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The respiratory care profession originated when "oxygen technicians"' were hired to transport cylinders around hospitals. Subsequently, mechanical ventilators were developed, beginning with primitive machines and evolving to moder...
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The respiratory care profession originated when "oxygen technicians"' were hired to transport cylinders around hospitals. Subsequently, mechanical ventilators were developed, beginning with primitive machines and evolving to modern, microprocessor-controlled ventilators. With the passage of time, the respiratory care profession grew from a small cadre of individuals trained on the job to an allied health profession composed of >100,000 formally educated, credentialed, licensed practitioners.Even in today's uncertain health care climate, the future prosperity of the respiratory care profession seems assured, at least in part because of the aging of the population. Therapists will function adequately in tertiary care, urban medical center intensive care units but may be overqualified for small, community hospitals. Some practitioners will work as generalists in patient-focused care settings or will broaden their technical expertise and perform multiple tasks such as electrocardiograms, electroencephalograms, or pulmonary function tests. Still others will specialize in home care or long-term ventilator care. Expansion of therapist-driven protocols will continue.Physicians are unlikely to support independent respiratory care practice similar to that of physical therapists. Current efforts by American Association for Respiratory Care leaders to dimmish the traditional close working relationship between physicians and respiratory care practitioners and to assume sole control of respiratory care accreditation, credentialing, and licensure either should be curtailed or will likely result in hospital respiratory care departments losing physician support and becoming incorporated into nursing departments.
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Purpose of reviewTo summarize current literature describing the respiratory complications of neuromuscular disease (NMD) and the effect of respiratory interventions and to explore new gene therapies for patients with NMD.Recent fi...
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Purpose of reviewTo summarize current literature describing the respiratory complications of neuromuscular disease (NMD) and the effect of respiratory interventions and to explore new gene therapies for patients with NMD.Recent findingsMeasurements of respiratory function focus on vital capacity and maximal inspiratory and expiratory pressure and show decline over time. Management of respiratory complications includes lung volume recruitment, mechanical insufflation-exsufflation, chest physiotherapy and assisted ventilation. Lung volume recruitment can slow the progression of lung restriction. New gene-specific therapies for Duchenne muscular dystrophy and spinal muscular atrophy have the potential to preserve respiratory function longitudinally. However, the long-term therapeutic benefit remains unknown.SummaryAlthough NMDs are heterogeneous, many lead to progressive muscle weakness that compromises the function of the respiratory system including upper airway tone, cough and secretion clearance and chest wall support. Respiratory therapies augment or support the normal function of these components of the respiratory system. From a respiratory perspective, the new mutation and gene-specific therapies for NMD are likely to confer long-term therapeutic benefit. More sensitive and standard tools to assess respiratory function longitudinally are needed to monitor respiratory complications in children with NMD, particularly the youngest patients.
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Respiratory distress is one of the most common reasons of an infant been admitted to the neonatal intensive care unit1,2. 15% of term infants and 29% of late preterm infants admitted to the neonatal intensive care unit develop sig...
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Respiratory distress is one of the most common reasons of an infant been admitted to the neonatal intensive care unit1,2. 15% of term infants and 29% of late preterm infants admitted to the neonatal intensive care unit develop significant respiratory morbidity; this is even higher for infants born before 34 weeks' gestation3 . Signs and symptoms of respiratory distress include cyanosis, grunting, nasal flaring, retractions, tachypnea, decreased breath sound with or without rales and/or ronchi, and pallor1 . A wide variety of pathologic lesions may be responsible for respiratory distress in newborn1 . Among those, Transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), congenital pneumonia, congenital heart disease (CHD), perinatal asphyxia (PNA), and congenital anomalies as tracheo-oesophageal fistula, and congenital diaphragmatic hernia4 . In Bangladesh, the second most common cause of neonatal death is birth asphyxia5 . So we need to focus on rapid recognition and quick management of respiratory difficulties to improve the outcome.
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Purpose: We aimed to evaluate the usefulness and safety of high-flow nasal cannula (HFNC) oxygen therapy in children with complex chronic diseases (CCD) with impending respiratory failure in the general ward.Methods: Medical recor...
