Respiratory care
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Randomized Controlled Trial Comparative Study
Gradual versus sudden weaning from nasal CPAP in preterm infants: a pilot randomized controlled trial.
There is paucity of information on the weaning of nasal CPAP (NCPAP) in preterm infants. As the weaning from NCPAP can be gradual or sudden, we wanted to determine which of the 2 methods was better. ⋯ There was no difference in the success of weaning from NCPAP between the 2 weaning methods. The weight and postmenstrual age at the time of successful NCPAP wean also did not differ between the 2 groups. These findings suggest that factors other than the method of CPAP wean, such as pulmonary maturity, may determine the success of NCPAP wean in preterm infants.
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Comparative Study
Comparing the effects of rise time and inspiratory cycling criteria on 6 different mechanical ventilators.
Inspiratory rise time and cycling criteria are important settings in pressure support ventilation. The purpose of this study was to investigate the impact of minimum and maximum rise time and inspiratory cycling criteria settings on 6 new generation ventilators. Our hypothesis was there would be a difference in the exhaled tidal volume, inspiratory time, and peak flow among 6 different ventilators, based, on change in rise time and cycling criteria. ⋯ Significant differences in exhaled tidal volume, inspiratory time, and peak flow were observed by adjusting rise time and cycling criteria. This research demonstrates that during pressure support ventilation strategy, adjustments in rise time and/or cycling criteria can produce changes in inspiratory parameters. Obviously, this finding has important implications for practitioners who utilize a similar pressure support strategy when conducting a ventilator wean. Additionally, this study outlines major differences among ventilator manufacturers when considering inspiratory rise time and cycling criteria.
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Randomized Controlled Trial Comparative Study
Peak expiratory flow in bed? A comparison of 3 positions.
Current guidelines for the correct peak expiratory flow (PEF) maneuver include standing. In the hospital setting, PEF values are often ordered to assess response to asthma therapy for exacerbations. We have observed that the PEF is sometimes performed with the patient in bed. ⋯ Clinicians should ensure that PEF is obtained with patients out of bed and in the standing position.
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Comparative Study
Physician-ordered aerosol therapy versus respiratory therapist-driven aerosol protocol: the effect on resource utilization.
The utilization of respiratory therapist (RT) driven protocols for single interventions, such as oxygen titration and bronchopulmonary hygiene, and protocols consisting of multiple interventions have been associated with improvements in resource utilization. Based on this, we started a quality improvement project to transition the delivery of respiratory care services from physician-ordered treatments to RT-driven protocols. During the first phase of our quality improvement project, we compared the frequency of bronchodilator administration and its associated costs, between a physician-ordered bronchodilator strategy and a RT-driven bronchodilator protocol strategy. ⋯ The application of an RT-driven bronchodilator protocol can hypothetically reduce the frequency of bronchodilator treatments, compared with a physician-ordered strategy, resulting in a theoretical reduction of costs in patients who require bronchodilator therapy.