Abstract：
BACKGROUND:The utilization of checklists, bundles, and protocols attempts to provide standardization in the delivery of patient care. Despite important progress obtained in the prevention of hospital-acquired infections, the daily management of mechanical ventilation is still prone to heterogeneity, depending on the number of providers manipulating the ventilator. Whether the number of changes made on ventilator parameters impacts clinical outcomes remains unknown. METHODS:A quality improvement project was designed to assess whether liberal manipulations of ventilator settings affect the rate of tracheostomy and 28 ventilator-free days. Over the course of 7 d, respiratory therapists recorded all ventilator changes in newly ventilated subjects. Ventilator changes were considered as major changes if manipulations included changes in the mode of ventilation. Minor changes included manipulations of settings within the same mode of ventilation. We evaluated whether the number of total and major changes affected clinical outcomes. Logistic regression was used for multivariate analysis. RESULTS:One-hundred seventeen ventilator manipulations were recorded among 54 subjects. Of those 117 ventilator changes, 35% were major manipulations. For every major ventilator manipulation, the odds of requiring tracheostomy increased 4.95 times. Furthermore, for every major ventilator change, there was an 18.6% decrease in 28 ventilator-free days. These associations were found after adjustments by APACHE (Acute Physiology and Chronic Health Evaluation) II score, body mass index, and type of ICU. The total number of changes was not associated with either primary outcome measure. CONCLUSIONS:The number of major ventilator manipulations is associated with rate of tracheostomy and stay on the ventilator.
journal_name
Respir Carejournal_title
Respiratory careauthors
Modrykamien AM,Killian L,Walters RWdoi
10.4187/respcare.03887subject
Has Abstractpub_date
2016-01-01 00:00:00pages
30-5issue
1eissn
0020-1324issn
1943-3654pii
respcare.03887journal_volume
61pub_type
杂志文章相关文献
Respiratory Care文献大全abstract：BACKGROUND:Electrical impedance tomography measures changes in lung impedance, which are mainly related to changes in lung volume. We used electrical impedance tomography to investigate the effects of high-flow nasal cannula (HFNC) and body position on global and regional end-expiratory lung impedance variation (ΔEELI)...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.02086
更新日期：2013-04-01 00:00:00
abstract：INTRODUCTION:A mass-casualty respiratory failure event where patients exceed available ventilators has spurred several proposed solutions. One proposal is use of a single ventilator to support 4 patients. METHODS:A ventilator was modified to allow attachment of 4 circuits. Each circuit was connected to one chamber of...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.01236
更新日期：2012-03-01 00:00:00
abstract：BACKGROUND:Improving quality of life (QOL) is a key goal in the care of patients with COPD. Pulmonary rehabilitation (PR) has clearly been shown to improve QOL, but is not accessible to many eligible patients. There is a need for alternative programs designed to improve patient well-being that are accessible to all pat...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.04984
更新日期：2017-08-01 00:00:00
abstract：BACKGROUND:The contribution of the central respiratory drive in the hypercapnic respiratory failure of neuromuscular diseases (NMD) is controversial. OBJECTIVE:To compare the CO2 response and the duration of weaning of mechanical ventilation between a group of NMD patients and a group of quadriplegic patients due to I...
journal_title：Respiratory care
pub_type： 杂志文章,多中心研究
doi：10.4187/respcare.01873
更新日期：2013-03-01 00:00:00
abstract：BACKGROUND:Recent literature suggests that optimization of tidal driving pressure (ΔP) would be a better variable to target for lung protection at the bedside than tidal volume (VT) or plateau pressure (Pplat), the traditional indicators of ventilator-induced lung injury. However, the usual range or variability of ΔP o...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.06599
更新日期：2019-08-01 00:00:00
abstract：:Because of the design characteristics, flow-triggering appears to offer measurable advantages over pressure-triggering, particularly during spontaneous breathing. During the trigger phase, flow-triggering provides a relatively shorter time delay than pressure-triggering. A trigger sensitivity that does not cause autoc...
journal_title：Respiratory care
pub_type： 共识发展会议,杂志文章,评审
doi：
更新日期：1992-09-01 00:00:00
abstract：:In health, the airways are lined by a layer of protective mucus gel that sits atop a watery periciliary fluid. Mucus is an adhesive, viscoelastic gel, the biophysical properties of which are largely determined by entanglements of long polymeric gel-forming mucins, MUC5AC and MUC5B. This layer entraps and clears bacter...
