American Association For Respiratory Care Research Articles

Improving Outcomes for Patients With Tracheostomy Through Implementation of AARC Clinical Practice Guidelines.

The COVID-19 global pandemic dramatically increased our institution's tracheostomy census. Comparing our existing protocols with American Association for Respiratory Care (AARC) January 2021 clinical practice guideline (CPG) relevant to caring for adult patients with tracheostomy in the acute care setting revealed numerous opportunities for improving our care of those patients. We assembled an interdisciplinary tracheostomy team to implement AARC CPG recommendations and manage all patients with tracheostomy in our hospital. We examined the effect our interdisciplinary team approach and implementation of AARC CPG recommendations had on the following metrics: average patient length of stay (LOS); ICU LOS; percentage of ventilator days; percentage of tracheostomy mask days; tracheostomy tube changes; decannulations; average time to decannulation; mortality; 30-d readmissions; and consultations for speech-language pathology (SLP), one-way speaking valves, physical therapy, and occupational therapy. A total of 203 subjects with tracheostomy were followed in a quality improvement study from June 2019-June 2023 (94 in the pre-intervention group, 109 in the post group). There were significant increases between before and after intervention groups in percentage of decannulations in acutely patients with tracheostomy/not present on admission, non-COVID subjects who survived hospitalization (11.8% vs 33.3%, P = .043), percentage of SLP consults (53.2% vs 89.0%, P < .001), and percentage of one-way speaking valve consults (17.0% vs 32.1%, P = .02). Establishment of an interdisciplinary tracheostomy team and implementation of AARC CPG recommendations for care of adult patients with tracheostomy in the acute care setting resulted in positive, statistically significant outcomes.

Academic Output of Fellows of the American Association for Respiratory Care.

Research is critical for the advancement of respiratory care. Fellows of the American Association for Respiratory Care (FAARCs) are nominated based on their significant contributions to the respiratory care profession. Research output is potentially an important component of qualification for FAARC. The purpose of this study is to report the academic output of respiratory therapist (RT) FAARCs. We identified FAARCs from the AARC web site. Research output was assessed by searching the Scopus and PubMed databases. We collected total research documents, citations, h-index, co-authors, and document type. We compared those with only the FAARC designation with RTs who are fellows in both the Society of Critical Care Medicine (FCCMs) and FAARC. We identified a total of 371 RT FAARCs, 4 RT FCCMs, and 10 with both designations. FAARCs were 70% male, 22% had a doctorate, 37% had a master's, 13% had a bachelor's, and 29% did not have a degree reported. There were no differences in sex or highest degree between FAARCs and FCCMs. FAARCs had a total of 3,724 publications and 110,207 citations while those with both designations had 1,304 publications and 43,181 citations. In Scopus, 46% of FAARCs had no publications, and 27% had ≥ 10 publications; of those with both credentials, 10% had no publications, and 70% had ≥ 10 publications. FAARCs inducted in 1998 and 1999 had significantly (P < .001) more publications than other eras. Compared to those with both credentials, FAARCs had fewer median publications (1 vs 50), lower h-index (1 vs 18), and fewer citations (1 vs 1,486), P < .001 for all. Total publications in PubMed were lower, and differences in publications were similar. RT FAARCs had a large number of publications and citations, although nearly half did not have any publications. Those with both FAARC and FCCM had significantly more academic output per fellow, although there are only 10 individuals with both credentials.

Barriers to Respiratory Care Research in the United States.

