Respiratory care
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Randomized Controlled Trial
Individualized PEEP Setting in Subjects With ARDS: A Randomized Controlled Pilot Study.
Low-tidal-volume ventilation may be associated with repetitive opening and closing of terminal airways. The use of PEEP is intended to keep the alveoli open. No method of adjusting the optimal PEEP has shown to be superior or to improve clinical outcomes. We conducted a pilot study to evaluate the effect of setting an individualized level of PEEP at the highest compliance on oxygenation, multiple-organ-dysfunction, and survival in subjects with ARDS. ⋯ In ARDS subjects, protective mechanical ventilation with PEEP application according to the highest compliance was associated with less organ dysfunction and a strong nonsignificant trend toward lower mortality. ClinicalTrials.gov Number NCT01119872.
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Randomized Controlled Trial Comparative Study
Volume rather than flow incentive spirometry is effective in improving chest wall expansion and abdominal displacement using optoelectronic plethysmography.
Incentive spirometers are widely used in clinical practice and classified as flow-oriented (FIS) and volume-oriented (VIS). Until recently the respiratory inductive plethysmography used to evaluate the effects of incentive spirometry on chest wall mechanics presented limitations, which may explain why the impact of VIS and FIS remains poorly known. ⋯ VIS promotes a greater increase in chest wall volume, with a larger abdominal contribution and lower respiratory muscle activity, than does FIS in healthy adults.
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Randomized Controlled Trial
Home unattended portable monitoring and automatic CPAP titration in patients with high risk for moderate to severe obstructive sleep apnea.
Obstructive sleep apnea is a disorder characterized by recurrent obstruction of the upper airways during sleep. The high prevalence of this disease led to proposed new strategies based on the home evaluation and management of patients. ⋯ A home diagnosis and titration approach should be considered in a subset of patients with obstructive sleep apnea. A single unattended titration night is sufficient to determine the therapeutic pressure.
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Randomized Controlled Trial Comparative Study
Effect of ventilatory variability on occurrence of central apneas.
To compare the influence of 2 ventilation strategies on the occurrence of central apneas. ⋯ NAVA was associated with increased ventilatory variability, compared to constant-level PSV. With NAVA the absence of over-assistance during sleep coincided with absence of central apneas, suggesting that load capacity and/or neuromechanical coupling were improved by NAVA and that this improvement decreased or abolished central apneas.
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Randomized Controlled Trial
Effect of visualization of raw graphic polysomnography data by sleep apnea patients on adherence to CPAP therapy.
CPAP is considered to be the cornerstone of therapy for obstructive sleep apnea. However, adherence to this treatment is frequently poor, which may lead to ongoing symptoms, including daytime sleepiness and poor cognitive function. We aimed to determine the efficacy of showing patients their raw graphic polysomnography (PSG) data in increasing their CPAP adherence. ⋯ Showing patients raw graphic PSG data does not seem to improve adherence to CPAP. BMI is a very strong predictor of CPAP adherence.