Respiratory care
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High-flow nasal cannula (HFNC) oxygen therapy has been broadly used. However, no consensus has been achieved on the practical implementation of HFNC and how to provide aerosol delivery during HFNC therapy in adult patients. ⋯ The clinical utilization of HFNC was variable, as were indications, flow settings, and criteria for adjustment. Many practices associated with concomitant aerosol therapy were not consistent with available evidence for optimal use. More efforts are warranted to close the knowledge gap.
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Observational Study
ACUTE RESPIRATORY DISTRESS SYNDROME OUTCOMES IN NON-RESEARCH SUBJECTS ASSESSED BY GENERALIZED PROSPECTIVE TRIAL ELIGIBILITY CRITERIA AND ADHERANCE TO LUNG-PROTECTIVE VENTILATION.
ARDS mortality is lower among subjects participating in randomized controlled trials (RCTs) compared to subjects in observational studies. Excluding potential subjects with inordinately high mortality risk is necessary to prevent masking the impact of potentially effective treatments. We inquired whether observed mortality differed between RCT-eligible and RCT-ineligible subjects managed with varying degrees of lung-protective ventilation in a non-research setting. ⋯ Mortality in non-research, RCT-eligible subjects was substantially lower compared to RCT-ineligible subjects. Managing non-research patients with ARDS by keeping plateau pressure ≤ 30 cm H2O and formal use of a lung-protective ventilation protocol significantly reduces mortality risk.
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It is unknown how the initial choice of respiratory support by pediatric ICU providers contributes to outcomes of nonintubated obese children with respiratory failure. We hypothesized that body mass index and the type of initial respiratory support applied are associated with poor clinical outcomes in patients who carry respiratory failure-associated diagnoses. ⋯ The selection of respiratory support may place overweight/obese pediatric patients at higher risk for endotracheal intubation. Due to methodological limitations, we were unable to draw conclusions about the initial approach to the respiratory management of overweight/obese pediatric patients. Further investigation may be warranted.
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This was a pilot study to analyze the effects of tracheostomy on patient-ventilator asynchronies and respiratory system mechanics. Data were extracted from an ongoing prospective, real-world database that stores continuous output from ventilators and bedside monitors. Twenty adult subjects were on mechanical ventilation and were tracheostomized during an ICU stay: 55% were admitted to the ICU for respiratory failure and 35% for neurologic conditions; the median duration of mechanical ventilation before tracheostomy was 12 d; and the median duration of mechanical ventilation was 16 d. ⋯ Tracheostomy did not affect patient-ventilator asynchronies or respiratory mechanics within 24 h before and after the procedure.