Respiratory therapists (RTs) are in a unique position to positively impact patient outcomes through respiratory care research. Research plays a key role in evidence-based medicine; however, few RTs perform and publish research. Identification of barriers experienced by RTs may help increase RT-driven research. Thus, we aimed to identify barriers and research interests for RTs. American Association for Respiratory Care (AARC) members were invited to anonymously complete a survey via an electronic link posted on AARC Connect. Survey domains included research training, experience, reasons for doing research, important respiratory topics, and barriers to conduct research. Responses from 82 surveys were analyzed. The majority were female (56%), and most had a graduate degree (61%), with a mean working experience of 25.3 ± 13.6 y. Fifty-seven percent of respondents reported at least one publication in a peer-reviewed journal. The desire to improve patient outcomes was the top-ranked reason for doing research. Most received research training through a graduate-level program (56%), but few had a formal research mentor (26%). Clinical research (67%) and quality improvement (63%) were the most common types of research. Data collection was the most common research role (51%). Invasive ventilation, advanced monitoring, and airway clearance were identified as the most important research topics. The primary barriers for RTs to conduct research were lack of protected time for research, opportunities to participate, training, departmental support, and mentorship. Lack of time, resources, and opportunities were identified as the primary barriers to RT research, and many RTs have not received formal research training. Resources such as formal mentorship, funding, and protected time may help increase RT participation in research.

Real-world diffusing capacity simulation data: how well do they fit current European Respiratory Society/American Thoracic Society acceptability criteria?

ERS/ATS D LCO standards recommend acceptability ranges for weekly D LCO simulation testing performed with a 3-L syringe. On some devices, the ERS/ATS limits may exceed or not fit a 3-sd range, in which case, simulation ranges based on 3 sd may be appropriate. https://bit.ly/3Z0YoZL.

Respiratory therapists’ role in research: results of a national survey

Background: While research is essential to respiratory therapy, little attention has been given to the role of respiratory therapists (RTs) in conducting research. To better understand the prevalence and spectrum of roles of RTs in research, a survey of RTs was designed and administered. Methods: The study was deemed exempt by the Cleveland Clinic Institutional Review Board. An invitation to participate in the survey was sent electronically to members of the American Association for Respiratory Care (AARC) via ‘AARConnect’ (the AARC’s social and professional networking site) on May 21, 2012 and the survey remained open until August 16, 2012. A second, similar survey was sent via ‘Listserve’ to 6,431 RTs in the state of Ohio and remained open from May 31, 2012 to August 16, 2012. Results: Response rates to the national and state-wide surveys were 0.16% and 13%, respectively. Eighty two individuals responded to the AARConnect survey, while the Ohio survey attracted 849 respondents. Of the 81 active AARConnect RT respondents, 31 (38%) reported being currently involved in research activity: 29 (36%) had been involved in research in the past but not currently, and 21 (26%) reported never being involved in any research activity. In contrast, fewer of the Ohio survey respondents reported research experience or involvement. Conclusions: To our knowledge, this represents the first survey of RTs to assess research roles. Limitations of this study include possible biases related to small sample size, self-selection of respondents, and self-reported data. Overall, these results both suggest that a minority of RTs have research experience and that additional study is needed to better characterise the prevalence and level of research experience of RTs

A Pre-Pandemic Evaluation of the State of Staffing and Future of the Respiratory Care Profession: Perceptions of Louisiana Respiratory Therapists.

Workforce development for the respiratory therapy (RT) profession is a growing concern. Upcoming staffing difficulties are expected due to retirement, attrition from the profession, and decreased enrollment in accredited RT programs nationwide. This study assessed respiratory therapists' perceptions of staffing needs and future trajectory of the RT profession. This cross-sectional study utilized a modified 39-question survey tool delivered via e-mail to 618 Louisiana members of the American Association for Respiratory Care (AARC) between November 2019-February 2020. The response rate was 19% (118/618). Although 50% of respondents perceived understaffing, 77.6% indicated the importance to remain in the RT profession. A majority (93.1%) agreed on the importance of maintaining an active membership in the AARC. Respondents working in a hospital setting perceived understaffed work environments more often than other groups. Salary was most important to the employee (33.6%, 39/116), followed equally by room for growth (14.7%, 17/116) and scope of practice (14.7%, 17/116). For the future of the profession, the ability to assess patients and develop care plans and the ability to receive reimbursement for services were indicated as most important factors. Most (69.8%) agreed that the entry-level minimum should be increased to the bachelor's degree, and 21.6% agreed the master's degree in RT should be supported to increase scope of practice. This study indicated a consistent perception of understaffed work environments in respiratory care, and respondents expressed a perceived importance of remaining in the RT profession. This study also indicated support for raising the entry-level standard in RT and a desire for higher education to achieve professional growth and advancement.