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Purpose: We aimed to evaluate the usefulness and safety of high-flow nasal cannula (HFNC) oxygen therapy in children with complex chronic diseases (CCD) with impending respiratory failure in the general ward.Methods: Medical records of subjects with HFNC oxygen use in the general ward at a Korean tertiary children’s hospital were reviewed. Children with CCD and impending respiratory failure were included. treatment success was defined as successful weaningfrom HFNC oxygen support and treatment failure as weaning failure that led to higher level of respiratory support such as invasiveventilation or noninvasive positive pressure ventilation.Results: Fifty cases were included. Thirty-five cases (70%) were weaned off HFNC oxygen successfully, 15 cases (30%) failed. At thetime of HFNC oxygen administration, the treatment failure group showed higher heart rate (P= 0.043), carbon dioxide partial pressure (P= 0.002), and initial inspired oxygen fraction (P= 0.007). Within 72 hours of initial treatment, 20% of patients in the treatmentsuccess group were weaned off the HFNC oxygen and half in the treatment-failure group required invasive ventilation. One case experienced complication.Conclusion: HFNC oxygen is safe and effective for respiratory support in the general ward to avoid invasive mechanical ventilationin children with CCD and impending respiratory failure.
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Multiple studies have shown the effects of prone (PP), supine (SP) and kangaroo (KP) positions on clinical and physiological outcomes in preterm newborns, but none compared these three types of positioning between them. To investi...
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Multiple studies have shown the effects of prone (PP), supine (SP) and kangaroo (KP) positions on clinical and physiological outcomes in preterm newborns, but none compared these three types of positioning between them. To investigate the influence of these positionings on heart rate, respiratory rate, peripheral oxygen saturation (SpO2) and alertness status in clinically stable preterm newborns (NBs) admitted to a neonatal intensive care unit. Methods: In a randomized clinical trial, clinically stable NBs with gestational ages from 30 to 37 weeks who were breathing spontaneously were allocated in three positioning groups: PP, SP and KP. Heart rate, breathing frequency, SpO2 and alertness status were evaluated immediately before and after 30 minutes of positioning. Results: In all, 66 NBs were assessed (corrected age: 35.48 ± 1.94 weeks; weight: 1840.14 ± 361.09 g), (PP: n = 22; SP: n = 23; KP: n = 21). NBs in the PP group showed a significant improvement in peripheral SpO2 (97.18 ± 2.16 vs 95.47 ± 2.93 vs 95.57 ± 2.95, p = 0.03) compared with the SP and KP groups. Conclusion: In clinically stable preterm NBs, the PP was associated with better peripheral oxygen saturation than the SP or KP. In addition, there was a reduction in heart rate within prone position group and in the KP group there was an increase in the number of NBs in the deep sleep classification.
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BACKGROUND: Use of respiratory therapist (RT)-guided protocols enhances allocation of respiratory care. In the context that optimal protocol use requires a system for auditing respiratory care plans to assure adherence to protocol...
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BACKGROUND: Use of respiratory therapist (RT)-guided protocols enhances allocation of respiratory care. In the context that optimal protocol use requires a system for auditing respiratory care plans to assure adherence to protocols and expertise of the RTs generating the care plan, a live audit system has been in longstanding use in our Respiratory Therapy Consult Service. Growth in the number of RT positions and the need to audit more frequently has prompted development of a new, computer-aided audit system. METHODS: The number and results of audits using the old and new systems were compared (for the periods May 30, 2009 through May 30, 2011 and January 1, 2012 through May 30, 2012, respectively). In contrast to the original, live system requiring a patient visit by the auditor, the new system involves completion of a respiratory therapy care plan using patient information in the electronic medical record, both by the RT generating the care plan and the auditor. Completing audits in the new system also uses an electronic respiratory therapy management system. RESULTS: The degrees of concordance between the audited RT's care plans and the "gold standard" care plans using the old and new audit systems were similar. Use of the new system was associated with an almost doubling of the rate of audits (ie, 11 per month vs 6.1 per month). CONCLUSIONS: The new, computer-aided audit system increased capacity to audit more RTs performing RT-guided consults while preserving accuracy as an audit tool. Ensuring that RTs adhere to the audit process remains the challenge for the new system, and is the rate-limiting step.
