Resp Care
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Review Meta Analysis
Effect of ventilator circuit changes on ventilator-associated pneumonia: a systematic review and meta-analysis.
Recent guidelines concerning prevention of ventilator-associated pneumonia recommend that ventilator circuits should not be changed routinely, but in practice circuit changes at regular intervals persist. ⋯ Frequent ventilator circuit changes are associated with a high risk of ventilator-associated pneumonia. No routine circuit change is safe and justified. Hospital infection-control policies and bedside practitioners should translate the evidence into clinical practice, if they haven't done so already.
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Comparative Study Clinical Trial
Effective inspired oxygen concentration measured via transtracheal and oral gas analysis.
The fraction of inspired oxygen (F(IO(2))) is quoted for different oxygen delivery systems, but variations in inspiratory flow and tidal volume make precise measurement difficult. We developed a reliable method of measuring the effective F(IO(2)) in patients receiving supplemental oxygen. ⋯ Exhaled gas sampled at the mouth accurately reflected the effective F(IO(2)) in the trachea. In relation to inspired oxygen flow, the effective F(IO(2)) was lower than is conventionally thought. Compared to nasal cannula, transtracheal catheter approximately doubled the effective F(IO(2)) at a given flow rate. Accurate knowledge of F(IO(2)) should aid clinicians in managing patients with acute and chronic lung diseases.
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Editorial Comment
Improved oxygenation and increased comfort: a great combination.
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Comparative Study Clinical Trial
High-flow oxygen therapy in acute respiratory failure.
To compare the comfort of oxygen therapy via high-flow nasal cannula (HFNC) versus via conventional face mask in patients with acute respiratory failure. Acute respiratory failure was defined as blood oxygen saturation < 96% while receiving a fraction of inspired oxygen > or = 0.50 via face mask. ⋯ HFNC was better tolerated and more comfortable than face mask. HFNC was associated with better oxygenation and lower respiratory rate. HFNC could have an important role in the treatment of patients with acute respiratory failure.
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Several portable oxygen concentrators (POCs) have become available in the United States. Technical trade-offs are made in designing POCs, so their performance is expected to differ. ⋯ These 4 POC models have markedly different performance, which emphasizes the need to adjust the POC setting to meet the specific patient's needs at rest and with activity.