Respiratory care
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Ineffective effort (IE) is a frequent patient-ventilator asynchrony in invasive mechanical ventilation. This study aimed to investigate the incidence of IE and to explore its relationship with respiratory drive in subjects with acute brain injury undergoing invasive mechanical ventilation. ⋯ IE was very common in subjects with acute brain injury. Low respiratory drive was independently associated with severe IEE.
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Noninvasive respiratory support (NRS) is widely used in pediatric ICUs (PICUs). However, there is limited experience regarding the utilization of NRS in non-PICU settings. We aimed to evaluate the success rate of NRS in pediatric high-dependency units (PHDUs), identify predictors of NRS failure, quantify adverse events, and assess outcomes. ⋯ In our cohort, we found NRS in PHDU safe and effective; however, maximum FIO2 > 0.5 post treatment and PEEP > 7 cm H2O were associated with NRS failure.
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Multicenter Study
DLCO Biologic Quality-Control Findings From a Multi-Center Global Study.
The 2017 American Thoracic Society/European Respiratory Society (ATS/ERS) diffusing capacity of the lung for carbon monoxide (DLCO) standards specify a control rule for assessing biologic quality control (BioQC) but have limited guidance on how to establish expected values for control rule variables. This study aimed to determine expected values for DLCO BioQC using coefficient of variation (CV) and compare that the mean ± 2 SD control rule yields the same precision as mean ± 12% of the mean. ⋯ A DLCO BioQC CV ≤ 6% is achievable across multiple sites, technologists, and brands of equipment. This CV value assures that measurements for control rule variables emerge from an expected range. A control rule of mean ± 2 SD appeared to yield similar results as the mean ± 12% of the mean rule reported in the 2017 ATS/ERS DLCO standards.
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Evidence-based practice relies on using research evidence to guide clinical decision-making. However, staying current with all published research can be challenging. ⋯ It provides a step-by-step guide to conducting a systematic review and meta-analysis, covering key steps such as formulating a research question, selecting studies, evaluating evidence quality, and reporting results. This paper is intended as a resource for clinicians looking to learn how to conduct systematic reviews and advance evidence-based practice in the field.
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Best practice guidelines for asthma management recommend education and spirometry at specific intervals. A written asthma action plan with education and spirometry is ordered at the discretion of physicians at our institution. An initial chart review revealed that asthma education and spirometry were not consistently ordered in the pediatric primary care clinics. This quality improvement study aimed to increase frequency of spirometry and asthma education in children with asthma seen in pediatric primary care through use of a respiratory therapist (RT)-driven protocol. ⋯ Implementation of an RT-driven protocol in an out-patient pediatric primary care setting significantly increased utilization of spirometry and education for children with asthma. RTs working in the pediatric out-patient primary care setting played a vital role in achieving best practices for asthma management. The implementation of the protocol enhanced interdisciplinary communication.