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Respiratory Care

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https://www.readbyqxmd.com/read/28634174/prognostic-value-of-uric-acid-for-pulmonary-thromboembolism
#1
Savas Ozsu, Arif M Çoşar, Hayriye Bektas Aksoy, Yilmaz Bülbül, Funda Oztuna, S Caner Karahan, Tevfik Ozlu
BACKGROUND: Pulmonary thromboembolism is a serious cardiovascular condition with considerable morbidity and mortality. Clinical studies have indicated that hyperuricemia is an independent risk factor for cardiovascular events. The aim of this study was to investigate possible value of the serum levels of uric acid (UA) in predicting 30-d pulmonary thromboembolism-related mortality. METHODS: Pulmonary thromboembolism was confirmed by computed tomography pulmonary angiography, demographic data, troponin, systolic pressure and pulse on admission, and simplified pulmonary embolism severity index assessment...
June 20, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28634173/a-comparison-of-2-respiratory-devices-for-sputum-clearance-in-adults-with-non-cystic-fibrosis-bronchiectasis
#2
Yasmin R Silva, Tracy A Greer, Lucy C Morgan, Frank Li, Claude S Farah
BACKGROUND: Airway clearance techniques are a vital part of routine care for patients with bronchiectasis. There is no clear superior modality. The Flutter combines oscillations (6-20Hz) and positive expiratory pressure; the Lung Flute combines positive expiratory pressure and low frequency acoustic waves (18-22Hz), to augment clearance. This project aimed to compare these devices. METHODS: This was a randomized crossover study of adult subjects with stable non-cystic fibrosis bronchiectasis (expectorating >25 mL/d)...
June 20, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28634172/identifying-an-oxygenation-index-threshold-for-increased-mortality-in-acute-respiratory-failure
#3
Brandon G Hammond, Pamela Garcia-Filion, Paul Kang, Mounica Y Rao, Brigham C Willis, Heidi J Dalton
BACKGROUND: The objective of this work was to examine current oxygenation index (OI) data and outcomes using electronic medical record data to identify a specific OI value associated with mortality. METHODS: This study was a retrospective electronic medical record data review from the pediatric ICU of Phoenix Children's Hospital, with data mining for variables to calculate OIs on subjects age 1 month to 20 y mechanically ventilated >24 h, excluding those with known intracardiac shunts or cyanotic heart disease...
June 20, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28634171/preoperative-functional-status-is-associated-with-unplanned-intubations-following-thyroidectomies
#4
Rodney A Gabriel, Brittany N Burton, Albert P Nguyen, Ulrich H Schmidt
BACKGROUND: Unplanned postoperative intubation is an important event that may influence the outcome of thyroid- and parathyroidectomies. We performed a focused study on the association of preoperative functional status with unplanned intubation outcomes in these relatively common surgeries. METHODS: Utilizing data from the National Surgical Quality Improvement Program database from 2007 to 2013, a propensity score-matched retrospective cohort study was performed assessing this outcome in the functionally independent versus dependent groups...
June 20, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28611230/effect-of-a-motivational-interviewing-based-health-coaching-on-quality-of-life-in-subjects-with-copd
#5
Hamid Rehman, Craig Karpman, Kristin Vickers Douglas, Roberto P Benzo
BACKGROUND: Improving quality of life (QOL) is a key goal in the care of patients with COPD. Pulmonary rehabilitation (PR) has clearly been shown to improve QOL, but is not accessible to many eligible patients. There is a need for alternative programs designed to improve patient well-being that are accessible to all patients with COPD. Our goal was to pilot test a simple, telephone-based health-coaching intervention that was recently shown to decrease readmission among hospitalized COPD patients and stable COPD patients eligible for PR...
