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Nelipovich S, Ozdowski L, Smith ME. Heated high flow nasal cannula and bilevel positive airway pressure in pediatric asthma exacerbations. J Asthma 2025:1-9. [PMID: 40062668 DOI: 10.1080/02770903.2025.2478122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 02/22/2025] [Accepted: 03/07/2025] [Indexed: 03/15/2025]
Abstract
OBJECTIVE Heated High Flow Nasal Cannula (HHFNC) and Bilevel Positive Airway Pressure (BPAP) are noninvasive respiratory support modalities used in pediatric asthma exacerbations. We aim to examine differences in characteristics and outcomes for patients admitted to the Pediatric Intensive Care Unit (PICU) on standard therapy (ST) alone (continuous albuterol and systemic corticosteroids), ST plus HHFNC, and ST plus BPAP. METHODS This is a retrospective and prospective observational cohort study. Chi-Squared/Fisher's exact and Kruskal Wallis tests were used for categorical and continuous outcomes, respectively. RESULTS 129 patients were included. Younger patients were placed on HHFNC while more severe patients were placed on BPAP. A multiple linear regression controlling for age, sex, race, ethnicity, and exacerbation severity revealed that patients admitted on BPAP had a longer duration of continuous albuterol compared to patients on ST alone (p = 0.02). No differences were found in respiratory support escalation, duration of respiratory support, or adverse events. The BPAP group had the most sedation use and longest length of stay (LOS). Median hourly respiratory rates (RR) increased in the HHFNC group over the first 12 h of admission and remained stable or decreased in the ST and BPAP groups. CONCLUSIONS This study found that BPAP use in pediatric asthma exacerbations is associated with increased exacerbation severity, longer duration of continuous albuterol, increased sedation use, and longer LOS. Although a multiple linear regression analysis was performed to control for multiple covariates including exacerbation severity, it is possible that intrinsic patient characteristics influenced these outcomes rather than BPAP usage.
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Affiliation(s)
- Shelby Nelipovich
- Department of Pediatrics, University of Rochester, Rochester, NY, USA
| | - Lauren Ozdowski
- Department of Pediatrics, University of Rochester, Rochester, NY, USA
| | - Michele E Smith
- Department of Pediatrics, University of Rochester, Rochester, NY, USA
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Teshale MM, Moges NA, Bitew MS, Birhanie SA, Gedfew M, Negese B, Telayneh AT, Ayenew T, Tsegaye D. Oxygen therapy practice and associated factors among nurses working at an Ethiopian Referral Hospital. Afr J Emerg Med 2024; 14:186-192. [PMID: 39104750 PMCID: PMC11298583 DOI: 10.1016/j.afjem.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 05/15/2024] [Accepted: 06/11/2024] [Indexed: 08/07/2024] Open
Abstract
Objective Supplemental oxygen therapy is suppling oxygen at quantities higher than those found in the atmosphere (>21 %) and is mostly prescribed for hypoxic patients. To avoid hypoxemia, hypercapnia, and oxygen poisoning, nurses closely monitor patients receiving oxygen therapy. There are considerable gaps in nurses' practice of oxygen therapy. Patients who receive inappropriate oxygen therapy may have negative effects, and it has financial repercussions for both individuals and nations. The aim of this study was to assess oxygen therapy practices and associated factors influencing oxygen administration among nurses in an Ethiopian Regional Hospital. Method From March 1 to March 30, 2019, a cross-sectional institutional study using quantitative methods was performed amongst nurses working at a referral hospital in northwestern Ethiopia. Data was gathered using structured self-administered questionnaires. Result In this study, 147 participants (91.3 %) were found to have inadequate practice with oxygen therapy. Nurses' lack of knowledge about carbon monoxide, adult patients' typical breathing rates, cardiopulmonary function, and devices (face mask, nasal cannula, oxygen concentrators, pulse oximeter and others) that are difficult for patients to accept were found to be factors associated with oxygen administration practice. Conclusion The findings of this study showed that nurses' use of oxygen administration was subpar. The institutional factors, knowledge gaps, and attitudes of nurses were identified as the determinants affecting oxygen administration practice. Nurses would do better to read up on oxygen administration, interact with one another and undertake further training.
