Respiratory care
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Vocal cord dysfunction is an upper-airway disorder characterized by exaggerated and transient glottic constriction causing respiratory and laryngeal symptoms. Common presentation is with inspiratory stridor often in the context of emotional stress and anxiety. Other symptoms include wheezing (which may be on inspiration), frequent cough, choking sensation, or throat and chest tightness. This is seen commonly in teenagers, particularly in adolescent females. The COVID-19 pandemic has been a trigger for anxiety and stress with an increase in psychosomatic illness. Our objective was to find out if the incidence of vocal cord dysfunction increased during COVID-19 pandemic. ⋯ It is important to recognize that vocal cord dysfunction has increased during the COVID-19 pandemic. In particular, physicians treating pediatric patients, as well as respiratory therapists, should be aware of this diagnosis. It is imperative to avoid unnecessary intubations and treatments with bronchodilators and corticosteroids as opposed to behavioral and speech training to learn effective voluntary control over the muscles of inspiration and the vocal cords.
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Observational Study
Systemic and Cerebral Effects of Physiotherapy in Mechanically Ventilated Subjects.
Physiotherapy may result in better functional outcomes, shorter duration of delirium, and more ventilator-free days. The effects of physiotherapy on different subpopulations of mechanically ventilated patients on respiratory and cerebral function are still unclear. We evaluated the effect of physiotherapy on systemic gas exchange and hemodynamics as well as on cerebral oxygenation and hemodynamics in mechanically ventilated subjects with and without COVID-19 pneumonia. ⋯ Protocolized physiotherapy improved gas exchange in subjects with COVID-19, whereas it improved cerebral oxygenation in non-COVID-19 subjects.
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Observational Study
Predicting Failure of Noninvasive Respiratory Support Using Deep Recurrent Learning.
Noninvasive respiratory support (NRS) is increasingly used to support patients with acute respiratory failure. However, noninvasive support failure may worsen outcomes compared to primary support with invasive mechanical ventilation. Therefore, there is a need to identify patients where NRS is failing so that treatment can be reassessed and adjusted. The objective of this study was to develop and evaluate 3 recurrent neural network (RNN) models to predict NRS failure. ⋯ RNN models using routinely collected time series data can accurately predict NRS failure well before intubation. This lead time may provide an opportunity to intervene to optimize patient outcomes.
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Multicenter Study Observational Study
Daily oxygenation support for patients hospitalized with SARS-CoV-2 in an integrated health system.
Many COVID-19 studies are constructed to report hospitalization outcomes, with few large multi-center population-based reports on the time course of intra-hospitalization characteristics, including daily oxygenation support requirements. Comprehensive epidemiologic profiles of oxygenation methods used by day and by week during hospitalization across all severities are important to illustrate the clinical and economic burden of COVID-19 hospitalizations. ⋯ Data representation of intra-hospital processes of care drawn from hospitals with varied size, teaching and trauma designations is important to presenting a balanced perspective of care delivery mechanisms employed, such as daily oxygen method utilization.