Respiratory care
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Approaches to respiratory care of patients needing prolonged mechanical ventilation (PMV) might be varied. In this study we assessed the predictive value of usual variables for extubation outcome in PMV patients. ⋯ In PMV subjects who tolerated spontaneous breathing trials and were ready to extubate, ineffective cough was the best predictor of extubation failure. Furthermore, extubation failure was associated with future mortality; thus, different management strategies need to be developed for improving patient outcome.
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Pulmonary hypertension (PH) is a common consequence of COPD. It has been speculated that patients showing serious PH and vascular remodeling without severe airway obstruction might benefit from vasoactive treatment. There is no approved drug available for COPD-induced PH. ⋯ The maximum gains in 6-min walk distance of the individual subjects were at the 9th, 13th, and 18th month. Oxygenation was stable, and no side effects were observed. We suggest from this experience that in clinical trials of PH in COPD, a follow-up of 16 weeks might cause underestimation of the treatment effects.
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For centuries, hospitals have served as the cornerstone of the United States healthcare system. Just like the majority of the general population, the respiratory care profession was born inside the hospital walls, just over 6 decades ago. While the knowledge, skills, and attributes of the respiratory therapist are critically necessary in acute care settings, the profession must move itself to a stronger position across the entire continuum of care of patients with acute and chronic cardiopulmonary diseases within the next several years to stay ahead of the curve of healthcare reform. In this paper, based on the 28th annual Philip Kittredge Memorial Lecture, I will examine the necessary strategies and values that the profession of respiratory care will need to successfully embrace to "think outside the box" and move the profession beyond the hospital walls for patient- and outcomes-focused, sustainable impact in the future healthcare delivery system.
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Editorial Comment
What's to be learned from 10 patients in one pediatric ICU?