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Affiliation(s)
| | - Nurilign Abebe Moges
- Debre Markos University, College of Health Science, Department of Public health, Ethiopia
| | | | | | - Mihretie Gedfew
- Debre Markos University, College of Health Science, Department of Nursing, Ethiopia
| | - Belete Negese
- Debre Birhan University, College of Health Science, Department of Nursing, Ethiopia
| | - Animut Takele Telayneh
- Debre Markos University, College of Health Science, Department of Public health, Ethiopia
| | - Temesgen Ayenew
- Debre Markos University, College of Health Science, Department of Nursing, Ethiopia
| | - Dejen Tsegaye
- Debre Markos University, College of Health Science, Department of Nursing, Ethiopia
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Bizuneh YB, Getahun YA, Melesse DY, Chekol WB. Assessment of knowledge, attitude, and factors associated with oxygen therapy for critically ill patients among nurses at the University of Gondar Comprehensive Specialized Hospital Northwest, Ethiopia, 2021. Ann Med Surg (Lond) 2022; 80:104334. [PMID: 35992207 PMCID: PMC9389197 DOI: 10.1016/j.amsu.2022.104334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background Administering oxygen therapy has an essential role in preventing and managing hypoxemia in both acute and chronic conditions. The aim of this study was to assess knowledge, attitude and factors associated with oxygen therapy for critically ill patients among nurses. Methods An institutional-based cross-sectional study was conducted from May 23 to June 07 at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, in 2021. A self-administered, structured and validated questionnaire was used. It has socio-demographic characteristics, multiple choice questions, items that measure the possible associated factors and items that were used to assess the level of knowledge and attitude. Epi Data (“The EpiData Association” Odense, Denmark) version 4.6 was used to enter data, and SPSS (IBM) version 20 was used to analyze it. Both bivariate and multivariate logistic regression analyses were used to identify associated factors. Variables with a p value < 0.05 were considered statistically significant. Results The overall proportion of critically ill patients with good knowledge and a positive attitude toward oxygen therapy was 33% (95% CI: 25.8–37.8) and 53.8% (95% CI: 49–59), respectively. Age (AOR; 1.738, 95% CI: 1.034–2.921), level of education (AOR; 7.731, 95% CI: 2.507–23.846) and guideline (AOR; 4.338, 95% CI: 2.233–8.428) and good level of practice (AOR; 1.885, 95% CI: 1.173–3.030) were discovered to be significant factors associated with good knowledge towards oxygen therapy and the reading guideline was found to be a significant factor associated with a positive attitude toward oxygen therapy (AOR; 1.396, 95% CI: 0.830–2.348). Conclusions and recommendations: The level of knowledge was low, whereas the attitude of nurses was positive towards oxygen therapy. Reading guidelines, older aged nurses, master holder nurses, and good practice were significant factors associated with good knowledge of oxygen therapy, and reading guidelines was statistically associated with a positive attitude toward oxygen therapy. Thus, nurses need to be aware and skillful regarding the updated oxygen therapy guidelines. They should improve their level of education. To assess the level of knowledge and attitude of nurses on oxygen therapy in critically ill patients. An institutional-based cross-sectional survey study was conducted. The overall proportions of good knowledge and a positive attitude toward oxygen therapy were 33% and 53.8%, respectively. The level of knowledge was low, whereas the attitude of nurses was positive towards oxygen therapy.
