Resp Care
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Comparative Study
Feasibility and potential cost/benefit of routine isoflurane sedation using an anesthetic-conserving device: a prospective observational study.
Inhaled sedation is efficient and easily controllable; in low concentrations it causes minimal changes in the patient and very little interference with hemodynamics. Awakening after inhaled sedation is quick and predictable. The major reason inhaled sedation has not become widely used in intensive care is that no commercially available administration device has been available. ⋯ Routine ICU isoflurane sedation with the AnaConDa is easily feasible, effective, safe, and has a relatively short awakening period. In some patients with sedation difficulties, this sedation method may significantly decrease sedation cost and enhance sedation efficacy.
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Review
Institutional review board consideration of chart reviews, case reports, and observational studies.
Though the need for human-subjects review is readily apparent to investigators when conducting a randomized clinical trial, that same requirement is often less obvious when considering activities such as chart reviews, observational studies, or even case reports. In some cases all that is needed is notification of the institutional review board, which might then exempt the research. ⋯ In all cases, including case reviews, quality-improvement projects, and chart reviews, the most cautious approach for the investigator is to discuss regulatory requirements with the institutional review board official to ensure compliance. I will review what constitutes human-subjects research and how investigators may access protected health information, and consider some examples of observational research.
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Comparative Study
Wheeze detection in the pediatric intensive care unit: comparison among physician, nurses, respiratory therapists, and a computerized respiratory sound monitor.
To correlate wheeze detection in the pediatric intensive care unit among staff members (a physician, nurses, and respiratory therapists [RTs]) and digital recordings from a computerized respiratory sound monitor (PulmoTrack). ⋯ Between the physician, RTs, and nurses there was agreement about the presence of wheeze in critically ill patients in the pediatric intensive care unit. Compared to the objective acoustic measurements from the PulmoTrack, the intensive care unit staff was similar in their ability to detect the absence of wheeze. The PulmoTrack was better than the staff in detecting wheeze.
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Retention of airway secretions is a common and serious problem in ventilated patients. Treating or avoiding secretion retention with mucus thinning, patient-positioning, airway suctioning, or chest or airway vibration or percussion may provide short-term benefit. ⋯ The movement of mucus simulant was influenced by the ventilation pattern and lung impedance. Flow bias obtained with ventilator settings may clear or embed mucus during mechanical ventilation.
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Comparative Study
Sleep and respiratory function after withdrawal of noninvasive ventilation in patients with chronic respiratory failure.
In patients with restrictive thoracic disease, little is known about changes in sleep and breathing if the patient stops using nocturnal noninvasive ventilation (NIV). Better understanding of those changes may affect NIV management and improve our understanding of the relationship of night-to-night variability of respiratory and sleep variables and morning gas exchange. ⋯ NIV discontinuation in patients with restrictive chronic respiratory failure previously stabilized on NIV promptly leads to nocturnal respiratory failure and within days to diurnal respiratory failure. Stopping NIV for more than a day or two is not recommended.