Respiratory care
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Review Meta Analysis
Frequency of Signs and Symptoms in Persons With Asthma.
Signs and symptoms of asthma are well established; however, no study has been performed to rank them. Therefore, we performed this systematic review and meta-analysis to determine the pooled frequencies of different signs and symptoms of asthma in subjects age ≥ 14 y to develop a patient-specific questionnaire. ⋯ Asthma severity was dependent on variety of symptoms, consisting mostly of wheezing, breathlessness, chest tightness, and cough. On the basis of our analysis, we recommend a combination of symptoms be included in diagnostic-based questionnaires to aid early diagnosis.
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Observational Study
Prevalence of and Risk Factors for Mechanical Ventilation Reinstitution in Patients Weaned From Prolonged Mechanical Ventilation.
Prolonged mechanical ventilation is increasingly common in ICUs. Although a consensus conference defined weaning success in this patient population, few studies have used this definition. A clear definition of successful weaning is useful to assess clinical and epidemiological outcomes, facilitate clinical decision making, and set goals of care. The aims of our study were to describe the prevalence of reinstitution of mechanical ventilation within 28 d in patients successfully weaned according to our institution criterion (ie, weaning success as per consensus guidelines), to describe reasons to reestablish mechanical ventilation, and to identify associated factors. ⋯ Reinstitution of mechanical ventilation within 28 d is a common event in patients considered to be weaned: 1 in 5 of such patients requires reconnection to mechanical ventilation, with sepsis being the most prevalent cause. Neurological comorbidity and delayed weaning are risk factors associated with reestablishment of mechanical ventilation. The presence of more than one risk factor increases the association with reinstitution of mechanical ventilation within 28 d of weaning.
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There are few reports in the literature supporting the understanding of the physiological mechanisms of intolerance in patients with COPD to perform unsupported upper limb activities. The aims of this study were to quantify the electrical activity and oxygenation of inspiratory and upper limb muscles, and to investigate whether electromyographic manifestations of muscle fatigue are related to upper limb function as assessed by the 6-min pegboard and ring test (6PBRT) in subjects with COPD and in healthy subjects. ⋯ Our results indicate that the 6PBRT was performed at a higher electrical activity in the accessory inspiratory muscles, such as the sternocleidomastoid muscle, and a lower oxygenation profile in the intercostal muscles in subjects with COPD compared with healthy controls, but without muscle fatigue signs. These findings suggest that the higher ventilatory demand presented in subjects with COPD could have contributed to the worse performance in this group without signals of peripheral muscle limitation.
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Mechanical insufflation-exsufflation (MI-E) devices increase expiratory air flow and thereby promote increased cough peak flow (CPF) in conjunction with a cough. There is little research looking at long-term use of MI-E in subjects with neuromuscular disease (NMD), and no long-term study has reported CPF, MI-E device settings, and adherence. ⋯ Greater exsufflation pressures than insufflation pressures, together with a shorter insufflation time than exsufflation time, were used. Predicting good adherence among the subjects was difficult. Subjects who produced daily secretions were more likely to use MI-E every day.