Resp Care
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Randomized Controlled Trial Comparative Study
Comparison between automatic tube compensation and continuous positive airway pressure during spontaneous breathing trials.
Various methods to perform spontaneous breathing trials (SBTs) exist, but no one method has been shown to be superior. Automatic tube compensation (ATC) is a new and potentially advantageous ventilation mode to use during SBT. We compared ATC to continuous positive airway pressure (CPAP) during SBTs, to determine their efficacy in identifying patients ready to be liberated from mechanical ventilation. ⋯ When applied as part of a respiratory-therapist-driven weaning protocol in a general intensive-care population, SBTs with ATC were safe but did not hasten liberation from mechanical ventilation, when compared to CPAP.
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Randomized Controlled Trial
Hallway versus treadmill 6-minute-walk tests in patients with chronic obstructive pulmonary disease.
The 6-min-walk test is widely used for functional evaluation of patients with chronic obstructive pulmonary disease (COPD), but the test requires a 30-m unobstructed hallway, which is not available in all institutions. A treadmill 6-min walk test might be more practical. ⋯ The hallway and treadmill walk tests are not interchangeable. We need further study and standardization of the treadmill 6-min walk test.
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Randomized Controlled Trial
Automatic tube compensation as an adjunct for weaning in patients with severe neuroparalytic snake envenomation requiring mechanical ventilation: a pilot randomized study.
This study aimed to evaluate if the combination of pressure-support ventilation (PSV) and automatic tube compensation (ATC) is superior to PSV alone in weaning patients with severe neurotoxic snake envenoming receiving mechanical ventilation. ⋯ The addition of ATC to a standard PSV-based weaning protocol significantly shortened time needed to wean patients with severe neurotoxic snake envenoming, without changing the duration of medical care, morbidity, or mortality.
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Randomized Controlled Trial
The addition of mechanical insufflation/exsufflation shortens airway-clearance sessions in neuromuscular patients with chest infection.
Mechanical insufflation/exsufflation (in-exsufflation) increases peak cough flow and may improve sputum clearance. No studies have compared current respiratory physiotherapy practice (manual percussion, shaking, and assisted cough) plus mechanical in-exsufflation to current physiotherapy practice without in-exsufflation in noninvasive-ventilation (NIV) dependent neuromuscular patients with an acute respiratory-tract infection. We hypothesized that airway clearance in these patients would be more effective with in-exsufflation, compared to without in-exsufflation. ⋯ This is a short-term study of the use of in-exsufflation as a supplement to standard NIV plus physiotherapy in a small group of patients with neuromuscular disease. The addition of mechanical in-exsufflation shortened airway-clearance sessions. The device appeared to be safe and well tolerated, and may provide additional benefit to patients with neuromuscular disease and upper-respiratory-tract infection; further studies are indicated.
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Randomized Controlled Trial Multicenter Study
Feasibility study of noninvasive ventilation with helium-oxygen gas flow for chronic obstructive pulmonary disease during exercise.
Individually, noninvasive ventilation (NIV) and helium-oxygen gas mixtures (heliox) diminish ventilatory workload and improve exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). NIV in combination with heliox may have additive effects on exercise tolerance in severe COPD. ⋯ The adjunctive use of NIV with heliox during exercise proved both safe and tolerable in patients with severe COPD. The lack of demonstrable efficacy to any of the treatment arms relative to placebo (P = .09) may be the result of the small sample size (ie, type 2 error)-a conclusion emphasized by the large standard deviations and differences in treatment group variances in exercise duration alone.