June 13, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28611229/variation-in-definition-of-prolonged-mechanical-ventilation
#6
Louise Rose, Michael McGinlay, Reshma Amin, Karen Ea Burns, Bronwen Connolly, Nicholas Hart, Philippe Jouvet, Sherri Katz, David Leasa, Cathy Mawdsley, Danny F McAuley, Marcus J Schultz, Bronagh Blackwood
Consistency of definitional criteria for terminology applied to describe subject cohorts receiving mechanical ventilation within ICU and post-acute care settings is important for understanding prevalence, risk stratification, effectiveness of interventions, and projections for resource allocation. Our objective was to quantify the application and definition of terms for prolonged mechanical ventilation. We conducted a scoping review of studies (all designs except single-case study) reporting a study population (adult and pediatric) using the term prolonged mechanical ventilation or a synonym...
June 13, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28611228/effect-of-interval-between-actuations-of-albuterol-hydrofluoroalkane-pressurized-metered-dose-inhalers-on-their-aerosol-characteristics
#7
Ariel Berlinski, David Pennington
BACKGROUND: Albuterol hydrofluoroalkane (HFA) either alone or with a valved holding chamber is used to treat bronchoconstriction. Delays between actuation and inhalation are common. Currently, the recommended interval between actuations of an albuterol HFA is 60 s. Using a shorter interval when multiple actuations are ordered will improve productivity in the hospital setting. METHODS: We studied aerosol characteristics of albuterol HFA (Ventolin, ProAir, and Proventil) with a cascade impactor calibrated at 30 L/min...
June 13, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28611227/lung-injury-etiology-and-other-factors-influencing-the-relationship-between-dead-space-fraction-and-mortality-in-ards
#8
Richard H Kallet, Hanjing Zhuo, Kelly Ho, Michael S Lipnick, Antonio Gomez, Michael A Matthay
BACKGROUND: In ARDS, elevated pulmonary dead-space fraction (VD/VT) is a particularly strong indicator of mortality risk. Whether the magnitude of VD/VT is modified by the underlying etiology of ARDS and whether this influences the strength of its association with mortality remains unknown. We sought to elucidate the impact of ARDS etiology on VD/VT and also to determine whether ARDS severity, as classified by the Berlin definition, has correspondence with changes in VD/VT. METHODS: This single-center, retrospective, observational study (2010-2016) measured VD/VT in 685 subjects with ARDS as part of clinical management with lung-protective ventilation...
June 13, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28588119/high-flow-nasal-cannula-utilization-in-pediatric-critical-care
#9
Kristen D Coletti, Dayanand N Bagdure, Linda K Walker, Kenneth E Remy, Jason W Custer
BACKGROUND: High-flow nasal cannula (HFNC) is increasingly utilized in pediatrics, delivering humidified air and oxygen for respiratory conditions causing hypoxia and distress. In the neonatal ICU, it has been associated with better tolerance, lower complications, and lower cost. Few data exist regarding indications for use and the epidemiology of disease/pathology that warrants HFNC in the pediatric ICU. METHODS: This study is a retrospective cohort study of patients admitted to a tertiary children's hospital pediatric ICU and placed on HFNC from October 1, 2011 to October 31, 2013...
June 6, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28588118/clinical-management-strategies-for-airway-pressure-release-ventilation-a-survey-of-clinical-practice
#10
Andrew G Miller, Michael A Gentile, John D Davies, Neil R MacIntyre
BACKGROUND: Airway pressure release ventilation (APRV) is a commonly used mode of ventilation designed to increase mean airway pressure and thus oxygenation. Different strategies for clinical management have been described in the literature but are largely based on physiologic concepts, animal data, and small clinical trials. The purpose of this study was to determine how APRV is currently managed by surveying practicing respiratory therapists with experience using APRV. METHODS: A 15-item survey was developed by the authors and posted on the AARConnect online media platform in January 2016 after being declared exempt by our institution's institutional review board...
