Respiratory care最新文献

Background: The COVID-19 global pandemic dramatically increased our institution's tracheostomy census. Comparing our existing protocols with American Association for Respiratory Care (AARC) January 2021 clinical practice guideline (CPG) relevant to caring for adult patients with tracheostomy in the acute care setting revealed numerous opportunities for improving our care of those patients. We assembled an interdisciplinary tracheostomy team to implement AARC CPG recommendations and manage all patients with tracheostomy in our hospital.

Methods: We examined the effect our interdisciplinary team approach and implementation of AARC CPG recommendations had on the following metrics: average patient length of stay (LOS); ICU LOS; percentage of ventilator days; percentage of tracheostomy mask days; tracheostomy tube changes; decannulations; average time to decannulation; mortality; 30-d readmissions; and consultations for speech-language pathology (SLP), one-way speaking valves, physical therapy, and occupational therapy.

Results: A total of 203 subjects with tracheostomy were followed in a quality improvement study from June 2019-June 2023 (94 in the pre-intervention group, 109 in the post group). There were significant increases between before and after intervention groups in percentage of decannulations in acutely patients with tracheostomy/not present on admission, non-COVID subjects who survived hospitalization (11.8% vs 33.3%, P = .043), percentage of SLP consults (53.2% vs 89.0%, P < .001), and percentage of one-way speaking valve consults (17.0% vs 32.1%, P = .02).

Conclusions: Establishment of an interdisciplinary tracheostomy team and implementation of AARC CPG recommendations for care of adult patients with tracheostomy in the acute care setting resulted in positive, statistically significant outcomes.

Background: Spinal cord injury (SCI) detrimentally impacts individuals' exercise capacity and respiratory parameters depending on sensory, motor, and autonomic dysfunctions. Regular physical activity (PA) positively impacts cardiovascular health and pulmonary function in these individuals. This study determined the relationship between PA and exercise capacity and respiratory parameters in individuals with SCI.

Methods: This cross-sectional study included 40 individuals with paraplegia. Assessments included the Physical Activity Scale for Individuals With Physical Disabilities (PASIPD), 6-min manual wheelchair propulsion test (MWPT_6min), MWPT slalom test (MWPT_slalom), 20-m MWPT propulsion test (MWPT_20m), pulmonary function test (FVC, FEV₁, FEV₁/FVC, and peak expiratory flow [PEF]), maximum inspiratory pressure (P_Imax), and maximum expiratory pressure (P_Emax).

Results: Subjects' mean age and body mass index were 46 ± 13 y and 26.8 ± 5.2 kg/m², respectively. PASIPD total score was significantly associated with MWPT_6min (r = 0.657, P < .001), MWPT_slalom (r = 0.403, P = .17) and MWPT_20m (r = 0.477, P = .056), FEV₁ (r = 0.552, P < .001), FEV₁/FVC (r = 0.532, P = .02), PEF (r = 0.683, P = .004), P_Imax (r = 0.484, P = .01), and P_Emax (r = 0.481, P = .16). However, PASIPD total score was not significantly associated with FVC (r = 0.168, P = .41).

Conclusions: PA level influenced exercise capacity and pulmonary function in individuals with SCI and may play an important role in delimiting physical fitness.