An interprofessional training program for intrahospital transport of critically ill patients: model build-up and assessment.

Intrahospital transport of critically ill patients for diagnostic or therapeutic procedures can be compromised by patient instability, equipment problems or inexperienced teamworking. This quasi-experimental study aimed to assess the effectiveness of an in-situ interprofessional simulation-based training (IIST) model for junior member transport teams. Newly registered postgraduate physicians, nurses and respiratory therapists underwent the IIST. The technical skills (TS) of each participant and non-technical skills (NTS) of each interprofessional team were assessed using well-validated checklists. Thirty-six participants enrolled and were randomly assigned to six experimental and six control teams. Most participants achieved a significantly higher level of both TS and NTS. Both the control and experimental teams overvalued their NTS in the pretest, while the posttest self-assessment scores among the experimental groups more closely matched the expert assessments. Despite challenges in scheduling and the setting, the IIST was successfully conducted in a crowded hospital, which enabled trainees to optimize their learning in a real-life environment. In conclusion, the IIST model can facilitate the development of both TS and NTS for transport team members. Transport teams made up of newly registered staff from different disciplines may lack insight into their NTS in critical patient transfer management, but simulation training may cause improvements.

The impact of aerosolized mucolytic agents on the airflow resistance of bacterial filters used in mechanical ventilation.

BACKGROUND/PURPOSE: In order to reduce the contamination in the ventilator, bacterial filters were placed on the expiratory limb of a ventilator circuit. Aerosolized mucolytic agents may increase the resistance of the ventilator. The goal of this study is to determine the impact of aerosolized mucolytic agents on the pressure change during mechanical ventilation. METHODS: A lung model was investigated with mucolytic inhaled agents of 10% acetylcysteine and 2% hypertonic saline. The agents were administered using a jet nebulizer every 45 minutes for 15 minutes. The pressure drop was measured after nebulization. The end point was referred to the 45(th) dose or obstruction of the filter. Furthermore, the pressure drop after steam autoclaving was also measured. RESULTS: The maximum pressure was significantly higher with 10% acetylcysteine than with 2% sodium chloride (39.32 ± 7.22 cmH2O vs. 3.53 ± 0.90 cmH2O, p < 0.001). With acetylcysteine filters, the pressure drop over 4 cmH2O occurred earlier and had a good relationship between the degree of pressure drop and doses. The acetylcysteine group yielded a significant difference in the pressure drop compared to the newly autoclaved and the end point of inhalation (p = 0.043). CONCLUSION: This study demonstrated the aerosolized mucolytic agents could increase the pressure drop of the bacterial filters during mechanical ventilation. The pressure drop of the bacterial filters was higher with 10% acetylcysteine. It is critical to continuously monitor the expiration resistance, auto-positive end-expiratory pressure, and ventilator output waveform when aerosolized 10% acetylcysteine was used in mechanical ventilation patients.

Effects of exercise training on pulmonary mechanics and functional status in patients with prolonged mechanical ventilation.

BACKGROUND: The functional status and outcomes in patients with prolonged mechanical ventilation (PMV) are often limited by poor endurance and pulmonary mechanics, which result from the primary diseases or prolonged time bedridden. We evaluate the impact of exercise training on pulmonary mechanics, physical functional status, and hospitalization outcomes in PMV patients. METHODS: Twenty-seven subjects with PMV in our respiratory care center (RCC) were divided randomly into an exercise training group (n = 12) and a control group (n = 15). The exercise program comprised 10 sessions of exercise training. The measurement of pulmonary mechanics and physical functional status (Functional Independence Measurement and Barthel index) were performed pre-study and post-study. The hospitalization outcomes included: days of mechanical ventilation, hospitalization days, and weaning and mortality rates during RCC stay. RESULTS: The training group had significant improvement in tidal volume (143.6 mL vs 192.5 mL, P = .02) and rapid shallow breathing index after training (162.2 vs 110.6, P = .009). No significant change was found in the control group except respiratory rate. Both groups had significant improvement in functional status during the study. However, the training group had greater changes in FIM score than the control group (44.6 vs 34.2, P = .024). The training group also had shorter RCC stay and higher weaning and survival rates than the control group, although no statistical difference was found. CONCLUSIONS: Subjects with PMV in our RCC demonstrated significant improvement in pulmonary mechanics and functional status after exercise training. The application of exercise training may be helpful for PMV patients to improve hospitalization outcomes.

Resolution of organ functional scores to predict the outcome in adult acute respiratory distress syndrome patients receiving high-frequency oscillatory ventilation.

BACKGROUND: High-frequency oscillatory ventilation (HFOV) may be used as a rescue therapy for adults with acute respiratory distress syndrome who have failed conventional ventilation (CV). We undertook a prospective study to investigate the determinants of mortality and the sequential evolution of organ failures in HFOV-treated adult acute respiratory distress syndrome patients. METHODS: The indication for HFOV was severe oxygenation failure (PaO2/FiO2 <120 mm Hg) while receiving aggressive CV support (defined by either PaO2 ≤65 mm Hg with FiO2 ≥0.6 when positive end-expiratory pressures >10 cmH2O or plateau airway pressure ≥35 cm H2O). Demographic, clinical, and physiologic data were collected prospectively (May 2007-July 2009). Organ System Failure (OSF), Sequential Organ Failure Assessment (SOFA), and Multiple Organ Dysfunction (MOD) scores were recorded during and after HFOV application. Additional outcome measures included HFOV successful weaning rate, cause of failure, complications, survival rate, and cause of death. RESULTS: The intensive care unit mortality rate was 62% (21 of 34). Survivors had a significantly shorter CV time before HFOV than nonsurvivors (32.8 hours ± 16.7 hours vs. 47.9 hours ± 26.2 hours, p = 0.049). Survivors had significantly lower baseline lung injury scores, OSF, SOFA, and MOD scores than nonsurvivors. After HFOV, the OSF, SOFA, and MOD scores were significantly decreased for survivors, particularly from day 3 onward. CONCLUSIONS: Survivors had early improvements in OSF scores after HFOV application. Organ failure system scoring may be used for deciding on HFOV initiation and for evaluating the effects of HFOV.

Aerosol distribution during open suctioning and long-term surveillance of air quality in a respiratory care center within a medical center.

BACKGROUND: The investigation of hospital air quality has been conducted in wards, ICUs, operating theaters, and public areas. Few studies have assessed air quality in respiratory care centers (RCCs), especially in mechanically ventilated patients with open suctioning. METHODS: The RCC air quality indices (temperature, relative humidity, levels of CO2, total volatile organic compounds, particulate matter [PM], bacteria, and fungi) were monitored over 1 y. The air around the patient's head was sampled during open suctioning to examine the probability of bioaerosol exposure affecting health-care workers. RESULTS: This investigation found that the levels of indoor air pollutants (CO2, PM, bacteria, and fungi) were below the indoor air quality standard set by the Taiwan Environmental Protection Agency. Meanwhile, the levels of total volatile organic compounds sometimes exceeded the indoor air quality standard, particularly in August. The identified bacterial genera included Micrococcus species, Corynebacterium species, and Staphylococcus species, and the predominant fungal genera included yeast, Aspergillus species, Scopulariopsis species, and Trichoderma species. Additionally, airborne PM2.5, PM1, and bacteria were clearly raised during open suctioning in mechanically ventilated patients. This phenomenon demonstrated that open suctioning may increase the bacterial exposure risk of health-care workers. CONCLUSIONS: RCC air quality deserves long-term monitoring and evaluation. Health-care workers must implement self-protection strategies during open suctioning to ensure their occupational health and safety in health-care settings.