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1.
BMJ Open Respir Res ; 9(1)2022 06.
Article in English | MEDLINE | ID: covidwho-1909781

ABSTRACT

INTRODUCTION: A new smartphone app (QUT Inspire) has been developed to detect inspiratory sound and deliver virtual incentive spirometry (ISy), a respiratory therapy technique used in postoperative recuperation, management of some chronic conditions and with potential applications in SARS-CoV-2 rehabilitation. The aim of this study was to compare the usability of this new app with a clinical ISy device as measured by effectiveness, efficiency and satisfaction. METHODS: In this mixed-methods randomised usability study, healthy volunteers (aged 39.2±12.2 years, n=24) compared inspirations using the QUT Inspire app and a Triflo II clinical ISy device. A post-test questionnaire and a semi-structured interview explored dimensions of usability regarding the new app. RESULTS: The duration of inspirations performed using the QUT Inspire app (7.3±2.0 s) were comparable with use of the Triflo II ISy device (7.5±2.3 s). No artefacts arising from the order of device testing were identified. App users held their phones adjacent but not proximal to their mouths (13.6±6.4 cm), notwithstanding instructions to keep the phone less than 5 cm away for optimal breath sound detection. The use of onscreen text or video instructional materials did not result in a significant reduction in this distance. Participants reported clear preferences for the app (100%, n=24) to motivate persistence with repeated inspirations. App gamification features such as a timer (75%, n=18) and breath counter (83.3%, n=20) were well regarded. Analysis of semi-structured interviews identified four main themes arising from this study: visual reward from responsive app animations, clinical look and feel influencing credibility, perceived effort affecting engagement and selective adoption of gamification features. CONCLUSION: This study demonstrates that a virtual ISy app can be effective, efficient and have high satisfaction. Improvements informed by this research include use of additional phone sensors to optimise sound detection and minimising the distance that phones are held from the user's mouth. Further research in randomised controlled trials are needed to evaluate performance of this app in clinical contexts where ISy is currently employed.


Subject(s)
COVID-19 , Mobile Applications , Humans , Randomized Controlled Trials as Topic , Respiratory Therapy , SARS-CoV-2 , Surveys and Questionnaires
5.
Pneumologie ; 76(4): 260-271, 2022 Apr.
Article in German | MEDLINE | ID: covidwho-1805704

ABSTRACT

Inhalation therapy is a cornerstone especially in pulmonary diseases or comorbidities, either in invasive or noninvasive mechanical ventilation. In pediatric patients, mainly in respiratory failure of the premature born child inhalation of surfactant is crucial in the therapy. Additional drugs given by inhalation are antibiotics, mucoactive substances and drugs that treat pulmonary hypertension. This article describes main deposition mechanisms of inhalation therapies and presents recommendations for correct performance of inhalation therapy in invasively as well as noninvasively ventilated patients in ICU. Also safety aspects for patients and medical staff during aerosol therapy in the Corona pandemic era are discussed.


Subject(s)
Intensive Care Units , Respiration, Artificial , Administration, Inhalation , Aerosols , Child , Humans , Respiratory Therapy
6.
PLoS Negl Trop Dis ; 16(3): e0010221, 2022 03.
Article in English | MEDLINE | ID: covidwho-1793647

ABSTRACT

Low-cost improvised continuous positive airway pressure (CPAP) device is safe and efficacious in neonatal respiratory distress. There is a great necessity for similar device in adults, and this has been especially made apparent by the recent Coronavirus Disease 2019 (COVID-19) pandemic, which is unmasking the deficiencies of healthcare system in several low-resource countries. We propose a simplified and inexpensive model of improvised CPAP in adults using locally available resources including aquarium air pumps and a novel pressure release mechanism. Although the safety and efficacy of improvised CPAP in adults are not established, the conceptual model we propose has the potential to serve as a lifesaving technology in many low-resource settings during this ongoing pandemic and thus calls for expedited research.


