Respiratory care
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Mobility is human body movement in all its forms, including bed-to-chair transfer, walking, daily tasks, participating in work and social functions, exercising, and using public transport. The mobility of people living with COPD is affected negatively by the disease symptoms. However, limited data are available on the life-space mobility in people with COPD on long-term oxygen therapy (LTOT). This study aimed to explore the life-space mobility in subjects with COPD on LTOT and verify whether life-space mobility is associated with comorbidities and symptoms, activity in daily life, exercise capacity performance, and quality of life. ⋯ Subjects with COPD on LTOT had limited life-space mobility. Interventions to reduce dyspnea and improve exercise capacity should be prioritized to increase this population's domestic and community mobility.
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Respiratory complications are common in patients who require venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for cardiac indications. We aimed to examine the frequency and characteristics of patients who develop multi-lobar atelectasis early in the course of VA ECMO and to identify factors associated with its occurrence. ⋯ Multi-lobar atelectasis commonly occurred in children who were receiving VA ECMO for cardiac failure and was associated with worse outcomes. Male patients, a subsequent VA ECMO run during the same hospitalization, and patients in whom mechanical ventilation was initiated shortly before ECMO cannulation may be at increased risk for this complication.
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Driving pressure (ΔP) and mechanical power (MP) may be important mediators of lung injury in ARDS; however, there is little evidence for strategies directed at reducing these parameters. We applied predictive modeling to estimate the effects of modifying ventilator parameters on ΔP and MP. ⋯ This novel conditional modeling confirmed expected response patterns for ΔP, with the response to adjustments depending on subjects' lung mechanics. Furthermore, a VT-driven approach should be favored over a breathing frequency-driven approach when aiming to reduce MP.
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Spinal muscular atrophy (SMA) is a neurodegenerative disease that results in progressive muscular atrophy and weakness. The primary cause of morbidity and mortality in these children is pulmonary disease due to poor airway clearance that leads to acute respiratory failure. There is a paucity of literature on the treatment of children with SMA and acute respiratory failure. ⋯ The subjects with SMA types I or II can be treated successfully with NIV and aggressive airway clearance during acute respiratory failure. Similarly, when intubation is required, successful extubation can be achieved with NIV transitional support combined with aggressive airway clearance maneuvers.