Respiratory care
-
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.
-
Multicenter Study
Feasibility of a Multi-Center Respiratory Therapist Endotracheal Intubation Study.
Respiratory therapists (RTs) have historically performed safe and effective intubations, yet there are limited multi-center data assessing their intubation performance. Multi-center data can be used to compare RT intubation performance to that of other professions and identify quality improvement opportunities at hospitals where RTs perform intubation. We aimed to explore the feasibility of a multi-center collaborative to evaluate RT intubation outcomes. ⋯ A collaborative examining RTs intubation performance was successfully initiated at 2 separate facilities. Intubations performed by RTs had a high success rate, with AE rates comparable to published results from other types of providers.
-
Multicenter Study Observational Study
Work of Breathing During Proportional Assist Ventilation as a Predictor of Extubation Failure.
Despite decades of research on predictors of extubation success, use of ventilatory support after extubation is common and 10-20% of patients require re-intubation. Proportional assist ventilation (PAV) mode automatically calculates estimated total work of breathing (total WOB). Here, we assessed the performance of total WOB to predict extubation failure in invasively ventilated subjects. ⋯ The discriminative performance of a PAV-derived total WOB value to predict extubation failure was good, indicating total WOB may represent an adjunctive tool for assessing extubation readiness. However, these results should be interpreted as preliminary, with specific thresholds of PAV-derived total WOB requiring further investigation in a large multi-center study.
-
Multicenter Study Observational Study
Daily oxygenation support for patients hospitalized with SARS-CoV-2 in an integrated health system.
Many COVID-19 studies are constructed to report hospitalization outcomes, with few large multi-center population-based reports on the time course of intra-hospitalization characteristics, including daily oxygenation support requirements. Comprehensive epidemiologic profiles of oxygenation methods used by day and by week during hospitalization across all severities are important to illustrate the clinical and economic burden of COVID-19 hospitalizations. ⋯ Data representation of intra-hospital processes of care drawn from hospitals with varied size, teaching and trauma designations is important to presenting a balanced perspective of care delivery mechanisms employed, such as daily oxygen method utilization.
-
Multicenter Study
Epidemiology of Weaning From Invasive Mechanical Ventilation in Subjects With COVID-19.
Patients requiring mechanical ventilation due to COVID-19 have different characteristics of evolution and outcome compared to the general ICU population. Although early weaning from mechanical ventilation is associated with improved outcomes, inadequate identification of patients unable to be weaned may lead to extubation failure and increased days on mechanical ventilation. Outcomes related to mechanical ventilation weaning in this population are scare and inconclusive. Therefore, the objective of this study was to describe the characteristics of mechanical ventilation weaning in subjects with acute respiratory failure induced by COVID-19. ⋯ The mechanical ventilation weaning process in subjects with COVID-19 was negatively affected by the disease, with many subjects never completing an SBT. Even though temporal variables were modified, the clinical outcomes in each weaning group were similar to those previously reported.