American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Aug 2014
Randomized Controlled TrialNasal High-flow vs Venturi Mask Oxygen Therapy After Extubation: Effects on Oxygenation, Comfort and Clinical Outcome.
Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce. ⋯ Compared with the Venturi mask, NHF results in better oxygenation for the same set FiO2 after extubation. Use of NHF is associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate. Clinical trial registered with www.clinicaltrials.gov (NCT 01575353).
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Am. J. Respir. Crit. Care Med. · Aug 2014
Randomized Controlled Trial Observational StudyThe Impact of Breastfeeding on Nasopharyngeal Microbial Communities in Infants.
Breastfeeding elicits significant protection against respiratory tract infections in infancy. Modulation of respiratory microbiota might be part of the natural mechanisms of protection against respiratory diseases induced by breastfeeding. ⋯ Our data suggest a strong association between breastfeeding and microbial community composition in the upper respiratory tract of 6-week-old infants. Observed differences in microbial community profile may contribute to the protective effect of breastfeeding on respiratory infections and wheezing in early infancy. Clinical trial registered with www.clinicaltrials.gov (NCT 00189020).
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Am. J. Respir. Crit. Care Med. · Aug 2014
READING PULMONARY VASCULAR PRESSURE TRACINGS How to handle the problems of zero leveling and respiratory swings.
The accuracy of pulmonary vascular pressure measurements is of great diagnostic and prognostic relevance. However, there is variability of zero leveling procedures, and the current recommendation of end-expiratory reading may not always be adequate. A review of physiological and anatomical data, supported by recent imaging, leads to the practical recommendation of zero leveling at the cross-section of three transthoracic planes, which are, respectively midchest frontal, transverse through the fourth intercostal space, and midsagittal. ⋯ This problem is amplified in patients with obstructed airways. With the exception of dynamic hyperinflation states, it is reasonable to assume that negative inspiratory and positive expiratory intrathoracic pressures cancel each other out, so averaging pulmonary vascular pressures over several respiratory cycles is most often preferable. This recommendation may be generalized for the purpose of consistency and makes sense, as pulmonary blood flow measurements are not corrected for phasic inspiratory and expiratory changes in clinical practice.