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Respiratory Care

Alice Bordessoule, Lise Piquilloud, Aissam Lyazidi, Amelia Moreira, Peter C Rimensberger
BACKGROUND: High-frequency oscillatory ventilation (HFOV) is used in cases of neonatal and pediatric acute respiratory failure, sometimes even as the primary ventilatory mode. Allowing patients (at least neonates) on HFOV to breathe spontaneously soon after intubation has been shown to be feasible, and this is becoming a more generally used approach for infants and small children. However, such an approach may increase the imposed work of breathing (WOB), raising the question of whether the imposed WOB varies with the use of newer-generation HFOV devices, which operate according to different functional principles...
July 17, 2018: Respiratory Care
Marcia S Volpe, Juliane M Naves, Gabriel G Ribeiro, Gualberto Ruas, Marcelo B P Amato
BACKGROUND: Standard mechanical insufflation-exsufflation (MI-E) therapy is applied with fast insufflation-exsufflation pressures to achieve high peak expiratory flows (PEF) and assist airway clearance. No attention is given to the resultant high peak inspiratory flows (PIF), although it may impair secretion removal. It has been proposed that an expiratory flow bias (ie, PEF higher than PIF) might be the key determinant for mucus clearance instead of the PEF alone. We examined the effects of 2 MI-E maneuvers, standard versus optimized, with fast and slow insufflation, respectively, along with different MI-E pressure settings on secretion displacement in 3 lung-impedance scenarios that simulated a patient on mechanical ventilation...
July 17, 2018: Respiratory Care
Teresa A Volsko, Neil L McNinch, Donald S Prough, Michael T Bigham
BACKGROUND: Adherence to guidelines for endotracheal tube (ETT) insertion depth may not be sufficient to prevent malposition or harm to the patient. To obtain an estimate of ETT malpositioning, we evaluated initial postintubation chest radiographs and hypothesized that many ETTs in multiple intubation settings would be malpositioned despite adherence to Pediatric Advanced Life Support and Neonatal Resuscitation Program guidelines. METHODS: In a random subset (randomization table) of 2,000 initial chest radiographs obtained from January 1, 2009, to May 5, 2012, we recorded height, weight, age, sex, ETT inner diameter, and cm marking at the lip from the electronic health record...
July 17, 2018: Respiratory Care
Márcio Luiz Ferreira de Camillis, Augusto Savi, Regis Goulart Rosa, Mariana Figueiredo, Ricardo Wickert, Luis Guilherme Alegretti Borges, Lucas Galant, Cassiano Teixeira
BACKGROUND: Few studies have evaluated the effects of mechanical insufflation-exsufflation (MI-E) in subjects on mechanical ventilation. Therefore, this study aimed to evaluate the effectiveness of MI-E on airway mucus clearance among mechanically ventilated ICU subjects. METHODS: A randomized, parallel-group, open-label trial was conducted between June and November 2017 in a single, mixed ICU. Adult ICU subjects receiving mechanical ventilation for > 24 h with stable ventilatory and hemodynamic status were randomized to receive either standard respiratory physiotherapy alone (control group) or respiratory physiotherapy by using an MI-E device (intervention group)...
July 17, 2018: Respiratory Care
Paulo Eugênio Silva, Karina Livino de Carvalho, Murillo Frazão, Vinicius Maldaner, Carlos Raphael Daniel, Mansueto Gomes-Neto
BACKGROUND: Inspiratory muscle strength has been considered an important marker of ventilatory capacity and a predictor of global performance. A new tool has become available for dynamically evaluating the maximum inspiratory pressure (the S-Index). However, the proper assessment of this parameter needs to be determined. Thus, the aim of the present study was to investigate the number of inspiratory maneuvers necessary to reach a maximum and reliable S-Index and the influence of inspiratory muscle warm-up on this assessment...
July 17, 2018: Respiratory Care
Daphna Vilozni, Adi Dagan, Moran Lavie, Ifat Sarouk, Bat-El Bar-Aluma, Moshe Ashkenazi, Sarina Levy Mendelovich, Yael Betzalel, Ori Efrati
BACKGROUND: Inspiratory capacity (IC) was scarely considered an important measured index of spirometry in patients with cystic fibrosis (CF). Abnormally low IC may indicate the onset of static/dynamic hyperinflation, which may be accompanied by dyspnea and an increase in the work of breathing. This cross-sectional study sought to determine whether measuring IC during spirometry, may add clinical value to FEV1 measurements in CF subjects. METHODS: Anthropometric, clinical, spirometry, and static lung volume data were gathered retrospectively from 98 of 165 patients with CF (mean ± SD age 26...
