Respiratory care
-
Randomized Controlled Trial
The Effect of Adding Noninvasive Ventilation to High-Intensity Exercise on Peripheral and Respiratory Muscle Oxygenation.
We sought to assess whether noninvasive ventilation (NIV) as an adjunct with high-intensity exercise (HIEx) is more effective than exercise alone or exercise + sham on respiratory and peripheral oxygenation and vascular function in subjects with coexisting COPD and heart failure (HF). ⋯ NIV as an adjunct to HIEx can acutely unload the respiratory musculature with better redistribution of available blood flow and beneficially modulate endothelial function. These results may influence the approach to cardiopulmonary rehabilitation in patients with coexisting COPD-HF.
-
Postextubation stridor (PES) is an imminently life-threatening event. Maximizing patient safety requires a systematic approach to screen patients for PES risk factors and a standardized test to evaluate that risk. This retrospective study of adult subjects was based on quality assurance data including standardized surveillance screening criteria and a volume-based cuff leak test (CLT) to evaluate PES risk among predominantly surgical-trauma and neurotrauma subjects. Data characterizing PES subjects also were collected. ⋯ Among predominantly surgical-trauma and neurotrauma subjects with a CLT, leak volume of ≥ 110 mL was associated with a PES risk of ∼6%, whereas the risk of PES was 7 times greater when the leak volume was < 110 mL.
-
Intermittent mandatory ventilation (IMV) is one kind of breath sequence used to classify a mode of ventilation. IMV is defined as the ability for spontaneous breaths (patient triggered and patient cycled) to exist between mandatory breaths (machine triggered or machine cycled). Over the course of more than a century, IMV has evolved into 4 distinct varieties, each with its own advantages and disadvantages in serving the goals of mechanical ventilation (ie, safety, comfort, and liberation). ⋯ Also included is a brief overview of the background information required for a proper perspective of the purpose and design of the innovations. Understanding these different forms of IMV is essential to recognizing the similarities and differences among many dozens of different modes of ventilation. This recognition is important for clinical application, education of caregivers, and research in mechanical ventilation.
-
Observational Study
Concise Versus Extended Lung Ultrasound Score to Monitor Critically Ill Patients With COVID-19.
Lung ultrasound (LUS) can be used to monitor critically ill patients with COVID-19, but the optimal number of examined lung zones is disputed. ⋯ Concise LUS was equally informative as extended LUS for monitoring critically ill subjects with COVID-19 in supine or prone position. Clinicians can monitor patients undergoing position changes but must be wary that LUS score index alterations may result from the position change itself rather than disease progression or clinical improvement.
-
Ellipta is a respiratory device that is a successor of the Diskus. A major difference between the devices is that Ellipta, especially the 2-strip type, includes a pair of blisters rather than a single blister as contained in Diskus. This study aimed to compare the particle-release properties and mechanical features of both devices. ⋯ The Ellipta required lower inspiratory flow than Diskus, which arises from a higher distribution to blister flow. Ellipta may be preferable to Diskus for patients with impaired pulmonary function.