Respiratory care
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Successful inhalation therapy depends on the ability of patients with COPD to properly use devices. We explored subjects' COPD knowledge, including education they receive from health care providers, treatment experiences, and practices with inhalation devices. ⋯ The survey showed differences between patients' beliefs and knowledge of COPD; the need for continuous education from health care providers, particularly on inhalation devices; and extensive use of pressurized metered-dose inhalers and dry-powder inhalers despite positive perceptions of SVNs.
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High-flow nasal cannula (HFNC) use has greatly increased in recent years. In non-neonatal pediatric patients, there are limited data available to guide HFNC use, and clinical practice may vary significantly. The goal of this study was to evaluate current HFNC practice by surveying practicing pediatric respiratory therapists. ⋯ There was no consensus on the definition of HFNC, how to set initial flow, or how to make adjustments. Aerosols were delivered by 75% of respondents, predominantly via a vibrating mesh nebulizer placed on the dry side of the humidifier. The definition of HFNC, how to set flow, and aerosolized medication delivery are areas in which more research is needed.
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High electrode temperature during transcutaneous monitoring is associated with skin burns in extremely premature infants. We evaluated the accuracy and precision of CO2 and O2 measurements using lower transcutaneous electrode temperatures below 42°C. ⋯ Transcutaneous electrode temperatures as low as 38°C allow an assessment of PtcCO2 as accurate as that with electrodes at 42°C.
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Comparative Study
A Comparison of the Adjustable Ranges of Inspiratory Pressurization During Pressure Controlled Continuous Mandatory Ventilation of 5 ICU Ventilators.
Faster inspiratory pressurization can improve patient-ventilator synchrony and reduce the patient's work of breathing during pressure controlled continuous mandatory (PC-CMV) ventilation. The characteristics of the pressurization ramp settings are not standardized across ventilators from different manufacturers. We performed a bench test of 5 models of ICU ventilators to examine the effects of pressurization ramp settings on the actual pressurization. ⋯ The adjustable ranges of the pressurization were largely different among the different types of ventilators. The actual absolute inspiratory pressurization during PC-CMV varied between the different ventilators even at similar pressurization ramp settings. Users should be mindful of the differences in the pressurization ramp settings.
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Observational Study
Accuracy of Transcutaneous CO2 Values Compared With Arterial and Capillary Blood Gases.
Transcutaneous monitors are utilized to monitor a patient's respiratory status. Some patients have similar values when comparing transcutaneous carbon dioxide (PtcCO2 ) values with blood gas analysis, whereas others show extreme variability. A retrospective review of data was performed to determine how accurately PtcCO2 correlated with CO2 values obtained by arterial blood gas (ABG) or capillary blood gas. ⋯ Based on these data, capillary blood gas comparisons showed less variation and a slightly lower correlation with PtcCO2 than did ABG comparisons. After accounting for serial measurements per patient, due to the wide limits of agreement and poor repeatability, the utility of relying on PtcCO2 readings for this purpose is questionable.