Respiratory care : the official journal of the American Association for Respiratory Therapy

206 Pages·1993·11.7 MB·English

by  American Association for Inhalation Therapy

1
November 1993
Volume 38, Number 1
RE/PIRATORW
A MONTHLY SCIENCEJOURNAL
38TH YEAR—ESTABLISHED 1956
Clean 'Em orToss 'Em: Does It
Callfor Matter?—An Editorial
1994Open ForumAbstracts
Physician-Ordered Use ofa
RespiratoryTherapyConsultService:
Early Experience
Residual Bacterial Contamination on
PulseOximetrySensors
Conventional CapandOne-WayValve
in Decannulation of Patientswith
Long-Term Tracheostomies
5 NewClinical Practice Guidelines
TransportoftheMechanicallyVentilatedPatient
FiberopticBronchoscopyAssisting
ResuscitationinAcuteCareHospitals
j^ IntermittentPositivePressureBreathing
BlandAerosolAdministration
39thAnnualConventionandExhibition 1993Open Forum Abstracts
December 11-14, 1993•Nashville,Tennessee
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RE/PIRATORU C&RE
AMonthlyScienceJournal.Established 1936.OfficialJournaloftheAmericanAssociationtorRespiratoryCare.
EDITORIALOFFICE CONTENTS November1993
D1a1l0l3a0sATbXie7s5L2a2n9e Volume38,Number1
[phone]
EDITOR EDITORIALS
PatBroughcrBARRT —
AKaSySeOWCeIbAeTrEMSEDRIRTTOR 1141 CbyleJaonhn"EWmSoorlTvoesrs—'SoEimlLaDkoeeCsitIyt;MaUtttaehr?
ASSISTANTEDITOR
ORIGINALCONTRIBUTIONS
DonnaStephensBBA
EDITORIALBOARD 1143 Physician-OrderedRespiratoryCarevsPhysician-OrderedUse
DeanHessMEdRRT,Chairman ofaRespiratoryTherapyConsultService:EarlyExperienceat
TRihcohmaarsdDABBraarnnessonERdRDTRRT TheClevelandClinicFoundation
CRhoabrelretsLGChDauirbbuirnnJrRMRTD byJamesKStoller.DavidHaney,JohnBurkluirt.LarryFergus,
TRNJDeoaahibmvoleeimrsdRatsJKMMPaDSictKeloEranlascllsoeymtnrraPeMMrheMDDDkDPhDRRT MDthceeCnanSriectsthiGyio,lneBso,efnREedMscpHCioraiasntinon,rgytRoTenh,beeLrcuaccpayyM—KeerCseltdeeirvt,ehlJ,aonDdh,onuOKghoimOoarrenas,,Kaenvdin
CONSULTINGEDITORS 1155 ResidualBacterialContaminationonReusablePulseOximetry
JFHrooawhnankrGEdBJBuirBofionrrdedonbMBaSDumRRMTD bSyenMsaorrtsinCWilkins—Portland, Oregon
BobDemersBSRRT
DonaldREltonMD 1161 ComparisonbetweenConventionalCapandOne-WayValvein
JCRRMHhoaouSabmngreeahJlrlsaetdsSsMtRBGMreaHFGmIutlesrruhkovsceiirtknwgMMsJeProDhDMnMDDSMDRRT tbRhyiecHhDaaeircdaMniWnnuhLliaLgtehi,to—JnaoLmfoenPsagtLiBeeAntatecsnh,,wiJCtoahhlLnifsooonrngn-iTaTeChrimanTgr,acahnedostomies
MichaelMcPeckBSRRT
JRoihchnaSrhdiRgeRoikcahaMrDdBSRRT CLINICALPRACTICEGUIDELINES
JRacBkriWaannSgmeirthMMBDARPFTRRT 1169 TransportoftheMechanicallyVentilatedPatient
JeffreyJWardMEdRRT 1173 FiberopticBronchoscopyAssisting
JOURNALASSOCIATES
StephenMAyresMD 1179 ResuscitationinAcuteCareHospitals
JJRooeshuenbpeBhnMDMoCwCinhvseetrtMnaiDaMcDkMD 1189 IntermittentPositivePressureBreathing
DonaldFEganMD 1196 BlandAerosolAdministration
