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Mashup Score: 2Effect of a Ventilatory Assist Device in Addition to Supplemental Oxygen on Exercise Endurance in Subjects With COPD - 16 hour(s) ago
BACKGROUND: This study assessed the clinical effects of a ventilatory assist (VA) device in addition to supplemental O2 (VA+O2) on exercise endurance in subjects with severe to very severe COPD managed with long-term oxygen therapy (LTOT). METHODS: This was a crossover clinical feasibility study of the effects of VA+O2 in subjects with severe to very severe COPD managed with LTOT ( N = 15). At visit 1, physiologic measures were obtained, and subjects were tested on the cycle ergometer with VA. Peak work rate and flow for continuous supplemental O2/VA+O2 were established. At visit 2, subjects exercised at a constant work rate of 80% peak work rate to maximum endurance after allocation to VA+O2 or O2. Cardiorespiratory variables, work rate, and dyspnea were included to define potential clinical benefits of VA+O2. Data were analyzed using a linear mixed model. RESULTS: Fifteen subjects with COPD (mean ± SD, age 67.9 ± 9.0 y, FEV1 0.89 ± 0.35 observed) completed the study. Exercise duratio
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Mashup Score: 4Peer Review for Respiratory Care - Denise Willis - 4 day(s) ago
In this video, section editor Denise Willis discusses the peer review process and how to provide high quality peer reviews.Paper: https://rc.rcjournal.com/co…
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Mashup Score: 12
Statistical analysis is an important part of the research process. Researchers are advised to include a statistician from the moment that the study is being planned. The statistical plan informs the research process, including sample size requirements and the most robust data collection. Once the data are collected, descriptive and inferential statistical analyses are performed. The results of this analysis determine whether the findings are significant, which leads to an interpretation of the findings. The importance of the statistical plan and analysis for the researcher is self-evident. However, it is also important for the reader of published papers to have some knowledge of statistical analysis. This allows critical review of all aspects of the published manuscript. The intent of this paper is to review some basic statistical concepts and thus allow the reader to become a better consumer of the literature.
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Mashup Score: 6Comparing the Performance Characteristics of Different Positive Expiratory Pressure Devices - 8 day(s) ago
BACKGROUND: Positive expiratory pressure (PEP) devices are widely used in clinical settings, yet the performance characteristics of these devices remain relatively unknown. This study compared the performance characteristics of 6 airway clearance devices by varying resistance and flow. METHODS: Mean PEP, peak PEP, oscillation frequency, and amplitude PEP of the Flutter, Pari PEP S, Acapella Choice, Acapella DM, Acapella DH, and Aerobika devices were obtained across flows of 5, 10, 15, 20, 25 and 30 L/min and at low, medium, and high resistance using an experimental apparatus custom-built for this bench study. RESULTS: Performance characteristics of the devices differed across flows and resistance settings (device × flow/resistance interaction; P < .001). At a fixed resistance, increasing flows increased mean PEP produced by the Acapella Choice, Acapella DH, Aerobika, and Pari PEP S. Increasing flow resulted in minimal change in mean PEP produced by the Flutter and Acapella DM. Increasi
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Mashup Score: 4The Peer Review Process - 9 day(s) ago
The purpose of peer review is to evaluate the scientific merit of the submitted work and to assess suitability for publication. This process is intended to provide an unbiased, independent critique to ensure publication of high-quality manuscripts that demonstrate validity and reliability. Reviewers are subject-matter experts who volunteer their time to participate in peer review. A proper review provides constructive and helpful feedback in a timely manner that authors can use to improve both current and future work. When given the opportunity to revise, authors should carefully consider all comments and adequately address all concerns. This paper provides guidance to clinicians for both aspects of the peer review process: participating as a reviewer and responding to reviewer feedback.