Subject(s)
COVID-19/therapy , Continuous Positive Airway Pressure/instrumentation , Equipment Design/economics , Respiratory Therapy/instrumentation , Adult , Humans , Noninvasive Ventilation/instrumentation , SARS-CoV-2
7.
Comput Math Methods Med ; 2022: 9612548, 2022.
Article in English | MEDLINE | ID: covidwho-1765204

ABSTRACT

Objective: To investigate the differences between inhaled nitric oxide (iNO) treatment and conventional therapy in the treatment of postoperative hypoxemia in obese patients with acute type A aortic dissection (ATAAD). Methods: ATAAD patients diagnosed and treated with emergency surgery in our hospital from June 2017 to December 2019 were retrospectively analyzed. Patients with postoperative hypoxemia were divided into the iNO group and control group. Propensity score matching was used to analyze clinical characteristics and results of the two groups. Results: A total of 218 ATAAD patients with BMI ≥ 25 were treated with surgery. Among them, 115 patients developed refractory hypoxemia (64 in the control group and 51 in the iNO group). Patients in the iNO group had significantly shorter invasive mechanical ventilation time, intensive care unit (ICU) stay, and hospital stay. After 6 h of iNO treatment, the PaO2/FiO2 ratio in the iNO group increased significantly, and this ratio was higher than that in the control group at 6, 12, 24, 48, and 72 h after treatment. Conclusion: Low-dose iNO could improve oxygenation and shorten mechanical ventilation and ICU stay in patients with hypoxemia after ATAAD surgery, but without significant side effects or increase in postoperative mortality or morbidity. These findings provide a basis for a randomized multicenter controlled trial to assess the efficacy of iNO in the treatment of hypoxemia after ATAAD surgery.


Subject(s)
Aneurysm, Dissecting , Nitric Oxide , Aneurysm, Dissecting/complications , Aneurysm, Dissecting/surgery , Humans , Hypoxia/drug therapy , Hypoxia/etiology , Nitric Oxide/therapeutic use , Obesity/complications , Respiratory Therapy , Retrospective Studies
8.
BMC Pulm Med ; 22(1): 52, 2022 Feb 05.
Article in English | MEDLINE | ID: covidwho-1690928

ABSTRACT

COVID-19 has inflicted the world for over two years. The recent mutant virus strains pose greater challenges to disease prevention and treatment. COVID-19 can cause acute respiratory distress syndrome (ARDS) and extrapulmonary injury. Dynamic monitoring of each patient's condition is necessary to timely tailor treatments, improve prognosis and reduce mortality. Point-of-care ultrasound (POCUS) is broadly used in patients with ARDS. POCUS is recommended to be performed regularly in COVID-19 patients for respiratory failure management. In this review, we summarized the ultrasound characteristics of COVID-19 patients, mainly focusing on lung ultrasound and echocardiography. Furthermore, we also provided the experience of using POCUS to manage COVID-19-related ARDS.


Subject(s)
COVID-19/diagnostic imaging , Echocardiography , Lung/diagnostic imaging , Point-of-Care Testing , Respiratory Distress Syndrome/diagnostic imaging , Respiratory Therapy/methods , COVID-19/therapy , Humans , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/virology
9.
Bull Exp Biol Med ; 172(3): 364-367, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1616180

ABSTRACT

The article presents a theoretical rationale and a clinical case of relief of post-COVID ventilation failure by inhalation of Xe and O2 gas mixture. Pneumonitis of coronavirus etiology transforms saturated phospholipids of surfactant into a solid-ordered phase, which disrupts surface tension, alveolar pneumatization, and alveolar-capillary gas exchange. Using molecular modeling (B3LYP/lanl2dz; GAUSSIAN09), we demonstrated that Xe atom due to the van der Waals dispersion interaction increases the distance between the phospholipid acyl chains providing a phase transition from the solid-ordered to liquid phase and restored the surface-active monolayer surfactant film. A clinical case confirmed that short-term inhalations of the Xe and O2 gas mixture relieved manifestations of ventilation insufficiency and increased SpO2 and pneumatization of the terminal parts of the lungs.


