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Respiratory Care

Federico Longhini, Ling Liu, Chun Pan, Jianfeng Xie, Gianmaria Cammarota, Andrea Bruni, Eugenio Garofalo, Yi Yang, Paolo Navalesi, Haibo Qiu
BACKGROUND: In patients with COPD exacerbation, noninvasive ventilation (NIV) is strongly recommended. NIV is generally delivered by using pneumatically triggered and cycled pressure support through a face mask. A specific method to generate neurally-controlled pressure support has been shown to improve comfort and patient-ventilator interaction. In addition, the helmet interface was better tolerated by patients compared with a face mask. Herein, we compared neurally-controlled pressure support through a helmet with pressure support through a face mask with respect to subject comfort, breathing pattern, gas exchange, pressurization and triggering performance, and patient-ventilator synchrony...
February 12, 2019: Respiratory Care
Mutsuo Onodera, Emiko Nakataki, Nobuto Nakanishi, Taiga Itagaki, Masami Sato, Jun Oto, Masaji Nishimura
BACKGROUND: During high-flow oxygen therapy, heated humidified gas is delivered at high flow. Although the warmth and humidity of this gas facilitates mucociliary function in the lower airway, warm and humid conditions also promote bacterial growth. Bacterial contamination of high-flow oxygen therapy circuits has not been well investigated. We examined the incidence of bacterial contamination in high-flow oxygen therapy circuits. METHODS: This was a prospective observational study in a university hospital 10-bed general ICU...
February 5, 2019: Respiratory Care
Robert M DiBlasi, Christine N Kearney, Justin C Hotz, John W Salyer, Jonathan A Poli, Dave N Crotwell, Silvia M Hartmann
BACKGROUND: Different brands of volume-targeted modes may vary the location of tidal volume (VT ) monitoring and whether peak inspiratory pressure is adjusted based on inspiratory, expiratory, or leak-compensated VT . These variables may result in different levels of support provided to patients, especially when an endotracheal tube (ETT) leak is present. We hypothesized that there would be no differences in gas exchange, triggering, or work of breathing between volume-targeted modes of 3 different brands of equipment in a surfactant-deficient, spontaneously breathing animal model with and without an ETT leak...
February 5, 2019: Respiratory Care
Yen-Huey Chen, Hsiu-Feng Hsiao, Li-Fu Li, Ning-Hung Chen, Chung-Chi Huang
BACKGROUND: Muscle atrophy and deconditioning are common complications in patients on prolonged mechanical ventilation (PMV). There are few studies that reviewed the effects of electrical muscle stimulation in this population. The purpose of this study was to examine the effects of electrical muscle stimulation on muscle function and hospitalization outcomes in subjects with PMV. METHODS: Subjects on mechanical ventilation for ≥21 d were randomly assigned to the electrical muscle stimulation group ( n = 16) or the control group ( n = 17)...
February 5, 2019: Respiratory Care
Jessyca P Selman, Fernanda C Lanza, Gustavo F Wandalsen, Dirceu Solé, Denis E O'Donnell, J Alberto Neder, Simone Dal Corso
BACKGROUND: Single-step tests have been proposed as simple and inexpensive challenges to diagnose exercise-induced bronchoconstriction (EIB) in the pediatric population. Work performed and the resulting ventilation, however, might be substantially lower in stepping than running. This might decrease the diagnostic yield of step-based challenges. METHODS: In a cross-sectional study, 53 children with asthma with exercise-related symptoms (34 boys, age 6-18 y) underwent an incremental stepping test, a 6-min constant stepping test, and a treadmill running test on different days...
February 5, 2019: Respiratory Care
Hideo Kaneko, Akari Suzuki, Jun Horie
BACKGROUND: Age- and lifestyle-related changes in respiratory and physical function affect cough strength. However, in older adults, the main factors that relate to cough strength remain unclear. This study was a preliminary investigation of factors that contribute to cough strength and the relationships between cough strength and respiratory function, physical performance, physical activity, and sedentary behavior in community-dwelling older adults. METHODS: By using accelerometers and other tools, we assessed cough peak flow (CPF), FVC, maximum inspiratory pressure (PImax ), maximum expiratory pressure (PEmax ), chest and abdominal wall mobility (breathing movement scale), physical performance (Timed Up and Go test and 30-s chair stand test), physical activity (steps, and locomotive and non-locomotive moderate-to-vigorous physical activity), and sedentary behavior (sedentary time) in 65 community-dwelling older adults (25 males and 40 females) without air-flow limitation...