July 17, 2018: Respiratory Care
Faye M Pais, Pratik Sinha, Kathleen D Liu, Michael A Matthay
ARDS has a high mortality in the acute setting, with long-term disability among disease survivors. In 1967, David Ashbaugh and colleagues first described the clinical features of ARDS, which were notably similar to the infantile respiratory distress syndrome. Half a century later, ARDS remains underrecognized and is associated with high mortality rates. Valuable insights from observational studies fail to demonstrate a mortality benefit in randomized controlled trials (RCTs). In the absence of a pharmacologic cure, supportive ventilator strategies limit rather than treat the ongoing lung injury...
July 10, 2018: Respiratory Care
Gustavo A Plotnikow, Arnaud W Thille, Daniela N Vasquez, Romina A Pratto, Corina M Quiroga, María E Andrich, Javier H Dorado, Ramiro S Gomez, Pablo A D'Annunzio, L Scapellato José, Dante Intile
BACKGROUND: High-flow nasal cannula (HFNC) enables delivery of humidified gas at high flow while controlling the F IO2 . Although its use is growing in patients with acute respiratory failure, little is known about the impact of HFNC on lung volume. Therefore, we aimed to assess lung volume changes in healthy subjects at different flows and positions. METHODS: This was a prospective physiological study performed in 16 healthy subjects. The changes in lung volumes were assessed by measuring end-expiratory lung impedance by using electrical impedance tomography...
June 26, 2018: Respiratory Care
Anne E Holland, Catherine J Hill, Leona Dowman, Ian Glaspole, Nicole Goh, Annemarie L Lee, Christine F McDonald
BACKGROUND: The aim of this work was to investigate the short- and long-term test-retest reliability of the 6-min walk distance (6MWD), peak heart rate, and nadir oxygen desaturation in idiopathic pulmonary fibrosis (IPF). METHODS: A reliability study of 70 adults with IPF was undertaken within out-patient pulmonary rehabilitation programs at 2 tertiary hospitals. Participants completed 2 baseline 6-min walk tests using a standard protocol, with continuous measures of percutaneous S pO2 and heart rate via pulse oximetry...
June 26, 2018: Respiratory Care
Barbara Moro, Loredana Baboi, Hodane Yonis, Fabien Subtil, Bruno Louis, Claude Guérin
BACKGROUND: During extracorporeal membrane oxygenation for ARDS, a range of 1-4 mL/kg predicted body weight tidal volume (VT ) is commonly used. We explored whether such a low VT could be adequately delivered by ICU ventilators, and whether such low VTs prevent the heated humidifier (HH) from reaching the recommended target of 33 mg/L absolute humidity (AH). METHODS: We attached a lung model to 5 ICU ventilators set in volume controlled mode and body temperature and pressure saturated...
June 26, 2018: Respiratory Care
Xiu-Mei Sun, Guang-Qiang Chen, Kai Chen, Yu-Mei Wang, Xuan He, Hua-Wei Huang, Xu-Ying Luo, Chun-Mei Wang, Zhong-Hua Shi, Ming Xu, Lu Chen, Eddy Fan, Jian-Xin Zhou
BACKGROUND: Stress index provides a noninvasive approach to detect injurious ventilation patterns and to personalize ventilator settings. Obtaining the stress index (SI), however, requires quantitatively analyzing the shape of pressure-time curve with dedicated instruments or a specific ventilator, which may encumber its clinical implementation. We hypothesized that the SI could be qualitatively determined through a visual inspection of ventilator waveforms. METHODS: Thirtysix adult subjects undergoing volume controlled ventilation without spontaneous breathing were enrolled...
June 26, 2018: Respiratory Care
Özlem Erçen Diken, Adem İlkay Diken, Adnan Yalçinkaya, Banu Gülbay, Turan Acican, Emre Demir, Sertan Özyalçin, Mehmet Emir Erol
BACKGROUND: The time and conditions may not be suitable for performing polysomnography (PSG) before urgent or emergent surgeries, for example, a coronary artery bypass graft. Unavailability in many centers, critical clinical situation, and inability to arrange a timely scheduled appointment are other limitations for PSG. In this study, we aimed to investigate if the STOPBANG Questionnaire may predict obstructive sleep apnea syndrome (OSAS) related postoperative pulmonary alterations during coronary artery surgery...
June 26, 2018: Respiratory Care
Kamilla Tays Marrara, Valéria Amorim Pires Di Lorenzo, Rodrigo B Jaenisch, Ramona Cabiddu, Tatiana de Oliveira Sato, Renata Gonçalves Mendes, Claudio R Oliveira, Dirceu Costa, Audrey Borghi-Silva
BACKGROUND: The primary objective of this study was to investigate whether noninvasive ventilation (NIV) can positively affect exercise capacity, maximum oxygen uptake ( V̇ O2 ), and symptoms after a 6-week physical training program for subjects with moderate to very severe COPD. METHODS: 47 subjects with COPD who were enrolled in a physical training program were randomized to either physical training alone or NIV + physical training (NIV-Physical training). Physical training consisted of dynamic aerobic exercises on a treadmill 3 times/week for 6 weeks, for a total of 18 sessions...