June 6, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28588117/aerosol-delivery-through-adult-high-flow-nasal-cannula-with-heliox-and-oxygen
#11
Patricia A Dailey, Robert Harwood, Kyle Walsh, James B Fink, Tina Thayer, Greg Gagnon, Arzu Ari
BACKGROUND: Heliox (helium-oxygen mixture) has been shown to reduce turbulence and improve aerosol delivery in a range of clinical settings. We questioned whether heliox as compared with oxygen via high-flow nasal cannula (HFNC) would affect aerosol delivery. We hypothesized that heliox would have a significant effect on aerosol delivery as compared with oxygen with both quiet and distressed breathing patterns. METHODS: A vibrating mesh nebulizer was placed at the inlet of a humidifier via HFNC with small adult cannula distal to the heated-wire circuit with prongs placed into simulated nares with a T-shaped trap and absolute filter connected to a breath simulator set to adult quiet and distressed breathing parameters...
June 6, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28588116/high-oxygen-concentrations-adversely-affect-the-performance-of-pulmonary-surfactant
#12
Craig D Smallwood, Parnian Boloori-Zadeh, Maricris R Silva, Andrew Gouldstone
BACKGROUND: Although effective in the neonatal population, exogenous pulmonary surfactant has not demonstrated a benefit in pediatric and adult subjects with hypoxic lung injury despite a sound physiologic rationale. Importantly, neonatal surfactant replacement therapy is administered in conjunction with low fractional FIO2 while pediatric/adult therapy is administered with high FIO2 . We suspected a connection between FIO2 and surfactant performance. Therefore, we sought to assess a possible mechanism by which the activity of pulmonary surfactant is adversely affected by direct oxygen exposure in in vitro experiments...
June 6, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28559471/gas-exchange-in-the-prone-posture
#13
Nicholas J Johnson, Andrew M Luks, Robb W Glenny
The prone posture is known to have numerous effects on gas exchange, both under normal conditions and in patients with ARDS. Clinical studies have consistently demonstrated improvements in oxygenation, and a multi-center randomized trial found that, when implemented within 48 h of moderate-to-severe ARDS, placing subjects in the prone posture decreased mortality. Improvements in gas exchange occur via several mechanisms: alterations in the distribution of alveolar ventilation, redistribution of blood flow, improved matching of local ventilation and perfusion, and reduction in regions of low ventilation/perfusion ratios...
May 30, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28559470/flow-decay-a-novel-spirometric-index-to-quantify-dynamic-airway-resistance
#14
Anita Oh, Tessa A Morris, Isaac T Yoshii, Timothy A Morris
BACKGROUND: Dynamic airway resistance from obstructive disease causes a concavity in the mid-expiratory portion of the spirometric flow-volume loop. We developed a simple model to measure the exponential decay in air flow during forced exhalation to quantify the extent of dynamic airway obstruction and facilitate the detection of obstructive airway diseases clinically. METHODS: We calculated flow decay as the slope of volume versus ln(1/flow) in mid-exhalation. We derived the normal range in a derivation group of healthy volunteers in whom spirometry had been performed repeatedly...
May 30, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28559469/physiological-requirements-to-perform-the-glittre-activities-of-daily-living-test-by-subjects-with-mild-to-severe-copd
#15
Gérson F Souza, Graciane L Moreira, Andréa Tufanin, Mariana R Gazzotti, Antonio A Castro, José R Jardim, Oliver A Nascimento
BACKGROUND: The Glittre activities of daily living (ADL) test is supposed to evaluate the functional capacity of COPD patients. The physiological requirements of the test and the time taken to perform it by COPD patients in different disease stages are not well known. The objective of this work was to compare the metabolic, ventilatory, and cardiac requirements and the time taken to carry out the Glittre ADL test by COPD subjects with mild, moderate, and severe disease. METHODS: Spirometry, Medical Research Council questionnaire, cardiopulmonary exercise test, and 2 Glittre ADL tests were evaluated in 62 COPD subjects...
