Respiratory care
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Randomized Controlled Trial Pragmatic Clinical Trial
Randomized Controlled Trial of Humidified High-Flow Nasal Oxygen for Acute Respiratory Distress in the Emergency Department: The HOT-ER Study.
Humidified high-flow nasal cannula (HFNC) is a novel method of oxygen delivery with increasing use in emergency departments and intensive care settings despite little evidence showing benefit over standard oxygen delivery methods (standard O2). The aim of this study was to determine whether HFNC compared with standard O2 given to subjects in acute respiratory distress would reduce the need for noninvasive ventilation or invasive ventilation. ⋯ HFNC was not shown to reduce the need for mechanical ventilation in the emergency department for subjects with acute respiratory distress compared with standard O2, although it was safe and may reduce the need for escalation of oxygen therapy within the first 24 h of admission.
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The Centers for Disease Control and Prevention have recently introduced new ventilator-associated pneumonia (VAP) surveillance on the basis of the infection-related ventilator-associated complication (IVAC) definition. We aim to evaluate the accuracy of this new IVAC algorithm for detecting VAP according to the 2008 Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) definition as the reference diagnosis (VAP-NHSN) in high-risk trauma patients. ⋯ IVAC criteria had a low accuracy for identifying VAP-NHSN in subjects with high-risk trauma.
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Observational Study
Value of Computed Tomography of the Chest in Subjects With ARDS: A Retrospective Observational Study.
The value of computed tomography (CT) of the chest in the management of patients with ARDS is poorly defined. The aim of this study was to assess the clinical utility of thoracic CT scans in subjects with ARDS using the Berlin definition. ⋯ Systematic evaluation of thoracic CT scans yielded information useful for making a diagnosis, predicting prognosis, and recognizing concomitant disorders requiring therapeutic interventions. Results obtained from CT scans led to changes in management in 26.5% of cases.
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FEV6 can be used as a convenient alternative to FVC. The aim of this study was to determine an alternative to the fixed cutoff points of FEV1/FVC <0.70 suitable for FEV1/FEV6 in primary care. ⋯ FEV1/FEV6 <0.72 can be used in primary care as a valid alternative to FEV1/FVC <0.70 as a fixed cutoff point for the detection of COPD in adults. This study suggests that FEV1/FEV6 is an effective and well validated option that should be used in primary care to detect COPD, which is a rampant problem.