Respiratory care
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ARDS has a high mortality in the acute setting, with long-term disability among disease survivors. In 1967, David Ashbaugh and colleagues first described the clinical features of ARDS, which were notably similar to the infantile respiratory distress syndrome. Half a century later, ARDS remains underrecognized and is associated with high mortality rates. ⋯ As a result, the task of identifying, consenting, and randomizing eligible patients within the enrollment window is challenging, further decreasing the number of subjects enrolled. Moreover, ARDS RCTs strictly adhere to lung-protective strategies, while ARDS observational studies continually demonstrate variable compliance. This review highlights the impact of patient- and trial-related factors on influencing mortality rates in ARDS observational studies and RCTs.
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The aim of this work was to investigate the short- and long-term test-retest reliability of the 6-min walk distance (6MWD), peak heart rate, and nadir oxygen desaturation in idiopathic pulmonary fibrosis (IPF). ⋯ The 6MWD is a reproducible measure of exercise capacity in people with IPF. Whereas the nadir SpO2 may be accurately determined from one test, evaluating change in 6MWD with interventions may require 2 tests on each occasion. (ClinicalTrials.gov registration NCT0016828.).
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Pulmonary contusions are thought to worsen outcomes. We aimed to evaluate the effects of pulmonary contusion on mechanically ventilated trauma subjects with severe thoracic injuries and hypothesized that contusion would not increase morbidity. ⋯ Overall, no significant differences were noted in mortality, length of stay, or pneumonia rates between severely injured trauma subjects with and without pulmonary contusions.
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Permissive hypercapnia is a lung-protection strategy. We sought to review our current clinical practice for the range of permissive hypercapnia and identify the relationship between PaCO2 and pH and adverse outcomes. ⋯ The routine targeting of higher than normal PaCO2 goals may lead to a low incidence of hypocapnia and associated adverse events. Hypercapnia is common, and moderate hypercapnia may increase the risk of neurologic injury and provide little pulmonary benefit.
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Tracheostomy is considered to be effective in the respiratory support of mechanically ventilated patients. We studied a single-center experience of surgical tracheostomy in mechanically ventilated patients to describe the demographics, risk factors, and outcomes of early (≤ 14 d after ventilation) versus late surgical tracheostomy (≥ 15 d after ventilation). ⋯ In elderly subjects, late surgical tracheostomy was not associated with increased 30-d morbidity or mortality rates. Comorbid conditions and subject age had a greater association with 30-d mortality rate than surgical tracheostomy timing.