Abstract:
BACKGROUND:Thousands of children require mechanical ventilation each year. Although mechanical ventilation is lifesaving, it is also associated with adverse events if not properly managed. The systematic implementation of evidence-based practice through the use of guidelines and protocols has been shown to mitigate risk, yet variation in care remains prevalent. Advances in health-care technology provided the ability to stream data about mechanical ventilation and therapeutic response. Through these advances, a computer system was developed to enable the coupling of physiologic and ventilation data for real-time interpretation. Our aim was to assess the feasibility and utility of a newly developed patient categorization and scoring system to objectively measure compliance with standards of care. METHODS:We retrospectively categorized the ventilation and oxygenation statuses of subjects within our pediatric ICU utilizing 15 rules-based algorithms. Targets were predetermined based on generally accepted practices. All patient categories were calculated and presented as a percent score (0-100%) of acceptable ventilation, acceptable oxygenation, barotrauma-free, and volutrauma-free states. RESULTS:Two hundred twenty-two subjects were identified and analyzed encompassing 1,578 d of mechanical ventilation. Median age was 3 y, median ideal body weight was 14.7 kg, and 63% were male. The median acceptable ventilation score was 84.6%, and the median acceptable oxygenation score was 70.1% (100% being maximally acceptable). Potential for ventilator-induced lung injury was broken into 2 components: barotrauma and volutrauma. There was very little potential for barotrauma, with a median barotrauma-free state of 100%. Median potential for a volutrauma-free state was 56.1%. CONCLUSIONS:We demonstrate the first patient categorization system utilizing a coordinated data-banking system and analytics to determine patient status and a surveillance of mechanical ventilation quality. Further research is needed to determine whether interventions such as visual display of variance from goal and patient categorization summaries can improve outcomes. (ClinicalTrials.gov registration NCT02184208.).
journal_name
Respir Carejournal_title
Respiratory careauthors
Walsh BK,Smallwood CD,Rettig JS,Thompson JE,Kacmarek RM,Arnold JHdoi
10.4187/respcare.04723subject
Has Abstractpub_date
2016-09-01 00:00:00pages
1168-78issue
9eissn
0020-1324issn
1943-3654pii
respcare.04723journal_volume
61pub_type
杂志文章相关文献
Respiratory Care文献大全abstract::In light of today's tight hospital financial picture caused by Medicare's prospective payment system and local constraints, capital expenditures must be made with great care and forethought. The process for purchase decision making should assess the need for the device; specifically identify what is required; carefull...
journal_title:Respiratory care
pub_type: 杂志文章
doi:
更新日期:1985-08-01 00:00:00
abstract::The presence of bronchiectasis (BR) in patients with rheumatoid arthritis (RA) has been recognized for many decades; nevertheless, little research has been undertaken in this area. It is important to recognize that BR coexistent with RA differs from the other types of BR. The purpose of this descriptive review was to ...
journal_title:Respiratory care
pub_type: 杂志文章,评审
doi:10.4187/respcare.01857
更新日期:2013-04-01 00:00:00
abstract:BACKGROUND:Directed cough maneuvers are often included in physiotherapy management aimed at preventing postoperative pulmonary complications after open heart surgery, but there is little scientific evidence of the effectiveness of directed cough maneuvers. METHODS:We conducted a randomized intra-subject crossover tria...
journal_title:Respiratory care
pub_type: 杂志文章,随机对照试验
doi:
更新日期:2008-08-01 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::The most critical factor in effective supervision is the supervisor's skill in human relations. A standardized test, the Supervisory Inventory of Human Relations, was administered to 39 credentialed respiratory therapists who were responsible for the work performance of at least two other individuals. It was found tha...
