Respiratory care
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Multicenter Study
Absence of airway secretion accumulation predicts tolerance of noninvasive ventilation in subjects with amyotrophic lateral sclerosis.
To assess factors that predict good tolerance of noninvasive ventilation (NIV), in order to improve survival and quality of life in subjects with amyotrophic lateral sclerosis. ⋯ Our study reveals 3 factors that are predictive of good NIV tolerance, in particular the absence of airway secretion accumulation, which should prompt NIV initiation before its appearance.
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Ventilator practices in patients at risk for acute lung injury (ALI) and ARDS are unclear. We examined factors associated with choice of set tidal volumes (VT), and whether VT < 8 mL/kg predicted body weight (PBW) relates to the development of ALI/ARDS. ⋯ Clinicians seem to respond to ALI/ARDS with lower initial VT. Initial VT, however, was not associated with the development of post-intubation ALI/ARDS or other outcomes.
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Multicenter Study
In-patient rehabilitation outcomes following lower extremity fracture in patients with pneumonia.
Pneumonia is a common comorbidity among hospitalized older adults and may impede functional restoration and increase medical cost. Medicare reimbursement rates for patients receiving in-patient medical rehabilitation services are higher for individuals who have comorbid pneumonia. We examined the impact of comorbid pneumonia on outcomes for patients with lower extremity fracture receiving in-patient medical rehabilitation services. ⋯ Our findings suggest that comorbid pneumonia is associated with poorer rehabilitation outcomes (stay, discharge functional status, and discharge setting) among subjects receiving in-patient rehabilitation services for lower extremity fracture.
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Multicenter Study
Why do patients with interstitial lung diseases fail in the ICU? a 2-center cohort study.
Admitting patients with interstitial lung disease (ILD) to the ICU is controversial, due to their associated high mortality when they require invasive mechanical ventilation. We aimed to determine the risk factors for mortality in ILD patients requiring ICU support due to acute respiratory failure. ⋯ Because of higher mortality, physicians should consider invasive ventilation cautiously in the ICU management of ILD patients with acute respiratory failure. NIV may be an option in less severely ill patients with APACHE II score < 20.
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Multicenter Study Comparative Study
Central respiratory drive in patients with neuromuscular diseases.
The contribution of the central respiratory drive in the hypercapnic respiratory failure of neuromuscular diseases (NMD) is controversial. ⋯ Subjects with acute hypercapnic respiratory failure due to NMD had reduced hypercapnic drive response, compared to ICU-AW subjects. The duration of weaning was longer in subjects with reduced hypercapnic drive response.