Respiratory care
-
Lung-protective ventilation targeting low tidal volumes and plateau pressures is the mainstay of therapy in patients with ARDS. This ventilation strategy limits pulmonary strain, inflammation, and injury, but it may be associated with profound hypercapnic acidosis. In such conditions, extracorporeal CO2 removal can attenuate or normalize hypercapnia and may even facilitate ultraprotective ventilation. ⋯ Systems adapted from conventional renal replacement platforms with blood flows < 500 mL/min can achieve significant CO2 elimination. Therefore, incorporating low-flow extracorporeal CO2 removal in a continuous renal replacement therapy circuit is an attractive therapeutic option. We reviewed the relevant literature on combining extracorporeal CO2 removal with continuous renal replacement therapy.
-
Review Meta Analysis
Effects of Inspiratory Muscle Training in Older Adults.
Inspiratory muscle training (IMT) has been widely applied to different populations, including the general population of older adults. In addition to increasing inspiratory muscle strength, other benefits of IMT in the health of this population have been reported. The primary aim of this study was to review the effects of IMT on the general parameters of health (eg, respiratory, functional, physical, and other variables) in older adults (≥ 60 y), and the secondary aim was to analyze the main IMT protocol used in the studies. ⋯ The reviewed studies revealed a positive trend for the effectiveness of IMT in improving inspiratory muscle performance in elderly subjects. More randomized studies are needed to evaluate other outcomes (eg, functional capacity, exercise capacity, cardiac autonomic control, quality of life, and others) to provide robust evidence that this training modality can promote improvements in health parameters in this population. In addition, the usual IMT prescription in this population is based on sets and repetitions, of mild to moderate intensity, performed on most days of the week, for ≥ 4 weeks.
-
Review Meta Analysis
Effects of Inspiratory Muscle Training in Older Adults.
Inspiratory muscle training (IMT) has been widely applied to different populations, including the general population of older adults. In addition to increasing inspiratory muscle strength, other benefits of IMT in the health of this population have been reported. The primary aim of this study was to review the effects of IMT on the general parameters of health (eg, respiratory, functional, physical, and other variables) in older adults (≥ 60 y), and the secondary aim was to analyze the main IMT protocol used in the studies. ⋯ The reviewed studies revealed a positive trend for the effectiveness of IMT in improving inspiratory muscle performance in elderly subjects. More randomized studies are needed to evaluate other outcomes (eg, functional capacity, exercise capacity, cardiac autonomic control, quality of life, and others) to provide robust evidence that this training modality can promote improvements in health parameters in this population. In addition, the usual IMT prescription in this population is based on sets and repetitions, of mild to moderate intensity, performed on most days of the week, for ≥ 4 weeks.
-
The use of noninvasive ventilation (NIV) is debated in de novo respiratory failure. Prolonged sessions, using a dedicated NIV ventilator, with high PEEP levels could be associated with better outcomes than shorter sessions using an ICU ventilator, with low PEEP levels. We performed a systematic review of randomized controlled trials to test whether the incidence of intubation was influenced by the NIV protocol in subjects admitted to the ICU for de novo respiratory failure. ⋯ Except for high PEEP levels that might be associated with lower intubation rates, the protocol for carrying out NIV does not seem to influence intubation rate in patients with de novo respiratory failure.
-
The use of noninvasive ventilation (NIV) is debated in de novo respiratory failure. Prolonged sessions, using a dedicated NIV ventilator, with high PEEP levels could be associated with better outcomes than shorter sessions using an ICU ventilator, with low PEEP levels. We performed a systematic review of randomized controlled trials to test whether the incidence of intubation was influenced by the NIV protocol in subjects admitted to the ICU for de novo respiratory failure. ⋯ Except for high PEEP levels that might be associated with lower intubation rates, the protocol for carrying out NIV does not seem to influence intubation rate in patients with de novo respiratory failure.