Respiratory care
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Limiting tidal volume (VT) in patients with ARDS may not be achieved once patient-triggered breaths occur. Furthermore, ICU ventilators offer numerous patient-triggered modes that work differently across brands. We systematically investigated, using a bench model, the effect of patient-triggered modes on the size and variability of VT at different breathing frequencies (f), patient effort, and ARDS severity. ⋯ Risk of VT > 6 mL/kg was significantly reduced in APRV and pressure support with guaranteed volume mode. APRV had the highest variability. Pressure support with guaranteed volume could be tested in patients with ARDS.
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The use of controlled mechanical ventilation results in a major reduction of diaphragmatic contractile force together with atrophy of diaphragm muscle fibers, which is a condition known as ventilator-induced diaphragmatic dysfunction. Ventilator-induced diaphragmatic dysfunction is one of the major contributors to weaning difficulties and even increased mortality. This review summarizes the current data on the pathogenesis and diagnosis of ventilator-induced diaphragmatic dysfunction, and it outlines the use of ultrasonography for diaphragm evaluation. In addition, current pharmacologic agents used to mitigate ventilator-induced diaphragmatic dysfunction are described, with a particular emphasis on the therapeutic potential of theophylline in patients with ventilator-induced diaphragmatic dysfunction-associated weaning difficulties.
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We recently demonstrated in a randomized study the feasibility and effectiveness of telephone-based health coaching using motivational interviewing on decreasing hospital readmissions and improving quality of life at 6 and 12 months after hospital discharge. In this qualitative study, we sought to explore the health-coaching intervention as seen from the perspective of the participants who received the intervention and the coaches who delivered it. ⋯ This study provided themes to further inform the delivery and implementation of health-coaching interventions in patients with COPD after hospital discharge. Health coaching forged partnerships and created a platform for patient engagement, which was confirmed by both participants and health coaches.
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Spontaneous breathing trials (SBTs) are used to assess the readiness for discontinuation of mechanical ventilation. When airway resistance (Raw) is elevated, the imposed work of breathing can lead to prolongation of mechanical ventilation. Biofilm and mucus build-up within the endotracheal tube (ETT) can increase Raw. Scraping the ETT can remove the biofilm build-up and decrease mechanical Raw. The primary aim of this study was to evaluate the impact of ETT scraping on Raw. The secondary aim was to determine whether decreasing Raw would impact subsequent SBT success. ⋯ This study demonstrated that ETT scraping can reduce Raw. The decrease in Raw post-ETT scraping did not affect subsequent SBT success.
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Readmission following a hospitalization for COPD is associated with significant health-care expenditure. ⋯ Receiving any component of a post-discharge integrated disease management program was associated with reduced 90-d readmission rate. Previous health-care utilization and lung function impairment were strong predictors of readmission.