Respiratory care
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Randomized Controlled Trial Comparative Study
A comparative study of 3 portable oxygen concentrators during a 6-minute walk test in patients with chronic lung disease.
The purpose of this study was to compare the ability of 3 portable oxygen concentrators (POCs) to maintain S(pO2) ≥ 90% during exercise in patients with chronic lung disease. ⋯ The Eclipse 3 was best at meeting the subjects' clinical needs. POC users should be appropriately tested during all activities of daily living, to ensure adequate oxygenation. The healthcare provider should provide information and help to direct the subject toward the most clinically appropriate oxygen system, while being mindful of the patient's preferences and lifestyle. (Clinicaltrials.gov NCT01653730).
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Randomized Controlled Trial
Pressures delivered by nasal high flow oxygen during all phases of the respiratory cycle.
Nasal high flow (NHF) oxygen therapy and CPAP are modes of noninvasive respiratory support used to improve respiratory function in multiple patient groups. Both therapies provide positive pressure, although this varies during the respiratory cycle. The purpose of this study was to measure and compare the airway pressure generated during different phases of the respiratory cycle in patients receiving NHF at various gas flows. ⋯ The expiratory pressure during NHF was higher than the mean pressure previously reported for NHF. This may account in part for the disproportional clinical effects seen with NHF. (Australian Clinical Trials Registry www.anzctr.org.au ACTRN12609000305224).
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Disease processes can impair ciliary function, alter secretion production and mucus rheology, and interfere with the cough reflex. Airway clearance therapy has been a cornerstone of therapy aimed at minimizing the devastating effects of airway obstruction, infection, and inflammation due to mucus stasis on the conducting airways and lung parenchyma. ⋯ These tools can be used to develop protocols and pathways to guide our practice. Monitoring and reporting patient, process, and financial outcomes are essential steps germane to the implementation of evidence-based care.
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As defined by the American Association for Respiratory Care, respiratory care protocols are "guidelines, usually written in algorithmic form, for providing respiratory therapy services." The need for protocols has been framed by the frequent occurrence of misallocation of respiratory care, consisting both of over-ordering (ie, prescribing respiratory care that is unlikely to confer benefit) and under-ordering services (ie, failing to prescribe services that would be expected to offer benefit). In this context, the current paper reviews available studies regarding the effectiveness of respiratory care protocols. Such studies can be organized into those assessing respiratory care treatments in the ICU, and those addressing non-ICU respiratory care. ⋯ Furthermore, 2 concordant randomized controlled trials have shown that comprehensive respiratory care protocol programs can enhance the allocation of respiratory care services, with concomitant savings and no excess adverse outcomes. Overall, while the overwhelming weight of available evidence supports the effectiveness of respiratory care protocols, gaps in current understanding remain, especially regarding settings outside the acute care hospital (eg, geriatric care, palliative care, and extended care facilities). In the same spirit that engendered the Sugarloaf Conference to assess the effectiveness of respiratory care, further assessment of the effectiveness of respiratory care protocols is encouraged and expected.
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Aspiration of colonized oropharyngeal secretions is a major factor in the pathogenesis of ventilator-associated pneumonia (VAP). A tapered-cuff endotracheal tube (ETT) has been demonstrated to reduce aspiration around the cuff. Whether these properties are efficacious in reducing VAP is not known. ⋯ In the setting of a VAP rate very near the average of ICUs in the United States, and where there was high adherence to a VAP prevention bundle, the use of a tapered-cuff ETT was not associated with a reduction in the VAP rate.