Respiratory care
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Observational Study
Head-of-Bed Elevation Improves End-Expiratory Lung Volumes in Mechanically Ventilated Subjects: A Prospective Observational Study.
Head-of-bed elevation (HOBE) has been shown to assist in reducing respiratory complications associated with mechanical ventilation; however, there is minimal research describing changes in end-expiratory lung volume. This study aims to investigate changes in end-expiratory lung volume in a supine position and 2 levels of HOBE. ⋯ HOBE significantly increases global and regional end-expiratory lung volume; therefore, unless contraindicated, all mechanically ventilated patients should be positioned with HOBE.
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Unidirectional breathing (UB), nose-in mouth-out (NMB) or vice versa, is thought to create PEEP, stabilize small airways, and increase expiratory flow and exhaled tidal volume (VT) in patients with expiratory obstructive disorders. However, the exact mechanism providing the benefits of UB remains unknown. Our hypothesis was that the benefits of UB are achieved mainly through reduction of upper airway dead space. ⋯ Our data suggest that a reduction in functional anatomic VD may be the underlying mechanism for the benefits associated with UB in COPD patients. (ClinicalTrials.gov registration NCT00784004.).
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Lung function parameters are used as end points in most clinical and therapeutic trials in cystic fibrosis (CF) and to evaluate the effects of airway clearance techniques. The aim of the study was to identify at what time point after a physiotherapy session spirometry (FEV1 and FVC) should be performed to obtain the highest result compared to baseline and to determine whether there are inter-individual and intra-individual differences in children and adults with CF. ⋯ Performing spirometry 30 min (adults) and immediately (children) after a session might be optimal if individual peak time values cannot be used.
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Percutaneous dilatational tracheostomy (PDT) has become an appropriate alternative to conventional surgical tracheostomy. It is now performed worldwide by a diverse array of physician specialists. Although adverse events are relatively uncommon, serious complications can arise from this bedside procedure. We report a patient who suffered life-threatening hemorrhage from a common carotid artery laceration and pseudo-aneurysm formation in the innominate artery following an elective PDT procedure.
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Pulmonary rehabilitation (PR) is a core component of the management of patients with moderate-to-very-severe COPD. However, as impairments in quadriceps muscle strength and health-related quality of life (HRQOL) are already present in patients with mild COPD, there is a need to investigate whether PR could also be beneficial to these patients. Thus, this study assessed the impact of PR on patients with mild COPD. ⋯ Patients with mild COPD benefit from PR and could therefore be routinely included in these programs. Studies with more robust designs and with long-term follow-ups are needed to inform guidelines for PR in mild COPD.