2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, the Society

2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, the Society

Is paediatric endotracheal suctioning by nurses evidence based? An International Survey.

Endotracheal suction (ETS) is essential in intubated patients to prevent tube occlusion and is one of the most common nursing interventions performed in intensive care. To explore how paediatric ETS practices reflect evidence-based practice (EBP) recommendations in paediatric intensive care units (PICU) worldwide. A cross-sectional electronic survey linked to a real patient suction episode. Nurses completed the survey following a recent ETS episode. Evidence-based practice (EBP) was defined based on four of the American Association for Respiratory Care (AARC) best evidence recommendations: pre-oxygenation before suction, use of a suction catheter no more than half the diameter of the tracheal tube, shallow depth of suction, and the continuous suction applied upon withdrawal of the catheter. Participants included PICU nurses who performed ETS in children (0-17 years) excluding preterm neonates. Four hundred forty-six complete surveys were received from 20 countries. Most nurses (80%, 367/446) reported that their units had local guidelines for ETS. The most common reason for suctioning (44%) was audible/visible secretions. Over half of ETS episodes (57%) used closed suction. When exploring the individual components of suction, 63% (282/446) of nurses pre-oxygenated their patient prior to suction, 71% (319/446) suctioned no further than 0.5cm past end of the endotracheal tube (ETT), 59% (261/446) used a catheter no more than half the diameter of the ETT, and 78% (348/446) used continuous negative pressure. 24% of nurses gave patients an additional bolus of sedative, analgesic, and/or muscle-relaxant medication prior to suction; this decision was not related to the child's history of instability with suction, as there was no significant difference in those who reported patients had a history of being unstable with suction (P= .80). 26% (117/446) of nurses complied with all four EBP components in the reported suctioning episode. Considerable variation in paediatric endotracheal suctioning practices exists internationally. Although most nurses applied single components of evidence-based recommendations during ETT suctioning, just a quarter applied all four elements. Nurses need to consider and strive to apply EBP principles to common nursing interventions such as ETS.

Home Oxygen Evaluation by Respiratory Therapists in Patients Hospitalized for COPD Exacerbations: The RIsOTTO Study.

The majority of prescriptions for supplemental oxygen are written when patients are discharged to home from the hospital and the evaluation of these patients is inconsistent. Respiratory Therapists receive training in the evaluation and management of patients needing oxygen. The primary goal of the study was to estimate the frequency with which respiratory therapists (RTs) evaluate the need for home oxygen in patients hospitalized for COPD exacerbations before discharge. An online questionnaire was distributed to RTs in the United States by the American Association for Respiratory Care. RTs were asked to indicate how frequently they evaluate the need for home oxygen on an ordinal scale: Never, Rarely/occasionally, Sometimes, Most of the time, Almost every time, or Every time. Consistent evaluation for home oxygen was defined as performing an evaluation for home oxygen therapy Almost every time or Every time (ie, > 75% of the time). Bivariate and multivariable analyses were assessed using the Fisher exact test and logistic regression models. Of 611 respondents, 490 were eligible for analysis. Fifty-eight percent of RTs reported consistently evaluating patients for home oxygen at rest, whereas 43% reported doing so during activity and 14% during sleep. Consistent evaluation for home oxygen requirements at rest was significantly associated with more years of practice (P = .03; highest among RTs with ≥ 30 y of practice at 40%), region of practice (P = .001; highest in the Midwest at 44%), and greater familiarity with criteria for home oxygen (P < .001; highest among RTs who selected Very familiar with guidelines from the Centers for Medicare and Medicaid Services at 58%). Practice in the Midwest and greater familiarity with criteria for home oxygen was associated with consistent evaluation for home oxygen during activity. Practice in the Midwest (vs Northeast; adjusted odds ratio 2.56, P < .001) and being very familiar with home oxygen criteria (vs not at all familiar; adjusted odds ratio 5.66, P < .001) were independently associated with a higher odds of evaluating for home oxygen at rest and with activity. Only 25% of RTs were involved in making decisions about home oxygen equipment. RTs do not consistently evaluate patients hospitalized for COPD exacerbations for home oxygen prior to discharge, and only a minority of RTs are involved in selecting home oxygen equipment.

