Respiratory care
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Multicenter Study Clinical Trial Observational Study
Predictors of Extubation Failure Related to Aspiration and/or Excessive Upper Airway Secretions.
Extubation failure may have several causes, including swallowing dysfunction, aspiration, and excessive upper airway secretions. We hypothesized that a bedside global swallowing pattern assessment including 9 criteria (volume of pharyngeal secretions, 5 swallowing motor items, swallowing reflex, and 2 gag reflexes) performed prior to extubation could identify patients at risk of extubation failure. ⋯ In subjects with prolonged ventilation, the presence of one or both gag reflexes could predict a reduction in extubation failure related to aspiration or excessive upper airway secretions. (Clinical trials.gov registration NCT00780078.).
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Editorial Multicenter Study
Mechanical Ventilation in Children on Venovenous ECMO.
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is used when mechanical ventilation can no longer support oxygenation or ventilation, or if the risk of ventilator-induced lung injury is considered excessive. The optimum mechanical ventilation strategy once on ECMO is unknown. We sought to describe the practice of mechanical ventilation in children on VV-ECMO and to determine whether mechanical ventilation practices are associated with clinical outcomes. ⋯ Ventilator mode and some settings vary in practice. The only ventilator setting associated with mortality was FIO2 , even after adjustment for disease severity. Ventilator FIO2 is a modifiable setting that may contribute to mortality in children on VV-ECMO.
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Randomized Controlled Trial Multicenter Study
Effect of Health Coaching Delivered by a Respiratory Therapist or Nurse on Self-Management Abilities in Severe COPD: Analysis of a Large Randomized Study.
Self-management of patients with COPD has received increasing attention in recent years given its association with improved outcomes. There is a scarcity of feasible interventions that can improve self-management abilities. We recently reported the positive effect of health coaching, started at the time of hospital discharge, on re-hospitalizations and emergency department visits for patients with COPD admitted for an exacerbation. In this substudy, we aimed to investigate the effects of health coaching delivered by a respiratory therapist or a nurse compared with guideline-based usual care on self-management abilities in COPD. ⋯ Health coaching delivered by a respiratory therapist or a nurse improved self-management abilities when applied to subjects with COPD after hospital discharge for an exacerbation. (ClinicalTrials.gov Identifier: NCT01058486, Mayo IRB 09-004341).
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Multicenter Study Clinical Trial
Effects of Changes in Apnea Time on the Clinical Status of Neonates on NIV-NAVA.
Apnea time allows the clinician to set a minimum spontaneous respiratory frequency when using noninvasive neurally-adjusted ventilatory assist (NIV-NAVA). Short apnea times may provide backup ventilation during periods of physiologic variability causing overventilation and suppression of spontaneous respiratory drive. Longer apnea times may allow more spontaneous ventilation but can result in insufficient respiratory support. The purpose of this study was to evaluate various apnea times in neonates on NIV-NAVA. ⋯ Short apnea times resulted in more switches into backup ventilation and longer time in backup ventilation but promoted clinical stability with fewer clinically important events in neonates ventilated with NIV-NAVA.
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Multicenter Study Clinical Trial
The Double-Trunk Mask Improves Oxygenation During High-Flow Nasal Cannula Therapy for Acute Hypoxemic Respiratory Failure.
High-flow nasal cannula (HFNC) oxygen therapy is used to deliver an FIO2 from 0.21 to 1.0. The double-trunk mask (DTM) is a device designed to increase the FIO2 in patients with a high inspiratory flow demand. The aim of our study was to evaluate the effect of DTM in hypoxemic subjects already receiving HFNC. ⋯ In subjects receiving oxygen via HFNC, the addition of the DTM over the HFNC increased PaO2 without changing the PaCO2 .