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Knowledge and Practice of Nurses towards Oxygen Therapy in the Public Hospitals of Harari Region, Ethiopia. JOURNAL OF RESEARCH DEVELOPMENT IN NURSING AND MIDWIFERY 2021. [DOI: 10.52547/jgbfnm.18.2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
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Thongprayoon C, Cheungpasitporn W, Chewcharat A, Mao MA, Kashani KB. Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA. BMJ Open 2020; 10:e034325. [PMID: 32205373 PMCID: PMC7103831 DOI: 10.1136/bmjopen-2019-034325] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the risk of acute respiratory failure in all hospitalised patients based on admission serum ionised calcium. DESIGN A retrospective cohort study. SETTING A tertiary referral hospital in Rochester, Minnesota, USA. PARTICIPANTS All hospitalised patients who had serum ionised calcium measurement within 24 hours of hospital admission from January 2009 to December 2013. Patients who were mechanically ventilated at admission were excluded. PREDICTORS Admission serum ionised calcium levels was stratified into six groups: ≤4.39, 4.40-4.59, 4.60-4.79, 4.80-4.99, 5.00-5.19 and ≥5.20 mg/dL. PRIMARY OUTCOME MEASURE The primary outcome was the development of acute respiratory failure requiring mechanical ventilation during hospitalisation. Logistic regression analysis was fit to assess the independent risk of acute respiratory failure based on various admission serum ionised calcium, using serum ionised calcium of 5.00-5.19 mg/dL as the reference group. RESULTS Of 25 709 eligible patients, with the mean serum ionised calcium of 4.8±0.4 mg/dL, acute respiratory failure requiring mechanical ventilation occurred in 2563 patients (10%). The incidence of acute respiratory failure was lowest when admission serum ionised calcium was 5.00-5.19 mg/dL, with the progressively increased risk of acute respiratory failure with decreased serum ionised calcium. In multivariate analysis with adjustment for potential confounders, the increased risk of acute respiratory failure requiring mechanical ventilation was significantly associated with admission serum ionised calcium of ≤4.39 (OR 2.52; 95% CI 2.12 to 3.00), 4.40-4.59 (OR 1.76; 95% CI 1.49 to 2.07) and 4.60-4.79 mg/dL (OR 1.48; 95% CI 1.27 to 1.72), compared with serum ionised calcium of 5.00-5.19 mg/dL. The risk of acute respiratory failure was not significantly increased when serum ionised calcium was at least 4.80 mg/dL. CONCLUSION The increased risk of acute respiratory failure requiring mechanical ventilation was observed when admission serum ionised calcium was lower than 4.80 mg/dL in hospitalised patients.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Thongprayoon C, Cheungpasitporn W, Chewcharat A, Mao MA, Vallabhajosyula S, Bathini T, Thirunavukkarasu S, Kashani KB. Risk of respiratory failure among hospitalized patients with various admission serum potassium levels. Hosp Pract (1995) 2020; 48:75-79. [PMID: 32063075 DOI: 10.1080/21548331.2020.1729621] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/11/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND The objective of this study was to assess the relationship between admission serum potassium and the risk of respiratory failure requiring mechanical ventilation in all hospitalized patients. METHODS All non-dialysis and non-mechanically ventilated patients who had serum potassium measurement at admission from 2011 to 2013 were studied. Serum potassium levels were stratified into five groups; ≤3.4, 3.5 to 3.9, 4.0 to 4.4, 4.5 to 4.9, 5.0 to 5.4, and ≥5.5 mEq/L. The outcome of interest was the respiratory failure requiring mechanical ventilation during hospitalization. Logistic regression analysis was performed to assess the independent risk of in-hospital respiratory failure requiring mechanical ventilation based on various admission serum potassium, using serum potassium of 4.0 to 4.4 mEq/L as the reference group. RESULTS Of 67,034 eligible patients, with the mean admission serum potassium of 4.2 ± 0.5 mEq/L, 2,886 (4.3%) patients developed respiratory failure requiring mechanical ventilation during hospitalization. As demonstrated by U-shaped association, increased risk of in-hospital respiratory failure was significantly associated with low admission serum potassium ≤ 3.4 mEq/L (odds ratio 1.36, p-value <0.001) and high admission serum potassium ≥5.5 mEq/L (odds ratio 1.37, p-value = 0.01). CONCLUSION Increased risk of in-hospital respiratory failure requiring mechanical ventilation was noted when serum potassium was below 3.5 mEq/L or above 5.4 mEq/L at the time of hospital admission. Patients with either hypokalemia or hyperkalemia are at risk of respiratory failure requiring mechanical ventilation.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center , Jackson, MS, USA
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic , Jacksonville, FL, USA
| | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona , Tucson, AZ, USA
| | - Sorkko Thirunavukkarasu
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic , Rochester, MN, USA
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Ruggeri P, Profazio C, Esquinas A. Post‐intensive care unit respiratory failure in older patients: Can we predict intensive care unit discharge properly? Geriatr Gerontol Int 2019; 19:838. [DOI: 10.1111/ggi.13720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Paolo Ruggeri
- Pulmonology Unit, Department of Biomedical and Dental Sciences, Morphological and Functional Images (BIOMORF)University of Messina Messina Italy
| | - Claudia Profazio
- Department of NeurosciencesNemo Sud Clinical Center for Neuromuscular Disorders Messina Italy
| | - Antonio Esquinas
