Respiratory care
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The fundamental goals of mechanical ventilation are to improve pulmonary gas exchange and relieve respiratory distress, thus permitting lung and airway healing, while at the same time lessening the risk for iatrogenic complications. This review will summarize some of the advances in mechanical ventilation in 2016, with a particular focus on ventilator-associated clinical challenges and outcomes.
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Noninvasive ventilation (NIV) is an important modality in clinical practice and is extensively studied. The growth of literature related to NIV over the past 20 years has made it difficult for clinicians to stay up to date with current best practice. This article will summarize some of the important NIV literature published in 2016 and describe any impact it may have related to the clinical use of NIV.
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The lower airway concentration of fractional exhaled nitric oxide (FENO) is unknown in children with chronic lung disease of infancy who have tracheostomy for long-term mechanical ventilation. We aimed to evaluate an online method of measuring FENO in a cohort of ventilator-dependent children with a tracheostomy and to explore the relationship between the peak FENO concentration (FENO peak) and the degree of respiratory support using the respiratory severity score. ⋯ FENO peak and plateau concentration can be measured online easily with a high degree of reliability and repeatability in infants and young children with a tracheostomy. FENO peak concentration from the lower airway is low and influenced by minute ventilation in children receiving mechanical ventilation.
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Comparative Study
Spiritual Well-Being and Correlated Factors in Subjects With Advanced COPD or Lung Cancer.
Spiritual care for patients with COPD has rarely been discussed, and thus much remains unknown about their needs. The aims of this study were to identify the factors associated with spiritual well-being and to compare the levels of spiritual well-being between subjects with advanced COPD and those with inoperable lung cancer. ⋯ These results suggest that subjects with advanced COPD experience spiritual well-being similar to that of subjects with inoperable lung cancer.
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Editorial
Impact of a Respiratory Therapy Assess-and-Treat Protocol on Adult Cardiothoracic ICU Readmissions.
The purpose of this retrospective medical record review was to report on recidivism to the ICU among adult postoperative cardiac and thoracic patients managed with a respiratory therapy assess-and-treat (RTAT) protocol. Our primary null hypothesis was that there would be no difference in all-cause unexpected readmissions and escalations between the RTAT group and the physician-ordered respiratory care group. Our secondary null hypothesis was that there would be no difference in primary respiratory-related readmissions, ICU length of stay, or hospital length of stay. ⋯ RTAT protocol implementation demonstrated a statistically significant reduction in all-cause ICU readmissions. The reduction in respiratory-related ICU readmissions did not reach statistical significance.