Respiratory care
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Comparative Study
Telemedicine Versus Face-to-Face Evaluations by Respiratory Therapists of Mechanically Ventilated Neonates and Children: A Pilot Study.
Mechanical ventilation is one of the most important therapeutic interventions in neonatal and pediatric ICUs. Telemedicine has been shown to reliably extend pediatric intensivist expertise to facilities where expertise is limited. If reliable, telemedicine may extend the reach of pediatric respiratory therapists (RTs) to facilities where expertise does not exist or free up existing RT resources for important face-to-face activities in facilities where expertise is limited. The aim of this study was to determine how well respiratory assessments for ventilated neonates and children correlated when performed simultaneously by 2 RTs face-to-face and via telemedicine. ⋯ Telemedicine technology was acceptable to RTs. Telemedicine evaluations highly correlated with face-to-face for 10 of 14 aspects of standard bedside respiratory assessment. Poor correlation was noted for more complex, patient-generated parameters, highlighting the importance of further investigation incorporating a virtual stethoscope.
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Extracorporeal membrane oxygenation (ECMO) is often used in patients with severe respiratory failure to improve oxygenation and survival. ECMO gives the lungs an opportunity to rest and recover. The addition of prone positioning therapy used concurrently with ECMO can further aid in optimizing alveolar recruitment and reducing ventilator-induced lung injury, ultimately resulting in fewer ICU admission days and improved overall survival. The objective of this review is to perform a systematic analysis of the complications reported with prone positioning and ECMO in the adult population and to briefly report on the patient outcomes in the studies. ⋯ This review highlights the limited complications documented during prone positioning and ECMO. More studies are needed to assess the clinical efficacy of the addition of prone positioning therapy to ECMO for patients in severe respiratory failure.
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Recently, it has been proved that fractional exhaled nitric oxide (FENO) results are in disagreement with other measurements of asthma control. The objective of this work is to present and validate new lung function/lung inflammation ratios. ⋯ We propose new lung function/lung inflammation ratios by which it may become possible to diagnose asthma in children and adolescents on the basis of a subject's spirometry and FENO measurements. We believe that our ratios are only supportive of the universally used parameters in the process of diagnosing asthma. (ClinicalTrials.gov registration NCT01805635.).