February 5, 2019: Respiratory Care
Maria Mc Frade, Ivanize Mm Dos Reis, Renata P Basso-Vanelli, Alexandre F Brandão, Mauricio Jamami
BACKGROUND: The importance of evaluating the functional capacity of patients with COPD is well known, and there is a wide range of tests described in the literature. The 6-min stationary walk test associated with virtual reality (STVR-6) was created in light of the current limitations of evaluation tests. It does not require a large physical space or sophisticated equipment, and it is not costly; furthermore, it can be performed by a single rater. The objective of this study was to evaluate intra- and inter-rater reproducibility and to verify the criterion validity of the STVR-6...
January 29, 2019: Respiratory Care
John Z Chen, Ira M Katz, Marine Pichelin, Kaixian Zhu, Georges Caillibotte, Warren H Finlay, Andrew R Martin
BACKGROUND: Portable oxygen concentrators (POCs) deliver oxygen in intermittent pulses. The challenge of establishing equivalence between continuous flow oxygen and nominal pulse flow settings on different POCs is well known. In vitro bench measurements and in silico mathematical modeling were used to compare the performance of 4 POCs versus continuous flow oxygen by predicting the F IO2 at the trachea and entering the acini. METHODS: Each of the 4 POCs was connected to a 3-dimensional printed replica of a human adult nasal airway via nasal cannula...
January 29, 2019: Respiratory Care
Luciana Dos Santos Andreata, Maria Raquel Soares, Carlos Ac Pereira
BACKGROUND: Healthy individuals without respiratory symptoms can sometimes present with low FEV1 /FVC. The objective of this study was to characterize and compare subjects without symptoms and with reduced FEV1 /FVC but normal FEV1 with subjects with mild obstructive lung disease. METHODS: Fifty healthy subjects with FEV1 /FVC below the fifth percentile of reference values (normal variants) were compared with 52 subjects with asthma and 48 subjects with COPD who had similar FEV1 /FVC...
January 22, 2019: Respiratory Care
Yasmin M Madney, Maha Fathy, Ahmed A Elberry, Hoda Rabea, Mohamed Ea Abdelrahim
BACKGROUND: There has been a growing trend toward delivering aerosolized medications using high-flow nasal cannula (HFNC). In some cases, patients who do not require high-flow oxygen to maintain adequate oxygenation may benefit from aerosol delivery while receiving low-flow oxygen via HFNC. The objective of this study was to quantify and compare the relative pulmonary and systemic delivery of salbutamol, with 2 different nebulizers, in patients with COPD receiving low-flow oxygen therapy through an HFNC...
January 22, 2019: Respiratory Care
Lisa J Franks, James R Walsh, Kathleen Hall, Guillermo Jacuinde, Stephanie Yerkovich, Norman R Morris
BACKGROUND: Positive expiratory pressure (PEP) devices are widely used in clinical settings, yet the performance characteristics of these devices remain relatively unknown. This study compared the performance characteristics of 6 airway clearance devices by varying resistance and flow. METHODS: Mean PEP, peak PEP, oscillation frequency, and amplitude PEP of the Flutter, Pari PEP S, Acapella Choice, Acapella DM, Acapella DH, and Aerobika devices were obtained across flows of 5, 10, 15, 20, 25 and 30 L/min and at low, medium, and high resistance using an experimental apparatus custom-built for this bench study...
January 22, 2019: Respiratory Care
Haytham H Eltrabili, Ahmed M Hasanin, Mahmoud S Soliman, Ahmed M Lotfy, Walid I Hamimy, Ahmed M Mukhtar
BACKGROUND: Sepsis-induced diaphragmatic dysfunction is one of the main risk factors of failure to liberate patients from mechanical ventilation. Several studies addressed diaphragmatic ultrasound as a valuable tool in the assessment of diaphragmatic function during liberation from mechanical ventilation in different populations. However, none of these studies examined the use of diaphragmatic ultrasound to predict failure of liberation from mechanical ventilation in subjects with sepsis METHODS: A prospective observational study was done with subjects on mechanical ventilation and with abdominal sepsis...
January 22, 2019: Respiratory Care
Adam Em Eltorai, Thomas J Martin, Shyam A Patel, Megan Tran, Ashley S Eltorai, Alan H Daniels, Grayson L Baird
BACKGROUND: Incentive spirometers were developed to facilitate sustained maximum inspiration. In addition to a slow-rising float that indicates volume displacement, the incentive spirometers includes a sensitive, rapid-fluttering flow indicator. Achieving the target inspiratory volume is believed to be the most important factor in successful incentive spirometers use. This investigation hypothesized that patients focus on the rapid fluttering of the flow indicator rather than volume float during incentive spirometers use...
