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Tidsskrift For Den Norske Laegeforening... May 2012Respiratory complications are the most common cause of acute and long-term morbidity and mortality in patients with spinal cord injury. (Review)
Review
BACKGROUND
Respiratory complications are the most common cause of acute and long-term morbidity and mortality in patients with spinal cord injury.
MATERIAL AND METHODS
The article is based on a non-systematic search in PubMed and the authors' clinical experience in treatment and follow-up of respiratory complications in patients with spinal cord injury.
RESULTS
The extent of respiratory complications is dependent on the level of spinal cord injury and the degree of motor completeness. In acute spinal cord injury, 80 % of patients may suffer from respiratory complications. Long-term follow-up indicates that respiratory complications are the most common cause of death in these patients. The most common respiratory complications are atelectasis, pneumonia and respiratory failure. Prevention of respiratory complications must be initiated immediately, independent of the level of spinal cord injury. The question of mechanical ventilation in the acute setting, and also during long-term follow-up must be addressed, along with aggressive secretion management. Patients with spinal cord injury have a high prevalence of sleep apnea that may influence their quality of life and rehabilitation.
INTERPRETATION
Respiratory complications are common in patients with spinal cord injury. These patients need a multidisciplinary approach. All disciplines involved must obtain knowledge of respiratory complications in the acute phase and in the longer term, to ensure patients are referred for necessary pulmonary review and follow-up.
Topics: Acute Disease; Humans; Norway; Patient Care Team; Respiration Disorders; Respiratory Therapy; Sleep Apnea Syndromes; Spinal Cord Injuries; Vital Capacity
PubMed: 22614314
DOI: 10.4045/tidsskr.10.0922 -
The Kaohsiung Journal of Medical... Oct 2020Mechanical ventilation (MV) is a common life support system in intensive care units. Accurate identification of patients who are capable of being extubated can shorten...
Mechanical ventilation (MV) is a common life support system in intensive care units. Accurate identification of patients who are capable of being extubated can shorten the MV duration and potentially reduce MV-related complications. Therefore, prediction of patients who can successfully be weaned from the mechanical ventilator is an important issue. The electronic medical record system (EMRs) has been applied and developed in respiratory therapy in recent years. It can increase the quality of critical care. However, there is no perfect index available that can be used to determine successful MV weaning. Our purpose was to establish a novel model that can predict successful weaning from MV. Patients' information was collected from the Kaohsiung Medical University Hospital respiratory therapy EMRs. In this retrospective study, we collected basic information, classic weaning index, and respiratory parameters during spontaneous breathing trials of patients eligible for extubation. According to the results of extubation, patients were divided into successful extubation and extubation failure groups. This retrospective cohort study included 169 patients. Statistical analysis revealed successful extubation predictors, including sex; height; oxygen saturation; Glasgow Coma Scale; Acute Physiology and Chronic Health Evaluation II score; pulmonary disease history; and the first, 30th, 60th, and 90th minute respiratory parameters. We built a predictive model based on these predictors. The area under the curve of this model was 0.889. We established a model for predicting the successful extubation. This model was novel to combine with serial weaning parameters and thus can help intensivists to make extubation decisions easily.
Topics: Aged; Aged, 80 and over; Electronic Health Records; Female; Humans; Intensive Care Units; Male; Middle Aged; Respiration, Artificial; Retrospective Studies; Ventilator Weaning
PubMed: 32729992
DOI: 10.1002/kjm2.12269 -
Respiratory Care Mar 2017Respiratory therapist (RT)-driven protocols have been in use for over 30 years. Protocols have been reported to decrease unnecessary or harmful therapy, health-care...
BACKGROUND
Respiratory therapist (RT)-driven protocols have been in use for over 30 years. Protocols have been reported to decrease unnecessary or harmful therapy, health-care costs, and hospital stay. This study represents the evaluation of an original respiratory care protocol in the pediatric ICU at Arkansas Children's Hospital for β-agonist and airway clearance interventions where one did not exist.
