Respiratory care
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Data are limited regarding current practice and outcomes for emergency department airway management in status asthmaticus. This paper describes the foremost methods and outcomes of airway management in patients in the emergency department who required intubation for status asthmaticus. ⋯ Status asthmaticus accounted for about 1% of emergent medical intubations. The majority of patients were intubated using rapid-sequence intubation after preoxygenation with BPAP and induction with ketamine, with the latter 2 practices being much more common for emergent intubations for status asthmaticus than for other medical indications.
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Automatic tube compensation (ATC) unloads endotracheal tube (ETT) resistance. We conducted a bench assessment of ATC functionality in ICU ventilators to improve clinical management. ⋯ ATC is used more frequently in clinical practice than expected. In addition, VT delivery by ATC differed slightly though significantly between ventilators.
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Pediatric ARDS is a heterogeneous disease entity with high morbidity and mortality. In this study, we categorized pediatric ARDS by direct and indirect initial triggering events and identified characteristics of survivors and nonsurvivors in these 2 subtypes. ⋯ Direct and indirect pediatric ARDS had distinct clinical characteristics, especially in terms of prognostic factors. Variables related to mechanical ventilation were significantly associated with mortality among subjects with direct pediatric ARDS, but not among subjects with indirect pediatric ARDS. Thus, this study provides evidence of the potential benefit of categorizing patients with pediatric ARDS by subtype for evaluating prognostic factors and developing adjusted management strategies to improve clinical outcomes.
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The transition from an ICU ventilator to a portable home ventilator (PHV) for children requiring long-term mechanical ventilation is a crucial step in preparing for discharge home and may not be successful on the first attempt. A review of this process at our institution revealed that some children required multiple trials before they were able to tolerate a PHV. A protocol was developed to standardize the transition process and reduce the number of failed attempts. Key features of the protocol included a transition readiness assessment and criteria for changing to the PHV. ⋯ The process of changing from an ICU ventilator to a PHV in children requiring long-term mechanical ventilation was improved through the use of a standardized protocol. Both the number of failed attempts and the length of time to achieve successful transition were reduced when the protocol was applied. Further study is needed to evaluate other medical and nonmedical factors that may affect successful transition to a PHV.
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In actuality, it is difficult to obtain an early prognostic stratification for patients with acute respiratory failure treated with noninvasive ventilation (NIV). We tested whether an early evaluation through a predictive scoring system could identify subjects at risk of in-hospital mortality or NIV failure. ⋯ Among the subjects treated with NIV for acute respiratory failure, the HACOR score seemed to be a useful tool to identify those at risk of in-hospital mortality.