Physician Support for Non-Physician Advanced Practice Providers for Persons With Cardiopulmonary Disease.

The use of non-physician advanced practice providers (NPAPP) has increased in the United States to offset shortages in the physician workforce. Yet there are still gaps in some locations where there is little to no access to quality health care. This study sought to identify whether physicians perceived a workforce gap and their level of interest in hiring an NPAPP with cardiopulmonary expertise to fill the perceived gap. An American Association for Respiratory Care (AARC)-led workgroup surveyed 1,401 physicians in 6 different specialties. The survey instrument contained 32 closed-ended questions and 4 open-ended questions. 74% of the 1,401 physician respondents agreed or strongly agreed that there will be a future need for an NPAPP with cardiopulmonary expertise. Respondents from sleep, pediatrics, pulmonary, and critical care were most likely to indicate that there is a current need for an NPAPP. A majority of respondents perceived that the specialized NPAPP would improve efficiency and productivity (74%), patient experience (73%), and patient outcomes (72%). Interest in adding this NPAPP did not increase when participants were told to presume authority for hiring, budget, and reimbursement. These results indicate that there is both a need for and an interest in hiring an NPAPP with cardiopulmonary expertise. Having an NPAPP would boost physician efficiency and productivity, improve the patient care experience, and provide benefits that other clinicians are not trained to provide to persons with cardiopulmonary disease. Results suggest there should be continued efforts to develop the NPAPP role to add value for physicians and patients alike.

Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association.

Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association.

Occupational-Induced Secondary Traumatic Stress and Posttraumatic Stress Disorder in Respiratory Therapists.

Secondary traumatic stress (STS) may occur in the caretakers of individuals who have experienced traumatic events or are suffering and, when severe, may be associated with posttraumatic stress disorder (PTSD) at a diagnostic level due to STS. For respiratory therapists (RTs), the incidence of STS and PTSD at a diagnostic level due to STS has not been examined. We assessed the prevalence of self-reported STS and PTSD at a diagnostic level due to STS in licensed RTs. Licensed RTs who were members of the American Association for Respiratory Care completed the Secondary Traumatic Stress Scale (STSS) based on feelings experienced over the preceding 30days and 12months. Results were evaluated on the basis of primary patient population (neonatal/pediatric vs adult), years of experience, and usual work location (ambulatory care, acute care, or ICU) using the McNemar chi-square analysis and the Fisher exact test. 201 licensed and practicing RTs completed the survey. 92% of the respondents worked ≥ 30 h/week, 75% worked in ICUs, 67% worked primarily with adults, and 89% had been in practice ≥ 6years. PTSD at a diagnostic level due to STS was common in all respondents, occurring in 36% based on experiences from the prior 30days and in 32% based on experiences from the prior 12months. No difference in PTSD at a diagnostic level due to STS was noted between RTs caring for neonatal/pediatric versus adult patients or between RTs based on years of work experience or based on work environment. STS and PTSD at a diagnostic level due to STS was common in RTs.

