Resp Care
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An earlier randomized, controlled trial showed that weekly or as-needed (as opposed to daily) changes of in-line suction catheters were associated with substantial cost savings, without a higher rate of ventilator-associated pneumonia (VAP). To examine the impact of decreasing the frequency of in-line suction catheter changes in our medical intensive care unit, we conducted an observational study, comparing the catheter costs and frequency of VAP during (1) a control period, during which in-line suction catheters were changed daily, and (2) a treatment period, during which the catheters were changed every 7 days or sooner if needed, for mechanical failure or soilage. ⋯ We conclude that (1) a policy of weekly (vs daily) change of in-line suction catheter is associated with substantial cost savings, with no significant increase in the frequency of VAP, and (2) to the extent that these findings confirm the results of prior studies they support a policy of changing in-line suction catheters weekly rather than daily.
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We report a case of ventilator auto-triggering resulting from tuberculous bronchopleural fistula being managed with chest tube suction. Early recognition of bronchopleural fistula-related auto-triggering is extremely important. ⋯ Auto-triggering was confirmed in our patient when tachypnea persisted despite pharmacologic neuromuscular paralysis. Auto-triggering can be reduced or eliminated by decreasing ventilator trigger sensitivity or by decreasing the air leak flow by reducing the degree of chest tube suction.
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Case Reports
Radiographically occult right main bronchus intubation with a fastrach laryngeal mask airway endotracheal tube.
We report a case in which the distal 3 cm of an LMA-Fastrach laryngeal mask airway (LMA) endotracheal tube (ETT) was radiographically invisible. After the LMA intubation, left lung atelectasis developed. The radiopaque wire coil built into the ETT was mistakenly believed to mark the end of the ETT, so the radiograph made it appear that the end of the ETT was 2 cm above the main carina. ⋯ In this case, even in retrospect, the true end of the ETT could not be seen on the radiograph. Clinicians should be aware that the final 3 cm of the LMA-Fastrach ETT can be radiographically invisible. We believe the manufacturer should redesign this ETT to include better radiopaque markers all the way to the end of the ETT.
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Practice Guideline Guideline
AARC clinical practice guideline. Capnography/capnometry during mechanical ventilation--2003 revision & update.
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Practice Guideline Guideline
AARC clinical practice guideline. Bland aerosol administration--2003 revision & update.