Respiratory care
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Noninvasive ventilation (NIV) intolerance is one reason for NIV failure. However, the characteristics, predictors, and outcomes of NIV intolerance are unclear. ⋯ NIV intolerance worsened subjects' outcomes. Younger subjects with a high heart rate and breathing frequency may be more likely to experience NIV intolerance.
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Non-ventilator ICU-acquired pneumonia after cardiothoracic surgery is challenging to diagnose, and little is known about its impact on patient outcomes. Here, our primary objective was to compare the sensitivity and specificity of cultures of 2 types of fiberoptic bronchoscopy (FOB) specimens: endotracheal aspirates (FOB-EA) and bronchoalveolar lavage fluid (FOB-BAL). The secondary objectives were to evaluate the sensitivity and specificity of spontaneous sputum cultures and of the modified Clinical Pulmonary Infection Score (CPIS) and to describe patient outcomes. ⋯ The modified CPIS has low diagnostic accuracy for non-ventilator ICU-acquired pneumonia. FOB-EA cultures perform less well than do FOB-BAL cultures for diagnosing non-ventilator ICU-acquired pneumonia. Spontaneous sputum is valuable when FOB cannot be performed but could be obtained in only a minority of subjects. When cultures are negative, antibiotic discontinuation is safe.
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Radial artery catheters are commonly placed for continuous blood pressure monitoring, frequent arterial blood gas analysis, or frequent blood sampling for diagnostic testing. Radial artery cannulation can be challenging and ultrasound guidance has emerged as a valuable adjunct for the placement of radial artery catheters. The advantages of ultrasound guidance include: real-time visualization of landmarks, improved pre-procedure planning, reduction in complications, less time spent at the bedside, and improved first-attempt success rates. ⋯ Ultrasound machines are readily available and widely utilized in many emergency departments, operating rooms, and ICUs. We will summarize the use of ultrasound guidance for the placement of radial artery catheters and describe the techniques used during ultrasound-guided arterial catheter placement. Training on the use of ultrasound should be encouraged for all practitioners who place radial artery catheters.
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Comparative Study
Effects of Breathing Pattern on Oxygen Delivery Via a Nasal or Pharyngeal Cannula.
During sedation for upper gastrointestinal endoscopy, oxygen delivery via a nasal cannula is often necessary. However, the influences of the oxygen delivery route and breathing pattern on the F(IO2) have not been thoroughly investigated. The aim of this simulation study was to investigate the difference in the F(IO2) with a pharyngeal cannula versus nasal cannula during high- or low-tidal volume (V(T)) ventilation and open- or closed-mouth breathing. ⋯ A pharyngeal cannula provided a higher F(IO2) compared with a nasal cannula at the same oxygen flow. Open-mouth breathing resulted in a higher F(IO2) compared with closed-mouth breathing when 5 L/min oxygen was delivered via a pharyngeal cannula. The breathing pattern did not affect the F(IO2) in this study.
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In our institution's pediatric emergency department, adherence to evidence-based asthma guidelines was noted to be suboptimal for patients with asthma exacerbations. We hypothesized that an evidence-based asthma protocol would improve time to treatment and adherence to National Institutes of Health guidelines for patients presenting to the emergency department with status asthmaticus. ⋯ An asthma protocol resulted in improved adherence to National Institutes of Health guidelines in children with status asthmaticus and improved efficiency in the administration of rescue bronchodilator and systemic corticosteroid therapy.