May 30, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28559468/severity-of-hypoxemia-and-other-factors-that-influence-the-response-to-aerosolized-prostacyclin-in-ards
#16
Richard H Kallet, Gregory Burns, Hanjing Zhuo, Kelly Ho, Justin S Phillips, Lance P Pangilinan, Vivian Yip, Antonio Gomez, Michael S Lipnick
BACKGROUND: ARDS is characterized by decreased functional residual capacity (FRC), heterogeneous lung injury, and severe hypoxemia. Tidal ventilation is preferentially distributed to ventilated alveoli. Aerosolized prostaglandin I2 exploits this pathophysiology by inducing local vasodilation, thereby increasing ventilation-perfusion matching and reducing hypoxemia. Therefore, aerosolized prostaglandin I2 efficacy may depend upon FRC. Both PaO2 /FIO2 and compliance of the respiratory system (CRS) are indirect signifiers of FRC and thus may partly determine the response to aerosolized prostaglandin I2...
May 30, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28559467/effect-of-ards-severity-and-etiology-on-short-term-outcomes
#17
Haitham El-Haddad, Hyejeong Jang, Wei Chen, Ayman O Soubani
BACKGROUND: We evaluated the outcome of subjects with ARDS in relation to etiology and severity in a retrospective cohort study of the ARDS Network randomized controlled trials. The primary outcome was 28-d mortality. The secondary outcomes were 60-d mortality and ventilator- and ICU-free days. For severity of ARDS, subjects were stratified according to PaO2/FIO2. The etiology of ARDS was classified into sepsis, pneumonia, aspiration, trauma, and others. RESULTS: A total of 2,914 subjects were included in these trials...
May 30, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28559466/inhaled-drug-therapy-2016-the-year-in-review
#18
Rajiv Dhand
Some recent salient publications related to inhaled drug therapy are discussed. Unexpectedly, a 2.5-μg once-daily dose of tiotropium (Respimat) had greater efficacy than the 5.0-μg daily dose. Occurrence of a reverse dose response serves to caution us that administering more drug is not always beneficial. Small-airway inflammation contributes to pathogenesis of asthma, especially severe asthma. However, there is no conclusive evidence that the use of small-particle aerosols to target small airways improves clinical outcomes in controlled clinical trials...
May 30, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28559465/reducing-unplanned-extubations-in-the-nicu-following-implementation-of-a-standardized-approach
#19
Kevin L Crezeé, Robert J DiGeronimo, Marilyn J Rigby, Rick C Carter, Shrena Patel
BACKGROUND: Unplanned extubations (UEs) have been associated with increased ventilator days, risk of infection, cardiopulmonary resuscitation, and resuscitation medication usage. The UE rate in our level 4 NICU is lower than the national average. Efforts to further reduce UE events at our institution led an interdisciplinary group to define steps to eliminate UEs. Steps included: (1) requiring at least 2 care providers at the bedside for movement of an intubated subject; (2) standardizing head and endotracheal tube (ETT) position; (3) defining a set methodology for ETT securing; (4) introducing a postoperative handoff to improve communication; and (5) implementing a post-UE assessment tool...
May 30, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28559464/smoke-biomass-exposure-and-copd-risk-in-the-primary-care-setting-the-puma-study
#20
Maria Montes de Oca, Gustavo Zabert, Dolores Moreno, Maria E Laucho-Contreras, Maria Victorina Lopez Varela, Filip Surmont
BACKGROUND: The evidence indicates that risk factors other than smoking are important in the development of COPD. It has been postulated that less traditional risk factors (eg, exposure to coal and/or biomass smoke) may interact with smoking to further increase COPD risk. This analysis evaluated the effect of exposure to biomass and smoking on COPD risk in a primary care setting in Latin America. METHODS: Subjects attending routine primary care visits, ≥40 y old, who were current or former smokers or were exposed to biomass smoke, completed a questionnaire and performed spirometry...
May 30, 2017: Respiratory Care
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