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Respiratory Care Feb 2011Over the past decade, concepts of control of breathing have increasingly moved from being theoretical concepts to "real world" applied science. The purpose of this... (Review)
Review
Over the past decade, concepts of control of breathing have increasingly moved from being theoretical concepts to "real world" applied science. The purpose of this review is to examine the basics of control of breathing, discuss the bidirectional relationship between control of breathing and mechanical ventilation, and critically assess the application of this knowledge at the patient's bedside. The principles of control of breathing remain under-represented in the training curriculum of respiratory therapists and pulmonologists, whereas the day-to-day bedside application of the principles of control of breathing continues to suffer from a lack of outcomes-based research in the intensive care unit. In contrast, the bedside application of the principles of control of breathing to ambulatory subjects with sleep-disordered breathing has out-stripped that in critically ill patients. The evolution of newer technologies, faster real-time computing abilities, and miniaturization of ventilator technology can bring the concepts of control of breathing to the bedside and benefit the critically ill patient. However, market forces, lack of scientific data, lack of research funding, and regulatory obstacles need to be surmounted.
Topics: Computer Systems; Critical Illness; Humans; Miniaturization; Monitoring, Physiologic; Pulmonary Medicine; Respiration, Artificial; Respiratory Therapy; Sleep Apnea Syndromes; Ventilator Weaning; Work of Breathing
PubMed: 21333174
DOI: 10.4187/respcare.01173 -
British Journal of Anaesthesia Oct 1959
Topics: Anesthesia; Equipment and Supplies; Respiratory Therapy
PubMed: 13836178
DOI: 10.1093/bja/31.10.450 -
Respiratory Care Jun 2015Pediatric patients are different from adult patients with respect to airway anatomy and breathing patterns. They are also incapable of following commands and often... (Review)
Review
Pediatric patients are different from adult patients with respect to airway anatomy and breathing patterns. They are also incapable of following commands and often reject breathing treatments. For these reasons, aerosol drug delivery is one of the most technically challenging aspects for clinicians providing respiratory care to young children. Improvements in nebulizer technology have provided better delivery options for pediatric patients. This review highlights research related to pediatric nebulizer and interface devices and how they can be used to provide the safest and most efficient treatments with the array of treatment delivery options. Also addressed are clinical controversies and debates in pediatric aerosol science, including drug delivery in crying versus resting infants, pressurized metered-dose inhalers and small-volume nebulizers for bronchodilator administration, continuous nebulization, noninvasive drug delivery options, and optimization of nebulizer performance during infant and large pediatric conventional and high-frequency ventilation.
Topics: Administration, Inhalation; Aerosols; Bronchodilator Agents; Child; Child, Preschool; Drug Delivery Systems; Equipment Design; Humans; Infant; Infant, Newborn; Nebulizers and Vaporizers; Respiratory Therapy
PubMed: 26070582
DOI: 10.4187/respcare.04137 -
European Journal of Pediatrics Jul 2010The most important goal of introducing noninvasive ventilation (NIV) has been to decrease the need for intubation and, therefore, mechanical ventilation in newborns. As... (Review)
Review
The most important goal of introducing noninvasive ventilation (NIV) has been to decrease the need for intubation and, therefore, mechanical ventilation in newborns. As a result, this technique may reduce the incidence of bronchopulmonary dysplasia (BPD). In addition to nasal CPAP, improvements in sensors and flow delivery systems have resulted in the introduction of a variety of other types of NIV. For the optimal application of these novelties, a thorough physiological knowledge of mechanics of the respiratory system is necessary. In this overview, the modern insights of noninvasive respiratory therapy in newborns are discussed. These aspects include respiratory support in the delivery room; conventional and modern nCPAP; humidified, heated, and high-flow nasal cannula ventilation; and nasal intermittent positive pressure ventilation. Finally, an algorithm is presented describing common practice in taking care of respiratory distress in prematurely born infants.
Topics: Algorithms; Continuous Positive Airway Pressure; Humans; Infant, Newborn; Infant, Premature; Intermittent Positive-Pressure Ventilation; Laryngeal Masks; Positive-Pressure Respiration; Respiratory Mechanics
PubMed: 20179966
DOI: 10.1007/s00431-010-1159-x -
Inquiry : a Journal of Medical Care... 2018Despite largely unproven clinical effectiveness, incentive spirometry (IS) is widely used in an effort to reduce postoperative pulmonary complications. The objective of...
