Respiratory care clinics of North America
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Respir Care Clin N Am · Sep 2004
ReviewSetting the positive expiratory-end pressure-FIO2 in acute lung injury/acute respiratory distress syndrome.
Airspace collapse is a hallmark of parenchymal lung injury. Strategies to reopen and maintain patency of these regions offer three advantages: improved gas exchange, less ventilator-induced lung injury, and improved lung compliance. Elevations in intrathoracic pressure to achieve these goals, however, may overdistend healthier lung regions and compromise cardiac function. ⋯ Mechanical approaches to achieve this balance are clinically difficult to do. Thus gas exchange algorithms with modest PaO2 goals are commonly used today. Recruitment maneuvers and long inspiratory time strategies may be useful adjuncts.
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Respir Care Clin N Am · Sep 2004
ReviewEmergency airway management in orbit: an evidence-based review of possibilities.
It is likely that the first responder to a medical emergency in space will be a nonphysician. Terrestrial experience has shown that even under optimal conditions experienced clinicians can have difficulty establishing an airway. Establishing and maintaining a patent airway is essential to ensuring a successful outcome from cardiopulmonary resuscitation or respiratory failure secondary to trauma or acute illness. ⋯ For minimally trained care providers the airway will also be the first route of administration of resuscitative pharmacologic agents. It is therefore of paramount importance that the method for securing and airway permit a successful outcome when used by nonphysician crewmembers during medical emergencies in space. This article evaluates airway management in the microgravity environment and applies to both the International Space Station and the Space Shuttle, whether operating independently or docked.
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Respir Care Clin N Am · Sep 2004
ReviewWhat is the role of high-frequency ventilation in adult respiratory distress syndrome?
The goal of positive-pressure mechanical ventilation is to provide respiratory support to a patient while allowing the underlying diseased lungs to heal. Research using both animal models and humans suggests that positive-pressure ventilation can injure the lung through both overdistension and under recruitment. ⋯ High-frequency ventilation provides such a strategy of mechanical ventilation. This article examines the utility of using high-frequency modes of mechanical ventilation in supporting the patient with ARDS.
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Respiratory care (RC) protocols are widely regarded as the most appropriate method for properly allocating and delivering most forms of respiratory therapy. The use of protocols has increased steadily over the past 15 years, but, despite the successes and modest implementation of RC protocols across the country, there is room for improvement in adopting RC protocols for the effective use of respiratory care services. It also seems that many physicians have yet to be won over, and RC managers need to take the first step toward protocol development and implementation. This article addresses some of the issues surrounding the development of respiratory care protocols and the impact that their implementation may have based on experience gained to date.
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Capital equipment and technology administration, as outlined in this article, is one of many responsibilities for managers of respiratory care. Planning for 1, 5, and 10 years, strategic budgeting, and systematic evaluation of existing and future devices will assist in creating a successful equipment and technology program. A successful capital equipment and technology program will enable respiratory care practitioners to treat patients effectively with the proper tools for success.