Resp Care
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Randomized Controlled Trial
Response to albuterol MDI delivered through an anti-static chamber during nocturnal bronchospasm.
Decreasing electrostatic charge on valved holding chambers increases the amount of drug delivered. However, there are no data demonstrating that this increases bronchodilatation. ⋯ Delivery of albuterol through an anti-static chamber provides a clinically relevant improvement in bronchodilator response during acute, reversible bronchospasm such as nocturnal bronchospasm.
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Randomized Controlled Trial Multicenter Study
Findings from the MATREX study: a treatment protocol for the delivery of manual chest therapy in respiratory care.
One of the difficulties in comparing the numerous studies on manual chest therapy (MCT) is the wide variety of techniques used and terms employed to describe the intervention. This lack of consistency in therapeutic approach and the absence of defined tools for evaluation have led to a continued air of skepticism about its true value. This paper presents a treatment protocol used in a large randomized controlled trial examining the efficacy and cost effectiveness of MCT for patients hospitalized with exacerbations of COPD. ⋯ With respect to the essential elements of MCT, the treatment protocol used in the MATREX trial offers sufficient flexibility to the therapist, while being robust enough to maintain clinical trial integrity. The level of adherence by therapists indicates its professional acceptability with respect to delivering and evaluating this therapy.
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Randomized Controlled Trial Comparative Study
A prospective, comparative trial of standard and breath-actuated nebulizer: efficacy, safety, and satisfaction.
Nebulized drug delivery is a cornerstone of therapy for obstructive lung disease, but the ideal nebulizer design is uncertain. The breath-actuated nebulizer (BAN) may be superior to conventional nebulizers. This study compared the BAN to standard nebulizer with regard to efficacy, safety, and patient and respiratory therapist (RT) satisfaction. ⋯ Patients and RTs expressed greater satisfaction with the BAN, compared with standard nebulizer. Pre- and post-treatment vital signs did not differ between groups, but use of the BAN was associated with a shorter duration and a lower occurrence of adverse events. Taken together, these data support the use of the BAN for nebulized medication delivery.
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Review Case Reports
Severe acute respiratory failure secondary to acute fibrinous and organizing pneumonia requiring mechanical ventilation: a case report and literature review.
A 27-year-old woman was admitted to our ICU with acute hypoxemic respiratory failure and criteria for ARDS. Despite an F(IO(2)) of 1.0 and a lung protective strategy, the patient died on day 15 without any improvement. The relatives gave consent for post-mortem analysis. ⋯ There is little information regarding the pathophysiology of this illness. Important questions remain regarding this disease, including predisposing factors and management. Patients who require mechanical ventilation have poor outcomes.
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Evidence-based medicine has assumed a major place in establishing the standard of care for many diseases. Yet practices based largely on clinical experience have often been difficult to change, even when clearly associated with patient harm. In this paper, based on the 27th Philip Kittredge Memorial Lecture, we highlight respiratory care practices that have clearly failed the tests of time and evidence yet sometimes tenaciously persist. We also discuss the appropriate use and potential abuse of evidence-based medicine.