Respiratory care
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The aim of this study was to assess the different methods of percutaneous tracheostomy in terms of successful performance of the tracheostomy as well as safety. Tracheostomy is the most common procedure performed on the airway for patients in ICUs. Lately, several methods of percutaneous tracheostomy (multiple dilator, progressive dilator, forceps dilation, screw-like dilation, balloon dilation, and translaryngeal) have been described, with theoretical advantages, but there is no consensus about which is better. ⋯ The Blue Rhino method is less difficult and has more minor bleeding events, but physicians also have more experience with this technique. However, trials are underpowered to define the best method.
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Hospital admissions for COPD exacerbations account for 70% of total costs of COPD treatment, and the duration of hospital stay is directly related to this cost. The aim of this study was to investigate possible associations of demographic, clinical, laboratory, and functional parameters with stay of subjects admitted for COPD exacerbations and to provide a score for the prediction of the need for prolonged hospitalization. ⋯ The AECOPD-F score could accurately predict stay in hospitalized COPD subjects. The implementation of this score in clinical practice could be useful in the discharge planning of such subjects.
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Respiratory mechanics refers to the expression of lung function through measures of pressure and flow. From these measurements, a variety of derived indices can be determined, such as volume, compliance, resistance, and work of breathing. Plateau pressure is a measure of end-inspiratory distending pressure. ⋯ The shape of the pressure-time curve might also be useful to guide the setting of PEEP (stress index). This has focused interest in the roles of stress and strain to assess the potential for lung injury during mechanical ventilation. This paper covers both basic and advanced respiratory mechanics during mechanical ventilation.
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In this study, we compared the predictive accuracy of voluntary cough peak flow (V-CPF) and involuntary cough peak flow (IV-CPF) for re-intubation in mechanically ventilated subjects. ⋯ V-CPF is noninvasive. It is much more accurate than IV-CPF as a predictor of re-intubation in cooperative patients because the IV-CPF may underestimate cough strength in patients with high V-CPF. However, it is unclear which is optimal for use in uncooperative patients.
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The significance of changes in P(aCO2) during long-term noninvasive ventilation (NIV) on prognosis remains unclear. We aimed to clarify whether stabilizing P(aCO2) during NIV had a favorable prognostic effect. ⋯ A decrease in the annual change of P(aCO2) during long-term NIV was shown to be a significantly prognostically favorable factor. Efforts to reduce P(aCO2) should be made if P(aCO2) increases at a greater rate during long-term NIV.