Mechanical ventilation is frequently used in pediatric patients to ensure adequate gas exchange, ameliorate respiratory distress, and enable resolution of pulmonary or other disorders. However, a number of important challenges remain in the pediatric population because there is a paucity of large-scale randomized controlled trials to generate data and inform clinical practice. This review summarizes a number of discoveries and advances that have been made in pediatric mechanical ventilation from...
Wed Jun 26, 2019 12:03
BACKGROUND:Bronchiectasis is characterized by abnormal and permanent dilatation of the bronchi, caused mainly by the progression of inflammatory processes and loss of the ability to remove mucus. Techniques to clear the airways are essential for the treatment of these patients. In this study, we aimed to evaluate the acute effects of oscillatory PEP and thoracic compression on both the clearance of secretions and impedance of airways in subjects with bronchiectasis.METHODS:This was a randomized crossover...
Wed Jun 26, 2019 12:03
BACKGROUND:Acute right ventricular dysfunction is a challenging problem in the immediate postoperative period following orthotopic heart transplantation. There are no prior reports of the use of inhaled iloprost in the setting of acute right ventricular dysfunction and acute pulmonary hypertension. Our hypothesis was that the use of inhaled iloprost in heart transplant recipients would be associated with a reduction in the duration of mechanical ventilation compared to patients being treated with...
Wed Jun 26, 2019 12:03
BACKGROUND:Collapsibility of upper airways may impair the efficacy of mechanical insufflation-exsufflation (MI-E) devices. The aim of this study was to determine the effect of a collapsible tube on peak expiratory flow (PEF) when using an MI-E device.METHODS:An MI-E device was attached to a lung simulator. Resistance was set at 5 and 20 cm H2O/L/s (R5, R20) for compliance settings of 20, 40, and 60 mL/cm H2O (C20, C40, C60). A series of 5 cycles were delivered at 3 pressures in the following order:...
Wed Jun 26, 2019 12:03
BACKGROUND:Among the types of physical exercise, resistance exercises have been gaining significant attention in the COPD population. The aim of this study was to compare effects of conventional resistance training and of training by using elastic tubes on muscle strength, exercise capacity, and creatine kinase clearance in subjects with COPD.METHODS:Twenty-eight subjects with COPD were randomized into the following: resistance training with the elastic tubing group and resistance training with the...
Wed Jun 26, 2019 12:03
BACKGROUND:In patients on mechanical ventilation, lung hyperinflation is often performed to reverse atelectasis and clear retained mucus. We evaluated the effects of manual hyperinflation and ventilator hyperinflation on mucus clearance, gas exchange, pulmonary mechanics, and hemodynamics.METHODS:Six mechanically ventilated pigs with severe Pseudomonas aeruginosa pneumonia randomly received either 12 manual hyperinflation breaths over a period of 2 min (through a gradual manual compression of a resuscitation...
Wed Jun 26, 2019 12:03
BACKGROUND:Chest physiotherapy has been reported to be beneficial in specific clinical contexts, yet it carries a risk of potential serious adverse events with little benefit in other patients. Therefore, identifying and limiting airway clearance therapies to patients with the greatest potential benefit and least risk is clinically relevant and important. This study aims to validate the Airway Clearance and Expansion Index (ACE-I) for the serial assessment of hospitalized pediatric patients with...
Wed Jun 26, 2019 12:03
BACKGROUND:High-flow nasal cannula (HFNC) therapy is used for patients with respiratory failure. Recently, HFNC therapy with very high gas flows (ie, gas flows of 60–100 L/min) was reported to generate higher positive airway pressure and an associated decrease in breathing frequency. However, the humidification of HFNC therapy with very high gas flow remains to be clarified.METHODS:We evaluated 3 heated humidifier systems: a single MR850, the Hummax2, and parallel MR850s. The MR850 is a pass-over...
Wed Jun 26, 2019 12:03
BACKGROUND:Airway clearance therapy (ACT) is a core component of daily treatment for cystic fibrosis (CF). However, surprisingly little is known about sustained or persistent use of ACT over time among adults with CF. This longitudinal study examined persistent adherence to ACT over 12 months and its modifiable predictors, drawing on aspects of Social Cognitive Theory and the Theory of Planned Behavior.METHODS:Subjects were drawn from a regional CF center in the southern United States. Predictor...
Wed Jun 26, 2019 12:03
BACKGROUND:Age- and lifestyle-related changes in respiratory and physical function affect cough strength. However, in older adults, the main factors that relate to cough strength remain unclear. This study was a preliminary investigation of factors that contribute to cough strength and the relationships between cough strength and respiratory function, physical performance, physical activity, and sedentary behavior in community-dwelling older adults.METHODS:By using accelerometers and other tools,...
Wed Jun 26, 2019 12:03
BACKGROUND:Obstructive lung disease is diagnosed by a decreased ratio of FEV1 to the vital capacity (VC). Although the most commonly used VC is FVC, American Thoracic Society guidelines suggest alternative VCs, for example, slow VC (SVC), may offer a more-accurate evaluation of breathing capacity. There is recent evidence that using only FEV1/FVC underrecognizes obstruction in subjects at high risk and who are symptomatic. Previous studies have indicated that healthy individuals show a minimum difference...
Wed Jun 26, 2019 12:03
Airway suctioning is an important health care intervention that can be associated with serious adverse effects. Given the risks involved with suctioning, it is important to ensure the clinical competence of health care professionals who perform it. A scoping review was conducted to identify the nature and extent of research related to the assessment of airway-suctioning competence for health care professionals working with adults. This included an examination of the assessment context, the type of...
Wed Jun 26, 2019 12:03
BACKGROUND:Noninvasive ventilation (NIV) is used to treat respiratory failure because it reduces the risks of endotracheal intubation and postextubation respiratory failure. A wide range of different interfaces is available, but concerns exist about rebreathing. This study evaluated a total face mask with a 2-limb ventilation circuit and separate access for inflow and outflow gas, which was developed to reduce rebreathing.METHODS:In a bench test, a standard total face mask (with a single connector...
Wed Jun 26, 2019 12:03
Wed Jun 26, 2019 12:03
BACKGROUND:All health-care providers who care for infants and children should be able to effectively provide ventilation with a bag and a mask. Respiratory therapists (RTs'), as part of rapid response teams, need to quickly identify the need for airway support and use adjunct airway interventions when subjects are difficult to mask ventilate. Before implementation of an educational curriculum for airway management, we assessed whether pediatric RTs' who enter the room of a simulated infant mannequin...
Wed Jun 26, 2019 12:03
Wed Jun 26, 2019 12:03
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