Implementing a bedside assessment of respiratory mechanics in patients with acute respiratory distress syndrome.

BACKGROUND: Despite their potential interest for clinical management, measurements of respiratory mechanics in patients with acute respiratory distress syndrome (ARDS) are seldom performed in routine practice. We introduced a systematic assessment of respiratory mechanics in our clinical practice. After the first year of clinical use, we retrospectively assessed whether these measurements had any influence on clinical management and physiological parameters associated with clinical outcomes by comparing their value before and after performing the test. METHODS: The respiratory mechanics assessment constituted a set of bedside measurements to determine passive lung and chest wall mechanics, response to positive end-expiratory pressure, and alveolar derecruitment. It was obtained early after ARDS diagnosis. The results were provided to the clinical team to be used at their own discretion. We compared ventilator settings and physiological variables before and after the test. The physiological endpoints were oxygenation index, dead space, and plateau and driving pressures. RESULTS: Sixty-one consecutive patients with ARDS were enrolled. Esophageal pressure was measured in 53 patients (86.9%). In 41 patients (67.2%), ventilator settings were changed after the measurements, often by reducing positive end-expiratory pressure or by switching pressure-targeted mode to volume-targeted mode. Following changes, the oxygenation index, airway plateau, and driving pressures were significantly improved, whereas the dead-space fraction remained unchanged. The oxygenation index continued to improve in the next 48 h. CONCLUSIONS: Implementing a systematic respiratory mechanics test leads to frequent individual adaptations of ventilator settings and allows improvement in oxygenation indexes and reduction of the risk of overdistention at the same time. TRIAL REGISTRATION: The present study involves data from our ongoing registry for respiratory mechanics (ClinicalTrials.gov identifier: NCT02623192 . Registered 30 July 2015).

Research capacity of respiratory therapists: A survey of views, opinions and barriers.

BACKGROUND: Evidence-based practice (EBP) is increasing in health care services. This means that respiratory therapists (RTs) should be effective consumers, users and producers of scientific research pertaining to respiratory therapy technology and respiratory physiology. However, little is known about RT opinions and attitudes toward research. Survey instruments to measure them are also uncommon. OBJECTIVE: The present article presents the results of a survey of RTs regarding research attitudes including interest, self-perceived skill and barriers. METHODS: A survey was developed in consultation with practicing RTs and education researchers. It was fielded in six academic hospitals in Toronto, Ontario. Surveys were completed and returned anonymously. Descriptive statistics and associations were examined. Subgroup differences were tested using ANOVA methods. RESULTS: Surveys were completed by 112 RTs (response rate 26.9%). The majority (approximately 80%) of respondents agreed that respiratory therapy research is important, that research can advance the profession and that RTs are suited to performing respiratory therapy research. More than 70% were interested in performing research as long as barriers were eliminated. Among eight potential barriers, lack of time was ranked as the top barrier 59% of the time. Lack of interest in performing research was the least relevant barrier. RTs' educational attainment was positively associated with willingness to perform research and belief in having the skills needed for research. CONCLUSION: Many RTs want to conduct research. They would need substantial support, including increased research exposure during respiratory therapy training, more time and support from trained researchers.

HISTORIQUE: La pratique fondée sur des données probantes (PDB) augmente dans les services de santé. Ainsi, les inhalothérapeutes (IT) devraient être des consommateurs, des utilisateurs et des producteurs efficaces de recherche scientifique portant sur la technologie en inhalothérapie et en physiologie respiratoire. Cependant, on ne sait pas grand-chose de l'avis et des attitudes des IT envers la recherche. De plus, il y a peu d'instruments de sondage pour les mesurer. OBJECTIF: Le présent article contient les résultats d'un sondage auprès des IT au sujet des attitudes envers la recherche, y compris l'intérêt, les compétences autoperçues et les obstacles. MÉTHODOLOGIE: Les chercheurs ont préparé un sondage en consultation avec les IT et les chercheurs en enseignement. Ce sondage a été envoyé dans six hôpitaux universitaires de Toronto, en Ontario. Les sondages ont été remplis et remis de manière anonyme. Les chercheurs ont examiné les statistiques descriptives et les associations. Ils ont vérifié les différences de sousgroupe selon les méthodes de l'analyse de variance. RÉSULTATS: Au total, 112 IT ont rempli le sondage (taux de réponse de 26,9 %). La majorité des répondants (environ 80 %) ont convenu que la recherche en inhalothérapie est importante, qu'elle peut faire progresser la profession et que les IT possèdent les compétences pour faire de la recherche en inhalothérapie. Plus de 70 % souhaitaient faire de la recherche, pourvu que les obstacles soient éliminés. Parmi huit obstacles potentiels, le manque de temps était classé comme le principal dans 59 % des cas. Le manque d'intérêt à effectuer de la recherche était le moins pertinent. Le niveau d'éducation des IT s'associait de manière positive à leur volonté de faire de la recherche et à leur conviction de posséder les compétences nécessaires pour en faire. CONCLUSION: De nombreux IT désirent faire de la recherche. Ils auraient besoin d'un appui considérable, y compris une plus grande exposition à la recherche pendant leur formation en inhalothérapie et plus de temps et de soutien de la part de chercheurs formés.