Respiratory care
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Hospitalized patients who develop at least one instance of cardiorespiratory instability (CRI) have poorer outcomes. We sought to describe the admission characteristics, drivers, and time to onset of initial CRI events in monitored step-down unit (SDU) patients. ⋯ Initial CRI most commonly occurred due to SpO2 and was associated with prolonged SDU and hospital stay. Findings suggest the need for clinicians to more closely monitor SDU patients transferred from an ICU and parameters (SpO2 , breathing frequency) that more commonly precede CRI events.
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Air stacking (AS) is a lung insufflation method that requires the use of a manual insufflator to provide air volumes higher than inspiratory capacity. Neuromuscular patients benefit the most from the maneuver; however, the acute effects of AS in healthy subjects are still unclear. ⋯ In healthy subjects, cough peak flow and chest wall volumes can be increased immediately after the application of the AS maneuver.
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Randomized Controlled Trial
Low-Volume Whole-Body Vibration Training Improves Exercise Capacity in Subjects With Mild to Severe COPD.
The objective of this study was to investigate the benefits of a low-volume out-patient whole-body vibration training (WBVT) program on exercise capacity in comparison with a calisthenics training program in subjects with COPD. ⋯ A low-volume WBVT program resulted in significantly and clinically relevant larger improvements in exercise capacity compared with calisthenics exercises in subjects with mild to severe COPD. (ClinicalTrials.gov registration DRKS9706.).
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Randomized Controlled Trial
Optimizing PEEP by Electrical Impedance Tomography in a Porcine Animal Model of ARDS.
Mechanical ventilation is necessary in diverse clinical circumstances. Especially in the context of ARDS, so-called protective ventilation strategies must be followed. It is already known that PEEP might enhance oxygenation in ARDS. However, determining the optimal PEEP settings in clinical routines is challenging. Electrical impedance tomography (EIT) is a promising technique with which to adjust ventilator settings. We investigated whether the combination of different EIT parameters, namely the global inhomogeneity and hyperdistension indices, may lead to a feasible and safe PEEP setting. ⋯ PEEP setting by EIT facilitates a more individual ventilation therapy. However, in our relatively short ARDS observation period of 24 h, no significant differences appeared in common clinical parameters compared with a control group.
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Spirometry is important for the differential diagnosis of dyspnea. However, some patients cannot exhale for ≥6 s to achieve the American Thoracic Society/European Respiratory Society criteria. The aim of this study was to demonstrate the reliability of a new parameter that quantifies the degree of concavity in the first 3 s to define airway limitation as a surrogate for the FEV1/FVC. ⋯ The AUC3/AT3 can be utilized as a surrogate parameter for the FEV1/FVC when patients cannot complete a 6-s expiratory effort. Additionally, the performance of this index is better than that of the FEV1/FEV3 in the identification of airway limitations.