Respiratory care
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Review
Apnea testing during brain death assessment: a review of clinical practice and published literature.
The diagnosis of brain death is a complex process. Strong knowledge of neurophysiology and an understanding of brain death etiology must be used to confidently determine brain death. The key findings in brain death are unresponsiveness, and absence of brainstem reflexes in the setting of a devastating neurological injury. ⋯ A "positive" test is defined by a total absence of respiratory efforts under these conditions. While apnea testing is not new, it still lacks consensus standardization regarding the actual procedure, monitored parameters, and evidence-based safety measures that may be used to prevent complications. The purpose of this report is to provide an overview of apnea testing and discuss issues related to the administration and safety of the procedure.
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Lung transplant patients commonly undergo transbronchial biopsy to evaluate for rejection. Post-biopsy radiographs are used to exclude pneumothorax, one of the most common major complications. We report a lung transplant patient who developed a pneumothorax 5 months after transbronchial biopsy, with multiple intervening chest computed tomograms documenting that the pneumothorax developed from the biopsy site. This case illustrates that in transplant patients transbronchial biopsy can evolve to pneumothorax several months later, despite normal post-biopsy radiographs.
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The influence of percutaneous tracheostomy on ventilator-dependence and clinical outcomes has been investigated in a number of studies. However, except for the variations during the procedure, the impact of tracheostomy on gas exchange has been scarcely explored. We investigated the effect of tracheostomy on respiratory function in a cohort of ICU patients. ⋯ Percutaneous tracheostomy did not worsen gas exchange in a cohort of ICU patients. In hypoxemic patients, tracheostomy appeared to improve oxygenation and ventilation.
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Reasons for referral for pulmonary function testing: an audit of 4 adult lung function laboratories.
Pulmonary function testing (PFT) is an important tool in the diagnosis and management of most respiratory conditions, and appropriate interpretation of test results is a fundamental component of the final report. As part of developing a structured approach to interpretation of PFT results, we wished to characterize primary reasons for referral for testing in a range of PFT laboratories. ⋯ We have found that the majority of PFTs are performed to follow disease progress or response to treatment. This has implications with inter- pretation of test results and the clinical utility of PFT.
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The effect of the respiratory therapist (RT)/patient ratio and RT organizational factors on respiratory resource utilization is unknown. We describe the impact of a multi-component intervention that called for an increase in RT/patient ratio (1:14 to 1:10), improved RT orientation, and formation of a core staffing model on best practice, including spontaneous breathing trials (SBTs) and catheter and bronchoscopically directed lower respiratory tract cultures, or bronchoalveolar lavage (BAL), in both ventilated and non-ventilated patients in the ICU. ⋯ A multi-component intervention, including an increase in RT/patient ratio, improved RT orientation, and establishment of a core staffing model, was associated with increased respiratory resource utilization and evidence-based practice, specifically BALs and SBTs.