- Department of Intensive Care and Noninvasive Vnetilatory UnitIntensive Care Unit, Hospital Morales Meseguer Murcia Murcia Spain
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Khalil Y, Mustafa EED, Youssef A, Imam MH, Behiry AFE. Neuromuscular dysfunction associated with delayed weaning from mechanical ventilation in patients with respiratory failure. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2012.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Yehia Khalil
- Department of Chest, Faculty of Medicine , Alexandria University, Egypt
| | | | - Ahmed Youssef
- Department of Chest, Faculty of Medicine , Alexandria University, Egypt
| | - Mohamed Hassan Imam
- Department of Physical Medicine, Rheumatology and Rehabilitation , Faculty of Medicine , Alexandria University, Egypt
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Aloushan AF, Almoaiqel FA, Alghamdi RN, Alnahari FI, Aldosari AF, Masud N, Aljerian NA. Assessment of knowledge, attitude and practice regarding oxygen therapy at emergency departments in Riyadh in 2017: A cross-sectional study. World J Emerg Med 2019; 10:88-93. [PMID: 30687444 PMCID: PMC6340817 DOI: 10.5847/wjem.j.1920-8642.2019.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 12/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Administering oxygen therapy (OT) has an essential role in preventing/managing hypoxemia in both acute and chronic conditions. It should be adjusted to achieve the normal oxygen saturation of 94%-98% in most cases. This study aims to evaluate knowledge, attitude and practice (KAP) of nurses, paramedics, emergency medical technicians (EMTs) and Emergency Medical Services (EMS) physicians working at emergency departments (ED) in Riyadh, Saudi Arabia. METHODS In this cross-sectional study, a structured questionnaire was used to assess KAP related to OT of nurses, paramedics, EMTs and EMS physicians currently working at an ED of a tertiary care hospital. Knowledge and attitude were assessed using a Likert scale from 1-5, whereas practice was assessed as a yes/no categorical variable. RESULTS A total of 444 emergency health-care workers (EHCWs) participated, of which 225 (50.7%) were male, with the majority (77%) in the age group of 20-35 years. Over half of the sample were nurses (266; 59.9%). The mean score for knowledge about OT was 5.51±1.45, attitude was 26.31±3.17 and for practices 4.55±1.76. The main factors which were associated with poor KAP were workload and lack of local guidelines. The distribution of overall practice score was significantly better among paramedics - nurses group and EMT - nurses group. CONCLUSION This study demonstrates that there is a gap in EHCWs' KAP, particularly regarding when to provide OT to a patient. This gap can affect patients' safety. Extensive educational and training programs about OT are needed to raise awareness among health-care providers.
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Affiliation(s)
- Amairah Fahad Aloushan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Raid Naysh Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fatmah Ismail Alnahari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulaziz Fahad Aldosari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nazish Masud
- Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences Riyadh, Saudi Arabia
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Guinan EM, Dowds J, Donohoe C, Reynolds JV, Hussey J. The physiotherapist and the esophageal cancer patient: from prehabilitation to rehabilitation. Dis Esophagus 2017; 30:1-12. [PMID: 27862675 DOI: 10.1111/dote.12514] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Esophageal cancer is a serious malignancy often treated with multimodal interventions and complex surgical resection. As treatment moves to centers of excellence with emphasis on enhanced recovery approaches, the role of the physiotherapist has expanded. The aim of this review is to discuss the rationale behind both the evolving prehabilitative role of the physiotherapist and more established postoperative interventions for patients with esophageal cancer. While a weak association between preoperative cardiopulmonary fitness and post-esophagectomy outcome is reported, cardiotoxicity during neoadjuvant chemotherapy and/or radiotherapy may heighten postoperative risk. Preliminary studies suggest that prehabilitative inspiratory muscle training may improve postoperative outcome. Weight and muscle loss are a recognized sequelae of esophageal cancer and the functional consequences of this should be assessed. Postoperative physiotherapy priorities include effective airway clearance and early mobilization. The benefits of respiratory physiotherapy post-esophagectomy are described by a small number of studies, however, practice increasingly recognizes the importance of early mobilization as a key component of postoperative recovery. The benefits of exercise training in patients with contraindications to mobilization remain to be explored. While there is a strong basis for tailored physiotherapy interventions in the management of patients with esophageal cancer, this review highlights the need for studies to inform prehabilitative and postoperative interventions.
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Affiliation(s)
- E M Guinan
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - J Dowds
- Department of Physiotherapy, St James's Hospital, Dublin, Ireland
| | - C Donohoe
- Department of Surgery, St James's Hospital Dublin, Dublin, Ireland
| | - J V Reynolds
- Department of Surgery, St James's Hospital Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - J Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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