Respiratory care
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Currently, >20 million people in the United States have asthma, and approximately 15 million adults have been diagnosed with COPD, with approximately the same number not yet having been diagnosed with this condition. Moreover, the overall burden of respiratory diseases is still increasing, in part due to environmental factors, such as air pollution. At the same time, the number of patients requiring hospitalization as well as the number of individuals admitted to ICUs from emergency departments has been on the rise over the last decade. ⋯ However, due to increasing scrutiny of health-care expenditures and limited resources, there is a growing need to document the impact of health-care providers in terms of clinical outcomes. As a profession, RTs should continue to describe the impact they have on patient outcomes and the value they bring to our health-care system. Promoting such investigative outcomes research, along with enhancing the professional aspects of the field of respiratory care, will ensure that the value of RTs does not go unappreciated.
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Diaphragm excursion is limited during respiratory maneuvers after a stroke. How the diaphragm is limited during reflexive coughs and affects the effectiveness of cough in stroke patients is unclear. This study aimed to measure reflexive cough strength by cough peak flow (CPF) induced by citric acid nebulization (2.8 mol/L), record diaphragm excursions during reflexive coughs in stroke subjects at risk of silent aspiration, and compare these values with those of stroke subjects without risk of aspiration or dysphagia. ⋯ Stroke subjects at risk of silent aspiration showed reduced CPF and more limited diaphragm excursion during the citric acid-induced reflexive cough test. (ClinicalTrials.gov registration NCT02080988.).
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Review
The Use of Speaking Valves in Children With Tracheostomy Tubes: What is the Scope of the Literature?
One-way speaking valves have been successfully used to restore audible meaningful speech in adult patients after tracheostomy tube placement. One-way speaking valves have also been used in pediatric patients after tracheostomy tube placement with promising results. We conducted a scoping review to synthesize and summarize the current evidence on the use of one-way tracheostomy tube speaking valves in the pediatric population to identify knowledge gaps that could inform future research programs and facilitate evidence-based clinical decision making. ⋯ Eligibility criteria for trials of speaking valves were inconsistent across all studies and included a combination of clinical assessment coupled with published indications. Much of the literature has focused on tolerance/successful use of speaking valves in children with a tracheostomy with limited evidence on its impact on verbal communication. Current evidence on the use of speaking valves in children with a tracheostomy, its indication, and its impact on verbal communication is inadequate, mandating further research in this area.
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Ultrasound-based diaphragmatic thickness fraction is a reflection of the size and function of the diaphragm. This study aimed to examine the value of this measurement in identifying patients with COPD who are at high risk for the development of symptoms and exacerbations. ⋯ Diaphragmatic thickness fraction measurements based on diaphragmatic ultrasound assessment in subjects with COPD seemed to be unable to identify subjects at high risk of symptoms and exacerbations as defined by the Global Initiative for Chronic Obstructive Lung Disease ABCD composite disease index.