Resp Care
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Review Meta Analysis
Effect of ventilator circuit changes on ventilator-associated pneumonia: a systematic review and meta-analysis.
Recent guidelines concerning prevention of ventilator-associated pneumonia recommend that ventilator circuits should not be changed routinely, but in practice circuit changes at regular intervals persist. ⋯ Frequent ventilator circuit changes are associated with a high risk of ventilator-associated pneumonia. No routine circuit change is safe and justified. Hospital infection-control policies and bedside practitioners should translate the evidence into clinical practice, if they haven't done so already.
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Comparative Study Clinical Trial
Effective inspired oxygen concentration measured via transtracheal and oral gas analysis.
The fraction of inspired oxygen (F(IO(2))) is quoted for different oxygen delivery systems, but variations in inspiratory flow and tidal volume make precise measurement difficult. We developed a reliable method of measuring the effective F(IO(2)) in patients receiving supplemental oxygen. ⋯ Exhaled gas sampled at the mouth accurately reflected the effective F(IO(2)) in the trachea. In relation to inspired oxygen flow, the effective F(IO(2)) was lower than is conventionally thought. Compared to nasal cannula, transtracheal catheter approximately doubled the effective F(IO(2)) at a given flow rate. Accurate knowledge of F(IO(2)) should aid clinicians in managing patients with acute and chronic lung diseases.
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Comparative Study
A novel, versatile valved holding chamber for delivering inhaled medications to neonates and small children: laboratory simulation of delivery options.
Delivery of bronchodilator to infants and small children from a pressurized metered-dose inhaler with valved holding chamber (pMDI-VHC) is limited by airway narrowness, short respiratory cycle time, and small tidal volume (V(T)). There is a need for a versatile, efficient VHC, given the variety of treatment modalities. ⋯ The reduced delivery of albuterol during mechanical ventilation (compared to during spontaneous breathing and manual resuscitation via ETT) was probably associated with the saturated atmosphere in the breathing circuit (37 degrees C, relative humidity > 99%), compared to the ambient air (22 +/- 1 degrees C, 44 +/- 7% relative humidity). The AeroChamber Mini VHC may provide a versatile alternative to VHCs that are designed exclusively for one aerosol treatment modality.
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Prolonged immobilization may harm intensive care unit (ICU) patients, and early mobilization has been proposed to counteract that process. We describe our experience in early rehabilitation of ICU patients, and its effects on physiologic outcomes. ⋯ Early rehabilitation is feasible and safe in patients in the ICU for longer than 1 week. The chair-sitting intervention was associated with nonsignificant oxygenation improvement. The tilting-up intervention was an effort as intense as walking.
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Comparative Study Clinical Trial
High-flow oxygen therapy in acute respiratory failure.
To compare the comfort of oxygen therapy via high-flow nasal cannula (HFNC) versus via conventional face mask in patients with acute respiratory failure. Acute respiratory failure was defined as blood oxygen saturation < 96% while receiving a fraction of inspired oxygen > or = 0.50 via face mask. ⋯ HFNC was better tolerated and more comfortable than face mask. HFNC was associated with better oxygenation and lower respiratory rate. HFNC could have an important role in the treatment of patients with acute respiratory failure.