Respiratory care
-
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.
-
Review
An Introduction to the Clinical Application and Interpretation of Electrical Impedance Tomography.
Electrical impedance tomography is no longer a new technology, but its clinical use at the bedside is still in its primary stage. Global research has drastically increased since its commercial availability, and this has slowly begun to make its way into routine clinical bedside use in some areas of the world. This paper will provide the bedside clinician an introduction to the technology, how it is used, and the most common applications found in the literature.
-
Contemplating the future should be grounded in history. The rise of post-polio ICUs was inextricably related to mechanical ventilation. Critically ill patients who developed acute respiratory failure often had "congestive atelectasis" (ie, a term used to describe ARDS prior to 1967). ⋯ Therefore, it is imperative we understand the long-crooked path needed to reach the era of protective ventilation in order to avoid similar mistakes moving forward. The emerging era is as difficult to fathom as our current practices and technologies were to those practicing 60 years ago. This review explores the history of mechanical ventilation in treating ARDS, describes current protective ventilation strategies, and speculates how ARDS management might look 20 years from now.
-
Multicenter Study
Flexible Bronchoscopy in Pediatric Venovenous Extracorporeal Membrane Oxygenation.
Pediatric patients with ARDS will on occasion need venovenous extracorporeal membrane oxygenation (VV-ECMO) for organ support. As these patients recover, they may benefit from lung recruitment maneuvers including flexible bronchoscopy (FB). The objective of this study was to assess the clinical course of patients who underwent FB while on VV-ECMO for ARDS. ⋯ FB can be performed on patients while anticoagulated on VV-ECMO with a low incidence of complications. FB may be beneficial especially when performed early in the course of VV-ECMO.
-
Teaching and learning using simulation-based methods is increasing in health professions education; however, the prevalence of simulation use in respiratory care programs to date has not been explored. ⋯ Simulation-based teaching and learning is widespread and varied, but there is a lack of faculty development in its use among respiratory care programs.