Subject(s)
COVID-19/complications , Oxygen/administration & dosage , Respiratory Insufficiency/therapy , Respiratory Therapy/methods , Xenon/administration & dosage , Administration, Inhalation , Anesthetics, Inhalation/administration & dosage , COVID-19/etiology , COVID-19/rehabilitation , COVID-19/therapy , Drug Combinations , Humans , Lung/drug effects , Lung/physiopathology , Male , Middle Aged , Respiration/drug effects , Respiratory Insufficiency/etiology , Russia , SARS-CoV-2
10.
Drug Deliv ; 29(1): 10-17, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1577575

ABSTRACT

Aerosol therapy is used to deliver medical therapeutics directly to the airways to treat respiratory conditions. A potential consequence of this form of treatment is the release of fugitive aerosols, both patient derived and medical, into the environment and the subsequent exposure of caregivers and bystanders to potential viral infections. This study examined the release of these fugitive aerosols during a standard aerosol therapy to a simulated adult patient. An aerosol holding chamber and mouthpiece were connected to a representative head model and breathing simulator. A combination of laser and Schlieren imaging was used to non-invasively visualize the release and dispersion of fugitive aerosol particles. Time-varying aerosol particle number concentrations and size distributions were measured with optical particle sizers at clinically relevant positions to the simulated patient. The influence of breathing pattern, normal and distressed, supplemental air flow, at 0.2 and 6 LPM, and the addition of a bacterial filter to the exhalation port of the mouthpiece were assessed. Images showed large quantities of fugitive aerosols emitted from the unfiltered mouthpiece. The images and particle counter data show that the addition of a bacterial filter limited the release of these fugitive aerosols, with the peak fugitive aerosol concentrations decreasing by 47.3-83.3%, depending on distance from the simulated patient. The addition of a bacterial filter to the mouthpiece significantly reduces the levels of fugitive aerosols emitted during a simulated aerosol therapy, p≤ .05, and would greatly aid in reducing healthcare worker and bystander exposure to potentially harmful fugitive aerosols.


Subject(s)
Aerosols , COVID-19 , Drug Delivery Systems , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Nebulizers and Vaporizers , Respiratory Therapy , Aerosols/administration & dosage , Aerosols/adverse effects , COVID-19/prevention & control , COVID-19/transmission , Computer Simulation , Drug Delivery Systems/instrumentation , Drug Delivery Systems/methods , Equipment Design , Humans , Infection Control/methods , Models, Biological , Particle Size , Respiratory Therapy/adverse effects , Respiratory Therapy/instrumentation , Respiratory Therapy/methods , SARS-CoV-2
12.
Arch Phys Med Rehabil ; 102(10): 1989-1997.e3, 2021 10.
Article in English | MEDLINE | ID: covidwho-1499615

ABSTRACT

OBJECTIVE: A meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effect of pulmonary rehabilitation on functional capacity and quality of life in interstitial lung diseases, including those caused by coronaviruses. DATA SOURCES: MEDLINE, EMBASE, SPORTDiscus, Cochrane Library, Web of Science, and MedRxiv from inception to November 2020 were searched to identify documents. STUDY SELECTION: Publications investigating the effect of pulmonary rehabilitation on lung function (forced vital capacity [FVC]), exercise capacity (6-minute walk distance [6MWD]), health related quality of life (HRQOL), and dyspnea were searched. DATA EXTRACTION: The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0). DATA SYNTHESIS: A total of 11 RCTs with 637 interstitial lung disease patients were eligible for analyses. The pooled effect sizes of the association for pulmonary rehabilitation were 0.37 (95% confidence interval [CI], 0.02-0.71) for FVC, 44.55 (95% CI, 32.46-56.64) for 6MWD, 0.52 (95% CI, 0.22-0.82) for HRQOL, and 0.39 (95% CI, -0.08 to 0.87) for dyspnea. After translating these findings considering clinical improvements, pulmonary rehabilitation intervention increased predicted FVC by 5.5%, the 6MWD test improved by 44.55 m, and HRQOL improved by 3.9 points compared with baseline values. Results remained similar in sensitivity analyses. CONCLUSIONS: Although specific evidence for pulmonary rehabilitation of coronavirus disease 2019 patients has emerged, our data support that interstitial lung disease rehabilitation could be considered as an effective therapeutic strategy to improve the functional capacity and quality of life in this group of patients.