Clinical Pearls

Approximately 8% to 10% of patients in surgical intensive care units (ICUs) will have a hospital-acquired pressure injury (PI) during their stay. These injuries may result in increased pain, increased costs, and longer stays. Although stage 1 PIs are the most common type and can deteriorate to a more severe stage, no studies have addressed the clinical course or outcomes of stage 1 PIs in ICU patients.Alderden and colleagues conducted a retrospective chart review to identify stage 1 PI outcomes. They found the following:To prevent further injury, the authors suggest that nurses consider aggressive treatment of older patients and patients who have factors associated with PI development.See Article, pp 471-476Stress from the hospital workplace environment can cause burnout, which may include emotional exhaustion, reduced feelings of personal accomplishment, and symptoms such as anger and fatigue. In addition, nursing burnout has been associated with medical errors, high turnover, and even posttraumatic stress.Cordoza and colleagues studied the effects of nurses taking daily work breaks in an outside garden setting compared with indoor-only breaks. They found the following: The authors suggest that outdoor garden breaks be used with other interventions to moderate burnout and stress. Although the nurses in this study may have been biased by working in a hospital that already had outdoor space for use by staff, patients, and patients’ families, the findings support the use of outdoor daily work breaks.See Article, pp 508-512The practice of instilling normal saline during suctioning of endotracheal tubes has been controversial for the past 3 decades. Despite evidence showing short-term complications with instillation, such as decreased oxygen saturation and compromised hemodynamics, some clinicians remain reluctant to not use saline.McKinley and colleagues compared the use of (1) no saline, (2) 0.225% saline, and (3) 0.9% saline with intubated pediatric patients. They found the following:The authors acknowledge that significant differences may not have been found because of the high noncompliance in the no-saline group. However, the findings support the American Association for Respiratory Care’s recommendation that saline not be routinely used. Future research on nurses’ perceptions is warranted.See Article, pp 486-494Alcohol withdrawal syndrome (AWS) is a life-threatening condition that has traditionally been treated with benzodiazepines and continuous evaluation using the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar). However, the traditional protocol has several limitations, including nursing staff burden and need for adjuvant therapy. With little research on alternative therapies, few other options for management are available.Tidwell and colleagues compared the traditional CIWA-Ar protocol with a phenobarbital protocol in patients being treated for AWS. They found the following:Phenobarbital provides longer symptom control that can decrease the burden of nursing assessments. The authors recommend a phenobarbital protocol be considered as an alternative therapy for AWS.See Article, pp 454-460

Communication of Career Pathways Through Associate Degree Program Web Sites: A Baseline Assessment.

The American Association for Respiratory Care sponsored a series of conferences that addressed the competency of the future workforce of respiratory therapists (RTs). Based upon the findings from those conferences, several initiatives emerged that support RTs earning a baccalaureate (or bachelor's) degree. The objective of this study was to identify the ways that associate degree programs communicate career pathways toward a baccalaureate degree through their Web sites. This cross-sectional observational study used a random sample of 100 of the 362 associate degree programs approved by the Commission on Accreditation for Respiratory Care. Data were collected from 3 specific categories: demographic data, baccalaureate completion information, and the Web page location for the program. The presence of statements related to any pathway toward a bachelor's degree, transfer credits, articulation agreements, and links for baccalaureate completion were recorded. The descriptive statistics in this study were reported as total numbers and percentages. Of the 100 programs in the random sample, only 89 were included in the study. Only 39 (44%) programs had links on their program Web site that had any content related to bachelor's degrees, 16 (18%) identified college transfer courses toward a bachelor's degree, and 26 (29%) programs included baccalaureate articulation agreements on their Web site. A minority of associate degree programs communicated career pathway information to their prospective and current students through program Web sites. An informative Web site would make the path more transparent for entry-level students to meet their future educational needs as their careers progress.

Perspectives on Incentive Spirometry Utility and Patient Protocols.

Incentive spirometry (IS) is widely used to prevent postoperative pulmonary complications, despite limited clinical effectiveness data and a lack of standardized use protocols. We sought to evaluate health care professionals' perspectives on IS effectiveness and use procedures. An online survey was distributed via social media and newsletters to relevant national nursing and respiratory care societies. Attitudes concerning IS were compared between the American Association for Respiratory Care (AARC) and the nursing societies. A total of 1,681 responses (83.8% completion rate) were received. The clear majority of these respondents agreed that IS is essential to patient care (92.7%), improves pulmonary function (92.0%), improves inspiratory capacity (93.0%), helps to prevent (96.6%) and to reverse (90.0%) atelectasis, helps to prevent (92.5%) and to reverse (68.4%) pneumonia, and is as effective as early ambulation (74.0%), deep-breathing exercises (88.2%), and directed coughing (79.8%). Furthermore, most health care professionals believed that IS should be used routinely preoperatively (78.1%) and postoperatively (91.1%), used every hour (59.8%), used for an average of 9.6 (95% CI 9.3-9.9) breaths per session, used to achieve breath holds of 7.8 (95% CI 7.4-8.2) s, used to reach an initial target inspiratory volume of 1,288.5 (95% CI 1,253.8-1,323.2) mL, and used to achieve a daily inspiratory volume improvement of 525.6 (95% CI 489.8-561.4) mL. Of all respondents, 89.6% believed they received adequate IS education and training. Respondents from the AARC endorsed significantly less agreement relative to the nursing societies on most parameters for IS utility. There was a major discrepancy between health care professionals' beliefs and the published clinical effectiveness data supporting IS. Despite reported adequate education on IS, variability in what health care professionals believed to be appropriate use underscores the literature's lack of standardization and evidence for specific use procedures.

