Resp Care
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Review Meta Analysis
Effect of ventilator circuit changes on ventilator-associated pneumonia: a systematic review and meta-analysis.
Recent guidelines concerning prevention of ventilator-associated pneumonia recommend that ventilator circuits should not be changed routinely, but in practice circuit changes at regular intervals persist. ⋯ Frequent ventilator circuit changes are associated with a high risk of ventilator-associated pneumonia. No routine circuit change is safe and justified. Hospital infection-control policies and bedside practitioners should translate the evidence into clinical practice, if they haven't done so already.
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Acute cardiogenic pulmonary edema (ACPE) is a common cause of respiratory failure that necessitates endotracheal intubation. In some patients intubation and its attendant complications can be avoided with noninvasive ventilation (NIV). Both continuous positive airway pressure (CPAP) and NIV have been evaluated in patients with ACPE. ⋯ Initial concern that NIV may be associated with a greater risk of myocardial infarction than CPAP was laid to rest by later studies. Despite a physiologic rationale that NIV should offer greater benefit than CPAP, NIV has not been found to offer any advantages regarding intubation rate or mortality compared with CPAP. We review the randomized controlled trials and summarize the evidence on NIV and CPAP in patients with ACPE.
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Review Meta Analysis
Role of noninvasive positive-pressure ventilation in postextubation respiratory failure: a meta-analysis.
There is a need for an intervention that prevents re-intubation in patients who have been weaned off mechanical ventilation. Noninvasive positive-pressure ventilation (NPPV) has been shown to facilitate weaning in mechanically ventilated patients. ⋯ Current evidence suggests that NPPV should be used judiciously, if at all, in patients with postextubation respiratory failure, but it appears to be promising as a prophylaxis to prevent re-intubation in patients "at risk" for developing postextubation respiratory failure.
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Meta Analysis
2000 Donald F. Egan Scientific Lecture. Are respiratory therapists effective? Assessing the evidence.
In the current cost-attentive health care climate, the effectiveness of various providers in delivering care is being examined closely. To evaluate the effectiveness of respiratory therapists (RTs) in delivering respiratory care in the intensive care unit (ICU), in adult non-ICU inpatient care, and in ambulatory care, this 27th Egan Lecture presents a systematic review of the available literature examining RTs' effectiveness in these settings. Overall, available studies support the effectiveness of RTs in providing care in various roles in all clinical venues, with the strongest evidence based on the results of concordant randomized controlled clinical trials. ⋯ Lower levels of evidence support RTs' roles in performing intubation, placing indwelling arterial lines, performing mini-bronchoalveolar lavage, allocating arterial blood gases, and in various counseling and teaching roles. Notwithstanding the considerable body of available evidence that buttresses RTs' effectiveness in delivering care, additional rigorously designed studies are needed to examine RTs' effectiveness in new roles (eg, geriatric care, pediatric care), in new venues (eg, extended care facilities), and to assure the generalizability of available findings to the broad spectrum of health care facilities (eg, academic and community-based facilities alike). Finally, the respiratory therapy community must continue to cultivate and suppport investigative expertise to assure continued inquiry.