Nasal cannula or high-flow oxygen for patients with COPD in acute respiratory distress?

There may be some confusion regarding the use of supplemental oxygen in patients with chronic obstructive pulmonary disease (COPD) who are experiencing acute respiratory distress. This article addresses a common nursing misconception regarding the use of high-flow oxygen administration via non-rebreather masks instead of low-flow oxygen administration via nasal cannulas in patients with COPD who are in acute respiratory distress, an issue that was investigated in a simulation education exercise and survey of the nursing staff at the authors' facility.

Nursing implications for prevention of adverse drug events in the intensive care unit.

Adverse drug events are common in the intensive care unit setting. Despite the existence of many long-standing safety principles (such as the "five rights") and new mechanisms to promote medication safety, there is still a gap between practice and the goal of patient safety. This is the result of the many human and system factors that impact care delivery.

Mobility interventions to improve outcomes in patients undergoing prolonged mechanical ventilation: a review of the literature.

Survivors of critical illness often undergo an extended recovery trajectory. Reduced functional ability is one of several adverse outcomes of prolonged bed rest and mechanical ventilation during critical illness. Skeletal muscle weakness is known to be one of the major phenomena that account for reduced functional ability.

Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit.

Background: Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff.

Objective: To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows.

Methods: During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams.

Perceptions of physicians, nurses, and respiratory therapists about the role of acute care nurse practitioners.

Background: Information about the contributions of acute care nurse practitioners to medical management teams in critical care settings is limited.

Objective: To examine contributions of acute care nurse practitioners to medical management of critically ill patients from the perspectives of 3 disciplines: medicine, respiratory care, and nursing.

Methods: Attending physicians, respiratory therapists, and nurses in 2 intensive care units were asked to list 3 advantages and 3 disadvantages of collaborative care provided by acute care nurse practitioners.

Management of patients in the intensive care unit: comparison via work sampling analysis of an acute care nurse practitioner and physicians in training.

Background: Little is known about aspects of practice that differ between acute care nurse practitioners and physicians that might affect patients' outcomes.

Objective: To determine if time spent in work activities differs between an acute care nurse practitioner and physicians in training (pulmonary/critical care fellows) managing patients' care in a step-down medical intensive care unit.

Methods: Work sampling techniques were used to collect data when the nurse practitioner had 6 months' or less experience in the role (T1), after the nurse practitioner had 12 months' experience in the role (T2), and when physicians in training provided care on a rotational schedule (nurse practitioner not present, T3).

Effect of tracheal gas insufflation during weaning from prolonged mechanical ventilation: a preliminary study.

Background: Tracheal gas insufflation reduces inspired tidal volume and minute ventilation in spontaneously breathing patients and may facilitate weaning from mechanical ventilation.

Objective: To determine if tracheal gas insufflation can reduce ventilatory demand during weaning trials in patients who require prolonged mechanical ventilation.

Methods: A reduction in ventilatory demand was defined as a relative decrease in tidal volume, minute ventilation, and mean inspiratory flow during trials with tracheal gas insufflation compared with the values during trials without this therapy.

Effects of continuous, expiratory, reverse, and bi-directional tracheal gas insufflation in conjunction with a flow relief valve on delivered tidal volume, total positive end-expiratory pressure, and carbon dioxide elimination: a bench study.

Introduction: Tracheal gas insufflation (TGI) can increase total positive end-expiratory pressure (total-PEEP) when flow is delivered in a forward direction, necessitating adjustments to maintain total-PEEP constant. When TGI is delivered throughout the respiratory cycle, additional adjustments are needed to maintain tidal volume (V(T)) constant.

Objective: Determine if bi-directional TGI (bi-TGI) (simultaneous flows toward the lungs and upper airway) in combination with a flow relief valve eliminates the increase in total-PEEP and maintains a constant V(T), thus simplifying TGI administration.