METHODS
This project was composed of 2 parts: a survey administered to RTs and licensed independent practitioners and a retrospective review of outcome data comparing a therapist-driven β-agonist/airway clearance protocol with physician-directed respiratory care ordering in a patient population admitted for acute respiratory failure.
RESULTS
Acceptance of the protocol was evident in the survey responses because overall perceptions surrounding the implementation of the β-agonist/airway clearance protocol were positive, and responders perceived that the protocol implementation elevated the status and increased the value of respiratory therapists. For the comparison of physician-directed orders with therapist-driven protocols, there were no significant differences between pre- and post-intervention groups for mean age, sex, mean daily acuity, or mean weighted daily acuity ( = .33, .19, >.99, and .79, respectively). There were also no differences in pediatric index of mortality 2, pediatric index of mortality 2 rate of mortality, pediatric risk of mortality 3 probability of death, and pediatric risk of mortality 3 scores ( = .63, .56, .19, and .44, respectively) between the 2 groups. When comparing physician-directed orders to therapist-driven protocols, all outcome measures (length of stay, β-agonist therapies, airway clearance therapies, and ventilator days) showed statistically and clinically important reductions, adjusting for subject characteristics ( < .001) for the therapist-driven protocol group.
CONCLUSIONS
In this institution, implementation of a β-agonist/airway clearance protocol resulted in significant reductions of subject interventions and improved outcomes by decreasing length of stay and ventilator days as well as contributing information where clinical evidence is scant, specifically the pediatric ICU.
Topics: Child; Child, Preschool; Clinical Protocols; Female; Health Plan Implementation; Humans; Intensive Care Units, Pediatric; Length of Stay; Male; Respiratory Insufficiency; Respiratory Therapy; Retrospective Studies; Treatment Outcome
PubMed: 28028189
DOI: 10.4187/respcare.04857 -
Respiratory Care Nov 2013Postoperative pulmonary complications (PPCs) are common and expensive. Costs, morbidity, and mortality are higher with PPCs than with cardiac or thromboembolic... (Review)
Review
Postoperative pulmonary complications (PPCs) are common and expensive. Costs, morbidity, and mortality are higher with PPCs than with cardiac or thromboembolic complications. Preventing and treating PPCs is a major focus of respiratory therapists, using a wide variety of techniques and devices, including incentive spirometry, CPAP, positive expiratory pressure, intrapulmonary percussive ventilation, and chest physical therapy. The scientific evidence for these techniques is lacking. CPAP has some evidence of benefit in high risk patients with hypoxemia. Incentive spirometry is used frequently, but the evidence suggests that incentive spirometry alone has no impact on PPC. Chest physical therapy, which includes mechanical clapping and postural drainage, appears to worsen atelectasis secondary to pain and splinting. As with many past respiratory therapy techniques, the profession needs to take a hard look at these techniques and work to provide only practices based on good evidence. The idea of a PPC bundle has merit and should be studied in larger, multicenter trials. Additionally, intraoperative ventilation may play a key role in the development of PPCs and should receive greater attention.
Topics: Biomedical Research; Humans; Postoperative Care; Postoperative Complications; Respiration Disorders; Respiratory Therapy
PubMed: 24155356
DOI: 10.4187/respcare.02832 -
Canadian Medical Association Journal Jan 1965
Topics: Acetylcysteine; Anti-Bacterial Agents; Bronchial Spasm; Cysteine; Drug Therapy; Epinephrine; Equipment and Supplies; Humans; Hypoxia; Isoproterenol; Mucus; Oxygen Inhalation Therapy; Phenylephrine; Propylene Glycols; Respiratory Therapy; Respiratory Tract Diseases
PubMed: 14228241
DOI: No ID Found -
Respiratory Care Jul 2017Interprofessional education (IPE) improves collaboration and patient care through joint education between health professions. Respiratory therapy (RT) faculty were...