June 26, 2018: Respiratory Care
André Stagnara, Loredana Baboi, Pascale Nesme, Fabien Subtil, Bruno Louis, Claude Guérin
BACKGROUND: Remote monitoring is increasingly used in patients who receive home mechanical ventilation. The average volume assured pressure support mode is a target volume pressure preset mode that delivers a given tidal volume (VT ) within a range of controlled inspiratory pressures. In a mode such as this, it is important to verify that the VT value retrieved from the ventilator SD card is accurate. METHODS: A lung model was set with C (Compliance) 0.075 L/cm H2 O and RI (Inspiratory resistance)-RE (Expiratory resistance) 15-25 cm H2 O/L/s (model 1) or with C 0...
June 19, 2018: Respiratory Care
Hejab J ALMutairi, Constance C Mussa, Clement T M Lambert, David L Vines, Shawna L Strickland
BACKGROUND: Oxygen therapy for patients with COPD and severe hypoxemia requires the use of oxygen delivery devices that allow mobility as needed. However, the characteristics of some devices may limit the freedom of individuals to be as physically active as they desire. Limited mobility may negatively affect the perceived quality of life of individuals with COPD. The aim of this study was to understand perceived limitations that patients with COPD experience in using long-term oxygen therapy (LTOT) devices...
June 19, 2018: Respiratory Care
Hemang Yadav, Adam Bartley, Sheila Keating, Laurie A Meade, Philip J Norris, Rickey E Carter, Ognjen Gajic, Daryl J Kor
BACKGROUND: Patients who develop ARDS from medical or traumatic causes typically present after the inciting event has already occurred. Postoperative ARDS is unique in that the inciting insult potentially responsible for ARDS is known ahead of time, which provides an opportunity to study the early pathophysiology of ARDS. The objective of this study was to better understand the early pathophysiology of postoperative ARDS through a temporal analysis of key biomarkers of interest. METHODS: We performed a case-control study of adults undergoing elective thoracic, aortic vascular, or cardiac surgery, which placed them at increased risk of developing postoperative ARDS...
June 19, 2018: Respiratory Care
Ambra Cesareo, Antonella LoMauro, Marika Santi, Emilia Biffi, Maria G D'Angelo, Andrea Aliverti
BACKGROUND: Duchenne muscular dystrophy (DMD) is characterized by progressive degeneration, wasting, and weakness of skeletal musculature, including respiratory muscles. Cough is also compromised with disease progression. Among cough-augmentation techniques, mechanical insufflation-exsufflation (MI-E) has demonstrated several clinical benefits in patients with chronic airway secretion obstruction and muscular weakness. In clinical practice, the use of MI-E in DMD patients is also suggested when they are stable with no airway infections...
May 29, 2018: Respiratory Care
Girish G Deshpande, John E Sanford, Sandeep Tripathi
BACKGROUND: In a traditional endotracheal tube (ETT), there is a linear outward pull through its attachment to the ventilator tubing that leads to risk of accidental dislodgement. This study was conducted to assess the ETT flow characteristics and to evaluate providers' intubation experience using two ETT's in a simulated setting. METHODS: Respiratory pressure-volume dynamics for the 2 ETTs were studied in a simulation laboratory by using 3 different flow settings and 2 different test lungs...
May 29, 2018: Respiratory Care
Jacqueline P Williams, Arzu Ari, Ramalingam Shanmugam, James B Fink
BACKGROUND: Closed suction catheters are commonly used with pressurized metered-dose inhalers (pMDIs) in ventilator-dependent patients receiving bronchodilator therapy. Although heated/humidified circuits result in a decrease in drug delivery, no studies have investigated the impact of a closed suction catheter with a pMDI on aerosol delivery during mechanical ventilation. We sought to quantify aerosol delivery with a variety of closed suction catheters and pMDI adapters in a simulated ventilator-dependent adult lung model with and without exhaled humidity...
May 29, 2018: Respiratory Care
Zheng Guan, Jing-Jie Liu, Hui Yuan, Yan-Feng Gao
BACKGROUND: The balance of oxygen delivery and consumption is essential in patients who are critically ill. Mixed venous oxygen saturation (Sv̄O2 ) is a standard method to evaluate oxygen delivery and consumption during anesthesia. However, Sv̄O2 is monitored through a pulmonary artery catheter, which is invasive. Regional cerebral oxygenation (rScO2 ) reflects oxygen saturation in a small region of the frontal lobes and is monitored noninvasively through near-infrared spectroscopy...
May 29, 2018: Respiratory Care
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