Subject(s)
COVID-19/rehabilitation , Lung Diseases, Interstitial/rehabilitation , Pneumonia, Viral/rehabilitation , Respiratory Therapy/methods , Severe Acute Respiratory Syndrome/rehabilitation , Humans , Quality of Life , Randomized Controlled Trials as Topic , SARS-CoV-2 , Walk Test
14.
PLoS One ; 16(9): e0256903, 2021.
Article in English | MEDLINE | ID: covidwho-1406751

ABSTRACT

INTRODUCTION: During COVID-19 pandemic, the use of several drugs has represented the worldwide clinical practice. However, though the current increase of knowledge about the disease, there is still no effective treatment for the usage of drugs. Thus, we retrospectively assessed use and effects of therapeutic regimens in hospitalized patients on in-hospital mortality. METHODS: COVOCA is a retrospective observational cohort study on 18 COVID centres throughout Campania Region Hospitals. We included adult patients with confirmed SARS-CoV-2 infection, discharged/dead between March/June 2020. RESULTS: 618 patients were included, with an overall in-hospital cumulative mortality incidence of 23.1%. Most prescribed early treatments were antivirals (72%), antibiotics (65%) and hydroxychloroquine/anticoagulants (≈50%). Tocilizumab, indeed, was largely prescribed late during hospitalization. Multivariable models, with a cut-off at day 2 for early COVID-19 therapy administration, did not disclose any significant association of a single drug administration on the clinical outcome. DISCUSSION: COVOCA represents the first multicenter database in Campania region. None drug class used during the pandemic significantly modified the outcome, regardless of therapy beginning, both overall and net of those already in non-invasive ventilation (NIV)/ orotracheal intubation (OTI) at hospitalization. Our cumulative incidence of mortality seems lower than other described during the same period, particularly in Northern Italy.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/drug therapy , COVID-19/mortality , Aged , COVID-19/epidemiology , Female , Hospital Mortality , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , Respiratory Therapy , Retrospective Studies
15.
BMJ Open Respir Res ; 8(1)2021 09.
Article in English | MEDLINE | ID: covidwho-1394124

ABSTRACT

Many patients struggle with ongoing symptoms in different domains (physical, mental, cognitive) after hospitalisation for COVID-19, calling out for a multidisciplinary approach. An outpatient multidisciplinary rehabilitation programme, according to a respiratory rehabilitation strategy, was set up for adult patients who were able to attend group sessions during 12 weeks. Results of 22 adult patients with COVID-19, of which 15 had required intensive care, were analysed and some general impressions and challenges of rehabilitation in COVID-19 were reported. Impressive results on physical recovery were determined after 6 weeks and 3 months, with significant improvement of lung function, muscle force and exercise capacity variables. A positive evolution of mental and cognitive burden was present, although less pronounced than the physical recovery. These mental and cognitive consequences seem, next to musculoskeletal and medical complications, the most challenging aspect of rehabilitating patients with COVID-19. These real-world data show feasibility and efficiency of a multidisciplinary respiratory rehabilitation programme after moderate to severe COVID-19 disease.


