Resp Care
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Cardiac arrest is a common and lethal medical problem; each year more than half a million people in the United States and Canada suffer cardiac arrest treated by emergency medical personnel or in-hospital providers. Of those who survive to hospital admission or suffer in-hospital arrest, 40-60% die prior to discharge. Neurologic injury is the major source of morbidity and mortality after recovery of spontaneous circulation. ⋯ Clear consensus statements recommend that unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled if the initial rhythm was ventricular fibrillation, and that therapeutic hypothermia should be considered for other patients (other rhythms or in-hospital arrest). However, the position that all patients should be cooled following cardiac arrest is probably too broad, given the lack of studies on patients with non-ventricular-fibrillation rhythms, in-hospital arrest, or non-cardiac causes of arrest. Further research is needed to determine the broadest application of moderate therapeutic hypothermia.
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Ventilator manufacturers and the respiratory care academic community have not yet adopted a standardized system for classifying and describing ventilation modes. As a result, there is enough confusion that potential sales, education, and patient care are all put at risk. This proposal summarizes a ventilator-mode classification scheme and complete lexicon that has been extensively published over the last 15 years. ⋯ For a complete and unique mode specification (as in an operator's manual) we would use all 3 components. The classification system proposed in this article uses the equation of motion for the respiratory system as the underlying theoretical framework. All terms relevant to describing ventilation modes are defined in an extensive glossary.
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Though advances in medical science have created improved therapies, often these are not widely provided throughout the health-care system. Also, there is growing recognition of the lack of safety in health-care delivery. ⋯ This paper explores the parallel developments in safety and quality-of-care assessment, evidence-based medicine, guideline creation, and how development of national and international quality-improvement campaigns are promoting rapid change in care delivery processes. I discuss how this new opportunity can improve the quality of respiratory care and enhance the adoption of respiratory care protocols.
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To determine the effect of endotracheal-tube cuff deflation on airflow and F(IO2) during high-frequency percussive ventilation (HFPV), and explore methods of correcting the cuff-deflation-associated decrease in mean airway pressure and F(IO2) at the carina. ⋯ Cuff-deflation-associated F(IO2), P(aw), and pulsatile V(T) compromise can be partially corrected by any of the 4 methods we studied. Injecting supplemental oxygen at the inspiratory fail-safe valve is the most effective method.
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We present a case of a patient with severe chronic obstructive pulmonary disease who developed dramatic mediastinal and subcutaneous emphysema, without pneumothorax, following a difficult intubation. Misdiagnosis of tracheal rupture as barotrauma from alveolar overdistention initially delayed intervention and caused persistence of subcutaneous emphysema. Despite efforts to minimize tidal volume and airway pressure, the large airway disruption and positive-pressure ventilation resulted in tension subcutaneous emphysema with near-fatal hemodynamic compromise, oliguria, and respiratory acidosis. Decompression with subcutaneous vents immediately reversed the life-threatening circulatory and respiratory compromise and stabilized the patient until surgical correction of the tracheal tear could be accomplished.