Respiratory care
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The effect of application of fingernail polish on SpO2 measurement remains unclear. We conducted this systematic review to ascertain the impact of fingernail polish on SpO2 measurement. ⋯ Although fingernail polish of some colors can marginally reduce SpO2 reading or occasionally impede SpO2 measurement, the variability is clinically insignificant.
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Ineffective effort (IE) is a frequent patient-ventilator asynchrony in invasive mechanical ventilation. This study aimed to investigate the incidence of IE and to explore its relationship with respiratory drive in subjects with acute brain injury undergoing invasive mechanical ventilation. ⋯ IE was very common in subjects with acute brain injury. Low respiratory drive was independently associated with severe IEE.
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Over the last decade, the literature exploring clinical applications for esophageal manometry in critically ill patients has increased. New mechanical ventilators and bedside monitors allow measurement of esophageal pressures easily at the bedside. ⋯ However, as with any measurement, technique, fidelity, and accuracy are paramount. This primer highlights key knowledge necessary to perform measurements and highlights areas of both uncertainty and ongoing development.
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Best practice guidelines for asthma management recommend education and spirometry at specific intervals. A written asthma action plan with education and spirometry is ordered at the discretion of physicians at our institution. An initial chart review revealed that asthma education and spirometry were not consistently ordered in the pediatric primary care clinics. This quality improvement study aimed to increase frequency of spirometry and asthma education in children with asthma seen in pediatric primary care through use of a respiratory therapist (RT)-driven protocol. ⋯ Implementation of an RT-driven protocol in an out-patient pediatric primary care setting significantly increased utilization of spirometry and education for children with asthma. RTs working in the pediatric out-patient primary care setting played a vital role in achieving best practices for asthma management. The implementation of the protocol enhanced interdisciplinary communication.