Resp Care
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Deaths and injuries related to accidental ventilator disconnection occur in complex ways. A death related to accidental ventilator disconnection is presented from a subacute ventilator facility, and corrective action is discussed. Single-limb ventilators are now equipped with a flow-bypass coupling that prevents patient-side occlusion during disconnect and therefore prevents low-pressure alarm malfunction. Physicians and respiratory therapists can consider this device to prevent partial or total occlusion of the ventilator tracheostomy adapter, thus allowing a low-pressure alarm in the event of a disconnect.
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Many healthcare professionals performing spirometry in primary care have had less than half a day's training in spirometry practice, and the validity of the test results is questionable. Longer training periods, with or without follow-up training, may improve test validity. ⋯ A 14-hour spirometry training course alone does not provide sufficient skill to perform spirometry to ATS criteria, and short-term follow-up is an essential component for improving test validity.
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Mediastinal and hilar lymph node evaluation with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is being performed with increasing frequency. Original reports described performance under general anesthesia. Patient satisfaction is an important determinant of whether EBUS-TBNA may be performed under conscious sedation. ⋯ EBUS-TBNA may safely be performed under conscious intravenous sedation and is associated with very high patient satisfaction.