Respiratory care
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While the number of reports of randomized controlled trials in physical therapy has increased substantially in the last decades, the quality and reporting of randomized trials have never been systematically investigated in the subdiscipline of cardiothoracic physical therapy. The primary aim was to determine the methodological quality and completeness of reporting of cardiothoracic physical therapy trials. Secondary aims were to investigate the range of clinical conditions investigated in these trials and the degree of association between trial characteristics and quality. ⋯ There is great potential to improve the quality of the conduct and reporting of trials evaluating the effects of cardiothoracic physical therapy.
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Comparative Study
"In vitro" evaluation of Heat and Moisture Exchangers designed for spontaneous breathing tracheostomized patients.
Heat and moisture exchangers (HMEs) are commonly used in chronically tracheostomized spontaneously breathing patients, to condition inhaled air, maintain lower airway function, and minimize the viscosity of secretions. Supplemental oxygen (O2) can be added to most HMEs designed for spontaneously breathing tracheostomized patients. We tested the efficiency of 7 HMEs designed for spontaneously breathing tracheostomized patients, in a normothermic model, at different minute ventilations (VE) and supplemental O2 flows. ⋯ The efficiency of HMEs in terms of temperature and absolute humidity is significantly affected by O2 supplementation and V(E).
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An athletic 21-year-old male was admitted to the surgical ICU after sustaining 2 stab wounds to his torso. He had an episode of left lung collapse early in his course, managed with suctioning and increased PEEP, to 15 cm H2O. ⋯ After premedication with glycopyrrolate, he was successfully extubated the following day, while his heart rate remained at his baseline of 50 beats/min. We review the physiologic mechanisms of bradycardia due to the removal of mechanical ventilation.
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Multicenter Study
High Resource Utilization Does Not Affect Mortality in Acute Respiratory Failure Patients Managed with Tracheostomy.
Tracheostomy practice in patients with acute respiratory failure (ARF) varies greatly among institutions. This variability has the potential to be reflected in the resources expended providing care. In various healthcare environments, increased resource expenditure has been associated with a favorable effect on outcome. ⋯ We were unable to demonstrate a positive relationship between resource expenditure and outcome in ARF patients managed with tracheostomy.
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Prolonged mechanical ventilation, longer hospital stay, and a lower rate of home discharge have been reported with patient-ventilator asynchrony in medical patients. Though commonly encountered, asynchrony is poorly defined within the traumatically injured population. ⋯ Ventilator asynchrony is common in trauma patients. It may be associated with SIMV with a set breathing frequency of ≥ 10 breaths/min, though not with longer mechanical ventilation, longer stay, or discharge disposition. (ClinicalTrials.gov NCT01049958).