GarethBGishMSRRT
GeorgeGregoryMD
JAHWoikhlFenlreiGEdaremeHrnioFvcdikMgkikHliMelnelDrmMhMoDDlzJrMD T12E0S1TYOLeUftRSRhoAulDdIerO,LNOeGckI,CanSdKCIhLeLstPainwithDyspneaandNonproductive
TJEAHlolehihanoannnmniaWKJnsgNPSLeiPeleovPsrneecotrtenotiyMpnRpgMDNihdaDRaunsRTMMDD CbyouCghWorthBrooksJrandShelleyCMishoe—Augusta, Georgia
BarryAShapiroMD LETTERS
PLSitRenvOdeaDBBUoaCrwcTdueIsnONSTAFF 1205 bMyorBeobObDj—eemcteirosn—stSotaBnrfaornds.onC-aClhiafotrbnuiran;HwuimtihdriefsipcoantsieonbyEdRitiocrhiaarldD
BDiolnlnCaryKenrauf Branson Cincinnati, Ohio
JeannieMarchant
RespiratoryCare(ISSN00989142)isamonthlypublicationofDaedalusEnterprisesIncfortheAmericanAssociationforRespiratoryCare.Copyright°1993byDaedalusEn-
terprisesInc.11030AbiesLane,DallasTX75229.Allrightsreserved.Reproductioninwholeorinpariwithouttheexpress,writtenpermissionofDaedalusEnterprisesInc.is
prohibited.TheopinionsexpressedinanyarticleoreditorialarethoseoftheauthoranddonotnecessarilyreflecttheviewsofDaedalusEnterprisesInc,theEditorialBoard,or
theAmericanAssociationforRespiratoryCare.NeithercanDaedalusEnterprisesInc,theEditorialBoard,ortheAmercian.AssociationforRespiratoryCareberesponsiblefor
theconsequencesoftheclinicalapplicationsofanymethodsordevicesdescribedherein.PrintedinUSA.
RespiratoryCarf,isindexedinHospilulLiterulureIiulexandinCumulativeIndextoNurshigandAlliedHealthLiterature.
SSuebcsocnrdipCtiloanssRaPtoesst:a$g5e.0p0aipderatcoDpayl;la$s5,0T.X00.pPeOrSyeTaMrA(S12TiEssRu:es)SeinntdheadUdSr;es$s70c.h0a0nginesalltootRheesrpcioruanttorrieysC(aarded,$D8a4e.d0a0lufosrEanitremariplriises,Inc.,11030AhlesLane,DallasTX75229.
RESPIRATORYCARE• NOVEMBER'93Vol38No 1 127
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MANUSCRIPTSUBMISSION CONTENTS, November 1993
InnesatrrutchteioennsdtoofrRAiu;tshpiorrastoarvndCaTrypeiostnsaisquaprrtienrtleyd c „,„„, Volume38,Number1
basis(Jan,Apr,July.Nov).
PHOTOCOPYING&QUOTATION OpenForumABSTRACTS
PHOTOCOPY[NG. Anymaterialinthisjournal
thatiscopyrightedbyDaedalusEnterprises.Inc 1211 OpenForumAbstracts
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commercialuse.andprovidedRtispiRAToR"!Carh AARCCONVENTIONEXHIBITORS
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RESPIRATORYCARE•NOVEMBER'93Vol38No 1 129
Abstracts
SummariesofPertinentArticlesinOtherJournals
Editorials,Commentaries,andReviewsToNote
The Dingell Hearings on Scientific Misconduct: Blunt ThreeCasesofParadoxicalVocalCordAdductionFol-
InstrumentsIndeed(soundingboard)—BHealy.NEnglJ lowed Up Over a 10-Year Period (case report)—JP
Med 1993;329:725. Hayes. MT Nolan, N Brennan. MX FitzGerald. Chest
1993:104:678.
Tviherwo)m—boHlyVsisAndienrsoAnc.uteJTMWyiolclaerrsdoina.l NInfEanrgcltioJn M(ered- The CRIB Score (letter)—AC Fenton, DJ Field, A Sol-
1993;329:703. imano,GAnnich.Lancet 1993:342:612.
