monitoring is associated with skin burns in extremely premature infants. We evaluated the accuracy and precision of CO2 and O2 measurements using lower transcutaneous electrode temperatures below 42°C. ⋯ Transcutaneous electrode temperatures as low as 38°C allow an assessment of PtcCO2 as accurate as that with electrodes at 42°C.
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Comparative Study
A Comparison of the Adjustable Ranges of Inspiratory Pressurization During Pressure Controlled Continuous Mandatory Ventilation of 5 ICU Ventilators.
Faster inspiratory pressurization can improve patient-ventilator synchrony and reduce the patient's work of breathing during pressure controlled continuous mandatory (PC-CMV) ventilation. The characteristics of the pressurization ramp settings are not standardized across ventilators from different manufacturers. We performed a bench test of 5 models of ICU ventilators to examine the effects of pressurization ramp settings on the actual pressurization. ⋯ The adjustable ranges of the pressurization were largely different among the different types of ventilators. The actual absolute inspiratory pressurization during PC-CMV varied between the different ventilators even at similar pressurization ramp settings. Users should be mindful of the differences in the pressurization ramp settings.
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Observational Study
Accuracy of Transcutaneous CO2 Values Compared With Arterial and Capillary Blood Gases.
Transcutaneous monitors are utilized to monitor a patient's respiratory status. Some patients have similar values when comparing transcutaneous carbon dioxide (PtcCO2 ) values with blood gas analysis, whereas others show extreme variability. A retrospective review of data was performed to determine how accurately PtcCO2 correlated with CO2 values obtained by arterial blood gas (ABG) or capillary blood gas. ⋯ Based on these data, capillary blood gas comparisons showed less variation and a slightly lower correlation with PtcCO2 than did ABG comparisons. After accounting for serial measurements per patient, due to the wide limits of agreement and poor repeatability, the utility of relying on PtcCO2 readings for this purpose is questionable.
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We sought to compare treatment satisfaction with inhaled medications among asthmatics using a metered-dose inhaler (MDI) or a dry-powder inhaler (DPI), and to correlate satisfaction with treatment adherence, pulmonary function, and airway inflammation. ⋯ MDIs were associated with better disease control and treatment adherence among subjects with asthma. Both MDI and DPI are likely to provide equivalent treatment satisfaction.
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Sensitive flow or pressure triggers are usually applied to improve ventilator response time. Conversely, too sensitive triggers can incur risk of auto-triggering, a type of asynchrony in which a breath is triggered without inspiratory muscle activity. A frequent cause of auto-triggering is cardiogenic oscillations, characterized by cyclical variations in pressure and flow waveforms caused by cardiac contractions. Our goal was to test trigger performance and capacity to abolish auto-triggering in 5 different ICU ventilators using different simulated levels of cardiogenic oscillations. ⋯ More sensitive triggers led to faster ventilator response, but also to more frequent auto-triggering. To avoid auto-triggering, less sensitive triggers were required, with consequent slower trigger response. To compare trigger performance in a scenario that more closely represents clinical practice, evaluation of the tradeoff between time delay and frequency of auto-triggering should be considered.