Respiratory care
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There is a growing interest in the role of comorbid anxiety in patients with COPD. Comorbid anxiety has a major impact on physical functioning, health-related quality of life, and healthcare utilization. However, the prevalence of clinical anxiety, particularly specific anxiety diagnoses, in patients with COPD remains unclear. ⋯ There is a high prevalence of clinical anxiety in patients with COPD. Social phobia and specific phobia appear to be particularly prevalent, yet they have received little attention within existing literature. Further research into effective management and screening for clinical anxiety disorders is warranted.
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Asthma has long been recognized as a common respiratory disease, and the recognition of sleep-disordered breathing is becoming more prevalent. Patients with these disorders are commonly seen by clinicians caring for patients with respiratory disease. There is also much academic interest in asthma and sleep-disordered breathing. The purpose of this paper is to review the recent literature related to asthma and sleep-disordered breathing in a manner that is most likely to have interest to the readers of Respiratory Care.
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Comparative Study
Prediction of optimal CPAP pressure and validation of an equation for Asian patients with obstructive sleep apnea.
The Hoffstein formula is the most widely used equation to predict optimal CPAP pressure in patients with obstructive sleep apnea, but it is based on data from white patients. The purpose of this study was to develop an equation for optimal CPAP based on data from Asian patients, and to compare this new formula with the Hoffstein formula. ⋯ Although our equation was somewhat better to predict optimal CPAP level in Asian subjects than the Hoffstein equation, the CPAP prediction equation did not accurately predict the prescribed CPAP level. Therefore, the usefulness of the CPAP prediction formula is limited in some clinical settings.
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New home ventilators are able to provide clinicians data of interest through built-in software. Monitoring of tidal volume (VT) is a key point in the assessment of the efficacy of home mechanical ventilation. ⋯ The inclusion of algorithms that calculate the pressure loss as a function of the flow exiting the ventilator in commercial models may increase the reliability of VT estimation.
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Selection of the PEEP associated with the best compliance of the respiratory system during decremental PEEP titration can be used for the treatment of patients suffering from ARDS. We describe changes in transpulmonary pressure (Ptp) and gas exchange during a decremental PEEP titration maneuver in subjects with pulmonary ARDS. ⋯ During decremental PEEP titration we sequentially observed high inspiratory Ptp that stressed lung tissue and increased VD/VT, and negative Ptp, indicating high risk of alveolar collapse, explaining worse oxygenation. PEEP selection based on Ptp and VD/VT in ARDS may help to avoid these situations.