Resp Care
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Randomized Controlled Trial Comparative Study
Chest physiotherapy with positive airway pressure: a pilot study of short-term effects on sputum clearance in patients with cystic fibrosis and severe airway obstruction.
The periodic administration of positive airway pressure combined with directed cough could aid mucus clearance in patients with cystic fibrosis (CF) and severe airway obstruction. ⋯ There were no differences in sputum clearance or pulmonary-function measures between mask PEP and short-term administration of either CPAP or NPPV combined with directed cough. After mask PEP these patients felt more tired than after CPAP or NPPV secretion-clearance therapy.
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Airway inflammation in acute and chronic respiratory diseases is characterized in part by abnormal pH in airway-lining fluid. The pH of exhaled-breath condensate (EBC) is low (acidic) in various pulmonary inflammatory diseases, including asthma, chronic obstructive pulmonary disease, cystic fibrosis, pneumonia, and acute respiratory distress syndrome. Because the time course of pH changes in the airway is not yet clear, we aimed to develop a method for frequent and intensive EBC pH data collection in mechanically ventilated patients. ⋯ Continuous monitoring of EBC pH from the ventilator exhaust port is safely achievable and reliably provides data that may become useful in monitoring critically ill patients.
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To determine the prevalence of confirmatory use of spirometry in patients admitted to a tertiary-care facility with the diagnosis of chronic obstructive pulmonary disease (COPD), including those with respiratory failure, and compare that to the use of confirmatory 2-dimensional echocardiography (2-D echo) in patients admitted with the diagnosis of congestive heart failure (CHF), to determine preferential confirmatory testing practices. ⋯ A large proportion of patients hospitalized with the diagnosis of COPD have never had a confirmatory test, including those with presumably advanced disease. Compared to patients with CHF, patients with COPD are less likely to have had the confirmatory test performed, even when both conditions coexist. Many patients with the clinical diagnosis of COPD have an inconsistent physiologic diagnosis. To impact the increasingly important problem of COPD, we must raise awareness of the need to confirm its diagnosis and severity with spirometry.
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Clinical Trial
A decremental PEEP trial identifies the PEEP level that maintains oxygenation after lung recruitment.
To assess the ability of a decremental trial of positive end-expiratory pressure (PEEP) to identify an optimal PEEP level that maintains oxygenation after a lung-recruitment maneuver. ⋯ A decremental PEEP trial identifies a PEEP setting that sustains for 4 h the oxygenation benefit of a 40-cm H2O, 40-s lung-recruitment maneuver.
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Randomized Controlled Trial
The effects of apparatus dead space on P(aCO2) in patients receiving lung-protective ventilation.
Lung-protective ventilation using tidal volume (V(T)) of 4-6 mL/kg (predicted body weight) reduces mortality (compared with traditional V(T)) in patients with acute respiratory distress syndrome and acute lung injury. Standardized use of lower V(T) can result in respiratory acidosis and has raised new concerns about the appropriate configuration of the ventilator circuit, especially in regard to the dead space (V(D)) of the apparatus. We hypothesized that, with a patient receiving lung-protective ventilation, the removal of all apparatus dead space from the circuit would reduce P(aCO2) and allow a reduction in minute ventilation. ⋯ In patients receiving lower-V(T) ventilation, removing all the apparatus V(D) from the ventilator circuit reduces P(aCO2) and increases pH, at a lower minute ventilation. This information will help guide ventilator-circuit configuration for patients receiving lung-protective ventilation.