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Mashup Score: 21Nocturnal Pressure Controlled Ventilation Improves Sleep Efficiency in Patients Receiving Mechanical Ventilation - 10 day(s) ago
BACKGROUND: Patients receiving mechanical ventilation commonly experience sleep fragmentation. The present meta-analysis compared the effects of pressure controlled ventilation (PCV) and pressure support ventilation (PSV) on sleep quality. METHODS: We conducted a search of the PubMed, Embase, and Cochrane Library databases for studies published before November 2023. In this meta-analysis, individual effect sizes were standardized, and the pooled effect size was determined by using random-effects models. The primary outcome was sleep efficiency. The secondary outcomes were wakefulness, percentages of REM (rapid eye movement) sleep and stages 3 and 4 non–REM sleep, the fragmentation index, and the incidence of apneic events. RESULTS: This meta-analysis examined 4 trials that involved 67 subjects. Sleep efficiency was significantly higher in the PCV group than in the PSV group (mean difference 15.57%, 95% CI 8.54%–22.59%). Wakefulness was significantly lower in the PCV group than in the P
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Mashup Score: 2Obesity and Extracorporeal Membrane Oxygenation - 11 day(s) ago
Obesity is increasing in prevalence worldwide and carries a theoretical increased risk of morbidity and mortality in critical illness, including hypercoagulability, thrombosis, and renal dysfunction. Obesity has historically been considered a relative contraindication to candidacy for extracorporeal membrane oxygenation (ECMO); however, recent research has suggested that obesity may be associated with improved outcomes in ECMO. This review was conducted to assess and synthesize the existing literature on ECMO outcomes in the obese population. We searched PubMed, Scopus, and CENTRAL databases for obesity and ECMO outcomes, and articles were screened independently by 2 authors. The selection process yielded 29 articles, with one ambispective and 28 retrospective cohort studies. Analyses of these studies show no evidence of globally increased mortality or complications in obesity. Prospective evaluation is needed to further investigate this relationship, but there is currently no evidence
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Mashup Score: 7Daily Evolution of Lung Dependent–Area Collapse Between Prone Position Sessions in ARDS Evaluated by Electrical Impedance Tomography - 14 day(s) ago
In ARDS, several prolonged sessions of prone position (PP) can improve survival.1 The major reason for proning patients is hypoxemia.2,3 Pulmonary edema increases the lung weight, and the consequence is a progressive increase in pressure along the vertical axis that squeezes gas from the most dependent dorsal lung units (de-recruitment). These units become gasless in supine position (SP), and this process is reversed by PP (recruitment). Indeed, with computed tomography scan, shifting from supine to PP led immediately to the inversion of the inflation gradient and to a redistribution of densities from dorsal to ventral lung regions.4 With PP, the dorsal pulmonary units tend to open while the ventral units, previously open, tend to collapse. When back in SP, the dorsal pulmonary units tend to reopen while the ventral units, previously open, tend to recollapse but not in a 1:1 ratio. Indeed, we expect a stabilization of dorsal lung aeration in patients recovering from ARDS. The dependent
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Mashup Score: 1
BACKGROUND: Previous studies that evaluated mortality in elderly subjects who received mechanical ventilation had conflicting results. The aim of this systematic review was to evaluate the effects of age on mortality. METHODS: A number of medical literature databases and the references listed (from 1974 to May 2015) were searched for studies that compared 2 different age groups. The primary outcome was mortality in subjects ages ≥ 65 y. The severity scores, ICU and hospital lengths of stay, and the presence of ventilator-associated pneumonia were secondary outcomes. Finally, mortality in the subjects with ARDS and of cutoff ages 70 and 80 y was assessed by subgroup analysis. Evidence quality was assessed by the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria score. RESULTS: Of the 5,182 articles identified, 21 were included. Subjects ages ≥ 65 y had higher mortalities (odds ratio [OR] 1.80, 95% CI 1.56–2.08; I2 = 71%). APACHE (Acute Physiology and Ch
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Mashup Score: 0The Effect of Delay Following the Clinical Decision to Perform Tracheostomy in the Critical Care Setting - 16 day(s) ago
BACKGROUND: Tracheostomy in patients who are critically ill is generally performed due to prolonged mechanical ventilation and expected extubation failure. However, tracheostomy criteria and ideal timing are poorly defined, including equivocal data from randomized controlled trials and median intubation to tracheostomy times that range from 7–21 d. However, a consistent finding is that only ∼50% of late tracheostomy groups actually undergo tracheostomy, with non-performance due to recovery or clinical deterioration. Unlike in many jurisdictions, elective surgical procedures in our institution require a court-appointed guardian, which necessitates an approximately 1-week delay between the decision to perform tracheostomy and surgery. This offers a unique opportunity to observe patients with potential tracheostomy during a delay between the decision and the performance. METHODS: ICU patients who were ventilated were identified for inclusion retrospectively by an application for guardians
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This month’s Editor’s Choice compared exercise endurance in subjects with severe COPD during standard oxygen therapy to a portable device that provides ventilatory assist plus O2 therapy via a nasal appliance. Paper: https://t.co/e1lW8VFwBF Editorial: https://t.co/ZwlfnMqEQk https://t.co/npcywkdt9j