journal_title:Respiratory care
pub_type: 杂志文章
doi:
更新日期:1978-07-01 00:00:00
abstract:BACKGROUND:The Nippy Clearway is a new mechanical insufflation-exsufflation device used to assist cough. METHODS:We compared the peak expiratory flow (PEF) with the Nippy Clearway versus the CoughAssist in a bench experiment. The relationship between PEF and pressure at the airway opening during exsufflation (minimum ...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.02345
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Patterns of pulmonary function tests (PFTs) and flow-volume loops among patients with clinically important tracheobronchomalacia (TBM) are not well described. Small studies suggest 4 main flow-volume loop morphologies: low maximum forced expiratory flow, biphasic expiratory curve, flow oscillations, and notc...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.02277
更新日期:2013-09-01 00:00:00
abstract::Sialorrhea or drooling represents quite a common problem in patients with amyotrophic lateral sclerosis (ALS). In this review, we describe the possible treatments for this issue. Current medical management is not always effective: anticholinergic drugs (atropine, glycopyrrolate, amitriptyline, hyoscyamine, and transde...
journal_title:Respiratory care
pub_type: 杂志文章,评审
doi:10.4187/respcare.02856
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Weaning through noninvasive ventilation (NIV) after early extubation may facilitate invasive ventilation withdrawal and reduce related complications in patients with hypercapnic respiratory failure. However, the effects of NIV weaning are uncertain in patients with acute hypoxemic respiratory failure (AHRF)....
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.07542
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:Obstructive lung disease is diagnosed by a decreased ratio of FEV1 to the vital capacity (VC). Although the most commonly used VC is FVC, American Thoracic Society guidelines suggest alternative VCs, for example, slow VC (SVC), may offer a more-accurate evaluation of breathing capacity. There is recent evide...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.06419
更新日期:2019-07-01 00:00:00
abstract::The development and evolution of the endotracheal tube (ETT) have been closely related to advances in surgery and anesthesia. Modifications were made to accomplish many tasks, including minimizing gross aspiration, isolating a lung, providing a clear facial surgical field during general anesthesia, monitoring laryngea...
journal_title:Respiratory care
pub_type: 杂志文章,评审
doi:10.4187/respcare.02868
更新日期:2014-06-01 00:00:00
abstract::Respiratory volume monitoring (RVM) has been developed to noninvasively measure minute ventilation (V̇E), tidal volume, and breathing frequency and to display real-time respiratory curves in nonintubated patients. Although RVM was originally developed for post-anesthesia and monitored anesthesia care, we describe 3 ap...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.03744
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:An increasing number of patients require prolonged mechanical ventilation (PMV), which is associated with high morbidity and poor long-term survival, but there are few data regarding the incidence and outcome of PMV patients from a community perspective. METHODS:We retrospectively reviewed the electronic m...
journal_title:Respiratory care
pub_type: 杂志文章,多中心研究
doi:10.4187/respcare.01096
更新日期:2011-11-01 00:00:00
abstract::Infants have low tidal volume, vital capacity, and functional residual capacity, and short respiratory cycles (low I:E ratio), which result in a low residence time for aerosol particles and, thus, low pulmonary deposition of aerosol particles (< 1% of the nominal dose), compared to adults (8-22%). Scintigraphy data su...
journal_title:Respiratory care
pub_type: 杂志文章,评审
doi:
更新日期:2004-06-01 00:00:00
abstract:BACKGROUND:Field walking tests are commonly used in patients with chronic pulmonary diseases for assessment of functional capacity. However, the physiological demands and magnitude of desaturation on 6-min walk test (6MWT), incremental shuttle walk test (ISWT), and endurance shuttle walk test (ESWT) have not been inves...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.07171
更新日期:2020-05-01 00:00:00
abstract:INTRODUCTION:Electrostatic attraction of aerosolized particles to the inner walls of an aerosol holding chamber (HC) made from a nonconducting material can reduce medication delivery, particularly if there is a delay between actuation and inhalation. OBJECTIVE:Compare total emitted mass and fine-particle mass (mass of...
