Respiratory care
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The word "quality" refers to the features of a product or service to which a certain value is ascribed. When it comes to hospital-based practices, quality has often been considered to be specific to the care provided. However, this specific perspective is transitioning toward a broader concept after the evolution of quality-improvement projects and quality frameworks at the organizational level. ⋯ Therefore, it would be ideal to have a core team of respiratory therapists trained in quality management and to initiate quality-improvement processes at the departmental level. Every respiratory therapy department should have its own quality-improvement team to assist with the process of training, implementation, and analysis. Thus, this article aimed to discuss the role of respiratory therapists and respiratory therapy departments in quality-improvement processes and projects to set benchmarks and enhance outcomes.
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Randomized Controlled Trial
Effects of Mechanical Insufflation-Exsufflation on Sputum Volume in Mechanically Ventilated Critically Ill Subjects.
Mechanical insufflation-exsufflation (MI-E) is a noninvasive technique performed to simulate cough and remove sputum from proximal airways. To date, the effects of MI-E on critically ill patients on invasive mechanical ventilation are not fully elucidated. In this randomized crossover trial, we evaluated the efficacy and safety of MI-E combined to expiratory rib cage compressions (ERCC). ⋯ In mechanically ventilated subjects, MI-E combined with ERCC increased the sputum volume cleared without causing clinically important hemodynamic changes or adverse events. (ClinicalTrials.gov registration: NCT03316079.).
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A recent paper reported that low muscle mass in the erector spinae muscles (ESM) was strongly associated with poor prognosis and declining muscle mass over time in subjects with COPD. However, effects of pulmonary rehabilitation (PR), if any, on ESM mass have not been reported. We hypothesized that PR reduces the annual decline in ESM mass. ⋯ ESM mass was shown to decline yearly in subjects with COPD. The annual decline in muscle mass was reduced by PR.
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Observational Study
ACUTE RESPIRATORY DISTRESS SYNDROME OUTCOMES IN NON-RESEARCH SUBJECTS ASSESSED BY GENERALIZED PROSPECTIVE TRIAL ELIGIBILITY CRITERIA AND ADHERANCE TO LUNG-PROTECTIVE VENTILATION.
ARDS mortality is lower among subjects participating in randomized controlled trials (RCTs) compared to subjects in observational studies. Excluding potential subjects with inordinately high mortality risk is necessary to prevent masking the impact of potentially effective treatments. We inquired whether observed mortality differed between RCT-eligible and RCT-ineligible subjects managed with varying degrees of lung-protective ventilation in a non-research setting. ⋯ Mortality in non-research, RCT-eligible subjects was substantially lower compared to RCT-ineligible subjects. Managing non-research patients with ARDS by keeping plateau pressure ≤ 30 cm H2O and formal use of a lung-protective ventilation protocol significantly reduces mortality risk.
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User errors in managing heated humidifiers (HHs) have been suggested to be a source of nasal burns in newborns treated with nasal CPAP. This study evaluated the risk of burns by reproducing 3 typical errors concerning the use of HHs. ⋯ In case of misuse, 5 of the 6 tested devices presented a severe risk of inducing skin burns, whereas the MR950 presented a moderate risk.