Respiratory care
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Observational Study
Including Organ Dysfunctions in a Predictive Score for Nosocomial Pneumonia After Cardiothoracic Surgery.
Clinical diagnosis of ICU-acquired pneumonia after cardiothoracic surgery is challenging. Johanson criteria (chest radiograph infiltrate, purulent tracheal secretions, fever, and leukocytosis) fail in half the cases. A high Clinical Pulmonary Infection Score (CPIS) and ≥ 2-point increase in Sequential Organ Failure Assessment (SOFA) score (SOFA↑ ≥ 2) may improve diagnosis. The aim of the study was to evaluate whether CPIS or SOFA↑ ≥ 2 contributes to predict ICU-acquired pneumonia in subjects after cardiothoracic surgery. ⋯ A clinical scoring system including at least SOFA↑ ≥ 2 increase barely improved ICU-acquired pneumonia prediction in subjects after cardiothoracic surgery.
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Mechanical insufflation-exsufflation (MI-E) has been proposed as a potential strategy to generate high expiratory flows and simulate cough in the critically ill. However, efficacy and safety of MI-E during invasive mechanical ventilation are still to be fully elucidated. This study in intubated and mechanically ventilated pigs aimed to evaluate the effects of 8 combinations of insufflation-exsufflation pressures during MI-E on mucus displacement, respiratory flows, as well as respiratory mechanics and hemodynamics. ⋯ MI-E appeared to be an efficient strategy to improve mucus displacement during invasive ventilation, particularly when set at +40/-70 cm H2O. No safety concerns were identified although a transient significant increase of transpulmonary pressure was observed.
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Editorial Comment
Pulse Oximeter Bias and Inequities in Retrospective Studies--Now What?
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During continuous flow CPAP for noninvasive respiratory support, a high flow (eg, 60-90 L/min) of gas with FIO2 titratable up to 1.0 is flown within a helmet or face mask, while a PEEP valve maintains the set pressure. A large amount of oxygen is wasted, whereas only a minimal amount is consumed. We describe a recirculation circuit designed to reuse the exhaust gas and save oxygen. ⋯ The recirculation system allowed a 4/5-fold reduction of oxygen consumption during simulated helmet CPAP therapy, whereas CO2 removal was effective for > 10 h. Recirculation minimally affected pneumatic performance of the CPAP continuous flow system, while improving gas conditioning as compared to the standard system.