Respiratory care
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Observational Study
Sleep Assessment in Critically Ill Subjects With Acute Hypoxemic Respiratory Failure.
Sleep deprivation alters respiratory muscle performance and may precipitate respiratory failure. This study aimed to assess sleep in subjects admitted to ICU for acute hypoxemic respiratory failure and its role in the risk of intubation. ⋯ Whereas total sleep time remained relatively preserved in critically ill subjects with acute hypoxemic respiratory failure, REM sleep time was uncommon or completely absent in a large number of subjects. Sleep did not differ between subjects who required intubation and those who did not. However, given a trend toward an increased risk of intubation in subjects with a complete absence of REM sleep, further studies are needed to better explore the impact of REM sleep on the risk of intubation.
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Determination of optimum PEEP levels remains an elusive goal. One factor is the recruitability of the lung, yet this is another difficult determination. Recently, a simple bedside technique, called the recruitment-to-inflation ratio, has been described and validated by comparison to the dual pressure-volume curve method. We describe the prior research and concepts of lung mechanics leading up to this metric and develop some background mathematics that help clinicians understand its meaning.
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The emerging challenges in the healthcare system require a vision for the future of respiratory care to ensure a successful transition to practice for new graduate respiratory therapists (RT). The nursing profession has recognized the need to acknowledge the successes and failures of graduates' transition to practice so that these programs can be continuously improved. The challenge is in identifying aspects of the transition to practice that may improve job satisfaction, retention, professional development, and patient care for RTs. This research aimed to explore the perceptions of new graduate RTs' experiences during their first year of practice and identify barriers and facilitators to a successful transition to practice. ⋯ New graduate RTs experienced many barriers to their transition to practice. Respiratory care leadership should identify barriers faced by new graduate RTs during their transition to practice. A nurse residency model may provide a framework for RT transition-to-practice programs. Improving transition-to-practice programs for new graduate RTs and surveying their experiences may lead to an increase in job satisfaction, retention, and improved patient care.