Chest
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Comparative Study
Occlusion pressure and its ratio to maximum inspiratory pressure are useful predictors for successful extubation following T-piece weaning trial.
In most weaning studies, failure group patients are reventilated prior to extubation, thus compromising the evaluation of the applied weaning indices' predictive values. This study determines the usefulness of both standard and recent indices in predicting successful extubation following prolonged mechanical ventilation. ⋯ PO.1 and PO.1/MIP ratio provide the best means of predicting extubation success, and they are not influenced by tracheal tube resistance.
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Comparative Study
CPAP reduces inspiratory work more than dyspnea during hyperinflation with intrinsic PEEP.
Hyperinflation with intrinsic positive end-expiratory pressure (PEEPi) loads the respiratory muscles and causes dyspnea in obstructive lung disease. Continuous positive airway pressure (CPAP) has shown some efficacy in reducing inspiratory work and dyspnea. However, in obstructive lung disease, inspiratory work and dyspnea may be increased by additional factors that may not be affected by CPAP. ⋯ We conclude that CPAP can substantially ameliorate the respiratory work load induced by hyperinflation with intrinsic PEEP. However, the effects of CPAP on dyspnea and endurance are more limited. This suggests that the limits to breathing at high lung volumes are related to factors in addition to respiratory muscle work, and that CPAP may be of more value in reducing the work than in relieving the distress of obstructive lung disease.
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Comparative Study
Predictors of patient adherence to long-term home nebulizer therapy for COPD. The IPPB Study Group. Intermittent Positive Pressure Breathing.
Patients with moderate to severe COPD are frequently prescribed expensive and complicated therapies that require adjustments in usual activities of daily living. However, little is known about factors that are associated with adherence to such treatment. The objective of this study was to identify characteristics of patients who were adherent to long-term home nebulizer therapy. ⋯ Sociodemographic, physiologic, and quality of life variables were associated with adherence to long-term nebulizer therapy.