- Educational Perspectives: Toward More Effective Neonatal Resuscitation: Assessing and Improving Clinical Skills. [Journal Article]Neoreviews 2019; 20(5):e248-e257N
- Newborn deaths following birth asphyxia remain a significant global problem, and effective resuscitation by well-trained professionals may reduce mortality and morbidity. Clinicians are often responsible for teaching newborn resuscitation to trainees. Multiple educational methods are used to teach these skills, but data supporting their efficacy are limited. Mask ventilation and chest compression…
Newborn deaths following birth asphyxia remain a significant global problem, and effective resuscitation by well-trained professionals may reduce mortality and morbidity. Clinicians are often responsible for teaching newborn resuscitation to trainees. Multiple educational methods are used to teach these skills, but data supporting their efficacy are limited. Mask ventilation and chest compressions are considered the basics of resuscitation. These technical motor skills are critically important but difficult to teach and often not objectively assessed. Teaching more advanced skills such as neonatal intubation is challenging, because teaching opportunities and working hours of learners have declined. Videolaryngoscopy appears to be an effective teaching tool that allows instruction during clinical practice. There is also emerging recognition that effective resuscitation requires more than individual clinical skills. The importance of teamwork and leadership is now recognized, and teamwork training should be incorporated because it improves these nontechnical skills. Simulation training has become increasingly popular as a method of teaching both technical and nontechnical skills. However, there are unanswered questions about the validity, fidelity, and content of simulation. Formal resuscitation programs usually incorporate a mixture of teaching modalities and appear to reduce neonatal mortality and morbidity in low- and middle-income countries. Emerging teaching techniques such as tele-education, video debriefing, and high-frequency training warrant further investigation.
- Different contributions from lungs and chest wall to respiratory mechanics in mice, rats, and rabbits. [Journal Article]J Appl Physiol (1985) 2019; 127(1):198-204JA
- Changes in lung mechanics are frequently inferred from intact-chest measures of total respiratory system mechanics without consideration of the chest wall contribution. The participation of lungs and chest wall in respiratory mechanics has not been evaluated systematically in small animals commonly used in respiratory research. Thus, we compared these contributions in intact-chest mice, rats, and…
Changes in lung mechanics are frequently inferred from intact-chest measures of total respiratory system mechanics without consideration of the chest wall contribution. The participation of lungs and chest wall in respiratory mechanics has not been evaluated systematically in small animals commonly used in respiratory research. Thus, we compared these contributions in intact-chest mice, rats, and rabbits and further characterized the influence of positive end-expiratory pressure (PEEP). Forced oscillation technique was applied to anesthetized mechanically ventilated healthy animals to obtain total respiratory system impedance (Zrs) at 0, 3, and 6 cmH2O PEEP levels. Esophageal pressure was measured by a catheter-tip micromanometer to separate Zrs into pulmonary (ZL) and chest wall (Zcw) components. A model containing a frequency-independent Newtonian resistance (RN), inertance, and a constant-phase tissue damping (G) and elastance (H) was fitted to Zrs, ZL, and Zcw spectra. The contribution of Zcw to RN was negligible in all species and PEEP levels studied. However, the participation of Zcw in G and H was significant in all species and increased significantly with increasing PEEP and animal size (rabbit > rat > mice). Even in mice, the chest wall contribution to G and H was still considerable, reaching 47.0 ± 4.0(SE)% and 32.9 ± 5.9% for G and H, respectively. These findings demonstrate that airway parameters can be assessed from respiratory system mechanical measurements. However, the contribution from the chest wall should be considered when intact-chest measurements are used to estimate lung parenchymal mechanics in small laboratory models (even in mice), particularly at elevated PEEP levels. NEW & NOTEWORTHY In species commonly used in respiratory research (rabbits, rats, mice), esophageal pressure-based estimates revealed negligible contribution from the chest wall to the Newtonian resistance. Conversely, chest wall participation in the viscoelastic tissue mechanical parameters increased with body size (rabbit > rat > mice) and positive end-expiratory pressure, with contribution varying between 30 and 50%, even in mice. These findings demonstrate the potential biasing effects of the chest wall when lung tissue mechanics are inferred from intact-chest measurements in small laboratory animals.
- Employment of an algorithm of care including chest physiotherapy results in reduced hospitalizations and stability of lung function in bronchiectasis. [Journal Article]BMC Pulm Med 2019; 19(1):82BP
- CONCLUSIONS: Standardized care for Bronchiectasis involving an algorithm for Mucociliary clearance that centers on initiation of HFCWO may help to reduce lung function decline, need for oral antibiotics, and reduced hospitalization rate.
- Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews. [Journal Article]Cochrane Database Syst Rev 2019; 1:CD011231CD
- CONCLUSIONS: There is little evidence to support the use of one airway clearance technique over another. People with cystic fibrosis should choose the airway clearance technique that best meets their needs, after considering comfort, convenience, flexibility, practicality, cost, or some other factor. More long-term, high-quality randomised controlled trials comparing airway clearance techniques among people with cystic fibrosis are needed.
- CPRural. [Clinical Trial]Can J Rural Med 2019 Jan-Mar; 24(1):13-17CJ
- CONCLUSIONS: Monthly practise of chest compressions with an interactive feedback device improved the quality and confidence of nurses' CPR skills. These results suggest that a higher frequency of CPR practice (than the minimum annual recertification) would improve both the quality and retention of CPR skills, specifically for low-volume rural hospitals.
- Objective Versus Self-Reported Adherence to Airway Clearance Therapy in Cystic Fibrosis. [Journal Article]Respir Care 2019; 64(2):176-181RC
- CONCLUSIONS: Self-reports overestimated actual adherence to airway clearance therapy, and the overestimation increased with treatment occurring in multiple households and prescribed therapy duration. Among participants with prescribed airway clearance therapy ≥ 60 min, overestimation increased with lower income. Objective measures of adherence are needed, particularly for lower-income children and those receiving treatments in multiple locations.
- Management of Non-Cystic Fibrosis Bronchiectasis. [Case Reports]Consult Pharm 2018; 33(11):658-666CP
- CONCLUSIONS: It is important for pharmacists to understand the pharmacologic and nonpharmacologic treatments for NCFB to better assist physicians and patients and improve therapeutic outcomes.
- Optimal training frequency for acquisition and retention of high-quality CPR skills: A randomized trial. [Journal Article]Resuscitation 2019; 135:153-161R
- CONCLUSIONS: Short-duration, distributed CPR training on a manikin with real-time visual feedback is effective in improving CPR performance, with monthly training more effective than training every 3, 6, or 12 months.
- IMPULSE OSCILLOMETRY AND SPIROMETRY IN SCHOOLERS SUBMITTED TO THE SIX-MINUTE WALK TEST. [Journal Article]Rev Paul Pediatr 2018 Oct-Dec; 36(4):474-481RP
- CONCLUSIONS: Repercussions were: increase in central and total airway resistance and reduction of FEF25-75% after 6MWT in schoolchildren, suggesting that greater attention should be given to submaximal tests in children with predisposition to airways alterations.
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- Should Oropharyngeal Airways Be Included With Public Automated External Defibrillators? [Journal Article]Circulation 2018; 138(16):1620-1622Circ