Incentive Spirometry Adherence: A National Survey of Provider Perspectives.

Patient adherence is a critical factor for success of patient-administered therapies, including incentive spirometry (IS). Patient adherence with IS is not known, so we sought to evaluate providers' perspectives on the current state of IS adherence and elucidate possible factors hindering patient adherence. Respiratory therapists (RTs) and nurses across the United States were surveyed via social media and online newsletters. Surveys were distributed to the relevant national RT and nursing societies: the American Association for Respiratory Care, the Academy of Medical-Surgical Nurses, the American Society of Peri-Anesthesia Nurses, and the American Association of Critical-Care Nurses. Responses from 1,681 (83.8% completion rate) RTs and nurses were received. The clear majority of all providers agreed that patient adherence is poor (86.0%; 1,416 of 1,647 respondents) and should be improved (95.4%; 1,551 of 1,626 respondents). Providers believe that IS adherence is hindered by various factors. The most common reasons cited were that patients forget to use their ISs (83.5%; 1,404 of 1,681 respondents), do not use them effectively (74.4%; 1,251 of 1,681 respondents), and do not use them frequently enough (70.7%; 1,188 of 1,681 respondents). These findings from a large national survey of health care providers highlight the need for improved IS adherence and indicate that patient forgetfulness may be a large contributor to nonadherence. Efforts aimed at improving IS adherence are warranted.

The Future of Respiratory Care: Results of a New York State Survey of Respiratory Therapists.

In the current health-care environment, respiratory care may need to make significant changes to academic preparation and clinical practice. The purpose of this research was to assess current needs of respiratory therapists (RTs) in New York State and to understand how RTs perceive their future clinical and academic roles. This study employed a descriptive, cross-sectional non-experimental design. Between October and December 2014, a 32-item online survey was distributed via e-mail to the 2,170 members of the New York State Society of Respiratory Care. Descriptive statistics were used to summarize responses, and bivariate analyses were assessed using Kruskal-Wallis and Mann-Whitney U tests. The response rate was 22% and resulted in 435 valid surveys returned. Seventy percent of 415 respondents agreed that the practice of respiratory care is at risk of losing practitioners. The most important incentive for retention of practitioners in the field was professional growth and an expanded scope of clinical practice. Specifically, the most important of these roles was gaining the ability to assess patients, develop a plan of care, and receive reimbursement for services. Sixty-four percent of 415 respondents strongly agreed that the minimum academic standard for RTs should be raised to the baccalaureate level. Of 415 respondents, the majority (78%) agreed that it is important for therapists to remain in the profession and to be an active member of the American Association for Respiratory Care (83%). These data are useful to the profession, notably for academic programs that must meet the need for a more highly prepared and skilled workforce. The findings emphasize that viability of the profession in the current health-care environment calls for the evolution of a more autonomous RT who can be reimbursed for services and obtain salaries that are competitive with other health professions.

Comparing the Effects of Suction and Routine Methods on Vital Signs, Arterial Blood Oxygen Saturation and Pain Level of Patients Hospitalized at the Intensive Care Unit

