Respiratory care
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Pulse oximetry measurement is ubiquitous in acute health care settings in high-income countries and is familiar to any parent whose child has been treated in such a setting. Oximeters for home use are readily available online and are incorporated in several smartphones and smartwatches. ⋯ Our findings suggest that the performance of consumer-grade devices varies considerably by both subject age and device. The pediatric fingertip device and smartphone application we tested are poorly suited for use in infants. The adult fingertip device we tested performed quite well in larger children with relatively normal oxygen saturations, and the pediatric fingertip device performed moderately well in subjects > 1 y of age who weighed < 30 kg. Given the vast number of devices available online and ever-changing technology, research to evaluate nonclinical oximeters will continue to be required.
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Impulse oscillometry (IOS) is a noninvasive technique that measures lung physiology independently of patient effort. In the present study, we aimed to investigate the utility of IOS parameters in comparison with pulmonary function testing (PFT) among hospitalized subjects, with emphasis on obstructive and small airway diseases. ⋯ We found that the IOS performed well in diagnosing small airway and obstructive diseases among hospitalized subjects. IOS might serve as an alternative to standard PFTs in non-cooperative or dyspneic hospitalized patients.
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At high ambient temperatures in ICU rooms, the humidification performances of heated-wire humidifiers are significantly reduced, with delivered gas humidity well below 30 mg H2O/L, which leads to an increased risk of endotracheal occlusions, subocclusions, or mucociliary dysfunction. The objective of the study was to evaluate the humidity delivered at the Y-piece with new-generation heated-wire humidifiers with advanced algorithm (FP950 [Fisher & Paykel Healthcare, Auckland, New Zealand] and VHB20 [Vincent Medical, Inspired, Hong Kong]) while varying ambient temperatures. ⋯ The new FP950 and VHB20 heated-wire humidifiers by using advanced algorithms demonstrated stable performance while varying the ambient temperature by 20-30°C, better than the previous generation of heated humidifiers when ambient temperatures were high.
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In children with congenital heart disease, extubation readiness testing (ERT) is performed to evaluate the potential for liberation from mechanical ventilation. There is a paucity of data that suggests what mechanical ventilation parameters are associated with successful ERT. We hypothesized that ERT success would be associated with certain mechanical ventilator parameters. ⋯ ERT pass rates decreased as ventilator support increased; however, some subjects were able to pass ERT despite high ventilator support. We found that [Formula: see text] was associated with ERT success and that protocols should consider using [Formula: see text] instead of PEEP thresholds for ERT eligibility. Cyanotic lesions were not associated with ERT success, which suggests that patients with cyanotic heart disease can be included in ERT protocols.
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Meta Analysis
Nocturnal Pressure Controlled Ventilation Improves Sleep Efficiency in Patients Receiving Mechanical Ventilation.
Patients receiving mechanical ventilation commonly experience sleep fragmentation. The present meta-analysis compared the effects of pressure controlled ventilation (PCV) and pressure support ventilation (PSV) on sleep quality. ⋯ Compared with PSV, PCV may improve sleep quality in patients receiving nocturnal mechanical ventilation.