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Kaur R, Scott JB, Weiss TT, Klein A, Charlton ME, Villanueva KA, Balk RA, Vines DL. Evaluation of a Closed Suction System with Integrated Tube Scraping Technology: A Randomized Controlled Trial. Respir Care 2023:respcare.10830. [PMID: 36669781 PMCID: PMC10353176 DOI: 10.4187/respcare.10830] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND: Endotracheal tube (ETT) scraping or sweeping refers to mucus removal from an ETT that can increase airway resistance. The study objective was to evaluate the effect of ETT scraping on the duration of mechanical ventilation (MV), time to first successful spontaneous breathing trial (SBT), duration of hospital stay, and occurrence of ventilator-associated events (VAE).METHODS: This was a single-center, randomized clinical trial of adult subjects intubated between October 2019 and October 2021. Subjects were randomly assigned to either ETT suctioning via a standard in-line suction catheter (control group) or ETT suctioning and scraping via a suction catheter with balloon sweeping technology (experimental group). Airway suctioning was performed as clinically indicated, and ETT was scraped every time a respiratory therapist suctioned the patient. The study outcome was duration of MV, time to first successful SBT, hospital stay, and VAE rate. Intent to treat statistical analysis was performed.RESULTS: Of 272 randomized subjects, the median age was 63 (IQR 52-73) years, 143 (53%) were males, and 154 (57%) had a primary diagnosis of acute respiratory failure. There were no significant differences between the groups in median duration (hours) of MV [72.2 (37-187) vs 70.6 (37-148); P = 0.58]. There was no significant difference between the study groups in median time (hours) to the first successful SBT [46.7 (IQR 30-87) vs 45.7 (IQR 27-95), P = 0.81], length of hospital stay (P = 0.76), the incidences of ventilator-associated conditions (P = 0.13), or infection-related ventilator-associated complications (P = 0.47).CONCLUSION: ETT suctioning plus scraping, compared to ETT suctioning alone, did not significantly improve the duration of mechanical ventilation, time to first successful SBT, length of hospital stay, and VAE. These study findings do not support the routine use of ETT scraping for mechanically ventilated patients.
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Affiliation(s)
- Ramandeep Kaur
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois, USA
| | - J Brady Scott
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois, USA.
| | - Tyler T Weiss
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois, USA
| | - Andrew Klein
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois, USA
| | - Megan E Charlton
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois, USA
| | - Kimberly A Villanueva
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois, USA
| | - Robert A Balk
- Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Rush University, Chicago, IL, United States
| | - David L Vines
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois, USA
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Abstract
Prone positioning (PP) has been used extensively for patients requiring invasive mechanical ventilation for hypoxemic respiratory failure during the COVID-19 pandemic. Evidence suggests that PP was beneficial during the pandemic, as it improves oxygenation and might improve chances of survival, especially in those with a continuum of positive oxygenation responses to the procedure. Additionally, the pandemic drove innovation regarding PP, as it brought attention to awake PP (APP) and the value of an interdisciplinary team approach to PP during a pandemic. APP appears to be safe and effective at improving oxygenation; APP may also reduce the need for intubation in patients requiring advanced respiratory support like high-flow nasal cannula or noninvasive ventilation. Teams specifically assembled for PP during a pandemic also appear useful and can provide needed assistance to bedside clinicians in the time of crisis. Complications associated with PP can be mitigated, and a multidisciplinary approach to reduce the incidence of complications is recommended.
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Affiliation(s)
- J Brady Scott
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois.
| | - Tyler T Weiss
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois
| | - Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, College of Health Sciences, Rush University, Chicago, Illinois
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Weiss TT, Cerda F, Scott JB, Kaur R, Sungurlu S, Mirza SH, Alolaiwat AA, Kaur R, Augustynovich AE, Li J. Prone positioning for patients intubated for severe acute respiratory distress syndrome (ARDS) secondary to COVID-19: a retrospective observational cohort study. Br J Anaesth 2020; 126:48-55. [PMID: 33158500 PMCID: PMC7547633 DOI: 10.1016/j.bja.2020.09.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background The role of repeated prone positioning in intubated subjects with acute respiratory distress syndrome caused by COVID-19 remains unclear. Methods We conducted a retrospective observational cohort study of critically ill intubated patients with COVID-19 who were placed in the prone position between March 18, 2020 and March 31, 2020. Exclusion criteria were pregnancy, reintubation, and previous prone positioning at a referring hospital. Patients were followed up until hospital discharge. The primary outcome was oxygenation assessed by partial pressure of oxygen/fraction of inspired oxygen ratio (Pao2/Fio2) ratio. A positive response to proning was defined as an increase in Pao2/Fio2 ratio ≥20%. Treatment failure of prone positioning was defined as death or requirement for extracorporeal membrane oxygenation (ECMO). Results Forty-two subjects (29 males; age: 59 [52–69] yr) were eligible for analysis. Nine subjects were placed in the prone position only once, with 25 requiring prone positioning on three or more occasions. A total of 31/42 (74%) subjects survived to discharge, with five requiring ECMO; 11/42 (26%) subjects died. After the first prone positioning session, Pao2/Fio2 (mean (standard deviation)) ratio increased from 17.9 kPa (7.2) to 28.2 kPa (12.2) (P<0.01). After the initial prone positioning session, subjects who were discharged from hospital were more likely to have an improvement in Pao2/Fio2 ratio ≥20%, compared with those requiring ECMO or who died. Conclusion Patients with COVID-19 acute respiratory distress syndrome frequently responded to initial prone positioning with improved oxygenation. Subsequent prone positioning in subjects discharged from hospital was associated with greater improvements in oxygenation.