BACKGROUND
Interprofessional education (IPE) improves collaboration and patient care through joint education between health professions. Respiratory therapy (RT) faculty were surveyed to evaluate their knowledge and attitudes toward IPE. We report current opportunities for IPE from faculty and compare responses from associate's, bachelor's, and master's degree programs and profit versus nonprofit institutions.
METHODS
We developed an online survey based on IPE literature and questions modified for the RT discipline. The survey was distributed by email to 874 faculty from the Commission on Accreditation for Respiratory Care accredited programs.
RESULTS
The response rate was 33%. Faculty identified IPE as an important component of RT education ( = 207, 80%) but reported challenges in integrating IPE into current curriculum. Overall, communication was ranked as the most important IPE competency ( = 104, 39%) and ethics least important ( = 131, 49%). When asked how many credit hours are required to teach IPE, 48% of respondents reported that they were unsure of an appropriate time requirement. Significant differences between associate's and bachelor's/master's degree program faculty were found on the following topics: institutional resources needed for IPE ( < .001), faculty availability ( < .001), curriculum availability for IPE ( = .02), and importance of including IPE at academic health center campuses ( < .001).
CONCLUSIONS
IPE is recognized as an important component of RT education by all faculty respondents. However, significant differences in knowledge and attitudes toward IPE exist between faculty in associate's versus bachelor's/master's degree programs. Revisiting the current accreditation standards program may allow IPE to take a more prominent role in RT curricula.
Topics: Attitude of Health Personnel; Curriculum; Faculty; Humans; Interprofessional Relations; Respiratory Therapy; Surveys and Questionnaires
PubMed: 28292972
DOI: 10.4187/respcare.05034 -
The Western Journal of Medicine Dec 1997
Topics: Clinical Protocols; Humans; Practice Guidelines as Topic; Respiratory Therapy; United States
PubMed: 9426490
DOI: No ID Found -
Neonatology 2013The aim of this conceptual review is to provide the reader with a broad perspective on progress made in respiratory support of preterm infants over the past five... (Review)
Review
The aim of this conceptual review is to provide the reader with a broad perspective on progress made in respiratory support of preterm infants over the past five decades. Landmark discoveries are described in their historical context and underlying theories of lung protection are discussed. The review finishes by integrating different approaches and perspectives into a state-of-the-art concept for lung-protective ventilation in this fragile patient population. Improvements in neonatal respiratory support in the 1970s and 1980s have contributed to dramatic improvements of mortality and morbidity rates among neonates with respiratory failure. Continuous positive airway pressure, antenatal corticosteroids and surfactant replacement therapy revolutionized the care of preterm infants. With the recognition that atelectrauma, volutrauma and oxygen toxicity are the main factors contributing to ventilator-induced lung injury, lung-protective strategies, including noninvasive respiratory support, tidal volume targeting during conventional mechanical ventilation and high frequency ventilation were developed in the 1990s. Given the fact that progress made in the last decade has only resulted in minor improvements in mortality and morbidity rates of neonates with respiratory failure, it seems unlikely that further refinements of current technologies will produce giant leaps forward in high-resource countries. It appears that entirely new approaches would be required. In contrast, knowledge and technology transfer of basic respiratory support strategies (e.g. use of oxygen, simple systems to provide continuous positive airway pressure), could have an enormous impact on the prognosis of neonates with respiratory failure in low-resource countries.
Topics: Adrenal Cortex Hormones; Continuous Positive Airway Pressure; High-Frequency Ventilation; History, 20th Century; History, 21st Century; Humans; Infant, Newborn; Infant, Premature; Pulmonary Surfactants; Respiration, Artificial; Respiratory Insufficiency; Respiratory Therapy
PubMed: 24107385
DOI: 10.1159/000354419 -
Respiratory Care Feb 2022Hospital-acquired pneumonia (HAP) and the need for positive-pressure ventilation (PPV) are significant postoperative pulmonary complications (PPCs) that increase...
