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

206 Pages·1993·11.7 MB·English
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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 A FOCUSED Approach UvertheyearsSensorMedicshasstrivedtoachieveasinglegoal PulmonaryFunction ...toproducethefinestmedicalinstrumentationusedinCardio- SensorMedicsrevolutionizedmeasurementtechnologywith pulmonaryCare.Todaytheseeffortsarerepresentedbyproducts theMassFlowSensorandFastResponseMultigasAnalyzerwhich thatreflectyearsofresearch,refinement,clinicaltrialandworld- allowstestingoveralargedynamicrangewithgreateraccuracy wideacceptance. combinedwithreducedtestingtimes.Thesetechniqueshavebeen fullytestedandvalidatedbyphysiologists,laboratoriesandinstitu- ^^ SleepDiagnostics tionsthroughouttheworldandareincorporatedintoproductsranging ^a^Realizingthatalargenumberoftheworld'spopulationsuffers fromsmallspirometerstotheModel6200Autobox. fromsleepdisorders,SensorMedicsfocuseditscomputerprogram- mingskillsandinstrumentdesigntospeedupandautomatethe Iyy/\ MetabolicMeasurement collectionandanalysisofrecordedphysiologicaldataduringsleep. Llis.SensorMedicsMetabolicMeasurementproductsbeganas Theseeffortsresultedinproductssuchastheportableandcom- aresponsetoresearchersmonitoringfitnessrequirementsforexplo- pletelyself-containedSomnoTrac\\\d\combinesinnovationand rationandsportsmedicine.Theresult,theMetabolicMeasurement miniaturizationintoacomprehensivesleepsystemprovidingcom- Carthasprovenitselfforovertwodecadestobeaninvaluable prehensivedataacquisition,analysisofthesleeprecordand instrumentinassessingmetabolismtoaidindiagnosingcardiac reportgeneration. andrespiratorydisorders,monitoringnutritionalrequirementsand measuringfunctionalcapacityandfitness. HLifeSupport SensorMedicshaslongrecognizedtheimportanceofworking Foradditionalinformationontheseandother partnershipswithphysicians,therapists,technicians,nursesand SensorMedicsproductscontactusat researchers.Onesuchpartnershipledtothedevelopmentand 1-800-231-2466,ext.8501orfaxto1-714-283-8439. releasein1991ofthe3100AOscillatoryVentilatorusedinthetreat- InEurope,call(31)30289711orfaxto(31)30286244. mentoftheverysickneonate.The3100Aisthemostrecentaddition inlifesupportproductsincludingPulseOximetryandTranscutaneous CO2/O2monitoring. SersorMedics Circle103onreaderservicecard VisitAARCBooth1022inNaslivilla TheCardiopulmonaryCareCompany* DISCOVER WHY MOSBY SETTING IS THE PACE IN RESPIRATORY THERAPY] New6lhEdilion! ManualofPulmonaryFunction Testing GregRuppel,MEd,RRT • containsexpandedinformationon pulmonaryfunctionequipmentand computerstocovertechnologiesthat arenowcommonlyavailable • incorporatesrecommendationsofthe AmericanThoracicSocietyandCenter forDiseaseControlregardingproto- colsandsafetyonqualityassurance issues October,1993.Approx.464pages,94 illustrations.(BookCode:07789)$29.95 (U.S.);$39.00(Can.) New5lhEdilion! ClinicalApplicationofBlood Gases New2ndEdition! BarryA.Shapiro,MD;withWilliamT. CoreTextbookofRespiratory Peruzzi,MDandRozannaKozlowska- New4lhEdilion! CarePractice Templin,RRT RespiratoryCarePharmacology ThomasA.Barnes,EdD,RRT;with20 • detailsthelatestinformationand JosephL.Raujr.,PhD,RRT contributors $D•14e21c5dvatp.iaierdo9ilsomvnl5ucvab,leuinuess(dmscrUsetee,i.irstsnSao.ht1nat)iio9;hnocdo9enos3$nbsm.,a.5lpic4oAa(nur.optntBe7depedoh5rrgeopceoank(lrsqxCsie.nuCaitainoivinc.3dnepaa)g2el,lmy:0ebsspnlierp0sttoaa7,tcog8itede3nisvgc9g,aa)allsua- •• aiAntumranenIpaenfsDddttwepSaiscid,;totcrrienhaapuoadtnnogooptsssrttni,tyehm-trtriioodsrcnoiperchusecoaltegrobrtulahveiidptoesaniiusrplgnvtr/gesxaemyatgpvcaoneneonnntdminaethprntgsuilcoi,nmSilnmeocIuagseadnDn,teaSid(idsaAiouucnRlnrodftsDfloua;Sdrec)--;to •• caductttaeeeoonprrsrsvddsetycea,irrottnhisopngebooedelrmmtssiohetneonauasicstwcasteaoirelodndemr,terbiiaenlanivsyngnapp,drripeiarorneceapitttxteniyieorcrcrraioeecyptlfilyiacseeoanensqnrd,e,eus,tiwaarpirencermsdshswepaanipytr-a- New! andcoughagents troubleshootingmalfunctions PrinciplesandApplicationsof December, 1993.Approx.420pages,126 December,1993.Approx.912pages,500 illustrations.