Respiratory care
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Editorial Comment
Ventilator Shortages and Solutions, Real and Imagined.
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Positive expiratory pressure (PEP) therapy imposes expiratory flow resistance to increase airway diameter and enhance mucus clearance. PEP is achieved several ways. Oscillatory PEP devices (OPEP) generate repeated occlusions that are known to reduce mucus viscosity. There are many marketed devices, but comparative performance is mostly unreported. The purpose of this study was to evaluate performance characteristics of many PEP/OPEP devices. For OPEP devices, we defined an optimal performance metric by creating an oscillation index that combines the OPEP performance characteristics. ⋯ PEP devices behaved similarly and as expected, with increased pressure with increased flow (flow resistors) or flow independence (threshold resistors). There was much greater variation in the performance of the OPEP devices. A higher oscillation index indicates better mechanical performance characteristics. Many devices have similar characteristics. However, the devices with the highest oscillation index have the highest flow amplitude and frequency, which may indicate better clinical performance.
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Randomized Controlled Trial
Electronic Medical Record-Based Pager Notification Reduces Excess Oxygen Exposure in Mechanically Ventilated Subjects.
Liberal oxygenation during mechanical ventilation is harmful in critically ill patients and in certain subsets of patients, including those with stroke, acute myocardial infarction, and cardiac arrest. Surveillance through electronic medical records improves safety of mechanical ventilation in the ICU. To date, this practice has not been used for oxygen titration ([Formula: see text]) in adults. We hypothesize that a surveillance system based on the electronic medical record to alert respiratory therapists to titrate [Formula: see text] is feasible, safe, and efficacious. ⋯ Use of an electronic surveillance system to titrate [Formula: see text] was safe and feasible and showed preliminary efficacy in reducing hyperoxemia. Our study serves to justify larger randomized controlled trials for [Formula: see text] titration.
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Randomized Controlled Trial
Comparison of the Effectiveness and Comfort Level of Two Commonly Used Mask Ventilation Techniques in a Simulated Model.
Mask ventilation is an important rescue airway skill for providing oxygenation and ventilation. Maintaining a good face mask seal is a fundamental factor for successful ventilation. Therefore, the aim of this study was to compare the effectiveness and comfortability of 2 commonly used mask ventilation techniques. ⋯ In our study, the median VT did not differ significantly between the 2 techniques. However, the C-E technique seemed to be superior to the V-E technique in terms of the number of effectively delivered breaths and comfortability. Further studies are recommended for basic airway management techniques.
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High-flow nasal cannula (HFNC) is an option for respiratory support in patients with acute hypoxic respiratory failure. To improve patient outcomes, reduce ICU-associated costs, and ease ICU bed availability, a multi-phased, comprehensive strategy was implemented to make HFNC available outside the ICU under the supervision of pulmonology or trauma providers in cooperation with a dedicated respiratory therapy team. The purpose of this study was to describe the education and implementation process for initiating HFNC therapy outside the ICU and to convey key patient demographics and outcomes from the implementation period. ⋯ A comprehensive implementation process and a robust therapy protocol were integral to initiating and managing HFNC in all hospital locations. Study findings indicate that patients with acute hypoxic respiratory failure can safely receive HFNC therapy outside the ICU with appropriate patient selection and staff education.