Respiratory care
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Observational Study
Predictors and Outcome of Early-Onset Pneumonia After Out-of-Hospital Cardiac Arrest.
Early-onset pneumonia (EOP) after out-of-hospital cardiac arrest is frequently observed. Causative factors are loss of airway protection during cardiac arrest, pulmonary contusion, and emergency airway management. We assessed the incidence, risk factors, and clinical course of EOP, and evaluated the impact of an early exchange of the prehospitally inserted endotracheal tube (ETT). ⋯ The rate of EOP was not significantly influenced by the exchange of the preclinically inserted ETT, but was associated with longer need for mechanical ventilation and ICU stay.
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To compare helmet noninvasive ventilation (NIV), in terms of patient-ventilator interaction and performance, using 2 different circuits for connection: a double tube circuit (with one inspiratory and one expiratory line) and a standard circuit (a Y-piece connected only to one side of the helmet, closing the other side). ⋯ The double tube circuit had significantly better patient-ventilator interaction and a lower rate of wasted effort at 30 breaths/min.
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Multicenter Study
Effects of inhaled corticosteroids on pneumonia severity and antimicrobial resistance.
Limited information is available regarding the impact of prior use of inhaled corticosteroids (ICS) in patients subsequently developing community-acquired pneumonia (CAP). We assessed the effects of prior ICS use on severity of illness and microbiology in CAP hospitalized patients. ⋯ Prior ICS use was associated with higher severity of illness at admission and higher incidence of antimicrobial-resistant pathogens in CAP hospitalized patients.
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Randomized Controlled Trial
Individualized PEEP Setting in Subjects With ARDS: A Randomized Controlled Pilot Study.
Low-tidal-volume ventilation may be associated with repetitive opening and closing of terminal airways. The use of PEEP is intended to keep the alveoli open. No method of adjusting the optimal PEEP has shown to be superior or to improve clinical outcomes. We conducted a pilot study to evaluate the effect of setting an individualized level of PEEP at the highest compliance on oxygenation, multiple-organ-dysfunction, and survival in subjects with ARDS. ⋯ In ARDS subjects, protective mechanical ventilation with PEEP application according to the highest compliance was associated with less organ dysfunction and a strong nonsignificant trend toward lower mortality. ClinicalTrials.gov Number NCT01119872.