Respiratory care
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Newer pulse oximetry technology is available that uses multiple wavelengths of light and is thereby able to measure more than 2 forms of hemoglobin, including carboxyhemoglobin (SpCO), methemoglobin (SpMet), and total hemoglobin (SpHb). Several studies have shown relatively low bias, but poor precision, for SpCO compared with HbCO. Evaluations of SpMet have been conducted primarily in normal subjects. ⋯ However, there are limitations to this approach, and it remains to be determined how well it can be applied clinically using existing pulse oximetry technology. The pulse oximeter signal is probably useful for applications beyond SpO2 However, the current technology is not mature, and improvements are necessary. With technology improvements, the use of pulse oximetry to detect SpCO, SpMet, SpHb, pulsus paradoxus, breathing frequency, and fluid responsiveness is likely to improve in the future.
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Patients are at risk for respiratory complications after sustaining blunt chest trauma, yet contradictory evidence exists about the utility of prophylactic respiratory therapy to reduce respiratory complications in this population. This study assessed the effectiveness of a proactive respiratory protocol on an in-patient ward to identify trauma patients at risk for pulmonary complications, administer appropriate therapies, and prevent deterioration requiring transfer to the ICU. ⋯ Study results suggest that a preventive respiratory protocol had a beneficial effect on patient outcomes; receiving the protocol reduced hospital days and eliminated unplanned admission to the ICU.
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Quality improvement methodology was applied to study sporadic reports that patients with asthma were not given bronchodilator treatments or assessed within an appropriate time frame when they were admitted from the emergency department to the medical ward. The goal was to increase the number of patients who had an interval between emergency department assessment/bronchodilator treatment and medical ward assessment/treatment of <120 min. ⋯ Through quality improvement methodology, the group was able to significantly decrease the time between the last assessment/bronchodilator treatment in the emergency department and the first assessment/treatment in the medical ward for subjects with asthma. Moreover, improvement was seen in all studied parameters despite similar volumes in emergency department visits.
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Volutrauma has been established as the key factor in ventilator-induced lung injury and can only be avoided if tidal volume (VT) is accurately displayed and delivered. The purpose of this study was to investigate the accuracy of displayed exhaled VT in a ventilator commonly used in small infants with or without a proximal flow sensor and using 3 methods to achieve a target VT in both a healthy and lung-injured neonatal pig model. ⋯ When the Servo-i ventilator is used in neonates, CCC or the in-line sensor should be employed due to the large positive bias and imprecision seen with CCC off and no sensor in-line.
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Peak expiratory flow (PEF) is a spirometric test that detects obstructive changes in the respiratory tract; has good correlation with the FEV1; and is much less expensive, simpler, and easier to perform under field conditions than FEV1. Chronic silicosis is also known to have obstructive features in advanced stages. Thus, this study was performed to assess the effect of silica exposure on PEF and the factors related to it. ⋯ Higher age, female sex, higher duration of exposure, and respiratory morbidity were found to be important correlates of PEF.