Saturday, September 18, 2010

Why is my Measured Peak & Plateau Pressures the Same?

Why are my measured peak & plateau pressures the same? Is this something to do with the ventilator, or the patient? Can this be right?

Monday, September 13, 2010

Application of Mid-Frequency Ventilation


My facility is a Long-term Acute Care Hospital licensed for 42 beds, which specializes in ventilator weaning and wound care management. In regards to ventilator weaning our patients primarily arrive from outlying intensive care units and been on mechanical ventilation for greater than seven days.
Our allotted hospital length of stay for patients „coded. for “Ventilator weaning” is twenty-five days. During this time period patients are either weaned from mechanical ventilation or placed for extended long-term care. December 2009 ventilator days were a mean of 6.5 days per patient (7 samples/patients), and when calculated for outliers to 3 standard deviations the mean decreased to 5.4 days (5 samples).
There are respiratory therapy driven ventilator guidelines which include ventilator management and ventilator weaning. The only ventilator we utilize is the Respironics Esprit which has been fine in our patient population, however, it has been cumbersome in patients which require additional respiratory mechanic measurements e.g. static compliance & resistance (in the Esprit you can only obtain these measurements in VC-CMV). “I guess I’m spoiled not having to calculate these parameters with other machines”. However, it is nice to polish my calculation skills ever so often.
Our standard modalities for ventilator management are PC-CMV and PC-CSV.

Tuesday, September 7, 2010

In the News -CMS Finalizes Inpatient Hospital Rules

The Centers for Medicare & Medicaid are proposing to change regulations which would allow Physician Assistants and Nurse Practitioners’ to write orders for Respiratory Care Services without a co-signature from a physician.

I believe this is an area of concern since respiratory care services specifically ventilator management is highly specialized. Additionally, there is no formal training regarding ventilator management in PA or NP programs, as a minimum pulmonary physicians have to train as fellow.
The below case study submitted from a colleague will articulate my point of view.