Resp Care
-
To examine physician practice in, and the costs of, prescribing inhaled bronchodilators to mechanically ventilated patients who do not have obstructive lung disease. ⋯ A substantial proportion of mechanically ventilated patients without obstructive lung disease received inhaled bronchodilators.
-
For weaning patients from prolonged mechanical ventilation, we previously designed a respiratory-therapist-implemented weaning protocol that decreased median weaning time from 29 days to 17 days. An acceleration step at the start of the protocol allowed patients with a rapid shallow breathing index (RSBI) of < or = 80 to advance directly to spontaneous breathing trials (SBTs). ⋯ The conservative RSBI threshold of
-
High-frequency ventilation can be delivered with either oscillatory ventilation (HFOV) or jet ventilation (HFJV). Traditional clinician biases may limit the range of function of these important ventilation modes. We hypothesized that (1) the jet ventilator can be an accurate monitor of mean airway pressure (P (aw)) during HFOV, and (2) a mathematical relationship can be used to determine the positive end-expiratory pressure (PEEP) setting required for HFJV to reproduce the P (aw) of HFOV. ⋯ HFJV is an accurate monitor during HFOV. These measurements can be used to calculate the predicted PEEP necessary to match P (aw) on the 2 ventilators. Replicating the P (aw) with adequate PEEP on HFJV may help simplify transitioning between ventilators when clinically indicated.
-
The time course of the physiological derangements that result from ventilator-induced lung injury has not been adequately described. Similarly, the regional topographies of pleural pressure and tissue edema have not been carefully mapped for this injury process. ⋯ Following the induction period, the development of ventilator-induced lung injury progressed steadily and then plateaued, as assessed by quantitative physiology variables during 6 hours of ventilation at a transpulmonary pressure of 35 cm H(2)O. Greater injury developed in animals that had a coexisting potential insult (thoracotomy). Injury development was not paralleled by bloodborne inflammatory cytokines.
-
Expert management of tracheal intubation has become fundamental to the routine practice of pulmonary physicians who work in respiratory intensive care units (ICUs). In Italy, tracheal intubation is not included as part of the training in respiratory medicine, and pulmonary physicians are usually dissuaded from managing intubations. ⋯ Pulmonary physicians trained in tracheal intubation can have a high success rate in performing intubation in the respiratory ICU. Collaborative efforts between anesthesiologists and pulmonary physicians are necessary to optimize the training, skill-retention, and back-up for advanced airway management in the respiratory ICU.