BACKGROUND
Hospital-acquired pneumonia (HAP) and the need for positive-pressure ventilation (PPV) are significant postoperative pulmonary complications (PPCs) that increase patients' lengths of stay, mortality, and costs. Current tools used to predict PPCs use nonmodifiable preoperative factors; thus, they cannot assess provided respiratory therapy effectiveness. The Respiratory Assessment and Allocation of Therapy (RAAT) tool was created to identify HAP and the need for PPV and assist in assigning respiratory therapies. This study aimed to assess the RAAT tool's reliability and validity and determine if allocated respiratory procedures based on scores prevented HAP and the need for PPV.
METHODS
Electronic medical record data for nonintubated surgical ICU subjects scored with the RAAT tool were pulled from July 1, 2015-January 31, 2016, using a consecutive sampling technique. Sensitivity, specificity, and jackknife analysis were generated based on total RAAT scores. A unit-weighted analysis and mean differences of consecutive RAAT scores were analyzed with RAAT total scores ≥ 10 and the need for PPV.
RESULTS
The first or second RAAT score of ≤ 5 (unlikely to receive PPV) and ≥ 10 (likely to receive PPV) provided a sensitivity of 0.833 and 0.783 and specificity of 0.761 and 0.804, respectively. Jackknifed sensitivity and specificity for identified cutoffs above were 0.800-0.917 and 0.775-0.739 for the first RAAT score and 0.667-0.889 and 0.815-0.79 for the second RAAT score. The initial RAAT scores of ≥ 10 predicted the need for PPV ( < .001) and was associated with higher in-hospital mortality ( < .001). Mean differences between consecutive RAAT scores revealed decreasing scores did not need PPV.
CONCLUSIONS
The RAAT scoring tool demonstrated an association with the need for PPV using modifiable factors and appears to provide a quantitative method of determining if allocated respiratory therapy is effective.
Topics: Hospital Mortality; Humans; Intensive Care Units; Intermittent Positive-Pressure Ventilation; Positive-Pressure Respiration; Reproducibility of Results
PubMed: 34815327
DOI: 10.4187/respcare.08555 -
Neonatology 2012Recent economic improvements in China have allowed the development of perinatal-neonatal care in sub-provincial regions. However, variations in neonatal respiratory and... (Review)
Review
Recent economic improvements in China have allowed the development of perinatal-neonatal care in sub-provincial regions. However, variations in neonatal respiratory and intensive care exist, especially in regions with limited resources. We conducted a series of collaborative clinical investigations into neonatal hypoxemic respiratory failure (NRF). In the study period from 2004 to 2005, this nationwide study found an incidence of NRF of 13.4% of total admissions to neonatal intensive care units (NICUs), with a mortality of 32%. Fewer than 30% of infants with respiratory distress syndrome (RDS) received surfactant treatment. Most cases of NRF had birth weights (BWs) of 1,000-1,500 g. Approximately 60% of deaths were due to withdrawal of respiratory support because of economic restraints despite initial response to therapy. Extremely low BW or gestational age accounted for less than 2% of all NRF cases, and their survival rate was less than 50%. A prospective clinical epidemiologic study of NRF in 14 NICUs, mainly sub-provincial centers, in Hebei province was undertaken in the study period from 2007 to 2008. NRF made up 16.9% of total NICU admissions, with increased use of surfactant (>50%) and continuous positive airway pressure (>80%) in this study. However, mortality due to RDS, meconium aspiration syndrome and pulmonary infection/sepsis remained higher than 30%, in part affected by socioeconomic factors. With measures to assist hospitalized neonates from low income families in urban areas, as well as the 'new rural cooperative health care program' to subsidize families from rural areas, the quality and affordability of NICU services may be improved in the forthcoming years.
Topics: China; Female; Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Intensive Care, Neonatal; Male; Pulmonary Surfactants; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Respiratory Therapy; Survival Rate
PubMed: 21934332
DOI: 10.1159/000329444