Home ventilator care.

The need for continuous home ventilatory care can arise when patients who are otherwise stable cannot be weaned from mechanical ventilatory support. Two cases are presented that show these patients can be cared for at home at a cost less than their care in the hospital. Before deciding on home ventilatory care for a patient, one should carefully consider all supportive measures, including drug therapy and psychosocial factors. The choice of home care equipment depends on many individualized considerations. The successful management of a patient on a home ventilator requires careful preparation, extensive home instruction, and continued follow-up by a home health care team.     

A pressure-limited critical care ventilator.

We developed a new pressure-limited ventilator system by modifying the Bird #7001M ventilator. Our aims were to free ICU floor space by wall-mounting the ventilator, and to employ a pressure-limited, gas-powered ventilator similar to our transport ventilator to aid in the training of members of our transport team. The system provides a peak pressure of 150 cm H2O and a peak flow of 208 L/min. When coupled with heated pneumatic nebulizers, it quietly provides a maximum gas flow of 208 L/min with nebulized water at 37 degrees C. We successfully used this system for over 4 years to provide a wide range of ventilatory support and oxygen therapy.     

The evolution of a long-term ventilator unit.

Long-term ventilator management in an acute care hospital creates a financial hardship for the patient and the family and in almost all cases, results in a financial loss for the institution. The authors discuss the establishment of a successful, state-of-the-art long-term ventilator unit in a chronic care facility. This experience illustrates the multi-dimensional impact of long-term ventilator management in health care.     

危重症婴幼儿长期经口气管插管呼吸机依赖的临床护理

气管插管机械通气是对呼吸衰竭和各种原因导致的呼吸功能不全患儿建立有效通气最有效的方法,也是危重患儿抢救成功的关键点[1]。对需保持较长时间的人工通气道或需呼吸器辅助呼吸的患儿,究竟是行气管切开好还是气管插管好一直是争论的问题。本研究通过对长时间气管插管机械通气患儿护理方法进行探讨研究,有效避免或减轻了插管时间长所导致的相关并发症,提高了抢救成功率。1资料与方法1.1一般资料选择2004年12月—2011年3月我院收治的     

Evaluating ventilator weaning best practice: a long-term acute care hospital system-wide quality initiative

Long-term acute care (LTAC) hospitals and units are becoming increasingly important to the management of patients who have serious, complex critical illnesses and require mechanical ventilation for extended periods of time. Kindred Healthcare, Inc., a nation-wide system of LTAC hospitals embarked on a quality initiative to establish a Ventilator Management and Weaning Best Practice. The process steps included: measurement of performance of all hospitals in the system using a risk-adjusted methodology to evaluate clinical outcomes, identification of facilities with superior outcomes; structured evaluation of the characteristics, practices, and protocols of these Best Practice hospitals; and utilization of the information gleaned from these hospitals to establish evidence-based LTAC best practice ventilator management guidelines. Key characteristics of the Best Practice LTAC hospitals were: hospital-wide philosophy that "everybody weans"-that is, all disciplines actively participate and all patients are expected to wean; collaborative multidisciplinary plans of care; a consistent and a 24-hour-a-day approach to ventilator management and weaning; daily communication; mutual respect for the contributions of all disciplines to the weaning process; early, aggressive nutrition support and intervention by rehabilitation services; use of 24-hour in-hospital advance practice nurses, hospitalists, or physician assistants; and intervention by physiatrists.     

Nursing informatics. Applications for long-term care

Long-term care (LTC) settings, specifically nursing homes, have found it difficult to manage the regulatory process and provide quality resident care without computerization. Clinical information systems in the current health care environment, including LTC, need to provide five functions. These five functions are providing the legal record of care; supporting clinical decision-making; capturing costs for financial purposes; accumulating a database for administrative queries, quality assurance, and research; and supporting data exchange between systems. While computerization may have occurred in LTC, the application of the informatics concepts with nursing standardized languages and financial and database usage may not have occurred. To succeed in the current health care environment, nursing informatics concepts need to be implemented in LTC. As a result, the quality of care for older adults in nursing homes will be improved. The purpose of this article is to identify application for nursing informatics use in the LTC setting.     

Financial implications of ventilator care

Mechanical ventilation is in the forefront of modern technologic advances. These advances can be life saving for some, death prolonging for others. As difficult medical, ethical, and economic issues are raised in relation to life-sustaining treatments, it is important to have as complete a data base as possible concerning costs and outcomes of mechanical ventilation, so that physicians, patients, families, and society as a whole can make appropriate decisions regarding its use.     

重症监护病房长期机械通气病人撤机前后的护理

[目的]总结重症监护病房长期机械通气病人撤机前后的护理措施.[方法]回顾性分析65例长期机械通气病人的临床资料.[结果]本组病人3 d后成功撤机34例,5 d后成功撤机14例,撤机时间＞10 d 8例,放弃治疗4例,死亡5例.[结论]加强重症监护病房长期机械通气病人撤机前后的护理是成功撤机的关键.     

Modification of a critical care ventilator for use during magnetic resonance imaging.

INTRODUCTION: The unique electromagnetic environment of the magnetic resonance imaging (MRI) scanner presents particular problems for critically ill patients requiring mechanical ventilation during MRI. Most currently available MRI-compatible ventilators are limited in scope and function and thus may not be suitable for patients requiring high peak inspiratory pressure or flow. METHODS: To determine whether a standard critical care ventilator could be used under MRI conditions, we modified a Siemens Servo 900C by replacing the standard oxygen blender with an MRI-compatible blender. We then calibrated the ventilator and tested it on a mechanical lung during active MRI scanning at magnetic fields up to 1.5 tesla. After verifying adequate function, we used the ventilator to support 21 critically ill patients requiring mechanical ventilation during MRI. RESULTS: In all cases we found no alterations in ventilator performance resulting from the electromagnetic interference typical of an MRI scan. We also found no abnormalities in the alarm systems for fraction of inspired oxygen, high inspiratory pressure, or minute volume. Finally, we found no degradation of MRI image quality resulting from ventilator operation during test scanning. CONCLUSIONS: We conclude that with minor modifications the Siemens 900C ventilator can safely ventilate critically ill patients during MRI.     

Modification of a critical care ventilator for anesthesia use

Some critically ill patients require ventilatory support during surgery that exceeds the capabilities of most anesthesia ventilators. We modified an Emerson 3MV ventilator for anesthesia use and measured delivered concentrations of isoflurane during simulated ventilation of a test lung with oxygen flow rates ranging from 5 to 45 L/min. Each measurement was made at atmospheric pressure and incremental levels of 5, 10, 15, and 20 cm H2O PEEP. The delivered anesthetic concentrations were stable at oxygen flow rates of 12.5 to 20 L/min and were unaffected by PEEP changes.