Resp Care
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Randomized Controlled Trial Comparative Study
Comparison of optimal positive end-expiratory pressure and recruitment maneuvers during lung-protective mechanical ventilation in patients with acute lung injury/acute respiratory distress syndrome.
In patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), the use of alveolar-recruitment maneuvers to improve oxygenation is controversial. There is lack of standardization and lack of clinical studies to compare various recruitment maneuvers. Recruitment maneuvers are closely linked to the selection of positive end-expiratory pressure (PEEP), which is also a subject of debate. ⋯ Sighs superimposed on lung-protective mechanical ventilation with optimal PEEP improved oxygenation and static compliance in patients with early ALI/ARDS.
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Randomized Controlled Trial
Effectiveness and safety of hypertonic saline inhalation combined with exercise training in patients with chronic obstructive pulmonary disease: a randomized trial.
Inhaled hypertonic saline is used for bronchial challenge and sputum induction in patients with chronic obstructive pulmonary disease (COPD). We studied the effects of saline aerosol inhalation before each exercise session in an 8-week pulmonary rehabilitation program. ⋯ The improvement in 6-min walk distance was greater with normal saline than with hypertonic saline. Hypertonic saline was associated with adverse effects. It is unclear whether the only predictor of improved functional exercise capacity was exercise training. (ClinicalTrials.gov number, NCT00639236.).
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Randomized Controlled Trial Comparative Study
A randomized multi-arm repeated-measures prospective study of several modalities of portable oxygen delivery during assessment of functional exercise capacity.
Ambulatory oxygen is an important component of long-term oxygen therapy. Pulse-dose technology conserves oxygen and thus increases the operation time of a portable oxygen system. ⋯ Between these 4 ambulatory oxygen systems there were no significant differences in S(pO(2)), walk time, or walk distance, and there was no evidence of inadequate oxygenation with the 2 systems that provide a lower oxygen concentration.
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Randomized Controlled Trial Multicenter Study Comparative Study
A study of the physiologic responses to a lung recruitment maneuver in acute lung injury and acute respiratory distress syndrome.
To determine the magnitude, duration, and consistency of the effects of lung recruitment maneuvers (RMs) on oxygenation, lung mechanics, and comfort in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). ⋯ These results do not support the addition of scheduled RMs to usual treatment for ALI or ARDS.
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Randomized Controlled Trial Comparative Study
Patient comfort during pressure support and volume controlled-continuous mandatory ventilation.
Pressure-support ventilation (PSV) is more comfortable than volume controlled-continuous mandatory ventilation (VC-CMV) in acute hypercapnic respiratory failure, in patients undergoing noninvasive ventilation. Physiologic measurements of patient status have been compared in PSV and VC-CMV in endotracheally intubated patients, but patient perception of comfort has not been measured in this population. ⋯ On average the patients felt more comfortable during PSV than during VC-CMV or PRVC, so PSV may be the preferred mode for awake intubated patients.