Our Editor's Choice paper is very relevant to respiratorycare practice. Haynes conducted a randomized controlled trial of cryoanalgesia (ice bag) to reduce pain associated witharterial blood gas puncture. The treatment group had a bagof ice applied to their wrist for 3 minutes prior to arterialpuncture. Ice application prior to arterial puncture was welltolerated and reduced procedure-related pain. As McSwainand Yeager point out in their editorial, this paper providesgood evidence that ice pack cryoanalgesia would be an appropriate addition to routine arterial puncture procedures in avariety of clinical settings.
Although noninvasive ventilation (NIV) is increasinglyused in general wards, limited evidence exists about its ability to provide effective ventilation in this setting. Olivieri etal evaluated NIV delivered in the ward and found that it was feasible and can be safely administered overnight. As emphasized by Baumann, the importance of staff training cannot beoveremphasized to obtain good results. It is important to tailor the NIV management program to the local culture, whichmight dictate the setting for NIV use.
Guidelines suggest limiting the plateau pressure (Pplat) to less than 30 cm H2O. Chan and colleagues determinedwhether Pplat within the first 24 hours of intensive care unit (ICU) admission is predictive of outcome, and whether lower Pplat was associated with lower mortality. They found thatlower Pplat was associated with lower mortality rate. Kalletreminds us of the importance of tidal volume reduction tolower Pplat, bearing in mind the potential impact of chestwall mechanics.
Danin et al measured the inner volume of the endotracheal tube before extubation using the acoustic reflection method. After extubation, the biofilm was studied with optical andatomic force microscopy, and bacteriological analysis wasperformed. They found that endotracheal tube biofilm appears quickly after intubation. Even after a soft rinse, a smallbut measureable part of biofilm remained strongly adheredto the lumen of the tube. Moreover, it contained potentiallypathogenic bacteria.
Chung et al evaluated aerosol distribution during opensuctioning and long-term surveillance of air quality in a respiratory care center. Airborne levels of particulate matterand bacteria were higher during open suctioning in mechanically ventilated patients. This emphasizes the need for theuse of personal protective equipment during open suctioningor, alternatively, the use of closed suction catheters.
The aim of the study by Sidler-Moix and colleagues wasto compare four different nebulizers, of three different types,with an in vitro model of albuterol delivery. Osmolality wasstable during nebulization with the vibrating mesh nebulizer,but increased with the jet and ultrasonic nebulizers. Albuteroldelivery was 1.6 and 2.3 times higher with the ultrasonic andvibrating mesh devices, respectively, as compared with thejet nebulizer. Particle size was significantly higher with the ultrasonic nebulizer.
Rosner and Mastropietro aimed to determine whetherprior cardiac surgery was independently associated with decreased survival after infant tracheostomy. They found thatcardiac surgery was independently associated with decreasedsurvival in infants requiring tracheostomy. Clinicians and families of infants in whom tracheostomy after cardiac surgery is deemed necessary should consider this when planning long-term care.
Vagheggini et al evaluated outcomes for prolonged mechanical ventilation after cardiac surgery. They found thatsubjects needing prolonged mechanical ventilation after combined cardiac surgery (coronary artery bypass grafting plus valve surgery) might have worse outcome than simple cardiacbypass surgery.
Ventilatory efficiency before and after lung volume reduction surgery (LVRS) was assessed by Armstrong andcolleagues. They sought to assess V̇E/V̇CO2 changes withLVRS compared to controls who only received standardmedical care. At 6-months, the LVRS group had significantly improved V̇E/V̇CO2 (improved ventilatory efficiency) and PETCO2; the control group did not demonstrate these changes. The changes were greatest in the subjects who improvedtheir exercise capacity after surgery.
Shimizu et al used an ECG-based screening tool forsleep-disordered breathing to examine the usefulness of cyclic variation of heart rate score in subjects with heart failure. They found that cyclic variation of heart rate determinedby Holter ECG was a useful screening index for severesleep-disordered breathing in subjects with heart failure.
The purpose of the study by Hommerding and colleagueswas to evaluate the effect of an aerobic exercise programbased on verbal and written guidelines on maximum exercise capacity using a cardiopulmonary exercise test, quality of life, and the self-reported aerobic exercise practice ofchildren and adolescents with cystic fibrosis. They found thatverbal and written guidelines for aerobic exercise, togetherwith supervision over the phone, had a positive impact on thereport of regular physical exercise practice by children andadolescents. However, no improvement was found in lungfunction and maximum exercise capacity or domains of thequality of life questionnaire.
Zanini et al conducted a study to define minimal clinically important difference estimate for the visual analog scale component of the EuroQol Group's 5-dimension questionnaire (EQ-VAS) after pulmonary rehabilitation (PR). They foundthat the EQ-VAS could be a practical alternative to moretime-consuming measures of health-related quality of life.
The aim of the study by Fuschillo et al was to analyze theeffects of combining PR with long-term oxygen therapy andnoninvasive ventilation in a homogeneous group of subjectswith kyphoscoliosis. Shortly after PR, there was an improvement in 6-min walk distance and dyspnea score at the end ofa 6-min walk test, but these changes were not confirmed at a 12-month follow-up visit. No significant effects of PR on arterial blood gases were observed.
Lou and colleagues evaluated the efficacy of a complexCOPD health management intervention in rural communitiesin China. Their health management program was an effectivecommunity-based strategy for the prevention and management of COPD in China. Similar programs might be effectiveother places around the world.
Fortis et al hypothesized that the difference between SVCand FVC increases as a function of body mass index (BMI).They found that FVC was larger than SVC in subjects withlow and normal BMI but no evidence of airflow obstruction, whereas FVC was smaller than SVC in overweight and obeseindividuals.
The aim of the study by Gochicoa-Rangel et al was to obtain reference values for impulse oscillometry in Mexicanchildren and adolescents. Although these equations weregenerated in a Mexican population, they are probably alsoapplicable in other Latin American populations with a similar ethnic background.
The aim of the study by Wan and colleagues was to investigate the effects of the azithromycin on the development of emphysema in smoking-induced COPD in rats. They found that azithromycin attenuates pulmonary emphysema in this experimental model.
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