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Affiliation(s)
- Tyler T Weiss
- Department of Respiratory Care, Rush University Medical Center, Chicago, IL, USA
| | - Flor Cerda
- Department of Nursing, Medical Intensive Care Unit, Rush University Medical Center, Chicago, IL, USA
| | - J Brady Scott
- Department of Respiratory Care, Rush University Medical Center, Chicago, IL, USA; Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
| | - Ramandeep Kaur
- Department of Respiratory Care, Rush University Medical Center, Chicago, IL, USA
| | - Sarah Sungurlu
- Department of Pulmonary and Critical Care, Rush University Medical Center, Chicago, IL, USA
| | - Sara H Mirza
- Department of Respiratory Care, Rush University Medical Center, Chicago, IL, USA; Department of Pulmonary and Critical Care, Rush University Medical Center, Chicago, IL, USA
| | - Amnah A Alolaiwat
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
| | - Ramandeep Kaur
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
| | - Ashley E Augustynovich
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
| | - Jie Li
- Department of Respiratory Care, Rush University Medical Center, Chicago, IL, USA; Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA.
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Kaur R, Weiss TT, Perez A, Fink JB, Chen R, Luo F, Liang Z, Mirza S, Li J. Practical strategies to reduce nosocomial transmission to healthcare professionals providing respiratory care to patients with COVID-19. Crit Care 2020; 24:571. [PMID: 32967700 PMCID: PMC7509502 DOI: 10.1186/s13054-020-03231-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023]
Abstract
Coronavirus disease (COVID-19) is an emerging viral infection that is rapidly spreading across the globe. SARS-CoV-2 belongs to the same coronavirus class that caused respiratory illnesses such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). During the SARS and MERS outbreaks, many frontline healthcare workers were infected when performing high-risk aerosol-generating medical procedures as well as when providing basic patient care. Similarly, COVID-19 disease has been reported to infect healthcare workers at a rate of ~ 3% of cases treated in the USA. In this review, we conducted an extensive literature search to develop practical strategies that can be implemented when providing respiratory treatments to COVID-19 patients, with the aim to help prevent nosocomial transmission to the frontline workers.
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Affiliation(s)
- Ramandeep Kaur
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL, 60612, USA
| | - Tyler T Weiss
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL, 60612, USA
| | - Andrew Perez
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL, 60612, USA
| | - James B Fink
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL, 60612, USA
| | - Rongchang Chen
- Shenzhen Institute of Respiratory Disease, Shenzhen People's Hospital (First Affiliated Hospital of South University of Science and Technology of China), Shenzhen, China
| | - Fengming Luo
- Department of Respiratory and Critical Care Medicine, West China Medical Center of Sichuan University, Chengdu, China
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Medical Center of Sichuan University, Chengdu, China
| | - Sara Mirza
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL, 60612, USA
| | - Jie Li
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL, 60612, USA.
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Greenberg JA, Gerhart J, Horst JN, Chen E, Hunter RL, O'Mahony S, Yeow ME, Fosler L, LaGorio LA, Meksraityte E, Weiss TT, Nowak K, Geddes J, Lambe SS, Fenton K, Shah RC. A Multidisciplinary Team-Based Approach to Improve Communication With Surrogates of Patients With Chronic Critical Illness. Am J Hosp Palliat Care 2019; 37:214-221. [PMID: 31526015 DOI: 10.1177/1049909119876606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Clinicians need to deliver prognostic information to surrogates of nondecisional, critically ill patients so that surrogates can make informed medical decisions that reflect the patient's values. Our objective was to implement a new approach for communicating with surrogates of patients with chronic critical illness. METHODS Surrogate decision makers of patients who were difficult to liberate from mechanical ventilation were prospectively enrolled. Surrogates met with different members of the intensive care unit treatment team for sequential 15-minute appointments to receive patient-specific assessments and education on chronic critical illness. The feasibility and acceptability of this approach were determined. A 24-question comprehension instrument was developed to assess a participant's understanding that a family member was displaying features of chronic critical illness. Each question was scored from 1 to 5, with larger scores indicating greater comprehension. RESULTS Over a 15-week period, educational sessions for 9 mechanically ventilated patients were conducted. On average, 2 surrogates per patient (range: 1-4) and 6 members of the interdisciplinary team (range: 4-6) were at each meeting. Surrogates and clinicians had very positive impressions of the communication intervention. The average preintervention comprehension score was 85 of 120 (standard deviation [SD]: 8, range: 71-101). The postintervention comprehension score was greater by 5 points on average (SD: 9, range: -11 to +20 points, P = .04). CONCLUSIONS Surrogates of critically ill patients approved of this novel communication approach and had a greater understanding of the patient's medical condition after the intervention.
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Affiliation(s)
- Jared A Greenberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, MI, USA
| | - Jacqueline N Horst
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Elaine Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.,Section of Palliative Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Rebecca L Hunter
- Division of Bone Marrow Transplant & Cellular Therapy, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sean O'Mahony
- Section of Palliative Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Mei-Ean Yeow
- Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Laura Fosler
- Section of Palliative Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Lisa A LaGorio
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Edita Meksraityte
- Department of Respiratory Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Tyler T Weiss
- Department of Respiratory Care, Rush University Medical Center, Chicago, IL, USA
| | - Kristen Nowak
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, IL, USA
| | - Jacqueline Geddes
- Department of Physical Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Stacy S Lambe
- Department of Physical Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Kara Fenton
- Department of Occupational Therapy, University of Illinois at Chicago, IL, USA
| | - Raj C Shah
- Department of Family Medicine and the Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
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