Background: One of the highly important duties at the intensive care units (ICUs) for maintaining airway and improving ventilation and oxygenation is suctioning; however, it must be done in a way so that, in addition to the mentioned advantages, it can have the least complications for the patient. Objectives: The aim of the present study was to compare the effect of two standard and routine suctioning methods on vital signs, arterial blood oxygen saturation and pain level of patients hospitalized at the ICU. Materials andMethods: The present quasi-experimental study was conducted during year 2012 on 80 patients under mechanical ventilation hospitalized at ICUs of Zahedan city. Patients were selected purposively and were randomly divided to two groups. In the first group, suctioning was done based on the standard method recommended by the American association for respiratory care (AARC) and in the second group; it was conducted based on routine nursing care. The data was collected by means of Behavioral Pain Scale (BPS) and bedside monitoring of the patients was done before and at one, five, ten and fifteen minutes after suctioning. Results: The results showed that suctioning based on the routine method leads to more pain and this pain continues for 10 minutes after suctioning and there was a statistically significant difference between the two groups at one and five minutes (P = 0.000, P = 0.000). The vital signs in both groups increased after suctioning and these changes were more in the second group, however, there was no significant difference between the two groups. Also, the level of arterial blood oxygen saturation increased after suctioning in both groups, but these changes were more in group 1 and there was a significant difference between the measurements at one, five, ten and fifteen minutes after suctioning and before suctioning (P = 0.00, P = 0.000, P = 0.000); yet in the second group, no significant difference was observed in none of the times (P > 0.05). Conclusions: The results of the present study showed that suctioning in the standard method brings about less pain for the patients. It results fewer changes in vital signs and also leads to increased arterial blood oxygen saturation. Thus, it should be included in the work program of the nurses through adequate training.

NURSES’ KNOWLEDGE IN THE MANAGEMENT OF CLINICAL ALARMS IN THE CRITICAL CARE UNIT OF A TERTIARY HOSPITAL, A CROSS-SECTIONAL STUDY

Background: In low and middle income countries like Kenya, nurses are overworked as the nurse to patient ratio is not as stipulated by the World Health Organization (WHO). In this sense clinical alarms are important as they are able to alert the nurses in the critical care units or other areas of the hospital on the change in the patient’s condition. Nurses therefore need to be knowledgeable about alarms so as to manage patients effectively. &#x0D; Methods: A descriptive cross-sectional study was carried out in the month of June 2014 where 87 nurses were recruited as study participants. A structured self-administered questionnaire was used to collect data. Chi square and Cramer’s V were used to calculate relationship between the variables. &#x0D; Results: Out of 87 respondents, 71.7% (62) were females and 27.6% (25) were males. The respondents responded to seven questions borrowed from an online Continuous Professional Development (CPD) program by the American Association for Respiratory Care (AACR) program on continuing education and scored 69% on average. There was a statistically significant association (p=0.049) between the question on knowledge, “Wiping electrodes with a rough washcloth or gauze and or using sandpaper on the electrode prevents spurious signals and helps to remove part of the stratum corneum allowing electrical signals to travel” and years worked in the critical care unit. The nurses who had worked in CCU for more than five years scored the highest (48.5%) whilst the ones who had worked in CCU for more than ten years scored the least (23.1%). &#x0D; Discussion: There is a deficit in knowledge on the management of clinical alarms, effective assessment and training on management of clinical alarms is necessary. Protocols and policies on alarm management need to be developed.

A taxonomy for mechanical ventilation: 10 fundamental maxims.

The American Association for Respiratory Care has declared a benchmark for competency in mechanical ventilation that includes the ability to "apply to practice all ventilation modes currently available on all invasive and noninvasive mechanical ventilators." This level of competency presupposes the ability to identify, classify, compare, and contrast all modes of ventilation. Unfortunately, current educational paradigms do not supply the tools to achieve such goals. To fill this gap, we expand and refine a previously described taxonomy for classifying modes of ventilation and explain how it can be understood in terms of 10 fundamental constructs of ventilator technology: (1) defining a breath, (2) defining an assisted breath, (3) specifying the means of assisting breaths based on control variables specified by the equation of motion, (4) classifying breaths in terms of how inspiration is started and stopped, (5) identifying ventilator-initiated versus patient-initiated start and stop events, (6) defining spontaneous and mandatory breaths, (7) defining breath sequences (8), combining control variables and breath sequences into ventilatory patterns, (9) describing targeting schemes, and (10) constructing a formal taxonomy for modes of ventilation composed of control variable, breath sequence, and targeting schemes. Having established the theoretical basis of the taxonomy, we demonstrate a step-by-step procedure to classify any mode on any mechanical ventilator.