Respiratory care
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Inspiratory muscle training (IMT) produces beneficial effects in COPD subjects, but the effects of expiratory muscle training (EMT) and EMT plus IMT in ventilatory training are still unclear. The aim of this study was to systematically review the effects of EMT and EMT plus IMT compared to control groups of COPD subjects. ⋯ EMT and EMT plus IMT improve respiratory muscle strength and can be used as part of the treatment during pulmonary rehabilitation of subjects with severe to very severe COPD.
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A reversed halo sign (RHS) is defined as the presence of a focal ring-shaped area of ground-glass opacity within a peripheral rim of consolidation. Although originally described in patients with cryptogenic organizing pneumonia, it has been described with several other noninfectious and infectious diseases, including fungal infections. ⋯ In this article, we systematically review the literature (PubMed and Embase) for the associations of the RHS. We have also proposed a diagnostic algorithm for an approach to a patient with an RHS.
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Observational Study
Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Patients.
When deciding whether mechanical ventilation is indicated, physicians integrate their findings on physical examination in a gestalt known as respiratory distress. Despite its importance, this gestalt is poorly understood. This study aims to describe the association between the rating of the severity of respiratory distress and vital signs, severity of illness, use of mechanical ventilation, and death. A prospective observational study with 1,134 consecutive subjects with uncertain triage evaluated by a critical care consult team was carried out in a public inner city teaching hospital. ⋯ A physician's rating of respiratory distress is independently predictive of intubation in 72 h. Vital signs explain only a small proportion of variance in distress; the other observations contributing to a physician's rating of distress must be determined.
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Observational Study
Inter-Observer Agreement of Spontaneous Breathing Trial Outcome.
Spontaneous breathing trials (SBTs) are a very important test in the weaning process. The trial involves evaluation of multiple objective and subjective variables. These characteristics could lead to variability in interpreting outcomes with important clinical implications. We aimed to measure the inter-observer agreement between respiratory therapists when analyzing SBT outcomes. ⋯ Within a respiratory therapist-driven weaning protocol, we found a near 90% inter-observer agreement in the interpretation of SBT outcomes. Our findings illustrate the complexity of interpreting fluctuating subjective and objective variables and their integration into one result: SBT success versus failure. Refining the definitions of variables and their limits for failure along with education might reduce this variability.