Continuous Positive Air Pressure

Baker, J & Baker, R.W. (2011) Health Care Finance, Basic Tools for Nonfinancial Managers (3rd Edition). Jones and Bartlett Publishers.

ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).

Jane’s asthma was acute severe. Initially to alleviate some of Jane’s breathlessness she was sat up right in the bed and supported with pillows to improve air entry. Due to her low oxygen saturations she was placed on 40% oxygen via Hudson mask (BTS 2006), as Jane was mouth breathing the mask was the appropriate device to use to ensure adequate oxygenation (Walsh 2002). According to Inwald et al (2001) hypoxemia is frequently a primary cause in numerous asthma related deaths. By administering oxygen promptly, for acute severe asthma, serious hypoxemia

I would tell the doctor to stop if he didn’t start and grab a manual ventilator and try to find a replacement mechanical ventilator.

The project aim was to propose the adaptation of a humidification device to offer comfort to patients who are on high flow oxygen therapy; and to provide in-service trainings to clinical staff. Fisher & Paykel humidifiers were chosen in the proposal as the company provides excellent support for staff; and my past experience has assured me that the equipment is reliable and simple to use for nurses.

Endotracheal tubes containing a tapered cuff have recently been approved by the United States Food and Drug Administration and, based on the findings from in vitro and in vivo studies, are believed to achieve a better tracheal seal (Bowton et al., 2013). This enhanced fit is suggested to reduce the passage of potentially contaminated secretions around the cuff and into the distal airway of mechanically ventilated patients, thereby decreasing the development of VAP. In a study executed by Bowton et al. (2013), researchers examined whether these tapered endotracheal tubes would be more effective in reducing actual rates of VAP. Their study utilized a two-period observational approach in which each study period took place over six of the same calendar months so as to eliminate potential variations in season related to VAP. All adults over the age of 18 who were admitted into a variety of specialized ICUs, whose VAP rates closely resembled the average of all ICUs in the United States, were included in the study. During the first six month period, all endotracheal tubes utilized by the facility contained the standard, barrel-shaped cuff. Following this period, an audit was performed to ensure that all of these tubes were removed and, subsequently, they were replaced with tapered-cuff endotracheal tubes. Additionally, all emergency medical

The rationale for this intervention is that humidification can help to thin tenacious secretions, lower the risk of mucus plug formation and allow for better expectoration and easier extraction via suctioning (Branson, 2007). This is particularly relevant for patients with tracheostomies since air entering their lungs is not warmed by the nasal turbinates and can lead to dry secretions that are hard to remove (Lewis, 2014). To implement this intervention I consulted the patient’s chart to confirm that this was recommended. I then attached the patient’s tracheostomy mask to a constant flow of warm humidified

One of the most common causes of an airway obstruction in unconscious patient's is their tongue. This problem can be overcome by the use of an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA). These airway adjuncts are inserted into the patient's mouth or nostril, and are designed to hold the tongue in a position that prevents it from occluding the airway. Another skill authorized for BLS providers is the use of a bag-valve-mask (BVM). This tool allows EMS personnel to deliver positive pressure ventilations to a patient who is not breathing sufficiently on their own. However, this skill is commonly performed improperly. When using a BVM, an EMS provider must make certain that his patient's airway is patent, and that his head is positioned properly. Furthermore, it is critical that an EMS provider ensures that the mask is maintaining a complete seal around his patient's nose and mouth. Otherwise, pressure needed to force air into the lungs escapes through the unsealed portion of the mask, reducing the effectiveness of the ventilation. Another, more advanced skill used by EMS providers is the performance of an endotracheal

All patients were followed with pulmonary artery catheters and invasive blood pressure. After orotracheal intubation, patients were ventilated with intermittent positive pressure with a tidal volume of 8 mL / kg, final expiratory positive pressure of 5 to 8 cmH2O and FiO2 of 60 to 100% to maintain arterial oxygen saturation above 95%.

Oronasal mask was used with all subjects to start NIV. Manually and/or Mechanically Assisted Cough - manually assisted cough was employed to provide optimal insufflations. Portable ventilator was used to deliver deep insufflations. Both assisted coughs were administered for the first 3 days of the home care practical by a respiratory care therapist, who visited the patients every morning. They trained them for 3 days how to use NIV. The pulmonology also visited the subjects for the first three days. The nurses visited the patients mornings and afternoons until recover them not to getting worst.

Two issues were to be addressed, length of stay (especially mechanically ventilated patients) and the failure of the medical staff to respond to nursing calls. This length of stay has improved. The medical staff response has improved but, remains an issue. Currently the program covers 7A - 7P. The over night cover is by a physician on call from home who may be called in. The I house coverage is provided by the hospitalist program. Some of these individuals are not proficient in airways or lines. The airway support is by a respiratory therapist or a nurse anesthetist ( a mid-level provider) when available. The coverage is haphazard, inconsistent, and at times unsafe. The goal of the proposed plan is to augment the 7P -7A at home physician with an in-house Midlevels who can reliably intubate, gain central access, and support the patient until assistance can

At Memorial Hermann Hospital in Texas, preventative strategies were implemented to reduce the VAP rates. The process improvement team developed a treatment plan which included the ventilator bundle and care practices to reduce VAPS to 0 in 6 months. Their main process measurement was ventilator bundle compliance and their key outcome measure was the number of VAPS per 100 ventilator days. The ventilator bundle was developed by the Institute for Healthcare Improvement to include protocols for mouth care and handwashing, head of bed alarms, subglottic suctioning, and use of an electronic compliance feedback tool (Sadeghi et al, 2013).

Although asthma is now often well-controlled and exacerbations are becoming rarer, the optimal treatment for serious, life-threatening asthma attack with respiratory failure remains under discussion. We recently experienced two cases of respiratory failure successfully treated with high flow nasal cannula (HFNC). HFNC is typically used in the respiratory failure in adults and pediatric patients in NICU. However, the report using this device to asthma is very

Mechanically ventilated patients are increasingly at the risk of acquiring Ventilator-associated pneumonia (VAP) which is the leading infectious complication, affecting from 8% to 28% of patients admitted in the intensive care units. Morbidity and mortality associated with the development of VAP is high, with mortality rates ranging from 20 to 41%.Development of VAP increases ventilator days, critical care and hospital lengths of stay. Essential airway management is one of the important interventions to prevent ventilator associated pneumonia. Manual Hyperinflation (MH) enhances clearance of airway secretions and thereby improved lung compliance, reduced inspiratory resistance, improved V/Q matching, cleared airway and re-expanding the collapsed alveoli. MH could resemble a forceful cough, with which, sputum could propagate from distal to more proximal areas that is, from the smaller airways toward the larger airways, where it can be easily removed through endotracheal suctioning. Hence MH followed by suctioning is considered to be a suitable intervention to prevent VAP among intubated and mechanically ventilated patients.

Mechanically ventilated patient who requires FiO2 >0.8 and/or positive end-expiratory pressure >12 mm Hg, or who has acutely worsening respiratory failure