Ventilator Assisted Care Case Study

The facility provides medical care for children and adolescents with severe physical and intellectual impairment conditions. The TWSCCC provides 24-hour skilled nursing care, 24-hour Respiratory Therapy services, Physical, Occupational, and Speech Therapy, Licensed On-site teachers, and a large variety of specialty care services (Truman W. Smith). The facility offers a viable and solicitous option for parents who are unable to take of their chronically ill children in their home, and for children who have been placed in state custody. The TWSCCC allows patients to receive the care they need and might otherwise not receive, in an adequately equipped facility via a staff of specialized care providers who advocate for the patients wants, rights, and well-being. The TWSCCC facility welcomes residents regardless of race, gender, religion, or economic status.

Adequate qualified medical staff must be present in all critical care areas caring for mechanically ventilated

Critically ill patients that require mechanical ventilation are at risk of developing secondary infections that may increase length of stay and possibly even morbidity. This fragile patient population requires special attention and meticulous adherence to established nursing standards of care. These standards of care are founded on evidenced based practices. It is important that nurses receive education about why these standards are in place and what consequences can result due to not following the established care protocols.

Ventilator-associated pneumonia is a bacterial infection that occurs in the lower respiratory system within the first 48 hours of endotrachal intubation (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011). Although any hospital patient is susceptible to pneumonia, ventilator dependent patients are at the highest risk of acquiring pneumonia. The purpose of this paper is to identify the risk factors, incidences, and preventions of ventilator-associated pneumonia (VAP) using a quantitative research study performed in Malaysia. “The aim of this

The team will navigate patients through the program, resources and pulmonary rehabilitation. The registered nurse will meet with the patient prior to discharge to evaluate and refer them to the appropriate services along with the social worker, which may find alternative way to pay for patients medication and other support services that may be offered. The nurse practitioner and the respiratory therapist will see the patient within 48 of hours upon admission into program. The nurse practitioner and respiratory therapist will evaluate the needs at home and enroll the patient in pulmonary rehabilitation, which will be part of the care offered to all patients. Resources for the patient will consist of a 24-hour hotline for patients who may need to seek medical advice prior to going to the emergency room. Patient will be supplied with emergency medications for home use if symptoms begin to appear. A nurse practitioner will be available to advice the patient in intervention with the emergency medications is indicated and advice if treatment may need to be continued in the emergency room. With the protocols in place for medications, the patient will be seen within 12 hours if use of the emergency medications were taken in the home. The nurse practitioner will update the electronic medical chart of the patient to document

I would choose pressure controlled - continuous mandatory ventilation (PC-CMV) for this patient. I would set up the ventilator with the following settings: initial PIP of 20 cm H2O and once patient is attached, I would adjust the PIP to 10 cm H2O above the determined plateau pressure, tidal volume at 90 ml (patient’s IBW is 14.5 kg and the recommended VT is 5 - 8 ml/kg), frequency at 30 (recommended is 20 - 35 for a toddler), FiO2 at 100%, PEEP at the recommended pressure of +5 cm H2O, and inspiratory time of 0.6 seconds (recommended is 0.6 - 0.7) (Walsh 335). I would also add heated humidity to the circuit via a heated pass-over humidifier set at 37 degrees Celsius. The alarm settings would be the following: humidifier high temperature alarm at 38 degrees C. and low temperature alarm at 30 degrees C., high pressure alarm set to 10 cm H2O above PIP and low pressure alarm set to 5 - 10 cm H2O below PIP, low exhaled tidal volume alarm set to 80 ml (10 - 15% below set tidal volume), high PEEP set to 7 cm H20 and low PEEP alarm set to 3 cm H2O (2 - 3 cm H2O above and below set PEEP), high respiratory rate alarm set to 42 and low respiratory rate set to 18 (40% above and below the set rate) (Cairo 106-109).

Ventilator - associated pneumonia (VAP) is the second most common hospital acquired infection (HAI) and is associated with high morbidity and mortality rates for ventilated patients in intensive care units (Bingham, Ashley, Jong, & Swift, 2010). The VAP increases patients’ mortality rates, length of stay and hospital costs (Hiner, Kasuya, Cottingham, & Whitney, 2010). The VAP is the leading causes of death due to nosocomial infections and the

The American Association for Respiratory Care is a non-profit organization which provides numerous resources for registered respiratory therapists all over the United States. Membership through the AARC renders an abundance of incentives such as professional development, respiratory care education, social networking opportunities, continuing education programs and much more. The American Association for Respiratory Care truly believes in the cause of respiratory therapy and in the rights of their patients to receive competent respiratory care. Their advocacy team works with local, state and federal governments concerning public policies that affect their patients as well as their profession.

The prevention of VAP through standardized care can reduce mortality rates, reduce mechanical ventilation days, and decrease costs and improve patient outcome.

2081488 Long term hospitalizations significantly impact the emotional and social development of children. Not only do hospitals eliminate the children’s comfortable and known enviroment, but they can potentialy foster a sense of isolation, anxiety, and fear. This past summer I worked on a pediatric oncology inpatient ward. I went room to room playing with children, holding babies so that their caregivers could have a break, and keeping teenage patients company. One day, I went into a young girl’s room who was completely alone.

To have a PHVP, a hospital needs to have a pediatric surgeon and pediatric ICU able to accommodate vent-dependent patients.

Respiratory therapists have one of the most exciting and gratifying careers within the medical field. Unfortunately as with any other job or career, it doesn’t come without having challenging times. Respiratory therapists work along-side physicians and are highly trained to treat patients with any sort of lung concern or breathing complications. This job requires hands on care, and deals with life and death daily. One specific scope of this field involves caring for patients (of all ages) attached to mechanical ventilation. It is the respiratory therapists’ responsibility to remove assistive ventilation to patients with written order from the doctor; which ultimately results in death of the patient (Keene, Samples, Masini, Byington).

Qualitative methodology is appropriate with this study because researchers focused on the satisfaction level of the caregiver and patient in addition to the time spent preparing and administering respiratory therapy and cost of treatment. The research doesn’t appear to infer or explain the actions or experiences of the participants, but rather uses supportive data acquired by post hospitalization survey to support the validity of the study.

Thank you Adam, I agree that there is a 12 case series but as you indicated that series reported weaning nava on invasive ventilation. If I remember right ( I need to review recent data) there is no report/case review that discuss using NAVA in both invasive and noninvasive ventilation during the weaning phase in CDH patients. Mike, what do you think about reporting our experience and emphasizing the use of NAVA during noninvasive ventilation?

This organization does research and provides clinical education on hydrodynamic monitoring, Interpretation of Arterial blood gases, mechanical ventilation, and education on procedures such as Fiberoptic endotracheal intubation procedure, endotracheal intubation by direct Laryngoscopy and Bronchoalveolar lavage. It also provides continuing education for clinicians and be on board about the latest advances on pulmonary and critical care. This not only educates the but also gives them contact hours for continuing