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Mashup Score: 7A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit - 9 hour(s) ago
BACKGROUND: Asthma is a common reason for admissions to the pediatric intensive care unit (PICU). Since June 2014, our institution has used a pediatric asthma clinical pathway for all patients, including those in PICU. The pathway promotes respiratory therapist–driven bronchodilator weaning based on the Modified Pulmonary Index Score (MPIS). This pathway was associated with decreased hospital length of stay (LOS) for all pediatric asthma patients; however, the effect on PICU patients was unclear. We hypothesized that the implementation of a pediatric asthma pathway would reduce hospital LOS for asthmatic patients admitted to the PICU. METHODS: We retrospectively reviewed the medical records of all pediatric asthma subjects 2–17 y old admitted to our PICU before and after pathway initiation. Primary outcome was hospital LOS. Secondary outcomes were PICU LOS and time on continuous albuterol. Data were analyzed using the chi-square test for categorical data, the t test for normally distri
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Mashup Score: 4Perspectives on Using Race in Pulmonary Function Testing: A National Survey of Fellows and Program Directors - 1 day(s) ago
BACKGROUND: Pulmonary function tests (PFTs) have historically used race-specific prediction equations. The recent American Thoracic Society guidelines recommend the use of a race-neutral approach in prediction equations. There are limited studies centering the opinions of practicing pulmonologists on the use of race in spirometry. Provider opinion will impact adoption of the new guideline. The aim of this study was to ascertain the beliefs of academic pulmonary and critical care providers regarding the use of race as a variable in spirometry prediction equations. METHODS: We report data from 151 open-ended responses from a voluntary, nationwide survey (distributed by the Association of Pulmonary Critical Care Medicine Program Directors) of academic pulmonary and critical care providers regarding the use of race in PFT prediction equations. Responses were coded using inductive and deductive methods, and a thematic content analysis was conducted. RESULTS: There was a balanced distributio
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Mashup Score: 3
BACKGROUND: Post–COVID-19 syndrome has affected millions of people, with rehabilitation being at the center of non-pharmacologic care. However, numerous published studies show conflicting results due to, among other factors, considerable variation in subject characteristics. Currently, the effects of age, sex, time of implementation, and prior disease severity on the outcomes of a supervised rehabilitation program after COVID-19 remain unknown. METHODS: This was a non-randomized case-control study. Subjects with post–COVID-19 sequelae were enrolled. Among study participants, those who could attend an 8-week, supervised rehabilitation program composed the intervention group, whereas those who couldn’t the control group. Measurements were collected at baseline and 8 weeks thereafter. RESULTS: Study groups ( N = 119) had similar baseline measurements. Participation in rehabilitation ( n = 47) was associated with clinically important improvements in the 6-min walk test (6MWT) distance, adj
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Mashup Score: 7Comparison of Web-Based and On-Site Lung Simulators for Education in Mechanical Ventilation - 3 day(s) ago
BACKGROUND: Training in mechanical ventilation is a key goal in critical care fellowship education. Web-based simulators offer a cost-effective and readily available alternative to traditional on-site simulators. However, it is unclear how effective they are as teaching tools. In this study, we evaluated the test scores of fellows who underwent mechanical ventilation training by using a web-based simulator compared with fellows who used an on-site simulator during a mechanical ventilation course. METHODS: This was a nonrandomized controlled trial conducted as part of a mechanical ventilation course that involved 70 first-year critical care fellows. The course was identical except for the simulation technology used. One group of instructors used a traditional on-site simulator, the ASL 5000 Lung Solution ( n = 39). The second group was instructed in using a web-based simulator, VentSim ( n = 31). Each fellow completed a pre-course test and a post-course test by using a validated, case-b
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Mashup Score: 9Respiratory Care: 69 (11) - 6 day(s) ago
November 01, 2024; Volume 69,Issue 11 Editor’s Choice Comparison of Web-Based and On-Site Lung Simulators for Education in Mechanical Ventilation, Megan Acho, Stephanie I Maximous, Michael B Keller, Eric Kriner, Christian J Woods, Junfeng Sun, Bashar S Staitieh, Burton W Lee, Nitin Seam…
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Mashup Score: 3Oxygen Use in Critical Illness - 8 day(s) ago
