Respiratory care
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The objective of this study was to determine whether the implementation of an inhaled nitric oxide protocol (INO) in a pediatric ICU (PICU) would reduce cost associated with its use without negatively affecting patient outcomes. ⋯ Implementation of an INO setup and weaning protocol in a PICU reduces the cost associated with its use without a statistically significant difference in mortality. In an era of increased awareness regarding healthcare spending, implementation of evidence-based protocols can provide a way to ensure the judicious utilization of medical resources.
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Arterial blood gas (ABG) analysis is not a routine test in sleep laboratories due to its invasive nature. Therefore, the diagnosis of obesity hypoventilation syndrome (OHS) is underestimated. We aimed to evaluate the differences in subjects with OHS and pure obstructive sleep apnea (OSA) and to determine clinical predictors of OHS in obese subjects. ⋯ Serum bicarbonate level and nadir saturation were independent predictive factors for the diagnosis of OHS.
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Accurate measurement of carbon dioxide elimination (V̇CO2 ) and oxygen consumption (V̇O2 ) at the bedside may help titrate nutritional and respiratory support in mechanically ventilated patients. Continuous V̇CO2 monitoring is now available with many ventilators. However, because normative data are sparsely available in the literature, we aimed to describe the range of V̇CO2 and V̇O2 values observed in mechanically ventilated children. We also aimed to examine the characteristics of V̇CO2 values that are associated with standard steady state (5-min period when V̇CO2 and V̇O2 variability are < 10%). ⋯ V̇CO2 and V̇O2 measurements correlated with subject height and age. Smaller and younger subjects produced larger amounts of CO2 and consumed more O2 per unit of body weight. The use of a 5-min period when V̇CO2 varied by < 5% predicted standard steady state. Our observations may facilitate greater utility of V̇CO2 at the bedside in the pediatric ICU and thereby extend the benefits of metabolic monitoring to a larger group of patients.
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Respiratory volume monitoring (RVM) has been developed to noninvasively measure minute ventilation (V̇E), tidal volume, and breathing frequency and to display real-time respiratory curves in nonintubated patients. Although RVM was originally developed for post-anesthesia and monitored anesthesia care, we describe 3 applications for this monitor in an otherwise austere setting at a missionary hospital in Kijabe, Kenya. Applications of RVM can be utilized in any ICU in a developing or developed country.