(BookCode:07184)$37.95 illustrations.(BookCode:06550)$53.95 CardiorespiratoryCare (U.S.);$49.50(Can.) (U.S.);$70.25(Can.) Equipment 800-426-4545, DavidH.Eubanks,EdD,RRTand Save time! Call toll-free: RogerBone,MD;with 14contributors Monday-Friday,7AM-6PM,CentralTime.FAXorders,314-453-4379.Pleasementionthis • includesdetailedcoverageofmicro- numberwhencalling:AHA-313.InCanada,calltoll-free:800-268-4178. processor-controlledequipmentand olattheesrtsitnaftoer-moaf-ttihoen-aorntdtehveicpersi,ncwiiptlhestahse \iLjl Pleasesendthebook(s)I'vecheckedonno-risk,30-dayapproval: well RUPPEL:ManualofPulmonaryFunctionTesting(07789)$29.95(U.S.);$39.00(Can.) • designedasaneasy-accessreference, SHAPIRO:ClinicalApplicationofBloodGases(07839)$41.95(U.S.);$54.75(Can.) weliitmhineaxtteentsiivmee-ccroonsss-urmeifnegresnecairncghteosfor EUBANKS:PrinciplesandApplicationsofCardiorespiratoryCareEquipment(01534) interrelatedmaterial $42.95(U.S.);$56.00(Can.) December,1993.Approx.384pages, RAU:RespiratoryCarePharmacology(07184)$37.95(U.S.);$49.50(Can.) 300illustrations.(BookCode:01534) BARNES:CoreTextbookofRespiratoryCarePractice(06550)$53.95(U.S.);$70.25(Can.) $42.95(U.S.);$56.00(Can.) SENDNOMONEYNOW!Takeafull30daystoevaluateyourpurchase.Ifnot completelysatisfied,simplyreturnyourselectionandowenothing.It'sthatsimple! Pleasebillme Chargemy: MasterCard VISA AmEx Card# Exp.date Mosby Signature \l^4 Daytimephone( ) Name 11830WestlineIndustrialDrive Address St. Louis,MO63146 City Slate Zip 130FlaskaDrive Aslulbjoercdtertsoacrheabniglelewdiftohropuotstnaogtei,ceh.anIfdluisnign,gaanpdursctahlaessealoersdelra,x.plwehaesreeatatpapcrhoptrhiiastceouApllonpraincdes Markham,Ontario send10PalNewmanaltheMosbyaddress.30-dayapprovalgoodinU.S.andCanada. CanadaL6G 1B8 RC/11/93 AHA-; Circle104onreaderservicecard VisitAARCBooth303inNashville OPSSHIPPERN°- pKGtoBE9S93B 900*0 More A Than Ventilator We're the onecompany thatpacksa completesystem When you unpack the 7200® Seriesventilatorysystem,you'llfind muchmorethanaventilator You'll findadedicationtoservice,aswell asclinical,educationalandtechni- cal support. Ours isn't just a ven- tilator,it'sasystem.The7200Series ventilatory system: The right WpreInItForIife" choice, for the right reasons. Call 3iPURITAN 1-800-255-6773. BENNETT® Circle129onreaderservicecard VisitAARCBooth704InNashville 1 1 RE/PIRATORU C&RE AMonthlyScienceJournal.Established 1936.OfficialJournaloftheAmericanAssociationtorRespiratoryCare. EDITORIALOFFICE CONTENTS November1993 D1a1l0l3a0sATbXie7s5L2a2n9e Volume38,Number1 (214)243-2272 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 The top ten reasons Ciba Corning will keep your lab "on top" of the blood gas business... RapidLyte*Reduced Heparinarterialblood gassyringes,partofa Awiderangeofstate-of-the-artanalyzersttiat completelineof canmeasurebloodgases,electrolytes,and/or blood-collection hemoglobin,supportedbyoneoftheindustry's productsto bestfieldorganizations. supportyour bloodgas needs. READYsensor ,the revolutionaryelectrodethat eliminatesremembraning maintenance!Nomore CustomerEducation soaking,rinsing,drying...no Specialists provide cathodepolishing...no on-sitetrainingso techniciantimewasted...and thatyouknow noexposuretobiohazardous everythingyou contamination. everwantedto knowaboutour 8 top-notchblood gasequipment. The270CO-oximeter, knownthroughoutthe industryforitssuperior opticsmodule,clinical accuracyandprecision, smallsamplesize,and NewDataMate blood on-boardqualitycontrol gasdatamanagement CpLroIgArraemqutihartemaedndtrse.sses scaypsatbielmit(yw)itphronveitdweosrk immediateaccessto patient,qualitycontrol, maintenance,and