Despite largely unproven clinical effectiveness, incentive spirometry (IS) is widely used in an effort to reduce postoperative pulmonary complications. The objective of the study is to evaluate the financial impact of implementing IS. The amount of time nurses and RTs spend each day doing IS-related activities was assessed utilizing an online survey distributed to the relevant national nursing and respiratory therapists (RT) societies along with questionnaire that was prospectively collected every day for 4 weeks at a single 10-bed cardiothoracic surgery step-down unit. Cost of RT time to teach IS use to patients and cost of nurse time spent reeducating and reminding patients to use IS were used to calculate IS implementation cost estimates per patient. Per-patient cost of IS implementation ranged from $65.30 to $240.96 for a mean 9-day step-down stay. For the 566 patients who stayed in the 10-bed step-down in 2016, the total estimated cost of implementing IS ranged from $36 959.80 to $136 383.36. Using national survey workload data, per-patient cost of IS implementation costed $107.36 (95% confidence interval [CI], $97.88-$116.98) for a hospital stay of 4.5 days. For the 9.7 million inpatient surgeries performed annually in the United States, the total annual cost of implementing postoperative IS is estimated to be $1.04 billion (95% CI, $949.4 million-$1.13 billion). The cost of implementing IS is substantial. Further efficacy studies are necessary to determine whether the cost is justifiable.
Topics: Cost-Benefit Analysis; Female; Health Care Costs; Humans; Internet; Length of Stay; Male; Motivation; Nursing Staff, Hospital; Postoperative Complications; Respiratory Therapy; Spirometry; Surveys and Questionnaires; United States
PubMed: 30175643
DOI: 10.1177/0046958018794993 -
Respiratory Care May 2009The role of the respiratory therapist in the care of patients with cystic fibrosis has expanded throughout the years. As key members of the multidisciplinary team,... (Review)
Review
The role of the respiratory therapist in the care of patients with cystic fibrosis has expanded throughout the years. As key members of the multidisciplinary team, respiratory therapists actively participate in the medical management of patients with cystic fibrosis along the continuum of care, from acute in-patient stays to the out-patient clinic and/or home setting. Through their involvement in diagnostic testing, administering therapy, or direct bedside care, patient and caregiver education, and disease management, respiratory therapists strive to preserve lung function, maintain overall health, and improve the patient's quality of life.
Topics: Cystic Fibrosis; Humans; Patient Satisfaction; Quality of Life; Respiratory Therapy; Treatment Outcome
PubMed: 19393103
DOI: 10.4187/aarc0439 -
Respiratory Care Mar 2003Respiratory distress syndrome is the most common respiratory disorder in preterm infants. Over the last decade, because of improvements in neonatal care and increased... (Review)
Review
Respiratory distress syndrome is the most common respiratory disorder in preterm infants. Over the last decade, because of improvements in neonatal care and increased use of antenatal steroids and surfactant replacement therapy, mortality from respiratory distress syndrome has dropped substantially. However, respiratory morbidity, primarily bronchopulmonary dysplasia, remains unacceptably high. The management of respiratory distress syndrome in preterm infants is based on various modalities of respiratory support and the application of fundamental principles of neonatal care. To obtain best results, a multidisciplinary approach is crucial. This review discusses surfactant replacement therapy and some of the current strategies in ventilatory management of preterm infants with respiratory distress syndrome.
Topics: Disease Management; Female; Humans; Infant, Newborn; Infant, Premature; Intensive Care, Neonatal; Nitric Oxide; Pregnancy; Pulmonary Surfactants; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Respiratory Therapy; United States
PubMed: 12667277
DOI: No ID Found -
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 -
Muscle & Nerve Sep 2012Respiratory complications are a common cause of morbidity and mortality in amyotrophic lateral sclerosis (ALS). Treatment of respiratory insufficiency with noninvasive... (Review)
Review
Respiratory complications are a common cause of morbidity and mortality in amyotrophic lateral sclerosis (ALS). Treatment of respiratory insufficiency with noninvasive ventilation (NIV) improves ALS patients' quality of life and survival. Evidence-based practice guidelines for the management of ALS patients recommend treatment of respiratory insufficiency with NIV as well as consideration of insufflation/exsufflation to improve clearance of airway secretions. Despite these recommendations respiratory therapies remain underused. In this review we provide a practical guide for the clinician to prescribe and manage respiratory therapies for the patient with ALS.
Topics: Amyotrophic Lateral Sclerosis; Evidence-Based Medicine; Humans; Respiratory Insufficiency; Respiratory Therapy
PubMed: 22907221
DOI: 10.1002/mus.23282 -
Respiratory Care Aug 2019
Topics: Referral and Consultation; Respiratory Therapy
PubMed: 31346076
DOI: 10.4187/respcare.07017