Respiratory care
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Comparative Study Controlled Clinical Trial
Comparison of usual and alternative methods to measure height in mechanically ventilated patients: potential impact on protective ventilation.
Protective ventilation implementation requires the calculation of predicted body weight (PBW), determined by a formula based on gender and height. Consequently, height inaccuracy may be a limiting factor to correctly set tidal volumes. The objective of this study was to evaluate the accuracy of different methods in measuring heights in mechanically ventilated patients. ⋯ Our results demonstrate that significant variability exists between the different methods used to measure height in bedridden patients on mechanical ventilation. Alternative methods based on lower leg and forearm measurements are potentially interesting solutions to facilitate the accurate application of protective ventilation.
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Turbuhaler and Diskus are commonly used powder inhaler devices for patients with respiratory disease. Their effectiveness is limited in part by a patient's ability to use them correctly. This has led to numerous studies being conducted over the last decade to assess the correct use of these devices by patients and health care professionals. ⋯ Little evidence is available to assess the relative importance of different criteria; however, brief patient training based on specific inhaler technique checklists leads to significant improvement in asthma outcomes. This paper reviews common checklists and scoring systems used for Turbuhaler and Diskus, discusses the problem of heterogeneity between different checklists, and finally recommends suitable checklists and scoring systems for these devices based on the literature and previous findings. Only when similar checklists are used across different research studies will accurate comparisons and meta-analysis be possible.
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Previous bench studies suggest that dynamic hyperinflation may occur if intrapulmonary percussive ventilation (IPV) is superimposed on mechanical ventilation in volume controlled continuous mandatory ventilation (VC-CMV) mode. We tested the hypothesis that pressure controlled continuous mandatory ventilation (PC-CMV) can protect against this risk. ⋯ When IPV is added to mechanical ventilation, the risk of hyperinflation is greater with VC-CMV than with PC-CMV. We recommend using PC-CMV to deliver IPV and adjusting the trigger variable to avoid autotriggering.
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The extubation period is one of the most challenging aspects for intensive care teams. Timely recognition of the return to spontaneous ventilation is essential for reducing costs, morbidity, and mortality. Several weaning predictors were studied in an attempt to evaluate the outcome of removing ventilatory support. The purpose of this study was to analyze the predictive performance of the modified integrative weaning index (IWI) in the extubation process. ⋯ We concluded that modified IWI, similar to other extubation predictors, does not accurately predict extubation failure.