Resp Care
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Comparative Study
Variations in tidal volume with portable transport ventilators.
As intra- and interhospital transportation of ventilator-dependent patients has become more commonplace, the number of portable transport ventilators has increased. Transport ventilators should be capable of delivering consistent tidal volume (VT) from breath to breath following changes in lung-thorax compliance and airways resistance. We sought to determine the effect of changes in compliance (C) and resistance (R) on the VT delivered by eight commercially available, time-cycled transport ventilators. ⋯ Decreases in VT with a transport ventilator predispose patients to hypoventilation, hypercapnia, and acidemia. Tidal volume often is not monitored continuously during transport, yet large decreases in VT must not be allowed when pulmonary mechanics are unstable. Internal pressure-limiting valves, venturi flow-generating devices, and compression volume in the breathing circuit are at least three factors that affect VT with transport ventilators.
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Errors in employee selection and consequent high turnover rates are expensive and can result in poor staff morale and possible harm to patients and personnel. ⋯ The data offer cautious evidence for the validity of some application items to predict some employee behaviors. The relatively low correlations among the criterion variables (absenteeism, tardiness, tenure, and performance) suggest that these items may be assessing substantially different aspects of employee behavior.
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The introduction of the intensive care unit (ICU) in the 1960s with its demands for management of large volumes of patient data drove the initial introduction of computers into the ICU. Since the mid-1960s computer systems for the ICU have evolved into the highly sophisticated bedside workstations commercially available today. Despite all of the technologic advances in computers, their application in ICUs in the United States continues to spread very slowly. ⋯ Research systems have demonstrated that if one extends these systems to incorporate a fully integrated database, decision-support tools, automation of data acquisition, and more sophisticated display and user-interface technology, then these ICU computer systems can have a significant impact on improving the quality and reducing the costs of patient care. For computers to be embraced in the ICU environment, commercial systems of the future must move beyond merely gathering and displaying information. They must help the clinician at the bedside assimilate the vast array of ICU data and help him to make more effective decisions.
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We report the evaluation of a cart we created to provide high frequency jet ventilation (HFJV) to neonates during intrahospital or interhospital transport. ⋯ Our HFJV transport system is adequate to transport an HFJV-dependent infant during the 30 to 60 minutes that may elapse when the cart is away from ambulance or hospital sources of electricity and gas. Available operating time with an HFJV transport system should be estimated conservatively; when an infant is dependent on HFJV, it would be well to have aircraft backup in case of ambulance breakdown or other contingencies.
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Increased stress, burnout, and lack of job satisfaction may contribute to a decline in work performance, absenteeism, and intent to leave one's job or field. We undertook to determine organizational, job-specific, and personal predictors of level of burnout among respiratory care practitioners (RCPs). We also examined the relationships among burnout, job satisfaction (JS), absenteeism, and RCPs' intent to leave their job or the field. ⋯ Reduced job stress, increased job independence and job control, improved role clarity, and higher levels of JS were all associated with lower levels of burnout. Managerial attention to these factors may improve patient care and reduce absenteeism and turnover among RCPs.