Respiratory care
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Case Reports
Successful Long-Term Airway Stabilization with a Modified Pacifier in a Syndromic Infant.
Airway management is one of the key aspects of neonatal anesthesia, and an oropharyngeal airway is used in daily intensive care practice to relieve upper-airway obstruction. Cleft palate is among the various congenital malformations that can cause difficult airway management. We describe a syndromic infant with alobar holoprosencephaly, whose long-term airway patency was maintained with a modified infant pacifier. We would like to share our experience and contribute to the literature with the introduction of a readily available and easily-inserted apparatus.
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Comparative Study
Difference in the physiological response to exercise in patients with distinct severity of COPD pathology.
Patients with COPD have reduced exercise tolerance associated with dyspnea. This exercise intolerance is primarily due to impaired ventilatory mechanics, but it is also associated with a combination of factors, including inefficient gas exchange, lactic acidosis at a low work rate, and exercise-induced hypoxemia. The survival prognosis of COPD patients with severely reduced exercise capacity is extremely poor, but the pathophysiology of these patients during exercise remains to be accurately established. The present study aimed to characterize life-threatening factors such as hypoxemia, acidosis, and sympathetic activation during exercise in these patients. ⋯ The mechanisms of exercise intolerance in COPD patients significantly differed among subjects with different exercise capacities. Subjects with the most severely reduced exercise capacity had the characteristics of exercise-induced hypoxemia, sympathetic overactivity, and progressive respiratory acidosis at low-intensity exercise. These life-threatening pathophysiological conditions could be improved by medication and/or pulmonary rehabilitation.
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Patients with cystic fibrosis perform airway clearance techniques and receive nebulized medications on a regular basis. Some positive expiratory pressure (PEP) devices allow concomitant administration of aerosol. I hypothesized that this practice alters the aerosol characteristics and patient dose. I compared the aerosol characteristics and patient dose of nebulized albuterol from 2 types of nebulizer, alone and when connected to different PEP and vibratory PEP devices. ⋯ Concomitant use of nebulizer and PEP or vibratory PEP devices that obstruct the aerosol pathway significantly decrease the aerosol particle size and the patient dose.
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Observational Study
Prediction of Pneumonia 30-Day Readmissions: A Single-Center Attempt to Increase Model Performance.
Existing models developed to predict 30 days readmissions for pneumonia lack discriminative ability. We attempted to increase model performance with the addition of variables found to be of benefit in other studies. ⋯ The addition of socioeconomic status and healthcare utilization variables significantly improved model performance, compared to the model using only the Centers for Medicare and Medicaid Services variables.
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We sought to determine whether the utilization of a respiratory therapist (RT) driven mechanical ventilation weaning protocol is associated with improvement in clinical outcomes in subjects with simple versus difficult weaning. ⋯ The RT-driven weaning protocol increased ventilator-free days among subjects with simple and difficult weaning, with no significant differences in ICU mortality or extubation failure.