Respiratory care
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We report the case of an adult patient with idiopathic pneumonia syndrome following allogeneic hematopoietic stem cell transplantation, which was successfully managed with venovenous extracorporeal membrane oxygenation (ECMO) and immunosuppressive therapy. A 30-year-old man with precursor B cell acute lymphocytic leukemia had received chemotherapy 10 years previously, with complete remission. He underwent allogeneic hematopoietic stem cell transplantation 4 months prior to enrollment, owing to leukemia relapse. ⋯ He subsequently developed acute hypercapnic and hypoxic respiratory failure that was unresponsive to conventional medical therapy. He was successfully managed with venovenous ECMO for 19 days, with complete resolution of his respiratory symptoms. Thus, judicious use of ECMO as a bridge before steroid and other conventional therapy take effect in patients with isolated respiratory failure appears justified.
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Randomized Controlled Trial
Assessing exercise capacity using telehealth: a feasibility study in adults with cystic fibrosis.
Provision of healthcare from a remote site may assist patients to access important services. We aimed to establish the feasibility of monitoring an assessment of exercise capacity using telehealth technology. ⋯ Exercise capacity assessment using the 3-min step test is feasible and accurate via remote videoconferencing in adults with CF.
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Portable ventilators are increasingly utilized in the intra- and inter-hospital transport of patients. We evaluated 4 portable ventilators, Impact EMV, CareFusion LTV 1200, Newport HT70, and Hamilton T1, in terms of triggering, delivered tidal volume (V(T)) accuracy, battery duration, delivered F(IO(2)) accuracy, and gas consumption. ⋯ Manufacturers continue to improve the performance of portable ventilators. All the ventilators we tested performed well on V(T) delivery across a range of settings, using both the internal drive mechanism (F(IO(2)) 0.21) and compressed oxygen (F(IO(2)) 1.0). Two of the ventilators were unable to deliver accurate F(IO(2)) across the range of V(T). None of the devices was clearly superior to the others in all aspects of our evaluation.
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Observational Study
Tracheostomy tube change before day 7 is associated with earlier use of speaking valve and earlier oral intake.
Presence of a tracheostomy tube often decreases the patient's ability to communicate and to tolerate oral intake. The initial tracheostomy tube change is often recommended between day 7 and 14 post insertion. Local guidelines permit tracheostomy tube change 5 days after insertion. ⋯ Tracheostomy tube change before day 7 is associated with earlier ability to tolerate speaking valve and oral intake. In this series, early tracheostomy tube change was not associated with an increased rate of complications.
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Clinical Trial
Feasibility and effectiveness of an educational program in Italian COPD patients undergoing rehabilitation.
Self-management education is associated with improvement in quality of life and reduction of hospital admissions. Nevertheless, the data are insufficient to formulate clear recommendations regarding the type and content of education programs for COPD patients, and few data are available on knowledge of the disease itself. ⋯ A formal COPD-EP is feasible and effective in improving subject knowledge and self-management. Specific learning instruments to follow up this population should be validated.