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chronic cough are presented in algorithmic form (Fig 1-3). Guidelines with algorithms for evaluating chronic cough in pediatric patients < 15 years of age are presented in the section entitled "Guidelines for Evaluating Chronic Cough in Pediatrics" 2,4 [Fig 4, 5]. For a full discussion on how to use the algorithms, please refer to these sections. Summary and Recommendations Recommendations for each section of these guidelines are listed under their respective section titles. For an in-depth discussion or clarification of each recommendation, readers are encouraged to read the specific section in question in its entirety. Methodology and Grading of the Evidence for the Diagnosis and Management of Cough 5 • The recommendations were graded, by consensus by the panel, using the American College of Chest Physicians Health and Science Policy Grading System, which is based on the following two components: quality of evidence; and the net benefit of the diagnostic and therapeutic procedure. • The quality of evidence is rated according to the study design and strength of other methodologies used in the included studies.

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We postulated that the variation of maximal voluntary inspiratory pressures (PI,max and Pdi,max) among individuals largely reflects the variation of the structural attributes of the inspiratory muscles, in particular the muscular cross-sectional area of the diaphragm (CSAdi) and its axially projected area (A(thor)). To test this postulate, we measured PI,max in 36 healthy subjects, including 3 children and 15 weight-lifters, and Pdi,max in 11 subjects. Structural measurements by ultrasonography and anthropometric calipers were available as reported in the companion manuscript. We found a high degree of correlation of Pdi,max with diaphragm thickness (tdi), CSAdi, and CSAdi/A(thor) (r2 = 0.89, 0.89, and 0.77, respectively). PI,max was also correlated with diaphragm structural measurements, although less well. The weight-lifters had greater pressures, thicker diaphragms, and greater diaphragm maximal stress (sigma(max)) than adults of similar stature who had not trained with weights. We conclude (1) that both Pdi,max and PI,max reflect in part structural attributes of the respiratory muscles; (2) that the variation of maximal transdiaphragmatic pressures is largely attributable to the normal variation of diaphragm structure; (3) weight lifting increases diaphragm structure and pressures.

Diaphragm US is a valid predictor of extubation success at some but not all PS settings. Using a ∆tdi% of 20 % on PS levels up to 10/5 cm of H2O may reduce both unnecessarily prolonged intubations and prevent emergent reintubations.

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Respiratory dysfunction frequently occurs in patients with advanced multiple sclerosis (MS), and may manifest as acute or chronic respiratory failure, disordered control of breathing, respiratory muscle weakness, sleep disordered breathing, or neurogenic pulmonary edema. The underlying pathophysiology is related to demyelinating plaques involving the brain stem or spinal cord. Respiratory complications such as aspiration, lung infections and respiratory failure are typically seen in patients with long-standing MS. Acute respiratory failure is uncommon and due to newly appearing demyelinating plaques extensively involving areas of the brain stem or spinal cord. Early recognition of MS patients at risk for respiratory complications allows for the timely implementation of care and measures to decrease disease associated morbidity and mortality.