Respiratory care
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Editorial Observational Study
High Failure Rate of Noninvasive Oxygenation Strategies in Critically Ill Subjects With Acute Hypoxemic Respiratory Failure Due to COVID-19.
The efficacy of noninvasive oxygenation strategies (NIOS) in treating COVID-19 disease is unknown. We conducted a prospective observational study to assess the rate of NIOS failure in subjects treated in the ICU for hypoxemic respiratory failure due to COVID-19. ⋯ As compared to hypoxemic respiratory failure due to other etiologies, subjects with COVID-19 who were treated with NIOS in the ICU were burdened by a 2-fold higher risk of failure. Subjects with a SAPS II score ≥ 33 and serum lactate dehydrogenase ≥ 405 units/L represent the population with the greatest risk.
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High-frequency ventilation is commonly utilized with neonates and with children with severe respiratory failure. Both high-frequency oscillatory ventilation (HFOV) and high-frequency jet ventilation (HFJV) are used extensively in neonates. HFJV can also be used in older, larger children. The purpose of this narrative review is to discuss the physiologic principles behind HFJV, examine the evidence supporting its use in neonatal and pediatric ICUs, give meaningful guidance for clinical application, and highlight potential areas for future research.
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Lean Six Sigma processes are used in health care systems to increase safety and efficiency. Daily huddles, one tool of the Lean Six Sigma process, have been used to increase patient safety, facilitate efficiency in problem solving, promote optimal patient outcomes, and reduce poor communication. Huddle utilization by respiratory care departments has not been previously reported. We describe our process of implementing daily huddles and the impact on departmental problem solving. ⋯ Twice-daily huddles implemented by our respiratory care department allowed for identification and timely resolution of process improvement opportunities.
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The 5-repetition sit-to-stand test (5STS) is valid and responsive in subjects with COPD, but there is a lack of information in subjects with asthma. We aimed to evaluate the usefulness of the 5STS as an outcome measure of pulmonary rehabilitation in subjects with asthma as compared to subjects with COPD. ⋯ The 5STS was a reliable outcome measure of pulmonary rehabilitation in subjects with asthma. It must be specifically assessed and may be included in the tools for assessment of effects of pulmonary rehabilitation also in these patients.