BackgroundThe lung-protective ventilation bundle has been shown to reduce mortality in adult acute respiratory distress syndrome (ARDS). This concept has expanded to other areas of acute adult ventilation and is recommended for pediatric ventilation. A component of lung-protective ventilation relies on a prediction of lean body weight from height. The predicted body weight (PBW) relationship employed in the ARDS Network trial is considered valid only for adults, with a dedicated formula required for each sex. No agreed PBW formula applies to smaller body sizes. This analysis investigated whether it might be practical to derive a unisex PBW formula spanning all body sizes, while retaining relevance to established adult protective ventilation practice.MethodsHistoric population-based growth charts were adopted as a reference for lean body weight, from pre-term infant through to adult median weight. The traditional ARDSNet PBW formulae acted as the reference for prevailing protective ventilation practice. Error limits for derived PBW models were relative to these references.ResultsThe ARDSNet PBW formulae typically predict weights heavier than the population median, therefore no single relationship could satisfy both references. Four alternate piecewise-linear lean body-weight predictive formulae were presented for consideration, each with different balance between the objectives.ConclusionsThe ‘PBWuf + MBW’ model is proposed as an appropriate compromise between prevailing practice and simplification, while also better representing lean adult body-weight. This model applies the ARDSNet ‘female’ formula to both adult sexes, while providing a tight fit to median body weight at smaller statures down to pre-term. The ‘PBWmf + MBW’ model retains consistency with current practice over the adult range, while adding prediction for small statures.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-017-0427-1) contains supplementary material, which is available to authorized users.
BackgroundDecades of clinical research into pulsed oxygen delivery has shown variable efficacy between users, and across a user’s behaviours (sleep, rest, activity). Modern portable oxygen concentrators (POCs) have been shown as effective as other oxygen delivery devices in many circumstances. However, there are concerns that they are not effective during sleep when the breathing is shallow, and at very high respiratory rates as during physical exertion. It can be challenging to examine the determinants of POC efficacy clinically due to the heterogeneity of lung function within oxygen users, the diversity of user behaviour, and measurement issues. Representative bench testing may help identify key determinants of pulsed-oxygen device efficacy.MethodsThree contemporary devices were bench-evaluated across three simulated breathing behaviours: activity, rest, & oronasal breathing during sleep. Emphasis was placed on breathing patterns representative of oxygen users.ResultsAll three POCs performed well during simulated breathing during exertion and at rest. Differences in triggering ability were noted for the scenario of oronasal breathing during sleep.ConclusionsThe results are supportive of contemporary POC triggering abilities. The differences shown in ultimate trigger sensitivity may have relevance to oronasal breathing during sleep or other challenging scenarios for pulsed oxygen delivery, such as dominant mouth breathing during exertion or unfavourable nasal geometry.
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