Browsing by Subject "Continuous Positive Airway Pressure"
Now showing 1 - 3 of 3
- Results Per Page
- Sort Options
Item The Invisible Force: Optimizing Novel Approaches in Anesthesiology and Infectious Diseases(2022-05-01T05:00:00.000Z) Vachon, Matthew Jonathan; Marull, Javier H.; Huth, James F.; Lin, MitchellThis work encompasses a theme revolving the OR: specifically, preoperatively, perioperatively, and postoperatively. Chapter 1 describes a novel method whereby biofilm is destroyed using Alternating Magnetic Fields (AMF). Using S. aureus grown on steel washers to simulate prosthetic joints, we were able to intermittently deliver 3s pulses for 15, 30, or 60 minutes to reduce bacterial load. Combined treatment with AMF and ceftriaxone (or linezolid) showed a 5-log decrease in bacterial load after 24 hours, whereas singular treatment with AMF or abx alone showed total regrowth or moderate decrease in bacterial load respectively. Chapter 2 describes a meta-analysis conducted to assess the safety and efficiency of sugammadex versus neostigmine as neuromuscular blockade (NMB) reversal agents. Neostigmine has been implemented in ORs for many years, but has disadvantages to using neostigmine including autonomic dysfunction like bradycardia and post-operative nausea & vomiting (PONV), and the necessity to administer the drug at the correct time due to its lag time in effect. Sugammadex appears to circumnavigate these problems, but the literature is still not definitive. We performed a meta-analysis that showed sugammadex as having a milder side effect profile compared to neostigmine with reduction in pneumonia (RR = 0.593, 95% CI (0.361, 0.671) and bradycardia (RR = 0. 535, 95% CI (0.424, 0.675), higher PONV risk (RR = 1.21, 95% CI (1.05, 1.39)), and with faster turnaround times. Chapter 3 describes a survey sent out to ambulatory surgical centers (ASC) on management of patients with obstructive sleep apnea (OSA). The need for a CPAP device in the immediate postoperative period at ambulatory surgical centers remains controversial because these ambulatory patients are healthier and have fewer complications. Only 59.7% of ASCs required their patients to bring their CPAP devices on the day of surgery, and 25.37% reported using a CPAP machine postoperatively within the past 2 years, with the highest CPAP usage at one facility being 20 times in that 2-year period. Studies further in-depth are necessary to assess postoperative complications that require a CPAP device to determine the urgency of ASCs implementing SAMBA's recommendations.Item Reducing CPAP Failure in Extremely Preterm Infants(2019-04-02) He, Henry; Reed, W. Gary; Kakkilaya, Venkatakrishna; Kapadia, VishalBACKGROUND: Extremely preterm infants (<29 weeks EGA) have high rates of respiratory distress syndrome (RDS). Continuous positive airway pressure (CPAP) ± intubation and surfactant administration provide a safe and effective way of treating RDS without the need for prophylactic intubation and surfactant administration. CPAP failure occurs when infants on CPAP must be subsequently intubated within the first 72 hours of life. LOCAL PROBLEM: The CPAP failure rate at Parkland Hospital is elevated compared to the gold standard neonatal ICU (NICU) at Columbia University. METHODS: Quality improvement tools were applied to assess areas for improvement in the CPAP process. The baseline rates of CPAP failure at the Parkland NICU were determined through chart review. Observation of the CPAP process and interviews with NICU staff was performed. INTERVENTIONS: A CPAP failure checklist was developed and placed in each NICU room. Quarterly training led by a respiratory therapist was provided to NICU staff. CPAP audits were updated, and a visual display of the proper CPAP setup was placed in each NICU pod. RESULTS: There was no significant change in the CPAP failure rate from 2015 to 2017. However, there was a reduction in the variation in the CPAP failure rate from 2015 to 2017. There was no change seen in the secondary outcome of the bronchopulmonary dysplasia rate but there was a significant decrease in the total ventilator days. During this time frame, there was also an increase in the number of infants arriving to the NICU on CPAP. CONCLUSION: Our interventions were not successful in lowering the CPAP failure rate. However, our interventions did have a measurable effect in lowering the variability of the failure rate. The decrease in the total ventilator days and increase in the number of infants being managed solely on CPAP indicates a culture shift in the NICU.Item [UT Southwestern Medical Center News](2010-06-04) Shear, Kristen Holland