journal_title:Respiratory care
pub_type: 杂志文章
doi:
更新日期:2006-05-01 00:00:00
abstract:BACKGROUND:It is difficult to apply noninvasive ventilation (NIV) simultaneously with pulsed-dose oxygen delivery. We evaluated the feasibility and efficacy of pulsed-dose oxygen delivery during NIV. METHODS:A bench study was conducted using a simulated lung during NIV, with a breathing frequency of 10 or 20 breaths/m...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.06922
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:In patients suffering from brain injury, end-tidal PCO2 (PETCO2 ) monitoring is controversial, but transcutaneous PCO2 (PtcCO2 ), which is noninvasive and utilizes immediate display, may be an alternative method. We hypothesized that PtcCO2 would be more accurate than PETCO2 for monitoring PaCO2 in patients ...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.02726
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:We recently demonstrated in a randomized study the feasibility and effectiveness of telephone-based health coaching using motivational interviewing on decreasing hospital readmissions and improving quality of life at 6 and 12 months after hospital discharge. In this qualitative study, we sought to explore th...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.05574
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:COPD is one of the most common respiratory diseases. Patients with COPD experience and suffer from various physical and psychological symptoms. We performed this study to identify symptom clusters and the effects on quality of life (QOL) in patients with COPD. METHODS:A total of 130 COPD subjects were recru...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.05374
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:High-flow nasal cannula (HFNC) use has greatly increased in recent years. In non-neonatal pediatric patients, there are limited data available to guide HFNC use, and clinical practice may vary significantly. The goal of this study was to evaluate current HFNC practice by surveying practicing pediatric respir...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.05961
更新日期:2018-07-01 00:00:00
abstract::Gorham syndrome is a rare disease that presents as progressive osteolysis, and may affect any part of the skeleton. The pathologic process involves the replacement of normal bone by aggressively expanding but non-neoplastic vascular tissue, resulting in massive osteolysis of the adjacent bone. If the spine and ribs ar...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.02355
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:There is paucity of information on the weaning of nasal CPAP (NCPAP) in preterm infants. As the weaning from NCPAP can be gradual or sudden, we wanted to determine which of the 2 methods was better. METHODS:A prospective randomized trial was conducted to compare the success of weaning from NCPAP when using ...
journal_title:Respiratory care
pub_type: 杂志文章,随机对照试验
doi:10.4187/respcare.01999
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:In a traditional endotracheal tube (ETT), there is a linear outward pull through its attachment to the ventilator tubing that leads to risk of accidental dislodgement. This study was conducted to assess the ETT flow characteristics and to evaluate providers' intubation experience using two ETT's in a simulat...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.05813
更新日期:2018-09-01 00:00:00
abstract::NOD is a common event in patients with symptomatic COPD who are not hypoxemic while awake. Up to 45% of these patients may have significant oxyhemoglobin desaturation during sleep, and most have evidence of pulmonary arterial hypertension. Although intuitively it would seem that supplemental oxygen during sleep should...
journal_title:Respiratory care
pub_type: 杂志文章,评审
doi:
更新日期:2000-02-01 00:00:00
abstract::The estimation of pleural pressure with esophageal manometry has been used for decades, and it has been a fertile area of physiology research in healthy subject as well as during mechanical ventilation in patients with lung injury. However, its scarce adoption in clinical practice takes its roots from the (false) idea...
journal_title:Respiratory care
pub_type: 杂志文章,评审
doi:10.4187/respcare.07425
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Most heat-and-moisture exchangers (HMEs) for patients with tracheostomy and spontaneously breathing are small and have suction ports that allow some expiratory gas to escape, which loses water vapor held in the expired gas. Recently, a heated-and-humidified high-flow system for spontaneously breathing patien...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.06294
更新日期:2019-02-01 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::Pulmonary hypertension (PH) is a common consequence of COPD. It has been speculated that patients showing serious PH and vascular remodeling without severe airway obstruction might benefit from vasoactive treatment. There is no approved drug available for COPD-induced PH. Most trials assessing the efficacy of vasoacti...
journal_title:Respiratory care
pub_type: 杂志文章
doi:10.4187/respcare.02058
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:Auto-regulated inspiratory support mode (ARIS) is an original closed-loop pressure-support system that regulates the slope ("A") and the initial level ("B") of the applied inspiratory pressure, in order to achieve an optimal minute ventilation under constrained respiratory frequency, tidal volume, and maximu...
journal_title:Respiratory care
pub_type: 杂志文章
doi:
更新日期:2005-08-01 00:00:00