Resp Care
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To determine whether outcomes (mortality and need for intensive care unit [ICU] readmission) of patients undergoing tracheostomy in the ICU can be predicted by common clinical or historical criteria. ⋯ These findings suggest that it is difficult to predict outcomes of patients who undergo tracheostomy in the ICU. Larger and prospective studies may help elucidate this matter.
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An aerosol of budesonide inhalation suspension is delivered when used with various jet-nebulizer/compressor combinations. The constant introduction of new nebulizer/compressor combinations raises the question of whether the performance of these match the performance of existing devices. The aim of this study was to determine in vitro the inhaled mass and aerosol characteristics of budesonide inhalation suspension from a selection of jet-nebulizer/compressor combinations presently marketed in the United States, Europe, and Japan. ⋯ The in vitro budesonide mass collected on the inhalation filter and delivery characteristics differed considerably between the 30 nebulizer/compressor combinations. The present in vitro characterization of jet nebulizers can be used as a guidance for selection of jet-nebulizer/compressor combinations for delivery of the budesonide nebulization suspension in the home-care setting. Further investigations of new nebulizer/compressor combinations are warranted.
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Nutritional support is frequently neglected in a busy intensive care unit (ICU) with overworked staff. There is a paucity of investigations on ICU nutrition from India. ⋯ Calorie and protein delivery to critically ill patients remains less than the recommended values. Inadequate calorie delivery is associated with higher odds of mortality.
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To measure the delivered fractional oxygen concentration (F(DO(2))) from preterm-size Laerdal silicone resuscitators (PLSR) without a reservoir. ⋯ The F(DO(2)) measured during this study did not differ from PLSR specifications. The F(DO(2)) did, however, differ from information contained in the North American Neonatal Resuscitation Program manual regarding use of a self-inflating bag without a reservoir. Care should be taken when selecting a self-inflating resuscitation device to provide blended air and oxygen, as high concentrations of oxygen may be delivered by these devices even when the reservoir is removed. American and Canadian recommendations for the provision of supplemental oxygen with self-inflating bags require reevaluation.
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A North American survey of respiratory therapist and physician tracheostomy decannulation practices.
Tracheostomy is a common surgical procedure performed on critically ill patients. However, little is known about how clinicians make decisions to decannulate patients, and whether similar decisions are made by respiratory therapists (RTs) and physicians. ⋯ Important differences exist in the decannulation practices of North American RTs and physicians. Evidence-based tracheostomy guidelines are needed to facilitate the safe and effective management of patients with tracheostomies.