Respiratory care
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Editorial Comment
Postextubation Stridor in COVID-19: Should We Be Worried?
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The management of mechanical ventilation critically impacts outcome for patients with acute respiratory failure. Ventilator settings in the early post-intubation period may be especially influential on outcome. Low tidal volume ventilation in the prehospital setting has been shown to impact the provision of low tidal volume after admission and influence outcome. However, there is an overall paucity of data on mechanical ventilation for air medical transport patients. The objectives of this study were to characterize air medical transport ventilation practices and assess variables associated with nonprotective ventilation. ⋯ The overwhelming majority of air medical transport subjects had tidal volume set empirically, which may be exposing patients to nonprotective ventilator settings. Given a lack of PBW assessments, the frequency of low tidal volume use remains unknown. Performance improvement initiatives aimed at indexing tidal volume to PBW are easy targets to improve the delivery of mechanical ventilation in the prehospital arena, especially for females.
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During invasive ventilatory support, infants and children are inherently at risk for developing injury or complications related to the insertion and maintenance of an endotracheal tube (ETT). It is essential for respiratory therapists to understand the factors that contribute to the propensity for harm while preparing for, inserting, securing, and maintaining the position of an ETT throughout the duration of use. Implementing care bundles based on the available literature is useful in reducing iatrogenic complications as well as the risk for morbidity and mortality of pediatric patients requiring an ETT to facilitate respiratory support.