journal_title：Respiratory care
pub_type： 杂志文章
doi：
更新日期：2007-07-01 00:00:00
abstract：BACKGROUND:Limited adult data suggest that airway driving pressure might better reflect the potential risk for lung injury than tidal volume based on ideal body weight, and the parameter correlates with mortality in ARDS. There is a lack of data about the effect of driving pressure on mortality in pediatric ARDS. This ...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.08024
更新日期：2020-10-06 00:00:00
abstract：BACKGROUND:Noninvasive ventilation (NIV) tolerance has been identified as an independent predictor of survival in amyotrophic lateral sclerosis (ALS). Volume control continuous mandatory ventilation (VC-CMV) NIV has been associated with poor tolerance. The aim of this study was to determine the tolerance of subjects wi...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.04172
更新日期：2015-12-01 00:00:00
abstract：:Extracorporeal life support (ECLS), or extracorporeal membrane oxygenation (ECMO) as it is also known, has been used to support over 45,000 patients to date. Overall survival is 62%. After many years of no change in equipment and technology, there has been a recent flurry of new pumps, cannulas, and oxygenators avail...
journal_title：Respiratory care
pub_type： 杂志文章,评审
doi：10.4187/respcare.01369
更新日期：2011-09-01 00:00:00
abstract：HYPOTHESIS:We hypothesized that aerosol distribution in the lungs of patients with cystic fibrosis changes with positive expiratory pressure (PEP). METHODS:Eight patients were randomized to one of 2 conditions. On one study day, patients inhaled saline aerosol containing 99mtechnetium generated by a Pari LC Plus nebul...
journal_title：Respiratory care
pub_type： 杂志文章,随机对照试验
doi：
更新日期：2005-11-01 00:00:00
abstract：BACKGROUND:Studies on the submaximal aerobic capacity of exclusive narghile smokers (ENS) seem necessary in view of effective prevention of cardiorespiratory diseases. The goal of the study was to assess, by 6-min walk test (6MWT) data, the submaximal aerobic capacity of ENS, to identify factors influencing their 6-min...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.03058
更新日期：2014-11-01 00:00:00
abstract：:Chronic obstructive pulmonary disease is easily detected in its preclinical phase, using office spirometry. Successful smoking cessation prevents further disease progression in most patients. Spirometry measures the ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV(1)/FVC), wh...
journal_title：Respiratory care
pub_type： 杂志文章,评审
doi：
更新日期：2003-12-01 00:00:00
abstract：:As hospitals begin to implement electronic medical records, the inadequacies of legacy paper charting systems will become more evident. One area of particular concern for respiratory therapists is the charting of mechanical ventilator settings. Our profession's lack of a standardized and generally accepted taxonomy fo...
journal_title：Respiratory care
pub_type： 杂志文章
doi：
更新日期：2010-12-01 00:00:00
abstract：BACKGROUND:High-flow nasal cannula (HFNC) oxygen therapy produces noise at a level such that patients often complain. However, the noise level has not been measured digitally. METHODS:We evaluated 3 types of HFNCs without filters and 2 types with filters attached for noise reduction. Optiflow (with and without a filte...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.05668
更新日期：2018-03-01 00:00:00
abstract：INTRODUCTION:Automatic tube compensation (ATC), a new ventilation mode that compensates for the work of breathing imposed by endotracheal tube resistance, recently became commercially available. METHODS:We conducted a laboratory study with a lung model and a Nellcor Puritan Bennett 840 ventilator to compare ATC and pr...
journal_title：Respiratory care
pub_type： 杂志文章
doi：
更新日期：2003-01-01 00:00:00
abstract：BACKGROUND:Extracorporeal membrane oxygenation (ECMO) is often used in patients with severe respiratory failure to improve oxygenation and survival. ECMO gives the lungs an opportunity to rest and recover. The addition of prone positioning therapy used concurrently with ECMO can further aid in optimizing alveolar recru...
journal_title：Respiratory care
pub_type： 杂志文章,评审
doi：10.4187/respcare.03882
更新日期：2016-02-01 00:00:00
abstract：:Although some clinicians still believe that cystic fibrosis (CF) lung disease is largely due to hypersecretion of very viscous mucus, it has never been demonstrated that there is mucus hypersecretion in CF and it is clear that there is almost no intact mucin (the principal polymeric component of normal mucus) in CF sp...
journal_title：Respiratory care
pub_type： 杂志文章,评审
doi：10.4187/002013209790983269
更新日期：2009-06-01 00:00:00
abstract：:An 8-year-old female with pancreatic-insufficiency cystic fibrosis presented with recurrent pharyngitis, and reduction in body mass index and height velocity during the previous 2 years. Her symptoms (eg, snoring and restless sleep) suggested obstructive sleep apnea, and physical examination revealed tonsillar hypertr...