calibrationreports. NewAPV (AnalytePerformance Verification)--anewbenchmark intheindustry.OurCustomer EducationSpecialistsassist youwithcorrelationstudies, calibrationvenfication,andall ofthedocumentationyouneed tomeetCLIAregulationsfor bringinginanewinstrument. OurConlirmation'Servicesprovide youwithvaluablequalitycontrol peer-comparisondocumentation. CLIAseminars tdheamtoendsutcraatteeand Your100%satisfactionisguaranteedwith piCrmLapIclAteimcaelntationof atuhnnecyoonondfliyotuioronnbeallsooginduatgrhaaesntipnerdeou!dstuWrceytsw!whaonIntoffyafcoetru,awtnoe'bree regulations. happyandwe'lldowhateverittakes.No questionsasked!Period!It'sassimpleasthat. CallyourCibaCorningAccountRepresentativetodayat1-800-255-3232. QCstylized,READYsensor,andMalearetrademarksolCibaCorningDiagnosticsCorpAPVisasen/icemarkofCibaCorningDiagnosticsCorp. RapidLyleandConfirmationareregisteredtrademarksolCibaCorningDiagnosticsCorp CIBA-CORNING ©1993.CibaCorningDiagnosticsCorp.Allrigfitsresen/ed PatentsPending 190-30054-A Circle118onreaderservicecard VisitAARCBooth304inNashville 1 1 MANUSCRIPTSUBMISSION CONTENTS, November 1993 InnesatrrutchteioennsdtoofrRAiu;tshpiorrastoarvndCaTrypeiostnsaisquaprrtienrtleyd c „,„„, Volume38,Number1 basis(Jan,Apr,July.Nov). PHOTOCOPYING&QUOTATION OpenForumABSTRACTS PHOTOCOPY[NG. Anymaterialinthisjournal thatiscopyrightedbyDaedalusEnterprises.Inc 1211 OpenForumAbstracts mpoasyesboefspchieonttoicfiocpioerdedfuocratnioonnaclomamdevrainccieamlentp.ur- 1315 OpenForumAuthors QUOTATION. Anyone may, without permis- CALLFOROpenForumABSTRACTS sion,quoteupto500wordsofmaterialinthis jporuirsensalIntch.atpirsovciodpeydrigthhetedquobtyatDiaoendaislufsorEnntoenr-- 1322 !994CallforOpenForumAbstracts commercialuse.andprovidedRtispiRAToR"!Carh AARCCONVENTIONEXHIBITORS iscredited.Longerquotationrequireswrittenap- provalbytheauthorandpublisher. 1318 AARCConventionExhibitors SUBSCRIPTIONS/CHANGESOF ADDRESS INDEXES RespiratoryCare D1a1l0l3a0sATbXie7s5L2a29n-e4593 1324 AuthorsinThisIssue (214)243-2272 1324 AdvertisersinThisIssue SUBSCRIPTIONS.Individualsubscriptionrates are$50.00peryear(12issues)intheU.S.and PuertoRico,$70.00peryearinallothercoun- tries;$95.00for2yearsintheU.S.andPuerto Rico.$135.00inallothercountries;and$140 for3yearsintheU.S.andPuertoRico,$200.00 inallothercountries{add$84.00peryearforair mail). Annual organizational subscriptions are offeredtomembersofassociationsaccordingto their membership enrollment as follows: 101- 500 members—.$5.00, 501-1,500 members— $4.50, 1,501-2,500 members—$4.25. 2.501- 5.000 members—$4.00. 5.001-10.000 mem- bers—$3.00.andover10.000members—$2.50, Singlecopies, whenavailable,cost$5.00;add $7.00airmailpostagetooverseascountries. CHANGEOFADDRESS.Sixweeksnoticeis requiredtoeffectachangeofaddress.Noteyour subscription number (from the mailing label) yourname,andbotholdandnewaddress, in- cludingzipcodes.Pleasenoteyoursubscription numberontheenvelope.Copieswillnotbere- placedwithoutchargeunlessrequestisreceived within60daysofthemailingintheU.S.orwith- in90daysinothercountries. MARKETINGDIRECTOR DaleGriffiths ADVERTISINGASSISTANT BethBinklcy ADVERTISING.Displayadvertisingshouldbe arranged with the advertising representatives. RespiratoryCaredoesnotpublishaclassified advertisingcolumn. PRODUCTADVERTISING: RATES&MEDIAKITS AriesAdvertisingRepresentatives 4OrchardHillRoad MarlboroNJ07746 (908)946-1224 fax(908)946-1229 RECRUITMENTADVERTISING: BethBinkley RespiratoryCare 11030AbiesLane DallasTX75229-4593 (214)243-2272 fax(214)484-6010 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:201-368-8118•Toll-Free:1-800-835-6275 cromil and cromolyn sodium groups FAX:201-368-8831 demonstrated statistically significant improvements in afternoon and eve- ning PEFRs. Collectively, the im- 1132 RESPIRATORYCARE•NOVEMBER'93Vol38No 1

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