Browsing by Subject "Respiratory Insufficiency"
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Item Acute pulmonary edema and related forms of acute respiratory insufficiency(1965-05-20) UnknownItem Acute respiratory failure in chronic obstructive pulmonary disease(1993-03-04) Pitcher, William DouglasItem Determination of Respiratory Depression Measured by Capnography of Acutely Intoxicated Patients Presenting to an Urban Emergency Department(2015-01-26) Danko, Colin; Au, Vincent; Onisko, Nancy S.; Severson, Katie; Kleinschmidt, KurtINTRODUCTION: The standard of care for monitoring the respiratory status of patients with altered sensorium until recently has been pulse oximetry and observation. While pulse oximetry measures peripheral arterial oxygen saturation, it does not adequately detect hypoventilatory status. We hypothesized that intoxicated patients would demonstrate clinically significant signs of hypoventilation and that ETCO2 monitoring may detect these changes earlier than pulse oximetry. METHODS: This was a pilot observational data collection study of intoxicated patients presenting to a single urban emergency department between June 6, 2014 and August 1, 2014. Research assistants (RA's) monitored the ED tracking board for patients presenting with chief complaints suggesting possible intoxication with drugs or alcohol. Patients eligible for enrollment were between age 18-80 years, had a baseline Rikers Sedation Agitation Scale Score of < 3 and the treating ED physician believed that the patient's altered mental status was "possibly" or "probably" related to use of an intoxicant. Vital sign data and end-tidal CO2 readings were collected at Baseline, 30, 60, 90 and 120 minutes then hourly there after. End points for data collection were: 1) demonstration of alertness for at least 60 consecutive minutes 2) disposition to home or another hospital department or 3) decompensating respiratory status requiring bi-pap, c-pap or intubation. RESULTS: Seven hundred ninety four patients were screened. Thirty-five met all enrollment criteria and were assigned a de-identified patient number. Six patients were excluded from the final data analysis (5 for critical errors in ETCO2 data collection and 1 had AMS of non-intoxication etiology). Of the remaining 29 patients, 20 were male, 9 female. Ages ranged from 19-54 yrs. Alcohol was one of the intoxicants in almost half of patients. Other intoxicants included benzodiazepines, synthetic cannabinoids, cocaine, heroin and diet pills. Some patients had exposure to more than one intoxicant. ETCO2 values of > 45 mmHg were considered indicators of hypoventilatory state. There were a total of 19 episodes of hypoventilatory status as indicated by ETCO2 > 45 mmHg. Of the patients with multiple episodes (> 2) of hypoventilatory status, two had used heroin, one 62 mg lorazepam. Pulse oximetry reflected a normal oxygen saturation during at least 6 of the episodes. CONCLUSION: ETCO2 may detect hypoventilatory status before pulse oximetry and should be standard of care in patients presenting with intoxication associated with CNS depression.Item Extracorporeal life support for respiratory failure(2019-11-08) Mohanka, ManishItem Methods of employing prolonged assisted respiration(1958-07-24) Miller, William F.Item Selected aspects of the treatment of respiratory failure(1968-04-11) Pierce, Alan K.Item Trends and Variations in Tracheal Intubation for Acute Respiratory Failure in the US(2024-01-30) Iancau, Alexander; Rosero, Eric B.; Karamchandani, KunalBACKGROUND: Acute respiratory failure (ARF) is a critical medical emergency with increasing mortality rates and hospitalizations in the United States (US). Tracheal intubation (TI) is often required to provide mechanical ventilation in these patients. However, recent evidence shows that TI in critically ill patients is associated with substantial morbidity and mortality, and hence, understanding trends and variations in the practice of TI in critically ill patients with ARF is crucial for improving patient outcomes and healthcare practices. HYPOTHESIS: The study aims to evaluate the frequency of TIs in ARF patients and to assess trends and variations in TI use across