Respiratory care clinics of North America
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Respir Care Clin N Am · Mar 2002
ReviewTraining for the transport of mechanically ventilated patients.
The transport of critically ill patients is hazardous, yet necessary. In these conditions monitoring may be challenging, and the ability to intervene when problems arise is often limited. Conducting safe transport of these patients has been shown to be possible when experienced personnel apply their knowledge appropriately. ⋯ This article proposes that formal training of transport teams be strongly considered at the institutional level, and it introduces the content and method of delivery of this training. Because these are expressed opinions, the concept should be explored and validated by an interventional study, establishing a baseline of transport complications in a given facility, implementing some form of training, and reevaluating the performance of the trained providers in the same institution. A significant reduction in complications would validate the time, effort, and expense of developing such a course and would provide a model for other institutions to follow.
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Although the primary focus of this article is on interhospital transport, some of the same basic transport principles and management techniques apply to intrahospital transport. The level of care provided during interhospital and intrahospital transport should be based on the neonate's diagnosis, clinical status, anticipated problems, and local, state, and national standards and regulations. ⋯ Planning and anticipation of problems are essential, as is care of the family. The transport team should evaluate each neonate's individual response to the transport.
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Respir Care Clin N Am · Dec 2001
ReviewThe use of high-frequency oscillatory ventilation in adults with acute lung injury.
The use of HFOV in adults is still in its infancy. There is, however, much promise to support further study of this ventilatory modality. Rescue case series have shown that HFOV is effective in improving gas exchange and appears safe in this group of extremely ill patients. ⋯ HFOV could be used as one of a number of new therapies for the patient failing to oxygenate on CMV. Its routine use to prevent VILI cannot be recommended at this time, as no data are available. Further clinical studies potentially leading to a large randomized controlled trial of HFOV versus best conventional therapy appear worth pursuing.
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High-frequency ventilation was first introduced 30 years ago as a method for reducing intrathoracic pressure during thoracic and laryngeal surgery. High-frequency oscillation was developed in the 1970's for the treatment of lung disease of prematurity but is now used for acute hypoxemic respiratory failure in all ages. High-frequency jet ventilation is still most commonly used as a rescue therapy.
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Respir Care Clin N Am · Dec 2001
ReviewHigh-frequency oscillatory ventilation in pediatric patients.
HFOV is a mode of ventilation that can achieve oxygenation and ventilation while maintaining maximal lung recruitment on the deflation limb of its pressure-volume curve. The primary theoretical advantages of HFOV over CMV in the management of acute lung injury are that HFOV allows adequate alveolar ventilation with minimal peak-trough pressure changes, provides lung recruitment, and avoids end-inspiratory overdistension of the relatively compliant nondependent lung. ⋯ The improved longer-term clinical outcomes on HFOV are presumably because of less ventilator-induced lung injury. As experience with HFOV in older patients grows, ventilator technology matures, and understanding of the pathophysiology of acute respiratory distress syndrome (RDS) deepens, it is likely that HFOV will find widespread use for the management of respiratory failure caused by acute lung injury in patients from preterm neonates to adults.