Resp Care
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Patients with chronic neuromuscular disease represent less than 10% of those receiving mechanical ventilation in the intensive care unit (ICU). Little has been reported regarding either ICU management of acute respiratory failure (ARF) in the era of noninvasive mechanical ventilation (NIV) or long-term outcomes. ⋯ In our ICU, chronic neuromuscular disease is an uncommon cause of ARF, for which we often use NIV. These patients had a low probability of death in the ICU. Long-term outcome was independent of the type of neuromuscular disease.
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Mortality is high among patients admitted to intensive care units (ICUs). Several prognostic markers have been described in such patients, but the literature contains no data comparing C-reactive protein (CRP) and cardiac troponin T (cTn-T), nor of a combination of CRP and cTn-T in the same patient group in the ICU. ⋯ Elevated CRP is an independent early prognostic marker of mortality risk in ICU patients. We suspect that a CRP-based prognosis strategy may be useful.
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The 5-stage Chester step test assesses aerobic capacity in healthy subjects. It has not been tested in patients with COPD. ⋯ Despite being highly reproducible, the Chester step test had a very short duration in patients with COPD. The number of steps incremented in each stage seems to be too large for these patients. An adaptation of the Chester step test should be considered for patients with COPD.
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Intensive-care mechanical ventilators regularly enter the market, but the gas-delivery capabilities of many have never been assessed. ⋯ Most of the tested ventilators performed at an acceptable level during the majority of evaluations, but some ventilators performed inadequately during specific settings. Bedside clinical evaluation is needed.
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Hudson prongs (Hudson RCI, Teleflex Medical, Research Triangle Park, North Carolina) (a device to deliver nasal continuous positive airway pressure) are often secured with a "Velcro mustache" in neonatal intensive care units. We report 2 premature infants who required bag-and-mask ventilation while on Hudson prongs secured with a Velcro mustache. Effective ventilation was achieved only after removing the Velcro mustache.