US hospitals. We hypothesize a declining trend in TIs among ARF patients and significant variability in TI utilization across US hospitals. METHODS: In our retrospective cohort study, we utilized the National Inpatient Sample (NIS) database from the HCUP. Patient selection relied on ICD 10th Revision codes to identify critically ill adults aged 18 and above who underwent TI and were diagnosed with ARF (2016-2020). We also extracted patient demographic and hospitalization details from the database. RESULTS: From 2016-2020, 2,531,420 patients were admitted to US hospitals with ARF, and of these, 522,746 underwent TI (26.02%). The mean age was 62 years, 44.4% were women, and the in-hospital mortality was 32.8% (95% CI, 32.6%-33.0%). The mortality among patients receiving TI increased significantly from 30.6% (95% CI, 30.1%-31.1%) in 2016 to 37.8% (95% CI, 37.3%-38.3%) in 2020 (p<.0001). However, the percentage of ARF-related hospitalizations receiving TI decreased from 23.9% (95% CI, 23.4% - 24.4%) in 2016 to 18.9% (95% CI, 18.5% - 19.3%) in 2020 (p<.0001). CONCLUSION: We found a decline in TI use for patients with ARF across hospitals in the United States. This could be due to the increased use of alternative techniques to manage ARF, such as non-invasive ventilation and high-flow nasal cannula.Item Use of Respiratory Acoustic Monitor for Postoperative Monitoring in Children(2016-01-19) Williams, Timothy; Aboul-Fettouh, Nader; Ploski, Roxana; Griffin, Allison; Szmuk, PeterRecording vital signs is the standard of care for all patients on the hospital wards after surgery to detect respiratory and cardiovascular depression before serious complications ensue. Of all the vital signs, an altered respiratory rate is one of the best predictors of respiratory depression, cardiac arrest, and admission to the ICU. Despite its clinical importance, respiration rate is the last core vital sign without a reliable and continuous monitoring method that patients can easily tolerate. Besides manually counting respiration, the two standards of care for monitoring respiratory rate: thoracic impedance pneumography (Tl) and capnometry, fall short of monitoring respiratory rate in a reliable and tolerable fashion. These limitations have lead the Masimo corporation to develop a bio-acoustic respiratory rate monitor (RAM) to non-invasively convert acoustical airflow patterns detected from the surface of the neck into respiratory rate measurements using an innovative adhesive sensor with an integrated acoustic transducer. The accuracy and reliability of RAM has not been evaluated in the in-patient surgical wards of the pediatric population. We compared the reliability and accuracy of RAM and Tl monitoring in postoperative pediatric patients at risk of adverse respiratory events while also assessing the tolerance of the RAM sensor and ECG pads (Tl). We recruited thirty children from 2 to 16 years old (mean age 6.58) who had a tonsillectomy due to OSA at Children's Medical Center (Dallas, TX). Following arrival to the inpatient care unit an adhesive RAM sensor and pediatric Sp02 finger sensor were connected along with standard Tl ECG pads. Vital signs were recorded from the RAM sensors and Tl, and a manual RR was obtained every 2-hours until patient discharge. Data from these 30 patients were combined with 30 patients recruited from Cincinnati Children's Hospital (Cincinnati, OH) for statistical analysis. The three measurement methods (Manual, RAM, and Tl) were found to be significantly different {p=0.0255). RAM and manual measurements of RR were on the average not significantly different (p=0.0255) with a higher correlation coefficient (0.5851), whereas Tl and manual RR measurements of RR are significantly different (p=0.0066) with a lower correlation coefficient (0.4898). The average RR difference between RAM and manual was 0.17 ± 6.81, and the average RR difference for Manual vs Tl was 1.39 ft 10.63. Additional results suggest that RAM may prove a more accurate and tolerable method for monitoring pediatric respiratory rate and respiratory depression, cardiac arrest, and admission to the ICU than the standard of care methods currently in use in hospitals across the country.