Respiratory care
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COVID-19-related ARDS is characterized by severe hypoxemia with initially preserved lung compliance and impaired ventilation/perfusion (V̇/Q̇) matching. PEEP can increase end-expiratory lung volume, but its effect on V̇/Q̇ mismatch in COVID-19-related ARDS is not clear. ⋯ In subjects with COVID-related ARDS placed on invasive mechanical ventilation for > 48 h, PEEP had a heterogeneous effect on V̇/Q̇ mismatch and, on average, higher levels were not able to reduce shunt. The subject's compliance could influence the effect of PEEP on V̇/Q̇ mismatch since an increased shunt was observed in subjects with lower compliance, whereas the opposite occurred in those with higher compliance.
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During continuous flow CPAP for noninvasive respiratory support, a high flow (eg, 60-90 L/min) of gas with FIO2 titratable up to 1.0 is provided within a helmet or face mask, while a PEEP valve maintains the set pressure. A large amount of oxygen is wasted, whereas only a minimal amount is consumed. We describe a recirculation circuit designed to reuse the exhaust gas and save oxygen. ⋯ The recirculation system allowed a 80% reduction of oxygen consumption during simulated helmet CPAP therapy, whereas CO2 removal was effective for > 10 h. Recirculation minimally affected pneumatic performance of the CPAP continuous flow system, while improving gas conditioning as compared to the standard system.
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Respiratory therapists (RTs) provide many types of patient care in different clinical settings. Burnout can have an undesirable effect on RTs and their patients. Managing the COVID-19 pandemic, specifically in hospitals, could induce stress in RTs and increase the likelihood of burnout. Therefore, this study aimed to measure the level of burnout among RTs during the COVID-19 pandemic. ⋯ A high prevalence of burnout was observed among RTs in one Saudi tertiary hospital. Burnout is associated with several factors, and interventions should target all domains of burnout. RT management and staff are responsible for addressing their needs and collaboratively working together to overcome burnout. Further investigations focusing on techniques and strategies to alleviate burnout are required.
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Manual and mechanical cough augmentation techniques are used for airway clearance when cough effort is ineffective. Mechanical insufflation-exsufflation (MI-E) has been a mainstay for respiratory complications of neuromuscular disorders, but its use has expanded to other conditions that result in respiratory muscle weakness and impaired cough, such as intubation and mechanical ventilation. Mechanical in-exsufflation has been used for cough augmentation in both adults and children but has been more widely evaluated in adults. ⋯ Electrical impedance tomography has been used for monitoring during mechanical ventilation and may have a role in assessing the effectiveness of MI-E. Much of the literature that supports MI-E is derived from small, single-center studies of adult populations. Future study is warranted for efficacy and optimization of MI-E therapy in various clinical applications.
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Endotracheal intubation is a routinely performed procedure in the ICU. Whereas it is recognized that endotracheal intubation can result in laryngeal and tracheal injury, this study evaluated factors that may affect the incidence of posterior vocal cord ulcers (PVCUs). ⋯ Earlier tracheostomy placement was associated with reduced severity of vocal cord ulcer formation. The Kaplan-Meier model suggests that waiting for 14 d is likely too long and earlier placement of a tracheostomy, within a week, may decrease the morbidity of posterior vocal cord injury.