Respiratory care
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Review Randomized Controlled Trial
Identification and Prevention of Extubation Failure in Adults using an Automated Continuous Monitoring Alert vs Standard Care: A Randomized Controlled Trial.
Postextubation monitoring helps identify patients at risk of developing respiratory failure. This study aimed to evaluate the effect of our standard respiratory therapist (RT) assessment tool versus an automated continuous monitoring alert to initiate postextubation RT-driven care on the re-intubation rate. ⋯ In subjects who received mechanical ventilation for > 24 h, there were no significant outcome or cost differences between our standard RT assessment tool or an automated monitoring alert to initiate postextubation RT-driven care. Using an automated continuous monitoring alert to initiate RT-driven care saved RT time. (ClinicalTrials.gov registration NCT04231890).
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Timing of intubation in COVID-19 is controversial. We sought to determine the association of the ROX (Respiratory rate-OXygenation) index defined as [Formula: see text] divided by [Formula: see text] divided by breathing frequency at the time of intubation with clinical outcomes. ⋯ Among a cohort of subjects with COVID-19 who were ultimately intubated, a higher ROX index at the time of intubation was positively associated with survival.
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The purpose of this study was to ascertain whether the COVID-19 pandemic and the instructional changes implemented in response to it affected student enrollment, retention, or success on the National Board for Respiratory Care credentialing examinations at an associate degree respiratory care program in the state of Texas. ⋯ The COVID-19 pandemic and the instructional changes implemented in response to it decreased students' first-time pass rate on the Therapist Multiple-Choice examination in the mid-pandemic group compared with the pre- and early-pandemic groups.
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Unplanned extubation (UE) is associated with adverse outcomes. The aim of the study was to compare the clinical outcomes in preterm infants who experienced at least one UE to those who did not experience any UE. ⋯ Infants who experienced UE had higher odds of spending longer time on mechanical ventilation and spent significantly more days in the hospital.
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Infection with SARS-CoV-2 in select individuals results in viral sepsis, pneumonia, and hypoxemic respiratory failure, collectively known as COVID-19. In the early months of the pandemic, the combination of novel disease presentation, enormous surges of critically ill patients, and severity of illness lent to early observations and pronouncements regarding COVID-19 that could not be scientifically validated owing to crisis circumstances. One of these was a phenomenon referred to as "happy hypoxia." Widely discussed in the lay press, it was thought to represent a novel and perplexing phenomenon: severe hypoxemia coupled with the absence of respiratory distress and dyspnea. ⋯ This narrative review examines silent hypoxemia during COVID-19 as well as hypotheses that viral infection of the central and peripheral nervous system may be implicated. Moreover, the credulous embrace of happy hypoxia and the novel hypotheses proposed to explain it has exposed significant misunderstandings among clinicians regarding the physiologic mechanisms governing both the control of breathing and the modulation of breathing sensations. Therefore, a substantial focus of this paper is to provide an in-depth review of these topics.