Resp Care
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Multicenter Study
Accidental decannulation following placement of a tracheostomy tube.
Accidental decannulation is a cause of substantial morbidity and mortality in patients in long-term acute care hospitals who require a tracheostomy tube. ⋯ Targeted interventions can significantly reduce both the incidence of AD following tracheostomy and associated morbidity. Best practice guidelines to help minimize AD in patients with tracheostomy tubes are proposed.
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Multicenter Study Comparative Study
Comparison of 2 correction methods for absolute values of esophageal pressure in subjects with acute hypoxemic respiratory failure, mechanically ventilated in the ICU.
A recent trial showed that setting PEEP according to end-expiratory transpulmonary pressure (P(pl,ee)) in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) might improve patient outcome. P(pl,ee) was obtained by subtracting the absolute value of esophageal pressure (P(es)) from airway pressure an invariant value of 5 cm H(2)O. The goal of the present study was to compare 2 methods for correcting absolute P(es) values in terms of resulting P(pl,ee) and recommended PEEP. ⋯ Referring absolute P(es) values to Vr rather than to an invariant value would be better adapted to a patient's physiological background. Further studies are required to determine whether this correction method might improve patient outcome.
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Multicenter Study
Adherence to acceptability and repeatability criteria for spirometry in complex lung function laboratories.
Few published data exist for adherence rates to spirometry acceptability and repeatability criteria in clinical respiratory laboratories. This study quantified adherence levels in this setting and observed changes in adherence levels as a result of feedback and ongoing training. ⋯ Clinical respiratory laboratories met published spirometry acceptability and repeatability criteria only 60% of the time in the first audit period. This improved with regular review, feedback, and implementation of a rating scale. Auditing of spirometry quality, feedback, and implementation of test rating scales need to be incorporated as an integral component of laboratory quality assurance programs to improve adherence to international acceptability and repeatability criteria.