The Experts below are selected from a list of 1176 Experts worldwide ranked by ideXlab platform

Edward F Haponik - One of the best experts on this subject based on the ideXlab platform.

  • large scale implementation of a Respiratory Therapist driven protocol for ventilator weaning
    American Journal of Respiratory and Critical Care Medicine, 1999
    Co-Authors: Wesley E Ely, Patricia A Bennett, David L Bowton, Sean M Murphy, Allison M Florance, Edward F Haponik
    Abstract:

    We prospectively investigated the large-scale implementation of a Respiratory-Therapist–driven protocol (TDP) that included 117 Respiratory care practitioners (RCPs) managing 1,067 patients with Respiratory failure over 9,048 patient days of mechanical ventilation. During a 12-mo period, we reintroduced a previously validated protocol that included a daily screen (DS) coupled with spontaneous breathing trials (SBTs) and physician prompt, as a TDP without daily input from a physician or “weaning team.” With graded, staged educational interventions at 2-mo intervals, RCPs had a 97% completion rate and a 95% correct interpretation rate for the DS. The frequency with which patients who passed the DS underwent SBTs increased throughout the implementation process (p < 0.001). As the year progressed, RCPs more often considered SBTs once patients had passed a DS (p < 0.001), and physicians ordered more SBTs (46 versus 65%, p = 0.004). Overall, SBTs were ordered more often on the medicine than on the surgical serv...

  • large scale implementation of a Respiratory Therapist driven protocol for ventilator weaning
    American Journal of Respiratory and Critical Care Medicine, 1999
    Co-Authors: E W Ely, Patricia A Bennett, David L Bowton, Sean M Murphy, Allison M Florance, Edward F Haponik
    Abstract:

    We prospectively investigated the large-scale implementation of a Respiratory-Therapist-driven protocol (TDP) that included 117 Respiratory care practitioners (RCPs) managing 1,067 patients with Respiratory failure over 9,048 patient days of mechanical ventilation. During a 12-mo period, we reintroduced a previously validated protocol that included a daily screen (DS) coupled with spontaneous breathing trials (SBTs) and physician prompt, as a TDP without daily input from a physician or "weaning team." With graded, staged educational interventions at 2-mo intervals, RCPs had a 97% completion rate and a 95% correct interpretation rate for the DS. The frequency with which patients who passed the DS underwent SBTs increased throughout the implementation process (p < 0.001). As the year progressed, RCPs more often considered SBTs once patients had passed a DS (p < 0.001), and physicians ordered more SBTs (46 versus 65%, p = 0.004). Overall, SBTs were ordered more often on the medicine than on the surgical services (81 versus 63%, p = 0.001), likely reflecting medical intensivists' prior use of this protocol. Important barriers to protocol compliance were identified through a questionnaire (89 respondents, 76%), and included: Physician unfamiliarity with the protocol, RCP inconsistency in seeking an order for an SBT from the physician, specific reasons cited by the physician for not advancing the patient to a SBT, and lack of stationary unit assignments by RCPs performing the protocol. We conclude that implementation of a validated weaning strategy is feasible as a TDP without daily supervision from a weaning physician or team. RCPs can appropriately perform and interpret DS data more than 95% of the time, but significant barriers to SBTs exist. Through a staged implementation process, using periodic reinforcement of all participants in ventilator management, improved compliance with this large-scale weaning protocol can be achieved.

Priya Prabhakaran - One of the best experts on this subject based on the ideXlab platform.

  • a Respiratory Therapist driven pathway improves timeliness of extubation readiness assessment in a single picu
    Pediatric Critical Care Medicine, 2020
    Co-Authors: Jeremy M Loberger, Ryan M Jones, Priya Prabhakaran
    Abstract:

