Respiratory care
-
The new Global definition of ARDS recently introduced a subgroup known as non-intubated ARDS. This study aimed to assess the risk of progression from noninvasive oxygen support to intubation and ARDS severity based on the SpO2 /FIO2 among non-intubated subjects with ARDS. ⋯ The non-intubated ARDS criteria encompassed a broader spectrum of subjects with lower in-hospital mortality compared to the Berlin criteria. The SpO2 /FIO2 and ARDS severity cutoff proposed in the new Global ARDS definition were valuable predictors of in-hospital mortality in these subjects.
-
Mechanical insufflation-exsufflation (MI-E) is crucial to assist patients with impaired cough, especially those with neuromuscular diseases. Despite recent advancements that enable real-time display of peak expiratory flow (PEF) and inspiratory volume, accurately monitoring these parameters with MI-E devices during treatment can still present challenges. ⋯ Our study highlighted consistent underestimation of PEF and inspiratory volume across MI-E devices. Improving device monitoring is essential for guiding MI-E therapy and ensuring patient safety.
-
Lung-protective ventilation is a standard intervention for mitigating ventilator-induced lung injury in patients with ARDS. Despite its efficacy, adherence to contemporary evidence-based guidelines remains suboptimal. We aimed to identify factors that affect the adherence of staff to applying lung-protective ventilation guidelines by analyzing real-time, continuously monitored ventilation data over a 5-year longitudinal period. ⋯ Staff are not yet universally adherent to lung-protective ventilation best practices. Strategies, for example, continuous monitoring, with frequent feedback to clinical teams may help.
-
Assessing respiratory mechanics in patients with acute hypoxemic respiratory failure who are not intubated could provide useful information about illness trajectory. Oscillometry is a respiratory function test used to measure total respiratory impedance during tidal breathing, which reveals resistive and elastic properties of the lung. This study assessed the feasibility of oscillometry in patients with acute hypoxemic respiratory failure and described their respiratory mechanics. ⋯ Respiratory mechanics in the participants with acute hypoxemic respiratory failure who were not intubated could be assessed by oscillometry in carefully selected cases.
-
CPAP benefits preterm infants with respiratory distress, including reduced bronchopulmonary dysplasia (BPD) incidence, surfactant use, and extubation failure. Successful CPAP weaning also promotes oral feeding. However, there is no consensus on the optimal weaning of CPAP in neonates. This study aimed to determine the effects of CPAP weaning guideline implementation on neonatal outcomes. ⋯ The implementation of the bubble CPAP weaning guideline improved the successful weaning of CPAP and promoted oral feeding in preterm infants.