Respiratory care
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Although the fundamentals of extracorporeal membrane oxygenation (ECMO) have not changed in 3 decades, the technical elements continue to improve and have evolved from an assemblage of individual components to more integrated systems with added features, enhanced safety, and improved maneuverability. The introduction of polymethylpentene (PMP) fiber technology has expanded the development of artificial membranes that have low resistance, are more biocompatible, and can be used for extended durations. Extracorporeal carbon dioxide removal techniques continue to be enhanced as stand alone technology and modified renal dialysis systems are introduced. ⋯ The use of high-fidelity simulation training has become a standard and important method for reinforcing technical skills, refining troubleshooting sequences, and enhancing team interactions. Modifications to mannequins and ECMO systems coupled with clinical and physiologic scenarios will help achieve greater realism and enhance learning. ECMO technology continues to improve, with adaptability and versatility being essential attributes.
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Randomized Controlled Trial
Effect of Humidified Noninvasive Ventilation on the Development of Facial Skin Breakdown.
The use of noninvasive ventilation masks is known to cause damage to facial skin tissue, which affects both the efficacy of the intervention and the patient's quality of life. The use of humidification with noninvasive ventilation is a common practice, but its relative role in the development of facial pressure ulcers has not been fully studied. ⋯ These findings indicated that noninvasive ventilation with humidification had a potential disrupting effect on the barrier function of facial skin, associated with changes in skin microclimate and function. Further research is required to establish the cause of mask-related skin damage and to evaluate the effects of mask design, application techniques, and air flow and humidity settings.
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Editorial Comparative Study
A Comparative Analysis of Ideal Body Weight Methods for Pediatric Mechanical Ventilation.
A universal method for determining ideal body weight (IBW) for the application of appropriate tidal volumes in children on mechanical ventilation is elusive. We sought to compare 3 commonly used IBW methods for subjects between ages 2 and 20 y. ⋯ The majority of the subjects demonstrated a clinically important error between the actual body weight and the IBW. The percent error increased in subjects > 25 kg actual body weight. These data underline the importance of obtaining height measurements and calculated IBW in pediatric patients who are mechanically ventilated.
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Remote monitoring is increasingly used in patients who receive home mechanical ventilation. The average volume assured pressure support mode is a target volume pressure preset mode that delivers a given tidal volume (VT) within a range of controlled inspiratory pressures. In a mode such as this, it is important to verify that the VT value retrieved from the ventilator SD card is accurate. ⋯ In the 3 home-care ventilators, the ventilator SD card underestimated VT. Factors involved in this difference differed among the ventilators.