The study by Li and colleagues evaluated the safety andeffectiveness of a rapid flow expulsion maneuver to clear subglottic secretions. They conducted both an in vitro and an in vivo study, and found that the rapid flow expulsion maneuver was safe and effective to clear subglottic secretions. The first maneuver was the most e ffective to expel the majority of secretions. Supine position and high peak flow improved the clearance efficiency. Lamb and Kriner suggest that a rapid flow expulsion maneuver could potentially add to the clinician's arsenal of options to remove subglottic secretions not removed by other modalities. To be determined will be the effectiveness and impact on important clinical outcomes whenusing this maneuver to clear subglottic secretions.
Kallet et al assessed the severity of hypoxemia and otherfactors that influence the response to aerosolized prostacyclinin subjects with ARDS. Mean PaO2/FIO2 increased by 33 mmHg (42%) on initiation of aerosolized prostacyclin, with a responder rate of 62%. A favorable response was most strongly associated with baseline PaO2/FIO2 and respiratory systemcompliance. As pointed out by Attaway and colleagues, the absence of mortality data brings into question the relevanceof the improvement in PaO2/FIO2. The heterogeneity of ARDS and its complex management strategies complicate evaluationof salvage therapies. The critical endpoint is mortality, but in the interim, evaluation of important surrogate endpoints suchas significant reductions in FIO2, decrease in the use or intensity of other salvage therapies, or need for ECMO might addimportant information.
In a retrospective cohort study of subjects admitted to atertiary children's hospital pediatric ICU (PICU), Coletti et al evaluated the utilization of high flow nasal cannula (HFNC).HFNC was utilized in 27% of all PICU admissions for a wide range of indications. The primary indications for the utilization of HFNC were status asthmaticus, status asthmaticuswith pneumonia, and bronchiolitis. The authors suggest the protocols should be developed for the initiation, escalation,and weaning of HFNC to optimize utilization. In their editorial, Baudin and Pouyau recognize that, with greater comfort,simplicity, and probably effectiveness, HFNC has succeeded in finding the favor of pediatric intensivists and respiratorytherapists. However, it now requires a more convincing level of evidence from randomized control trials in the PICU.
Crezeé and colleagues evaluated a quality improvementinitiative to reduce unplanned extubations in a neonatal ICU.The development of standard guidelines to prevent unplannedextubations, and a quality review process to track unplannedextubations, resulted in important information for educationand practice change. These changes significantly improved the unplanned extubation rate through improved teamwork,accountability, and communication.
The study by Vitaliti et al compared the efficacy and safetyof 2 noninvasive respiratory support methods, helmet CPAPand HFNC, in children with respiratory distress admittedto the PICU. They found that both CPAP and HFNC were efficient in improving the clinical condition of subjects withmild to moderate respiratory distress. Clinical response toCPAP was more efficient and rapid than HFNC.
The goal of the study by Rehman and colleagues was topilot test a simple, telephone-based health coaching intervention that was shown to decrease readmission among subjectswith COPD. They found that a telephone-delivered motivational interviewing-based coaching program for COPD subjects was feasible, well accepted by subjects and providers,simple, and novel intervention to improve the well being ofsubjects with COPD. This pilot study provides insight into a possible alternative to an onsite pulmonary rehabilitation program for patients with limited access to that program.
The Glittre-ADL test is proposed to evaluate the functional capacity of patients with COPD. The objective of the study by Souza et al was to compare the metabolic, ventilatory andcardiac requirements, and time taken to carry out the Glittre-ADL test by subjects with mild, moderate, and severe COPD. They found that, as the degree of airflow obstruction progresses, subjects with COPD present significantly lower ventilatory reserve to perform the Glittre-ADL test. Metabolic and cardiac reserves may differentiate the more severe subjects. Perhaps these variables are better outcomes to differentiate functional performance than Glittre-ADL test.
The study by Montes de Oca et al evaluated the exposureto biomass and smoking on COPD risk in a primary care setting from Latin America. Subjects with COPD had a higher exposure to biomass and smoking compared to subjects without COPD. Smoking and biomass were both risk factors forCOPD, but they did not appear to have an additive effect.
Tambascio and colleagues evaluated the effects of the flutter valve on sputum inflammation, microbiology and transportof respiratory secretions in subjects with bronchiectasis. The use of flutter valve 30 min per day for at least 4 weeks wasenough to change physical properties and improve mucustransport by coughing. It also contributed to the reduction ofthe number of inflammatory cells in the respiratory secretionsof subjects with bronchiectasis.
The aim of the study by Lee and colleagues was to identifylaboratory parameters that are correlated with the bronchiectasis severity index (BSI) and FACED score. Several laboratory variables were identified as possible prognostic factorsfor non-cystic fibrosis bronchiectasis. Among them, the serum albumin level exhibited the strongest correlation and wasidentified as an independent variable associated with the BSIand FACED scores.
Using in vitro experiments, Smallwood et al assesseda possible mechanism by which the activity of exogenouspulmonary surfactant is adversely affected by direct oxygen exposure. The characteristics of pulmonary surfactant were adversely affected by short-term exposure to oxygen. Specifically, surface tension studies revealed that short-term exposure of surfactant film to high concentrations of oxygenexpedited the frangibility of pulmonary surfactant, as shownwith the surface area change. This suggests that reductions in pulmonary compliance and associated adverse effects could begin to take effect in a very short period of time. If these findings can be demonstrated in vivo, a role for reduced FIO2during exogenous surfactant delivery may have a clinical benefit.
The aim of the study by Ozsu and colleagues was to investigate the possible value of the serum levels of uric acid inpredicting 30-day pulmonary thromboembolism-related mortality. They found that serum uric acid level was an independent predictor of short-term mortality in pulmonary thromboembolism. This suggests that serum uric acid levels may be a potential biomarker for predicting outcome in patients withacute pulmonary thromboembolism.
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