FFaotraalmCeenreObvraalleF(actasFemrbeopolrits)—mEAsEsoEctichaetlelds.wiDtThWaoPnagt,enGt PSarfeestsyur(er-ePvrieeswe)t—PVeBntBillaantciho,n.MPJaorntes,2:AJMLeacyhoann,icNsCaamn-d
Davidson.PLHouston.Chest 1993:104:962. ner.Chest 1993:104:904.
Sfeerveenncteh,1A9n9n3ua(clonNfoerretnhceApmreorciecedainngCsy)s—tiPcedFiiabtrroPsiuslmCoonno-l MHiegthh-aFermeoqguleonbciynVednutriilnagtioNnit(reidcitoOrixail)d—eJTPheKirnaseplyla.wiStHh
1993(Supplement9). Abman.Lancet 1993:.342:615.
PneumocystiscariniiPneumoniain TheCRIB (ClinicalRiskIndexfor pitaldeathwiththatofbirthweightin
Patients without Predisposing Ill- Babies) Score: A Tool for Assess- a separate cohort of488 similar in-
nesses: Acute Epis—odeand Follow- ingInitialNeonatalRiskandCom- fants.Theareaunderthereceiverop-
Up of Five Cases S Cano, F Ca- paring Performance of Neonatal erating characteristic (ROC) curve
—
pote, A Pereira, E Calderon. J Cas- Intensive CareUnits The Interna- forpredictingdeathinthisvalidation
tillo.Chest 1993:104:376. tional Neonatal Network. Lancet cohort (a measure ofthe predictor's
1993:342:193. accuracy) was significantly greater
Pneumocystis carinii pneumonia forCRIB than for birthweight alone
(PCP) isdescribedalmostexclusive- Assessment of different hospitals' (0.90 [SE 0.051 vs 0.78 [0.03], p =
ly in immunocompromised hosts. performance in neonatal intensive 0.04). Both indices of initial risk
This report describes ourexperience care has tended to rely on risk of were used toassess the performance
with acute episodes and the follow- mortality adjusted only for birth- ofnine tertiary and four non-tertiary
upoffivepatientswithPCPwhohad weight. We have developed a neo- hospitals in the UK. We looked at
no known predisposing conditions. natal scoring system, CRIB (clinical hospital mortality among the 1300
The average follow-up period was risk index for babies), to take ac- infants in the development and val-
3.6 years (range, 2.6 to 4 years). count of other factors. Scores are idationcohortsplus248otherinfants
Lymphocyte subpopulations (CD4, given for birthweight, gestational ofbirthweight 1500gorlessorges-
CDS, and CD4:CD8), serum immu- age, maximum and minimum frac- tational age less than 31 weeks.
noglobulins (IgG, IgM, and IgA), tion of inspired oxygen and maxi- Without adjustment for initial risk,
and serologic studies for human im- mum base excess during the first 12 there was no clear difference in
munodeficiency virus were carried h, and presence of congenital mal- group inortality between the tertiary
outonallpatientsatleasttwice,both formations.CRIBwasdevelopedret- and non-tertiary hospitals. However,
at the beginning and the end of the rospectively in a cohort of 812 in- calculation ofrisk-adjusted mortality
follow-up. None ofthe patients pre- fantsofbirthweight 1500gorlessor by means ofCRIB showed that ba-
sentedcompatibledatawithAIDSor gestational age less than 31 weeks biesweretwiceaslikelytodieinthe
any other identifiable risk factors. treated in four UK tertiary hospitals non-tertiary hospitals as in the ter-
We conclude that PCP can occur in between 1988and 1990. The scoring tiary hospitals (odds ratio 2.12 [95%
patients who apparently do not have system was then validated by com- CI 1.39-3.241). Adjustment forbirth-
iminunosuppression. paringitsvalueasapredictorofhos- weight alone also showed hisher
1130 RESPIRATORYCARE•NOVEMBER'93Vol38No 11
BMoIded.
Even If You Could Intubate
You Don't Have To.