January 22, 2019: Respiratory Care
Constance C Mussa, Afnan Al-Raimi, Ellen A Becker
BACKGROUND: The modified early warning score (MEWS) is used to detect early clinical deterioration and to escalate care as needed. Respiratory therapists (RTs) usually do not use the MEWS even when it is implemented as a default in the electronic health record system. This study explored whether the technology acceptance model could predict the intentions of RTs to use the MEWS. METHODS: A validated survey that uses a pretest/posttest design was used to determine the effect of an educational intervention (lecture and interactive small group session) on RTs' MEWS knowledge...
January 22, 2019: Respiratory Care
Juandi Zhou, Jia Song, Shijin Gong, Weihang Hu, Minjia Wang, Aibing Xiao, Cong Zhang, Zhouzhou Dong
BACKGROUND: Lung ultrasound is a valuable imaging tool in the diagnosis of community-acquired pneumonia. However, its diagnostic accuracy in ventilator-associated pneumonia (VAP) has not been fully investigated. The aim of this study was to evaluate the diagnostic performance of the combination of a lung ultrasound with procalcitonin (PCT) in mechanically ventilated subjects with symptoms suggestive of pneumonia. METHODS: A prospective study of 124 subjects with suspected VAP in 2 multidisciplinary ICUs was conducted between December 2016 and October 2017...
January 22, 2019: Respiratory Care
Alberto Zanella, Gaetano Florio, Emanuele Rezoagli, Martina Pastore, Paolo Cadringer, Osvaldo Biancolilli, Eleonora Carlesso, Vittorio Scaravilli, Giuseppe Ristagno, Antonio M Pesenti
BACKGROUND: Endotracheal suctioning is mandatory to prevent complications caused by the retention of tracheal secretions. Endotracheal suctioning is often performed late, when patients show signs of respiratory and hemodynamic alterations. We conceived a prototype device that, when synchronized with the ventilator, automatically removes secretions collected below the endotracheal tube (ETT) cuff, thus avoiding endotracheal suctioning. The aim of our investigation was to assess the performance of this novel prototype in vitro...
January 8, 2019: Respiratory Care
Michael J Morris, Andrew J Skabelund, Frederic A Rawlins, Roger A Gallup, James K Aden, Aaron B Holley
BACKGROUND: There is significant concern about the respiratory health of deployed military service members given the reported airborne hazards in southwest Asia, which range from geologic dusts, burn pit emissions, chemical exposures, and increased rates of smoking. There has been no previous comparison of pre- and post-deployment lung function in these individuals. METHODS: Military personnel who deployed to southwest Asia in support of ongoing military operations were recruited from the Soldier Readiness Processing Center at Fort Hood, Texas, from 2011 to 2014...
January 8, 2019: Respiratory Care
Hwan Il Kim, Jae Hwa Cho, So Young Park, Young Seok Lee, Youjin Chang, Won-Il Choi, Yun Su Sim, Jae Young Moon, Kwangha Lee, Ki-Suck Jung, Sunghoon Park
BACKGROUND: In Asian countries, nationwide data on patients undergoing home mechanical ventilation are limited. METHODS: This study investigated the prevalence and primary indications for home mechanical ventilation use in South Korea by using nationwide registry data from the National Health Insurance Service. RESULTS: The study period included a total of 4,785 subjects on home mechanical ventilation (mean ± SD age, 56.0 ± 23.9 y; females, 40...
December 24, 2018: Respiratory Care
Magalie Caudron, Tanya Holt, Geoff DE Cuvelier, Jeffrey Dmytrowich, Gregory Hansen
Pediatric ARDS continues to be a management challenge in the ICU with prolonged hospitalizations and high mortality. Thromboembolic pulmonary embolism and in situ pulmonary artery thrombosis might represent underappreciated thrombotic processes for a subset of these patients. Although well described in the adult literature, descriptions of pulmonary thromboses with pediatric ARDS are limited to case reports. However, many risk factors for pulmonary thromboses are present in children with ARDS (eg, coagulopathy, endothelial injury, central venous catheters, concomitant inflammatory diseases), suggesting a much higher incidence is plausible...
December 24, 2018: Respiratory Care
Wei-Jie Guan, Jing-Jing Yuan, Hui-Min Li, Yan Huang, Chun-Lan Chen, Yong-Hua Gao, Rong-Chang Chen, Nan-Shan Zhong
BACKGROUND: Bronchiectasis is a chronic debilitating suppurative disease that significantly impacts quality of life. Clinical outcomes like exacerbations, are usually physician centered; however, the patients' experience, health-related behaviors, and expectations have frequently been neglected. In addition, patients' health perceptions may be influenced by their culture. OBJECTIVE: To determine the health perception and behavior in adults with bronchiectasis. METHODS: We performed semi-directive interviews, which were audiotaped, with 60 adults with bronchiectasis between April 2016 and December 2016...
December 11, 2018: Respiratory Care
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