Resp Care
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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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Office spirometers are now widely used to detect obstructive lung diseases. To test the technical characteristics of these devices, simulation of different forced expiratory maneuvers is performed, using computer generated waveforms. However, the tests with human subjects are also useful to detect technical flaws. The procedure used by some authors to test the accuracy of office spirometers is to compare measurements made by 2 spirometers connected in series. ⋯ Connecting the spirometers in series gives variable results, depending on the position of the spirometer in the assembly. Individual tests are therefore essential, as results are not interchangeable.
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To investigate the predictive value of the maximal inspiratory pressure obtained by a digital vacuometer using a unidirectional valve (P(ImaxUV)) as to weaning outcome, and to compare its performance with the respiratory drive using airway occlusion pressure at 0.1 second (P(0.1)), and P(0.1)/P(ImaxUV). ⋯ Every studied index had only a modest performance regarding prediction of weaning outcome. Of note, P(ImaxUV) values obtained by digital technology using a unidirectional valve performed better than historically reported using a conventional techniques, surpassing P(0.1) and P(0.1)/P(ImaxUV) in this regard.
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Editorial Comment
Aerosol therapy in tracheotomized children: time for guidelines!
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Randomized Controlled Trial
Automated oxygen flow titration to maintain constant oxygenation.
One century after the introduction of the oxygen flow meter into clinical practice, we have developed a device, FreeO(2), that automatically titrates the oxygen flow delivered to spontaneously breathing patients, with the aim of maintaining a stable S(pO(2)). We evaluated this system in healthy subjects during induced hypoxemia. ⋯ In this model of induced hypoxemia, the FreeO(2) system that automatically titrates the oxygen flow was more efficient at maintaining the S(pO(2)) target, while ensuring a statistically significant reduction in the rates of severe hypoxemia and hyperoxia, in comparison with air or constant oxygen flow. These beneficial results were obtained with less oxygen, in comparison to a constant oxygen flow.