Detectionofcarbondioxide(CO2)exhaledfrom
thelungshasbeenusedsuccessfullytoconfirm
thatanendotrachealtubeisinthetrachea.So
successfully,infact,thattheAdvancedCardiacLife
Support(ACLS)guidelinesfromtheAmericanHeart
Association(AHA)recommendcarbondioxide
detectionasanadjuncttoclinicalassessmentwhen
verifyingcorrecttubeplacement.
EASYCAP''' meets the most
recentACLS guidelines.
Nellcor'sMSy
CAPend-tidal
carbondioxide
1
ABSTRACTS
odds of death in non-tertiary hos- tine use. International comparisons Nedocromil Sodium Is More Ef-
pitals (1.45 [1.01-2.11]). CRIB is a ofstaffingpolicyandorganisationof fectiveThanCromolynSodiumfor
robust index of initial neonatal risk neonatal intensive care units are the Treatment ofChronic Rever—s-
that is more accurate than birth- needed to investigate the reasons for ible Obstructive Airway Disease
weight and simple enough for rou- variationsinperformance. S Lai, PD Dorow, KK Venho, SS
Chatterjee.Chest 1993:104:438.
In amulticenter.double-blind, group
comparative trial, the efficacy ofne-
docromil sodium (nedocromil,4 mg,
ARE YOU INCREASING THE RISK OF fourtimesdaily [qid]),cromolynso-
dium (2 mg, qid), and placebo was
SPREADING TUBERCULOSIS compared in patients receiving in-
TO YOUR STAFF AND ALL OTHERS haled ^2-agonists and inhaled cor-
ticosteroids for the treatment of
IN YOUR FACILITY? chronic, reversible, obstructive-air-
waydisease. Aftera2-weekbaseline
period, 132 patients (8 centers) be-
For information onthe tweentheagesof20and75yearsen-
Model MSB 1043 tered a 4-week run-in period in
PortableSafety Booth which the dose of inhaled corti-
CallToll-Free: costeroid was reducedby 50%. Dur-
1-800-835-6275or ing therun-inphase, deterioration of
201-368-8118 symptoms (total symptom score) by
ten points qualified patients to enter
Ifyouoryourstaffareperform the6-weekdrugtrialperiod. Patients
ingsputuminductionproce- in the nedocromil treatment group
duresinotherthananegative showed the most robust and consis-
pressure,HEPAfilter, UVlight tent improvements over placebo and
environment,youareincreasing cromolyn sodium for all daily diary
theriskofspreadingthisdreaded variables.Statisticallysignificantim-
disease. provementsoverplacebowere noted
Areyouputtingyourself,yourstaff,andpatients for both active treatment groups for
atriskbyadministeringaerosolizedpentamidine daytime, nighttime, and total symp-
toAIDSpatientsInanopenenvironment? tom score. Symptom scores for ne-
docromil were statistically signifi-
SIfpyuotuurma/nPsewnetarmtiodeiinteheMrAquXeIstMiUoMniSsAYFesE,TfYinBdOoOutTHhowwi/llthheelMparprkotIeBct csaondtiluymiamnpdropvleadceobvoerfobrobtohthcrdoamyotliymne
you,yourstaff,andeveryoneinyourfacilityfromairborne
pathogens. and nighttime asthma. Patients treat-
ed with nedocromil also demonstrat-
Thisproductisportableandrequiresnoassembly. ed a significant reduction in the use
of nighttime as needed (prn) fii-
MarkCare Medical Systems, Inc. agonists ascompared with eitherthe
placebo-orcromolyn sodium-treated
groups. Only nedocromil-treated pa-
tients demonstrated a statistically
iiiiii SOLUTIONS,INC. spiegankifeixcapnitratiomrpyrofvleomwernattein(PmEoFrRn)inags
87Route17North•Maywood,NJ07607 compared with placebo. Both nedo-
Telephone:[phone]•Toll-Free:1-800-835-6275 cromil and cromolyn sodium groups
FAX:[phone]
demonstrated statistically significant
improvements in afternoon and eve-
ning PEFRs. Collectively, the im-
1132 RESPIRATORYCARE•NOVEMBER'93Vol38No 1