Resp Care
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Multicenter Study
Attitudes of respiratory therapists and nurses about measures to prevent ventilator-associated pneumonia: a multicenter, cross-sectional survey study.
To understand the reported practices of and adherence to evidence-based guidelines for the prevention of ventilator-associated pneumonia (VAP) among respiratory therapists (RTs) and registered nurses (RNs) in academic and nonacademic intensive care units. ⋯ Consumers, the Centers for Disease Control and Prevention, and other organizations are currently trying to implement mandatory reporting of hospital infections, including VAP rate. Without a definition of VAP suited to individual institutions, an organized data-collection and reporting method, and team-based approaches to preventing and treating VAP, hospitals may not be able to meet these requests and track improvement efforts. Prevention measures need to be translated to bedside practice to improve the outcomes of critically ill patients.
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Randomized Controlled Trial
Adoption of lower tidal volume ventilation improves with feedback and education.
To determine whether feedback and education improve adoption of lung-protective mechanical ventilation (ie, with lower tidal volume [V(T)]). ⋯ Adoption of a lower-V(T) ventilation strategy in patients with acute lung injury or acute respiratory distress syndrome is far from complete in the Netherlands. Adoption of a lower-V(T) strategy improves after feedback and education.
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To derive a clinical prediction rule that uses bedside clinical variables to predict extubation failure (reintubation within 48 h) after a successful spontaneous breathing trial. ⋯ With our clinical prediction rule that incorporates an assessment of mental status, endotracheal secretions, and pre-extubation P(aCO(2)), clinicians can predict who will fail extubation despite a successful spontaneous breathing trial.
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One device that has been proposed to address the need for emergency ventilation is the Vortran Automatic Resuscitator. ⋯ The Vortran Automatic Resuscitator showed an automatic increase in frequency and decrease in V(T) that resulted in inappropriate levels of minute alveolar ventilation over a range of compliance and resistance values expected in paralyzed patients ventilated for respiratory failure. The variable performance under changing load, along with the lack of alarms, should prompt caution in using the Vortran Automatic Resuscitator for emergency ventilatory support in situations where the patient cannot be constantly monitored by trained and experienced operators.