Respiratory care
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Randomized Controlled Trial
Effects of Volume Guaranteed Ventilation Combined with Two Different Modes in Preterm Infants.
Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes. Therefore, we investigated the effects of SIMV+VG and PSV+VG on ventilatory parameters, pulmonary inflammation, morbidity, and mortality in preterm infants. ⋯ PSV+VG provided closer tidal volumes to the set value in ventilated preterm infants with respiratory distress syndrome and was not associated with overventilation or a difference in mortality or morbidity when compared to SIMV+VG. Therefore, PSV+VG is a safe mode of mechanical ventilation to be used for respiratory distress syndrome.
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Ultrasound-based diaphragmatic thickness fraction is a reflection of the size and function of the diaphragm. This study aimed to examine the value of this measurement in identifying patients with COPD who are at high risk for the development of symptoms and exacerbations. ⋯ Diaphragmatic thickness fraction measurements based on diaphragmatic ultrasound assessment in subjects with COPD seemed to be unable to identify subjects at high risk of symptoms and exacerbations as defined by the Global Initiative for Chronic Obstructive Lung Disease ABCD composite disease index.
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Editorial Observational Study
Predicting Extubation Outcome by Cough Peak Flow Measured Using a Built-in Ventilator Flow Meter.
Successful weaning from mechanical ventilation depends on the patient's ability to cough efficiently. Cough peak flow (CPF) could predict extubation success using a dedicated flow meter but required patient disconnection. We aimed to predict extubation outcome using an overall model, including cough performance assessed by a ventilator flow meter. ⋯ CPF measured using the flow meter of an ICU ventilator was able to predict extubation success and to build a composite score to predict extubation failure. The results were close to that found in previous studies that used a dedicated flow meter. This could help to identify high-risk subjects to prevent extubation failure. (ClinicalTrials.gov registration NCT02847221.).
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Usual practice in community health-care settings indicates that arterial catheters are inserted by physicians. In the context of a respiratory therapist (RT)-managed arterial catheter placement protocol being implemented in our community hospital, the current study describes the implementation and outcomes of this RT-managed arterial catheter insertion and maintenance program. ⋯ This experience establishes the feasibility of an RT-managed arterial catheter placement program in a community ICU. The RT-managed program was characterized by a high degree of success and safety and allowed arterial catheter placement at times when intensivists were not available in the ICU. This experience extends the sparse reported experience of RT-managed arterial catheter placement programs and underscores the value of RTs as members of the ICU team.
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According to Taiwan's integrated delivery system policy, ventilator-dependent patients are successfully liberated from mechanical ventilation in accordance with step-down care. However, premature discharge affects the 14-d readmission quality index. Therefore, we explored the risk and related factors of subjects liberated from mechanical ventilation who were re-intubated within 14 d. ⋯ Factors associated with re-intubation within 14 d after ventilator liberation are related to the level and quality of the care setting; thus, to prevent re-intubation, more attention should be paid to higher-risk ventilator-dependent subjects after they are liberated from mechanical ventilation.