Respiratory care
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Despite its life-saving nature, invasive mechanical ventilation does not come without risk, and the avoidance of invasive mechanical ventilation is the primary goal of noninvasive respiratory support. Noninvasive respiratory support in the form of continuous or bi-level positive airway pressure were considered the only viable options to accomplish this for many years. ⋯ The amount of research being performed in this clinical space is impressive, to say the least, and it is rapidly evolving. It is the responsibility of the clinicians trained to use these therapies in the management of respiratory failure to understand the currently available evidence, benefits, and risks associated with the type of noninvasive respiratory support being used to treat our patients.
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COVID-19 resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a pandemic of respiratory failure previously unencountered. Early in the pandemic, concentrated infections in high-density population cities threatened to overwhelm health systems, and ventilator shortages were predicted. An early proposed solution was the use of shared ventilation, or the use of a single ventilator to support ≥ 2 patients. ⋯ Prior to 2020, there were 7 publications on this topic. A year later, more than 40 publications have addressed the technical details for shared ventilation, clinical experience with shared ventilation, as well as the numerous limitations and ethics of the technique. This is a review of the literature regarding shared ventilation from peer-reviewed articles published in 2020.
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Pediatric noninvasive ventilation (NIV) is used commonly in the acute care setting and is associated with high incidence of patient ventilator asynchrony. ⋯ Significant asynchrony exists during NIV with a commonly used acute care ventilator and nasal cannula interface, which raises questions regarding its utility in clinical practice in the pediatric population.
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The COVID-19 pandemic has led to an increased demand for mechanical ventilators and concerns of a ventilator shortage. Several groups have advocated for 1 ventilator to ventilate 2 or more patients in the event of such a shortage. However, differences in patient lung mechanics could make sharing a ventilator detrimental to both patients. Our previous study indicated failure to ventilate in 67% of simulations. The safety problems that must be solved include individual control of tidal volume (VT), individual measurement of VT, individualization of PEEP settings, and individual PEEP measurement. The purpose of this study was to evaluate potential solutions developed at our institution. ⋯ The results of this simulation-based study indicate that devices for individual control and display of VT and PEEP are effective in extending the usability and potential patient safety of multiplex ventilation.
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Unplanned extubation (UE) is a preventable adverse event and may lead to additional complications such as cardiovascular resuscitation or respiratory compromise in a critically ill neonate during an emergent re-intubation. A quality improvement project to reduce unplanned endotracheal tube dislodgement would reduce these morbidities. We aimed to reduce UEs in the NICU to 1 UE/100 ventilator days by October 2018. ⋯ Development of a quality improvement project by a multidisciplinary taskforce, along with several PDSA cycles including education and staff awareness, reduced the UE rate by 84% in a level 4 NICU. Ongoing surveillance, education, and review of UE cases will be key to maintaining UE events at a goal of 1 UE/100 ventilator days.