Respiratory care
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Tracheostomy facilitates ambulatory extracorporeal membrane oxygenation (ECMO) as a bridge to recovery or lung transplantation in patients with respiratory failure, yet data on this procedure in this population are lacking. This report describes a series of pediatric ICU patients who had a bedside tracheostomy performed while being supported on ECMO and examines the potential impact of this procedure on active rehabilitation and sedation requirements. ⋯ Bedside tracheostomy can feasibly be performed on pediatric patients being supported with ECMO as a way to improve mobility, promote ambulation, and decrease sedation. Timing and ideal surgical approach require further study to fully maximize benefits and minimize risks.
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Spontaneous breathing trials (SBTs) are used to assess the readiness for discontinuation of mechanical ventilation. When airway resistance (Raw) is elevated, the imposed work of breathing can lead to prolongation of mechanical ventilation. Biofilm and mucus build-up within the endotracheal tube (ETT) can increase Raw. Scraping the ETT can remove the biofilm build-up and decrease mechanical Raw. The primary aim of this study was to evaluate the impact of ETT scraping on Raw. The secondary aim was to determine whether decreasing Raw would impact subsequent SBT success. ⋯ This study demonstrated that ETT scraping can reduce Raw. The decrease in Raw post-ETT scraping did not affect subsequent SBT success.
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COPD is common, and inhaled medications can reduce the risk of exacerbations. Incorrect inhaler use is also common and may lead to worse symptoms and increased exacerbations. We examined whether inhaler training could be delivered using Internet-based home videoconferencing and its effect on inhaler technique, self-efficacy, quality of life, and adherence. ⋯ Inhaler training using teach-to-goal methodology delivered by home videoconference is a promising means to provide training to patients with COPD that can improve technique, quality of life, self-efficacy, and adherence.
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Observational Study
The Contributing Risk of Tobacco Use for ARDS Development in Burn-Injured Adults With Inhalation Injury.
This study aims to determine the relationship between tobacco use, inhalation injury, and ARDS in burn-injured adults. ⋯ In mediation analysis, inhalation injury was the overwhelming predictor for ARDS development, whereas tobacco use has its strongest effect indirectly through inhalation injury. Patients with at least moderate inhalation injury are at greatest risk for ARDS development despite baseline risk factors like tobacco use.
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Since 1998, the Global Initiative for Obstructive Lung Disease (GOLD) has worked with health care professionals, medical researchers, and public health officials around the world to optimize the prevention, treatment, and management of COPD. GOLD has continually worked to ensure COPD management strategy recommendations are aligned with current published research. ⋯ As respiratory therapists (RTs) are front-line clinical professionals throughout the COPD continuum of care, a thorough understanding of the new GOLD recommendations for practice is critical. New recommendations regarding diagnosis, severity assessment, and both pharmacologic and nonpharmacologic treatment of COPD are presented, and suggestions for how RTs can integrate these recommendations into COPD care practices are provided.