Respiratory care
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Re-titrations, an atypical approach to reverse PAP failure, was investigated retrospectively. ⋯ Technology-related problems due to mask discomfort/leak, pressure intolerance, and residual breathing events were associated with PAP failure in subjects seeking second opinions. Technological solutions (changes in masks, modes, and pressures) were addressed during REPAP protocol, after which 72% of subjects re-initiated PAP use. These technological interventions were associated with improved objective and subjective sleep variables and reversal of PAP failure.
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Comparative Study
Accuracy of Oxygen Consumption and Carbon Dioxide Elimination Measurements in 2 Breath-by-Breath Devices.
Although accurate quantification of oxygen consumption (V̇O2 ) and carbon dioxide elimination (V̇CO2 ) provides important insights into a patient's nutritional and hemodynamic status, few devices exist to accurately measure these parameters in children. Therefore, we assessed the accuracy and agreement of 2 devices currently on the market using a pediatric in vitro model of gas exchange. ⋯ The E-COVX demonstrated bias and limits of agreement that were not clinically acceptable; therefore, application of this module to pediatric patients would not be recommended. The new module, E-sCAiOVX, demonstrated acceptable bias and limits of agreement for the V̇O2 and V̇CO2 in the range 40-100 mL/min (which corresponds to patients in the range of ∼5-16 kg).
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Air stacking (AS) is a lung insufflation method that requires the use of a manual insufflator to provide air volumes higher than inspiratory capacity. Neuromuscular patients benefit the most from the maneuver; however, the acute effects of AS in healthy subjects are still unclear. ⋯ In healthy subjects, cough peak flow and chest wall volumes can be increased immediately after the application of the AS maneuver.
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Early enteral nutrition is recommended for mechanically ventilated patients in several studies and guidelines. In contrast, the effects of early enteral nutrition on noninvasive ventilation (NIV) have not been investigated extensively. The lack of an established method of airway protection suggests that enteral nutrition administration to these patients could increase airway complications and worsen outcomes. ⋯ Among subjects receiving NIV, enteral nutrition was associated with increased risk of airway complications but did not affect mortality. Enteral nutrition should be carefully considered in these patients.