Oxygen is the most commonly used drug in critical care. However, because it is a gas, most clinicians and most patients do not regard it as a drug. For this reason, the use of medical oxygen over the past century has been driven by custom, practice, and “precautionary principles” rather than by scientific principles. Oxygen is a life-saving drug for patients with severe hypoxemia, but, as with all other drugs, too much can be harmful. It has been known for many decades that the administration of supplemental oxygen is hazardous for some patients with COPD and other patients who are vulnerable to retention of carbon dioxide (ie, hypercapnia). It has been recognized more recently that excessive oxygen therapy is associated with significantly increased mortality in critically ill patients, even in the absence of risk factors for hypercapnia. This paper provides a critical overview of past and present oxygen use for critically ill patients and will provide guidance for safer oxygen use in
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Mashup Score: 15Physiological Effects of High-Flow Tracheal Oxygen in Tracheostomized Patients Weaning From Mechanical Ventilation - 13 day(s) ago
BACKGROUND: High-flow tracheal oxygen (HFTO) is being used as supportive therapy during weaning in tracheostomized patients difficult to wean from invasive mechanical ventilation. There is, however, no clinical evidence for such a strategy. Therefore, we conducted a systematic review to summarize studies evaluating the physiologic effects of HFTO during tracheostomy-facilitated weaning and to identify potential areas for future research in this field. METHODS: Observational and interventional studies on critically ill subjects weaning from mechanical ventilation via tracheostomy published until December 22, 2022, were eligible. Studies on high-flow oxygen, only in children, non-human models or animals, on clinical outcome only, abstracts without full-text availability, case reports, and reviews were excluded. Main outcomes were end-expiratory lung volume (EELV) and tidal volume using electrical impedance tomography, respiratory effort assessed by esophageal manometry, work of breathing
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Mashup Score: 1
BACKGROUND: We investigated the measurement of end-tidal partial pressure of carbon dioxide (PETCO2) with a capnometer in patients with respiratory failure, and we determined whether this technique could provide an alternative to measurement of PaCO2 using arterial blood gas analysis in the clinical setting. METHODS: We measured PETCO2 in subjects with hypoxemic and hypercarbic respiratory failure using a capnometer. We simultaneously measured PaCO2, venous partial pressure of carbon dioxide (Pv̄CO2), and transcutaneously measured partial pressure PCO2 (PtcCO2). We analyzed agreements among these parameters with Bland-Altman analysis. We obtained 30 samples from subjects with hypoxemic respiratory failure and 30 samples from subjects with hypercarbic respiratory failure. RESULTS: Thirty subjects with hypoxemic respiratory failure and 18 subjects with hypercarbic respiratory failure participated in this study. Significant relationships were found between PETCO2 and PaCO2, between PtcCO2
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Mashup Score: 3
Patients with acute respiratory failure may exhibit an excessive respiratory drive that often results in large tidal volumes (![Formula][1] ),1 potentially leading to patient self-inflicted lung injury.2,3 When noninvasive support strategies are used, clinicians often have limited control over large ![Formula][2] , which have been reported to be independently associated with failure of noninvasive respiratory support.4 Therefore, monitoring ![Formula][3] and minute ventilation holds high clinical relevance for optimizing the management of these patients. CPAP is a noninvasive respiratory support modality that delivers an adjustable PEEP level that is chosen by the clinician, with free flow and no inspiratory pressure support. Accordingly, previous literature shows that CPAP does not increase ![Formula][4] in patients with acute respiratory failure.5 In addition, in a recently published study, the application of CPAP in a murine model of acute lung injury was shown to be a protective te
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Mashup Score: 2The Relationship of Diaphragmatic Ultrasound-Based and Manometric Indices With Difficult Weaning in Tracheostomized Patients - 16 day(s) ago
BACKGROUND: Patients with a tracheostomy and difficult weaning from invasive mechanical ventilation constitute a challenging problem in critical care. An increased duration of ventilation may lead to diaphragmatic dysfunction and a noninvasive assessment of the diaphragm, such as ultrasound, attracts interest in the clinical practice. We evaluated the relationship of ultrasound-derived indices with weaning outcome and with established indices of respiratory strength and load in subjects who are tracheostomized and undergoing weaning. METHODS: This prospective study was conducted at an academic ICU in Greece. Twenty subjects with tracheostomy and difficult weaning, during a spontaneous breathing trial, underwent time synchronous diaphragmatic sonography and esophageal manometry, to assess diaphragmatic excursion and thickening fraction, esophageal and transdiaphragmatic pressures, pressure-time product of the esophageal pressure, and maximum inspiratory pressure. The primary outcome was
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Throwback Thursday, Miller et al published “A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit” in the November issue of the journal. https://t.co/E7btxzH0OA https://t.co/ziDZ1JiS0V