Respiratory care
-
Randomized Controlled Trial
Acute Effects of Lung Expansion Maneuvers in Comatose Subjects With Prolonged Bed Rest.
Patients with decreased consciousness are prone to prolonged bed rest and respiratory complications. If effective in reducing atelectasis, lung expansion maneuvers could be used to prevent these complications. In comatose, bedridden subjects, we aimed to assess the acute effect on regional lung aeration of 2 lung expansion techniques: expiratory positive airway pressure and the breath-stacking maneuver. Our secondary aim was to evaluate the influence of these lung expansion techniques on regional ventilation distribution, regional ventilation kinetics, respiratory pattern, and cardiovascular system. ⋯ In comatose subjects with prolonged bed rest, expiratory positive airway pressure and breath-stacking promoted brief increases in lung aeration. (ClinicalTrials.gov registration NCT02613832.).
-
Randomized Controlled Trial
Comparing Noninvasive Ventilation Delivered Using Neurally-Adjusted Ventilatory Assist or Pressure Support in Acute Respiratory Failure.
The use of neurally-adjusted ventilatory assist (NAVA) during noninvasive ventilation (NIV) results in better patient-ventilator interaction. Whether this improves clinical outcomes lacks dedicated study. ⋯ The use of NAVA during NIV did not improve NIV failure rate or 28-d mortality in subjects with acute respiratory failure. However, patient-ventilator asynchrony and NIV-related complications were reduced with NAVA.
-
Randomized Controlled Trial
Effects of 0 PEEP and < 1.0 FIO2 on SpO2 and PETCO2 During Open Endotracheal Suctioning.
Hyperoxygenation and hyperinflation, preferably with a mechanical ventilator, is the most commonly used technique to prevent the adverse effects of open endotracheal suctioning on arterial oxygenation and pulmonary volume. However, limited data are available on the effects of oxygen concentrations < 100% and PEEP with zero end-expiratory pressure (0 PEEP) to improve oxygenation and to maintain adequate ventilation during open endotracheal suctioning. The aim of this study was to analyze the behavior of [Formula: see text] and end-tidal CO2 pressure ([Formula: see text]) in open endotracheal suctioning using the 0 PEEP technique with baseline [Formula: see text] (0 PEEP baseline [Formula: see text]) and 0 PEEP + hyperoxygenation of 20% above the baseline value (0 PEEP [Formula: see text] + 0.20) in critically ill subjects receiving mechanical ventilation. ⋯ The appropriate indication of the hyperinflation strategy via mechanical ventilation using 0 PEEP with or without hyperoxygenation proved to be efficient to maintain [Formula: see text] and [Formula: see text] levels. These results suggest that the technique can minimize the loss of lung volume due to open endotracheal suctioning. (ClinicalTrials.gov registration NCT02440919).
-
Randomized Controlled Trial
Avoidance of Routine Endotracheal Suction in Subjects Ventilated for ≤ 12 h Following Elective Cardiac Surgery.
Mechanical ventilation requires an endotracheal tube. Airway management includes endotracheal suctioning, a frequent procedure for patients in the ICU. Associated risks of endotracheal suctioning include hypoxia, atelectasis, and infection. There is currently no evidence about the safety of avoiding endotracheal suction. We aimed to assess the safety of avoiding endotracheal suction, including at extubation, in cardiac surgical patients who were mechanically ventilated for ≤ 12 h. ⋯ Endotracheal suctioning can be safely minimized or avoided in low-risk patients who have had cardiac surgery and are expected to be ventilated for < 12 h after surgery.
-
Randomized Controlled Trial
Clinical Efficacy of Vibrating Mesh and Jet Nebulizers With Different Interfaces in Pediatric Subjects With Asthma.
Nebulizers are commonly used in emergency departments to deliver bronchodilators to children with asthma exacerbations. However, no clinical study comparing a vibrating mesh nebulizer with a jet nebulizer is available in this patient population. The purpose of this study was to compare the clinical efficacy of a vibrating mesh nebulizer to a jet nebulizer combined with a mouthpiece or mask in children with asthma exacerbations admitted to the emergency department. ⋯ Subjects treated with a vibrating mesh nebulizer required significantly fewer treatments and less time to achieve a mild asthma score. In subjects with a mask interface, the vibrating mesh nebulizer significantly reduced the probability of admission compared to jet nebulizer. (ClinicalTrials.gov registration NCT02774941.).