Respiratory care
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Chronic infection with Pseudomonas aeruginosa in patients with cystic fibrosis (CF) is associated with increased morbidity. Chronic infection can cause limb and respiratory muscle compromise. Respiratory muscle function can be assessed via maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), and the pressure-time index of the respiratory muscles (PTImus). We studied the effect of chronic P. aeruginosa infection on respiratory muscle function in patients with CF. ⋯ CF subjects with chronic P. aeruginosa infection exhibited impaired respiratory muscle function and decreased inspiratory muscle strength, and chronic P. aeruginosa infection independently impacts respiratory muscle function in subjects with CF.
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Nasal CPAP is widely used in neonatal ICUs. Aerosolized medications such as inhaled steroids and β agonists are commonly administered in-line through nasal CPAP, especially to infants with bronchopulmonary dysplasia. We hypothesized that aerosol delivery to the lungs via variable-flow nasal CPAP in an in vitro model would be unreliable, and that the delivery would depend on the position of the aerosol generator within the nasal CPAP circuit. ⋯ Isotope delivery from an aerosol generator placed near the humidifier on variable-flow nasal CPAP was negligible in this in vitro setup; however, such delivery was significantly improved by locating the aerosol generator closer to the nasal CPAP interface.
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The apnea test is used to determine the absence of respiratory drive when determining brain death. Current guidelines for performing the apnea test do not specify the size of insufflation catheter (IC) to use with each endotracheal tube (ETT) size, despite case reports describing procedure-related complications with the use of various IC sizes. We studied the effect of the ratio of IC outer diameter to ETT inner diameter on the pressure and volume generated within the lungs during the apnea test. ⋯ An IC with an outer diameter < 70% of the ETT inner diameter, at 6 L/min, may prevent inappropriate lung pressure and volume during the apnea test. This recommendation, coupled with current American Academy of Neurology guidelines for the determination of brain death, may reduce the risk of procedure-related complications.
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The patterns and kinetics of changes in SpO2 in the 6-min walk test (6MWT) and cycling test have not been addressed in patients with COPD. ⋯ Measurement of start-vs-nadir ΔSpO2 rather than start-vs-end ΔSpO2 during the 6MWT is recommended, because start-vs-nadir ΔSpO2 is greater, and the nadir SpO2 is earlier. In both the 6MWT and the cycling exercise test, desaturation can be predicted with the oxygen-cost-diagram score, which has more capability to predict peak exercise performance than the 6MWT.
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Editorial Comment
Aerosol Administration During Nasal CPAP in Newborns Can Be Optimized.