Respiratory care
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The exponential increase in the complexity of ventilator technology has created a growing knowledge gap that hinders education, research, and ultimately the quality of patient care. This gap is best addressed with a standardized approach to educating clinicians, just as education for basic and advanced life support classes is standardized. We have developed such a program, called Standardized Education for Ventilatory Assistance (SEVA), based on a formal taxonomy for modes of mechanical ventilation. ⋯ The first 3 levels of SEVA are free and open to the public. We are developing mechanisms to offer the other levels. Spinoffs of the SEVA program include a free smartphone app that classifies virtually all modes on all ventilators used in the United States (Ventilator Mode Map), a free biweekly online training sessions focusing on waveform interpretation (SEVA-VentRounds), and modifications to the electronic health care record system for entering and charting ventilator orders.
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Continuous aerosolized β2 agonist, namely albuterol, is the most commonly used therapy for critical asthma. Benzalkonium chloride is a preservative present in some formulations of aerosolized albuterol solutions that can induce bronchospasm. Recent studies have shown that inhalation of albuterol containing benzalkonium chloride might induce unintended bronchoconstriction and poor outcomes. This study aimed to investigate whether using albuterol solutions containing benzalkonium chloride results in prolonged hospital length of stay (LOS). ⋯ In contrast to published literature showing that benzalkonium chloride may be associated with a longer duration of continuous albuterol nebulization and hospital LOS, our study demonstrated that benzalkonium chloride-containing albuterol is safe for continuous nebulization in critically ill children and not associated with worse outcomes.
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Observational Study
Changes in Peripheral Oxygen Saturation in Hospitalized Subjects During Fiberoptic Bronchoscopy: High-Flow Nasal Cannula versus Standard Oxygen Therapy.
Hypoxemia is a relatively common complication in stable patients during fiberoptic bronchoscopy (FOB). To prevent this complication, high-flow nasal cannula (HFNC) has been described as an alternative to standard oxygen therapy. However, the advantages of HFNC over standard oxygen therapy in acute care patients receiving supplemental oxygen before FOB performed with an oral approach are unknown. ⋯ In acute subjects who required oxygen support before FOB, the use of HFNC during FOB with an oral approach was associated with a smaller decrease in SpO2 and lower Δ SpO2 compared with standard oxygen therapy.