Respiratory care
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The current frequency of noninvasive (NIV) and invasive mechanical ventilation use in asthma exacerbations (AEs) and the relationship to outcomes are unknown. ⋯ There was a substantial increase in the use of mechanical ventilation, accompanied by a shift from invasive mechanical ventilation to NIV. Although we could not determine the clinical reasons for this increase, hospital stay and mortality were unchanged. A randomized trial is needed to determine whether NIV can improve outcomes in AEs before widespread adoption makes it impossible to conduct such a trial.
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Emergency airway management represents an event with high acuity but unpredictable frequency and therefore presents a challenge for adequate staffing. Given circadian and seasonal variations, we hypothesized that the majority of emergency airway events happen after normal working hours and during the winter months. ⋯ Emergency airway service utilization is highest during daytime hours, with seasonal variations composed of higher consults in the winter and lower consults in the summer.
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In patients with COPD, we investigated the effect of the fat-free mass (FFM) on maximal exercise capacity and the relationship with changes in operational lung volumes during exercise. ⋯ This study shows that FFM depletion plays a part in the reduction of exercise capacity in COPD patients, regardless of dynamic hyperinflation, and is strictly associated with poor cardiovascular response to exercise and to leg fatigue, but not with dyspnea.