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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 reso...
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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.
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Ventilator hyperinflations are used by physiotherapists for the purpose of airway clearance in intensive care. There is limited data to guide the selection of mechanical ventilator modes and settings that may achieve desired flow ...
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Ventilator hyperinflations are used by physiotherapists for the purpose of airway clearance in intensive care. There is limited data to guide the selection of mechanical ventilator modes and settings that may achieve desired flow patterns for ventilator hyperinflation. A mechanical ventilator was connected to two lung simulators and a respiratory mechanics monitor. Peak inspiratory (PIFR) and expiratory flow rates (PEFR) were measured during manipulation of ventilator modes (pressure support ventilation [PSV], volume-controlled synchronised intermittent mandatory ventilation [VC-SIMV] and pressure-controlled synchronised intermittent mandatory ventilation [PC-SIMV]) and ventilator settings (including set tidal volume, positive end-expiratory pressure, inspiratory flow rate, inspiratory pause, pressure support, inspiratory time and/or inflation pressure). Additionally, each trial was conducted with high (0.05 I/cmH(2)O) and low (0.01 I/cmH(2)O) compliance settings on the lung simulators. Each trial was dichotomised into success or failure under three categories (attainment of PIER/PEER less than or equal to 0.9, PEFR-PIFR greater than 17 I/mm, PEER greater than or equal to 40 I/mm). A total of 232 trials were conducted (96 VC-SIMV, 96 PC-SIMV, 40 PSV). A greater proportion of VC-SIMV trials were ceased due to high peak inspiratory pressures (35%). However, VC-SIMV trials were more likely to be successful at meeting all three outcome measures (26 VC-SIMV trials, 7 PC-SIMV trials, 0 PSV trials). It was found that manipulation of settings in VC-SIMV mode appears more successful than PSV and PC-SIMV for ventilator hyperinflations.
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BACKGROUND: Hammock positioning is now frequently used with preterm infants admitted to ICUs. However, few studies have investigated the extent to which hammock positioning reduces pain and improves the sleep-wakefulness state com...
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BACKGROUND: Hammock positioning is now frequently used with preterm infants admitted to ICUs. However, few studies have investigated the extent to which hammock positioning reduces pain and improves the sleep-wakefulness state compared with traditional positioning. METHODS: Twenty-six clinically stable newborns with gestational ages from 30 to 37 weeks who were breathing spontaneously were randomly assigned to 2 groups: a hammock-positioning group (n = 13), in which newborns were placed in hammocks in the lateral position, and a traditional-positioning group (n = 13), in which they were kept nested, also in the lateral position. The following variables were evaluated at the beginning and the end of the treatment: pain (with the Premature Infant Pain Profile, and Neonatal Facial Coding System), sleep-wakefulness state (with the Brazelton Neonatal Behavioral Assessment Scale), heart rate, breathing frequency, and peripheral S-pO2. RESULTS: The subjects in the hammock-positioning group showed an improvement in pain compared with the traditional-positioning group(Premature Infant Pain Profile score, 2.62 +/- 1.89 vs 2.31 +/- 1.97, Delta P < .008) and sleep-wakefulness state score (2.08 +/- 0.64 vs 1.23 +/- 0.44, Delta P < .001), reduced heart rate (151.69 +/- 5.44 vs 142.77 +/- 5.18 beats/min, Delta P <.001), breathing frequency (52.31 +/- 4.05 vs 50.23 +/- 2.55 beats/min, Delta P = .024), and increased peripheral S-pO2 (94.69 +/- 2.14 vs 98.00 +/- 1.22%, Delta P <.001). CONCLUSIONS: Hammock positioning was an effective treatment option to reduce pain and improve sleep-wakefulness state. It also helped to reduce heart rate and breathing frequency, and to increase peripheral S-pO2, which made it a treatment option for preterm infants.
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