Subject(s)
COVID-19 , Respiratory Therapy , Adult , COVID-19/rehabilitation , Critical Care , Female , Humans , Male , Middle Aged , Respiratory Function Tests , Treatment Outcome
16.
Phys Med Rehabil Clin N Am ; 32(2): 263-276, 2021 05.
Article in English | MEDLINE | ID: covidwho-1392486

ABSTRACT

Cardiopulmonary telerehabilitation is a safe and effective alternative to traditional center-based rehabilitation. It offers a sustainable solution to more conveniently meet the needs of patients with acute or chronic, preexisting or newly acquired, cardiopulmonary diseases. To maximize success, programs should prioritize basic, safe, and timely care options over comprehensive or complex approaches. The future should incorporate new strategies learned during a global pandemic and harness the power of information and communication technology to provide evidence-based patient-centered care. This review highlights clinical considerations, current evidence, recommendations, and future directions of cardiopulmonary telerehabilitation.


Subject(s)
Cardiac Rehabilitation/methods , Health Services Accessibility , Respiratory Therapy/methods , Telerehabilitation/methods , COVID-19/epidemiology , Cardiac Rehabilitation/economics , Humans , Pandemics , Respiratory Therapy/economics , SARS-CoV-2 , Telerehabilitation/economics , United States/epidemiology
17.
Rev Mal Respir ; 37(6): 505-510, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-1386577

ABSTRACT

The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.


Subject(s)
Aftercare/methods , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Aftercare/standards , Ambulatory Care/methods , Ambulatory Care/standards , COVID-19 , Cardiovascular Diseases/prevention & control , Coronavirus Infections/complications , Coronavirus Infections/rehabilitation , Critical Care/methods , Critical Care/standards , Diagnostic Techniques, Respiratory System/standards , Disease Management , Emergency Medical Services/methods , Emergency Medical Services/standards , Health Priorities , Hospitalization , Humans , Inpatients , Outpatients , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/rehabilitation , Respiratory Therapy/methods , Respiratory Therapy/standards , Symptom Assessment/methods , Symptom Assessment/standards , Thromboembolism/prevention & control , Thrombophilia/drug therapy , Thrombophilia/etiology
18.
BMC Pulm Med ; 21(1): 228, 2021 Jul 13.
Article in English | MEDLINE | ID: covidwho-1358999

ABSTRACT

RATIONALE: The SARS-CoV2 pandemic increased exponentially the need for both Intensive (ICU) and Intermediate Care Units (RICU). The latter are of particular importance because they can play a dual role in critical and post-critical care of COVID-19 patients. Here, we describe the setup of 2 new RICUs in our institution to face the SARS-CoV-2 pandemic and discuss the clinical characteristics and outcomes of the patients attended. METHODS: Retrospective analysis of the characteristics and outcomes of COVID-19 patients admitted to 2 new RICUs built specifically in our institution to face the first wave of the SARS-CoV-2 pandemic, from April 1 until May 30, 2020. RESULTS: During this period, 106 COVID-19 patients were admitted to these 2 RICUs, 65 of them (61%) transferred from an ICU (step-down) and 41 (39%) from the ward or emergency room (step-up). Most of them (72%) were male and mean age was 66 ± 12 years. 31% of them required support with oxygen therapy via high-flow nasal cannula (HFNC) and 14% non-invasive ventilation (NIV). 42 of the 65 patients stepping down (65%) had a previous tracheostomy performed and most of them (74%) were successfully decannulated during their stay in the RICU. Length of stay was 7 [4-11] days. 90-day mortality was 19% being significantly higher in stepping up patients than in those transferred from the ICU (25 vs. 10% respectively; p < 0.001). CONCLUSIONS: RICUs are a valuable hospital resource to respond to the challenges of the SARS-CoV-2 pandemic both to treat deteriorating and recovering COVID-19 patients.


