Canadian journal of respiratory therapy : CJRT = Revue canadienne de la thérapie respiratoire : RCTR
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Oscillatory positive expiratory pressure (OPEP) devices facilitate secretion clearance by generating positive end expiratory pressure. However, different device designs may produce different levels of expiratory pressure with the same expiratory flow rate. We bench tested four devices to determine the relationship between expiratory flow and expiratory pressure in each. ⋯ In this bench test of OPEP devices, we found considerable variability in expiratory flow requirements needed to generate an expiratory pressure of >10 cm H2O. Our finding suggests that smaller patients or those with limited expiratory airflow due to diseases such as COPD, obesity, chronic congestive heart failure, and restrictive lung disease may have better results when matched to OPEP devices requiring less expiratory airflow.
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Cricothyrotomy can either be performed by an "open" cricothyrotomy technique, or by a needle (Seldinger) technique. Clinical uncertainty exists regarding which technique is more effective. We compared three different techniques for cricothyrotomy, performed by anesthesiologists on a manikin. ⋯ This research examines three techniques for cricothyrotomy in the "Can't Intubate, Can't Oxygenate" scenario. Our data, as well as data from other studies, suggest that a practice shift towards a surgical technique, and away from needle based techniques, may be warranted.
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Percutaneous tracheostomy is a common procedure in the intensive care unit and, on patient transfer to the wards, there is a gap in ongoing tracheostomy management. There is some evidence that tracheostomy teams can shorten weaning to decannulation times. In response to lengthy weaning to decannulation times at Trillium Health Partners - Credit Valley Hospital site (Mississauga, Ontario), an interprofessional tracheostomy team, led by respiratory therapists and consisting of speech-language pathologists and intensive care physicians, was implemented. ⋯ An interprofessional tracheostomy team can improve the quality of tracheostomy care through earlier tracheostomy tube changes and swallowing assessment referrals. The lack of improved weaning to decannulation time was potentially due to poor adherence with established protocols as well as a change in mechanical ventilation practices. To validate the findings from this particular institution, a more rigorous quality improvement methodology should be considered in addition to strategies to improve protocol compliance.
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Clinical simulation has become established as a commonly used educational approach in respiratory therapy, though questions remain with regards to the evidence basis for its use in some contexts. In conjunction with the development of a new iteration of the National Competency Framework (NCF), the National Alliance of Respiratory Therapy Regulatory Bodies (NARTRB) reaffirmed its desire to continue to recognize the use of simulation as an educational tool. Given the expressed uncertainty as to best practices in the use of clinical simulation in entry-to-practice respiratory therapy education programs, the NARTRB requested the creation of an expert workgroup to develop a list of recommendations from which an implementation plan could be developed for the next iteration of the NCF. ⋯ The recommendations indicate that the use of formative assessment in clinical simulations along with deliberate practice has been clearly shown to improve learning outcomes for which the simulations are designed. However, it is advised that the use of clinical simulation for the summative assessment of competency (e.g., to assess readiness for practice) be exercised cautiously in the context of respiratory therapy education. A number of requisite instructional design factors that should be considered before implementing summative simulation-based assessments are identified, including the validation of summative assessment tools.
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A common procedure within intensive care units (ICUs) is the suctioning of respiratory secretions in patients who have been intubated or who have undergone tracheostomy. Previous studies have shown a wide variation in suctioning practices, and although current evidence does not support the routine practice of normal saline instillation (NSI), anecdotally, this is believed to be a common practice. ⋯ RNs and RRTs continue to practice NSI despite evidence-based practice guidelines suggesting that this therapy may be detrimental to patients. Increased awareness of best practices with respect to endotracheal tube suction generally, and NSI specifically, should be the focus of professional education in both groups of ICU staff.