Resp Care
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Flexible fiberoptic bronchoscopy is a commonly performed procedure for which the indications, technical aspects, and potential patient complications have been well described. However, limited information is available regarding damage to the instrument itself. In order to better describe the types and causes of bronchoscope damage, repair costs, and time out of service, we performed a postal survey of hospital bronchoscopy laboratories in Alabama, Mississippi, and Louisiana. ⋯ The average time out of service (mean, SD) for each damaged bronchoscope was 3.5 (3.9) weeks, and the average repair cost per episode of bronchoscope damage was $2,726.13 ($1,391.21). At least 19 episodes of bronchoscope damage occurred during cleaning and disinfecting procedures. We conclude that the majority of bronchoscope damage and repair costs should be potentially preventable and suggest that a program to familiarize all personnel handling bronchoscopes with proper maintenance and handling procedures should decrease the risk of bronchoscope damage.
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Because of the design characteristics, flow-triggering appears to offer measurable advantages over pressure-triggering, particularly during spontaneous breathing. During the trigger phase, flow-triggering provides a relatively shorter time delay than pressure-triggering. A trigger sensitivity that does not cause autocycling can be set while a short time delay is maintained. ⋯ With a flow-by or demand-flow system, the circuit pressure-sensing site influences the flow-pressure control algorithm in the post-trigger phase only. In microprocessor-based ventilators, the shortcomings seen with pressure-triggering during the post-trigger phase can unquestionably be overcome with a better ventilator algorithm design or the application of a small amount of pressure support. However, during the trigger phase, the impact of this effort is less clear.
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These changes are proposed as a starting point for the more logical application of ventilator terminology and are for your consideration and debate. It is our contention that this system can be easily adopted once the basics of the classification system are understood.