Subject(s)
COVID-19/therapy , Intermediate Care Facilities , Respiratory Care Units , Respiratory Therapy , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
19.
Biomed Res Int ; 2021: 5822259, 2021.
Article in English | MEDLINE | ID: covidwho-1358938

ABSTRACT

BACKGROUND: COVID-19 patients can present with neurological manifestations in the form of headache, dizziness, hyposmia, myalgia, peripheral neuropathy, acute cerebrovascular disease, and encephalopathy. Neurological involvement could be due to virus-induced brain hypoxia, brain infection, or immune reaction. We aim to describe the neurological presentation of COVID-19 patients and study their neuroimaging findings and disease outcome. METHOD: The study is a single-centre, retrospective, observational study in Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE. Patients diagnosed with COVID-19 between March and May 2020 who presented with neuropathological features with or without respiratory manifestations of COVID-19 were enrolled. Electronic records were studied for age, sex, duration of hospitalization, detailed neurological presentation, history or documented concomitant fever and respiratory features of COVID-19, inflammatory markers, neuroimaging, progress, and disease outcome. RESULTS: Thirty-three patients of 10 nationalities presented with neurological manifestations. Mean (range) age was 51.4 (21-86) years. Twenty-four had comorbidities, and 18 had no prior or concomitant respiratory symptoms. Ten patients presented with encephalopathy and exhibited altered behavior/sensorium: 7 presented with myositis, 8 with stroke, and 4 with seizures, and 4 had peripheral and cranial nerve involvement. The mean (average) duration of hospital stay was 11.4 days (1-38) with the longest observed in stroke patients. Fifteen patients (45%) died and 3 (9%) had residual weakness. Serum ferritin, CRP, and procalcitonin were higher in the severe disease group and correlated with risk of death. Twelve of 22 brain images showed abnormalities including haemorrhage, infarcts, small vessel ischemia, and oedema. Risk of death was higher in older age but did not differ based on the underlying neuropathology. CONCLUSION: COVID-19 patients who present with neurological involvement have a higher risk of mortality which is aggravated by older age and higher inflammatory markers. The type of neurological pathology does not seem to influence the risk of mortality.


Subject(s)
COVID-19/complications , COVID-19/diagnosis , Nervous System Diseases/etiology , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Brain/diagnostic imaging , COVID-19/epidemiology , Female , Hospitalization , Humans , Inflammation Mediators/blood , Male , Middle Aged , Nervous System Diseases/diagnosis , Nervous System Diseases/diagnostic imaging , Neuroimaging , Pandemics , Prognosis , Respiratory Therapy , Retrospective Studies , SARS-CoV-2/pathogenicity , United Arab Emirates/epidemiology , Young Adult
20.
PLoS One ; 16(8): e0251378, 2021.
Article in English | MEDLINE | ID: covidwho-1354756

ABSTRACT

BACKGROUND: The benefit of tocilizumab on mortality and time to recovery in people with severe COVID pneumonia may depend on appropriate timing. The objective was to estimate the impact of tocilizumab administration on switching respiratory support states, mortality and time to recovery. METHODS: In an observational study, a continuous-time Markov multi-state model was used to describe the sequence of respiratory support states including: no respiratory support (NRS), oxygen therapy (OT), non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV), OT in recovery, NRS in recovery. RESULTS: Two hundred seventy-one consecutive adult patients were included in the analyses contributing to 695 transitions across states. The prevalence of patients in each respiratory support state was estimated with stack probability plots, comparing people treated with and without tocilizumab since the beginning of the OT state. A positive effect of tocilizumab on the probability of moving from the invasive and non-invasive mechanical NIV/IMV state to the OT in recovery state (HR = 2.6, 95% CI = 1.2-5.2) was observed. Furthermore, a reduced risk of death was observed in patients in NIV/IMV (HR = 0.3, 95% CI = 0.1-0.7) or in OT (HR = 0.1, 95% CI = 0.0-0.8) treated with tocilizumab. CONCLUSION: To conclude, we were able to show the positive impact of tocilizumab used in different disease stages depicted by respiratory support states. The use of the multi-state Markov model allowed to harmonize the heterogeneous mortality and recovery endpoints and summarize results with stack probability plots. This approach could inform randomized clinical trials regarding tocilizumab, support disease management and hospital decision making.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/drug therapy , Respiratory Therapy/methods , Aged , Female , Humans , Male , Markov Chains , Middle Aged , Noninvasive Ventilation , Oxygen Inhalation Therapy , Respiration, Artificial , Time Factors , Treatment Outcome
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