Resp Care
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Comparative Study
Prevalence of chronic obstructive pulmonary disease and tobacco use in veterans at Boise Veterans Affairs Medical Center.
Although its prevalence is still debated, chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States, and smoking cessation remains the only intervention that can significantly improve the prognosis of COPD. ⋯ The prevalence of COPD in patients at the Boise Veterans Affairs Medical Center was consistent with that in other United States surveys, although the underutilization of screening spirometry in those at risk for COPD may have caused underestimation of the prevalence. Smoking, age, and male sex were identified as significant risk factors for COPD, and the prevalence of active smoking remains high in this population of veterans.
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The American Association for Respiratory Care has established a task force to identify potential new roles and responsibilities of respiratory therapists (RTs) in 2015 and beyond. The first task force conference confirmed that the healthcare system in the United States is on the verge of dramatic change, driven by the need to decrease costs and improve quality. Use of evidence-based protocols that follow a nationally accepted standard of practice, and application of biomedical innovation continue to be important competency areas for RTs. ⋯ The education needed by the workforce to assume the new responsibilities emerging as the healthcare system changes starts with a close look at the competencies that will be needed by graduate RTs upon entry into practice. Future specialty practice areas for experienced RTs are identified without defining specific competencies. We present the findings of the task force on the competencies needed by graduate RTs upon entry into practice in 2015.
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Case Reports
Alveolar dead-space response to activated protein C in acute respiratory distress syndrome.
We report a complicated case of acute respiratory distress syndrome (ARDS) from severe sepsis, in which we measured the ratio of physiologic dead space to tidal volume (V(D)/V(T)) with volumetric capnography prior to, during, and after therapy with human recombinant activated protein C. Previous studies hypothesized that early in ARDS, elevated V(D)/V(T) primarily reflects increased alveolar V(D), probably caused by pronounced thrombi formation in the pulmonary microvasculature. This may be particularly true when severe sepsis is the cause of ARDS. ⋯ Thus, improved alveolar perfusion persisted despite signs of alveolar de-recruitment. This suggests that activated protein C may have reduced microvascular obstruction. This report provides indirect evidence that microvascular obstruction may play an important role in elevated V(D)/V(T) in early ARDS caused by severe sepsis.