Respiratory care
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Editorial Comment
Pulmonary function testing coming of age for the elderly.
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Randomized Controlled Trial Comparative Study
Heated humidification improves clinical outcomes compared to a heat-and-moisture exchanger in children with tracheostomies.
The upper airway humidifies and warms inspired gases before they reach the trachea, a process bypassed by the insertion of a tracheostomy, necessitating humidification of inspired gases. The optimal method of humidification is not known. ⋯ Over 20 hours use, HH, compared to HME, improved work of breathing. Over a longer 10 week treatment period HH resulted in decreased adverse clinical events.
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Randomized Controlled Trial
Oxygen supplementation in noninvasive home mechanical ventilation: the crucial roles of CO2 exhalation systems and leakages.
When supplemental oxygen is added to noninvasive ventilation using a non-ICU ventilator, it is usually introduced with a preset flow into the circuit near the ventilator; however, the impact of different CO2 exhalation systems and leaks on the actual FIO2 and gas exchange has not been elucidated. ⋯ The use of a leak port circuit and the occurrence of leak around the interface significantly reduced oxygen concentration at the mask and negatively impacted gas exchange in subjects receiving home noninvasive ventilation and supplemental oxygen. (German Clinical Trials Registry, www.drks.de, DRKS00000449).
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Current American Association for Respiratory Care (AARC) clinical practice guidelines recommend a suction catheter to endotracheal tube ratio (SC/ETT) based on the external diameter of the SC and the internal diameter of the ETT. An SC/ETT ratio of < 50% is consistent with the current recommendation. We theorized that a more satisfactory assessment of SC/ETT ratio could be accomplished using volume or area formulas and expansion of diameter recommendations. Some respiratory care texts recommend an SC/ETT ratio that exceeds the clinical practice guideline standard. ⋯ Our results support an alternative SC/ETT ratio when pairing SCs and ETTs.
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Children with neurological impairment often suffer from insufficient airway secretion clearance, which substantially increases their respiratory morbidity. The goal of the study was to assess the clinical feasibility of high-frequency chest wall compression (HFCWC) therapy in neurologically impaired children with respiratory symptoms. ⋯ Regular HFCWC therapy may reduce the number of hospitalizations in neurologically impaired children.