    OBJECTIVES Our smart aim was to decrease the time between when a mechanically ventilated patient was eligible for and when they underwent their first extubation readiness test (delta time) by 50% within 3 months through the development and implementation of a Respiratory Therapist-driven extubation readiness test pathway. DESIGN Quality improvement project. SETTING Single, tertiary care, 24-bed, academic PICU. PATIENTS Pediatric patients admitted to the PICU and requiring mechanical ventilation for a primary pulmonary process. INTERVENTIONS We developed an extubation readiness test pathway that consisted of an eligibility screen and a standard testing process. Patients were screened every 3 hours. Upon passing the screen and being cleared by a prescriber, a test was initiated. No clinical management was dictated to prescribers. MEASUREMENTS AND MAIN RESULTS The preintervention and intervention cohorts included 109 and 43 mechanical ventilation courses, respectively. The mean delta time decreased from 33.77 hours to 2.92 hours after pathway implementation (p = 0.000). The medical length of stay decreased from 196.6 to 177.2 hours (p = 0.05). There were no statistically significant changes in duration of mechanical ventilation until first extubation (112.9 vs 122.3 hr; p = 0.651) and 48-hour extubation failure rate (16.5% vs 4.8%; p = 0.056). The sensitivity and positive predictive value for the extubation readiness test were 89.5% and 94.4%, respectively. The mean for all process compliance measures was 91.5%. CONCLUSIONS A Respiratory Therapist-driven extubation readiness test pathway can be safely implemented in a large, academic PICU. The pathway resulted in earlier extubation readiness testing without increasing key balancing measures-the duration of mechanical ventilation, PICU length of stay, or the extubation failure rate.

Enrico Clini - One of the best experts on this subject based on the ideXlab platform.

C Romerodapueto - One of the best experts on this subject based on the ideXlab platform.

  • noninvasive mechanical ventilation in acute Respiratory failure patients a Respiratory Therapist perspective
    The Open Respiratory Medicine Journal, 2015
    Co-Authors: V Hidalgo, C Giuglianojaramillo, R Perez, F Cerpa, H Budini, D Caceres, T Gutierrez, J Molina, J Keymer, C Romerodapueto
    Abstract:

    PhysioTherapist in Chile and Respiratory Therapist worldwide are the professionals who are experts in Respiratory care, in mechanical ventilation (MV), pathophysiology and connection and disconnection criteria. They should be experts in every aspect of the acute Respiratory failure and its management, they and are the ones who in medical units are able to resolve doubts about ventilation and the setting of the ventilator. Noninvasive mechanical ventilation should be the first-line of treatment in acute Respiratory failure, and the standard of care in severe exacerbations of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema, and in immunosuppressed patients with high levels of evidence that support the work of physioTherapist. Exist other considerations where most of the time, physicians and other professionals in the critical units do not take into account when checking the patient ventilator synchrony, such as the appropriate patient selection, ventilator selection, mask selection, mode selection, and the selection of a trained team in NIMV. The physioTherapist needs to evaluate bedside; if patients are properly connected to the ventilator and in a synchronously manner. In Chile, since 2004, the physioterapist are included in the guidelines as a professional resource in the ICU organization, with the same skills and obligations as those described in the literature for Respiratory Therapists.

Jeremy M Loberger - One of the best experts on this subject based on the ideXlab platform.

  • a Respiratory Therapist driven pathway improves timeliness of extubation readiness assessment in a single picu
    Pediatric Critical Care Medicine, 2020
    Co-Authors: Jeremy M Loberger, Ryan M Jones, Priya Prabhakaran
    Abstract:

    OBJECTIVES Our smart aim was to decrease the time between when a mechanically ventilated patient was eligible for and when they underwent their first extubation readiness test (delta time) by 50% within 3 months through the development and implementation of a Respiratory Therapist-driven extubation readiness test pathway. DESIGN Quality improvement project. SETTING Single, tertiary care, 24-bed, academic PICU. PATIENTS Pediatric patients admitted to the PICU and requiring mechanical ventilation for a primary pulmonary process. INTERVENTIONS We developed an extubation readiness test pathway that consisted of an eligibility screen and a standard testing process. Patients were screened every 3 hours. Upon passing the screen and being cleared by a prescriber, a test was initiated. No clinical management was dictated to prescribers. MEASUREMENTS AND MAIN RESULTS The preintervention and intervention cohorts included 109 and 43 mechanical ventilation courses, respectively. The mean delta time decreased from 33.77 hours to 2.92 hours after pathway implementation (p = 0.000). The medical length of stay decreased from 196.6 to 177.2 hours (p = 0.05). There were no statistically significant changes in duration of mechanical ventilation until first extubation (112.9 vs 122.3 hr; p = 0.651) and 48-hour extubation failure rate (16.5% vs 4.8%; p = 0.056). The sensitivity and positive predictive value for the extubation readiness test were 89.5% and 94.4%, respectively. The mean for all process compliance measures was 91.5%. CONCLUSIONS A Respiratory Therapist-driven extubation readiness test pathway can be safely implemented in a large, academic PICU. The pathway resulted in earlier extubation readiness testing without increasing key balancing measures-the duration of mechanical ventilation, PICU length of stay, or the extubation failure rate.