PageRespiratory!

>What an incredible waste of resources.

>Same in both NICU's I previously worked in. We also administered all the surfactant.

>Not to mention the costs ($) associated with positive pressure therapy. I would imagine the longer term hidden costs would be notable as well, positive pressure used for lung recruitment can be dangerous. For sure, its bound to be appropiate for certain Pt populations however. As it stands, NIPPV is for Pts with acute respiratory failure that still have spontaneous effort and a patent AW. Certain NIPP ventilators may be used on intubated Pts as well, The Vision BiPAP by Respironics for example.

>Hey, I just call 'em as I see 'em. Let me get this straight, you make an incredibly vague post questioning a procedure citing something you read somewhere. And then when another poster suggests the hospital may bill for it because its provided by a different profession than yours, you agree. And then after four pages of posters asking you to cite what you "read somewhere" you post the title of a nursing textbook. Perhaps for the benefit of the "OTHERS" you can tell us the chapter or even the page you're talking about. FTR: According to Chapter 39, pg. 907 under the ASSSESMENT OF OUTCOME heading in 'Egans Fundamentals of Respiratory Care' 9th edition, the benefits of I.S. include - improvement in signs of atelectasis, decreased RR, resolution of fever, return to normal pulse rate, improved breath sounds, improvement in chest radiograph, increased PaO2 & decreased PaCO2 (be sure not to confuse with PAO2 & PACO2), improved vital capaciy and peak flows, return of FRC to preoperative values (unless a pnuemonectomy was performed) and improved inspiratory muscle function. All this with a fairly inexspensive, non invasive, portable, easy to operate piece of equipment.

>Undoubtedly a Malloy student that just realized they're getting half the education for ten times the cost.GO LIONS!

>>Cripes, why don't they just order IPPB? NIPPV is a VENTILATOR, for Pt's with acute respiratory failure.

What are you getting at? Out with it already. I cannot find one single piece of literature that states "I.S. doesn't work", and about 500 that says it is effective. This one inparticular: The AARC clinical guidelines for SMI (Do you even know what that means?) http://www.rcjournal.com/cpgs/ispircpg.html] outlines it the best.Me thinks the OP is full of it and has a hidden agenda.

"Back from the dead 'yall.........back from the dead"

Synchronized...Intermittent...Mandatory...Ventilation...SIMV is a set rate (volume control or pressure control [either a set tidal volume or insp pressure]) and the Pt is able to breathe spontaneously (with or without pressure support) inbetween mandatory breaths. Pressure support is only activated during spontaneous breaths. In Assist Control (often called CMV or AC) the Pt may initiate a breath but it will be a set mandatory breath. There should be a trigger setting (pressure or flow) that determines how much effort is neccessary to initiate a breath. Often a vent will "autotrigger" if this is set to low, and/or, there is a lot of condensation (rainout) or some sort of partial occlusion or something in the circuit.

>>Hello cart, meet horse.

>Absolutely agree with everything excpet above quoted. An I'll admit I may be splitting hairs here, but "Ventilation" can only be assesed with a CO2 measurement. It seems to me WOB is what you're refering to. I often administer morphine to the dyspneic terminally ill Pt. and you're correct, CO2 (ventilation) is not a concern, easing thier WOB is what we're after. EGANS Fundamentals of Respiratory Care 9th edition, page 235: "Ventilation is determined by the partial pressure of CO2 and the resulting pH, specifically in the arterial blood. Ventilation is effective when the PaCO2 is maintained at a level that keeps the pH WNL." I definalely agree with you, this isn't "Right Vs. Wrong" it's more like "which term do you like better" LOL!

>That has been the majority of my experience as well, variable dependent on the physician. One place had a hard and fast rule, on the 7th day intubated they got trached........can you guess how many people I weaned on the 8th or 9th day?!?! As far as the peds go, I believe a cuffless ETT can stay in place longer with less injury caused to the airway.

.....................Ventilation does not equal oxygenation......................Tacypnea: abnormal elevation of respiratory rate. (Notice no mention of depth of breaths or ventilation).....Bradypnea: abnormal decrease in respiratory rate (Again, no mention of ventilation)Hyperpnea: deep breathing (Notice no mention of rate or ventilation)....Hypopnea: Shallow breahing (No mention of rate or ventilation).....Hypercapnea: abnormal presence of excess amounts of CO2 in the blood.....Hypoventilation: ventilation less than necessary to meet metobolic needs, signified by a pCO2 greater than 45 mmHg in the arterial blood.....Hypocapnea: presence of lower than normal amounts of CO2 in the blood.....Hyperventilation: ventilation in excess of that necessary to meet metobolic needs, signified by a pCO2 less than 35mmHg in the arterial blood.....Kussmauls respiration: hyperpnea associated with DKA (notice kussmauls specifically associates with DKA).....Cheyene Stokes respiration: abnormal, repeating pattern of breathing characterized by alternating progressive hypopnea and hypoventilation ending in brief apnea. (Notice ventilation has been assesed, personally I've only seen this in TBI or otherwise neurologically compromised Pt's)Biots respiration: breathing characterized by irregular periods of apnea alternating with periods in which four or five breaths of identical depth are taken. (Notice no mention of ventilation, this Pt may have a perfect blood gas) Source: EGANS Fundamentals of Respiratory Care, 9th edition.

So far, so good. Ventilation = bulk movement of air. Perhaps. The Pt may indeed have adequate ventilation and still be hypoxic. CO2 is far more diffusible than O2. So there may be inpaired gas exchange, but normal ventilation. Of course you may have a perfectly healthy person from a pulmonary stantpoint with a metabolic component reflected in the blood gas. (metabolic acidosis compensated [or partially compensated] for by hyperventilation.) [Kussmauls in DKA Pt's.] NEVER! the ONLY measurement of ventilation is by CO2. Exhaled CO2 may be monitored, but like any non invasive measurement, its not as precise as (in this case) a blood gas. Again, the Pt's CO2 is the ONLY true measurement of ventilation. A Pt's WOB certainly may be visually assesed however. It seems you have your terminology mixed up a bit.....if your tachypneic Pt is indeed hypoventilating, supressing thier RR would not correct the hypercapnea it would make it worse. Administering an opiate to relieve dyspnea for a hospice/palliative care Pt will certainly reduce WOB and make them more comfortable.

> Above bolded is incorrect, ones ventilation cannot be assed without a CO2 measurment. (ABG/endtidal/ect.). Even though a Pt. is tacypneic, they may not be hyperventilating. And yes hyperventilation is associated with metobolic acidosis compensation, however I feel hypoxemia is a more common cause.