Resp Care
-
Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema but has been defined recently as the physiologic finding of nonreversible pulmonary function impairment. This surveillance summary reports trends in different measures of COPD during 1971-2000. ⋯ COPD is a major cause of morbidity, mortality, and disability in the U.S. Despite its ease of diagnosis, COPD remains an underdiagnosed disease, chiefly in its milder and more treatable form.
-
We tested the feasibility of incorporating a dyspnea evaluation protocol into bedside assessments routinely performed by respiratory therapists (RTs) on mechanically ventilated patients at a university teaching hospital. ⋯ Initial implementation of a dyspnea evaluation protocol was moderately successful in prompting RTs to ask mechanically ventilated patients whether they felt short of breath during scheduled bedside visits. A rapid bedside evaluation for dyspnea may prove useful in evaluating the effect on patient distress of implementing protocols designed to optimize ventilator settings or the use of sedating drugs during mechanical ventilation. By this approach RTs may also be able to promote a patient-centered approach to managing respiratory failure in the intensive care unit.
-
Many technologic and management strategies related to mechanical ventilation have been introduced in recent years. Strategies that avoid intubation and get patients extubated sooner decrease costs related to mechanical ventilation. ⋯ There is an increasing list of examples in which short-term physiologic outcomes such as improvements in blood gas values are not related to patient-important outcomes such as survival. When new mechanical ventilation technology and strategies are introduced, a question we need to ask ourselves is whether these are solutions for problems or whether these are simply solutions in search of problems.
-
The clinical utility of measures of dyspnea has been debated in the health care community. Although breathlessness can be evaluated with various instruments, the most effective dyspnea measurement tool for patients with chronic lung disease or for measuring treatment effectiveness remains uncertain. Understanding the evidence for the validity and reliability of these instruments may provide a basis for appropriate clinical application. ⋯ The dyspnea measurement instruments we studied meet important standards of validity and reliability. Discriminative measures have limited clinical utility and, when used for populations or conditions for which they are not designed or validated, the data collected may not be clinically relevant. Evaluative measures have greater clinical utility and can be applied for outcome purposes. Measures should be applied to the populations and conditions for which they were designed. The relationship between clinical therapies and the measurement of dyspnea as an outcome can develop as respiratory therapists become more comfortable with implementing dyspnea measurement instruments and use the data to improve patient treatment. Dyspnea evaluation should be considered for all clinical practice guidelines and care pathways.
-
Comparative Study
Relationship of neonatal endotracheal tube size and airway resistance.
Infants receiving mechanical ventilation require narrow-lumen, small-diameter endotracheal tubes. ⋯ The higher resistance of the 2.5 mm tube may be detrimental to extremely low birthweight infants kept on mechanical support merely "to grow." The higher resistance may increase the work of breathing and thus increase caloric expenditure and impede growth.