Resp Care
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Mass critical care events are increasingly likely, yet the resource challenges to augment everyday, unrestricted critical care for a surge of disaster victims are insurmountable for nearly all communities. In light of these limitations, an expert panel defined a circumscribed set of key critical care interventions that they believed could be offered to many additional people and yet would also continue to offer substantial life-sustaining benefits for nonmoribund critically ill and injured people. ⋯ Nonetheless, Emergency Mass Critical Care currently remains the only comprehensive construct for mass critical care preparedness and response. This paper reviews current concepts to provide life-sustaining care for hundreds or thousands of people outside of traditional critical care sites.
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Federal funding provides state public and private health care systems the ability to build and maintain a reserve supply of ventilators for emergency response to mass casualty incidents. Studying and planning the ventilator reserve capability requires subject-matter expertise, identification of best mechanical-ventilation practices and quality care standards, and contingency planning. ⋯ This paper discusses the pros and cons of stockpiling ventilators at one site (to be distributed as needed to disaster areas) versus increasing the number of ventilators at all hospitals. Respiratory-device corporations, respiratory professional associations, and respiratory therapists should be involved in the planning and development of respiratory mass casualty response systems.
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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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We describe a unique presentation of polymyositis-associated pneumonitis. A 45-year-old man with a history of polymyositis presented with an episode of fever, cough, dyspnea, rapidly progressive respiratory failure, and unilateral pulmonary infiltrates. ⋯ The patient was treated with systemic corticosteroids and had complete resolution of respiratory failure and pulmonary infiltrates. We discuss polymyositis/dermatomyositis-associated pneumonitis.