journal_title：Respiratory care
pub_type： 杂志文章
doi：
更新日期：2009-12-01 00:00:00
abstract：BACKGROUND:We previously reported the effects of high-flow nasal cannula (HFNC) oxygen therapy on thoraco-abdominal synchrony. This study was designed to clarify the effect of HFNC on thoraco-abdominal synchrony in pediatric subjects after cardiac surgery and to investigate HFNC optimal flow in this population. METHOD...
journal_title：Respiratory care
pub_type： 杂志文章,随机对照试验
doi：10.4187/respcare.06193
更新日期：2019-01-01 00:00:00
abstract：:Surface active material is important in the function of both the infant and adult lung. In the premature infant, surfactant depletion results in the requirement for very high distending pressures to open alveoli. As a consequence, shunt, hypoxemia, and right ventricular dysfunction occur. Surfactant replacement, espec...
journal_title：Respiratory care
pub_type： 杂志文章,评审
doi：
更新日期：2000-06-01 00:00:00
abstract：:Since 1998, the Global Initiative for Obstructive Lung Disease (GOLD) has worked with health care professionals, medical researchers, and public health officials around the world to optimize the prevention, treatment, and management of COPD. GOLD has continually worked to ensure COPD management strategy recommendation...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.05402
更新日期：2017-11-01 00:00:00
abstract：:This review explains the fundamentals of electrostatic spray (electrospray) atomization, with emphasis on operation in the so called cone-jet mode, which produces droplets with a very narrow size distribution. Since the control of droplet size is key to maximizing distal lung deposition, the electrospray should be wel...
journal_title：Respiratory care
pub_type： 杂志文章
doi：
更新日期：2002-12-01 00:00:00
abstract：INTRODUCTION:High-flow nasal cannula (HFNC) can deliver heated and humidified gas (up to 100% oxygen) at a maximum flow of 60 L/min via nasal prongs or cannula. The aim of this study was to assess the short-term physiologic effects of HFNC. Inspiratory muscle effort, gas exchange, dyspnea score, and comfort were evalua...
journal_title：Respiratory care
pub_type：
doi：10.4187/respcare.03814
更新日期：2015-10-01 00:00:00
abstract：:Exacerbations are a hallmark feature of COPD and contribute to morbidity and mortality. There is general agreement that the pharmacotherapy of COPD exacerbations includes bronchodilators, corticosteroids, and antibiotics. Strong evidence exists for the benefit of corticosteroids for exacerbations and of antibiotics in...
journal_title：Respiratory care
pub_type： 杂志文章,评审
doi：10.4187/respcare.05912
更新日期：2018-06-01 00:00:00
abstract：BACKGROUND:Endotracheal intubation is a common procedure performed by respiratory therapists (RTs). The purpose of this study was to describe current RT intubation practices in North Carolina through the use of a survey instrument. METHODS:A survey was developed by the authors using REDCap. The survey was sent via ema...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.07338
更新日期：2020-07-01 00:00:00
abstract：BACKGROUND:The primary focus of previous aerosol research during mechanical ventilation was the endotracheal tube (ETT). Consequently, there are limited data in the literature on the delivery of inhaled medications administered with different aerosol devices in mechanically ventilated patients with a tracheostomy tube ...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.04125
更新日期：2015-11-01 00:00:00
abstract：BACKGROUND:Volume-targeted ventilation is increasingly used in low birthweight infants because of the potential for reducing volutrauma and avoiding hypocapnea. However, it is not known what level of air leak is acceptable during neonatal volume-targeted ventilation when leak compensation is activated concurrently. ME...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.05012
更新日期：2017-01-01 00:00:00
abstract：:The data available to guide clinical management of acute lung injury and acute respiratory distress syndrome are much more limited for infants and children than for adult patients. This paper reviews the available medical data and the pertinent physiology on the management of pediatric patients with acute lung injury...
journal_title：Respiratory care
pub_type： 杂志文章
doi：10.4187/respcare.01515
更新日期：2011-10-01 00:00:00
abstract：:Technological innovations in the ICU have led to artificially prolonged life, with an associated cost. Chronic critical illness (CCI) occurs in patients with prolonged mechanical ventilation and allostatic overload, and is associated with a discrete and consistent metabolic syndrome. Metabolic interventions are extra...
journal_title：Respiratory care
pub_type： 杂志文章,评审
doi：10.4187/respcare.01620
更新日期：2012-06-01 00:00:00
