Respiratory Care

BACKGROUND: Transportation of critically ill, mechanically ventilated patients from intensive care units for diagnostic and therapeutic procedures has become common in the last decade. Maintenance of adequate oxygenation and ventilation during transport is essential. We evaluated the Impact Uni-Vent 750 portable ventilator in the laboratory and in the clinical arena to determine its usefulness during inhospital transport. MATERIALS & METHODS: In the laboratory, we deter-mined the Uni-Vent 750's ability to assure tidal volume (VT) delivery in the face of decreasing compliance of a test lung and tested the alarm systems. Using a two-compartment lung model modified to simulate spontaneous breathing, we also evaluated the responsiveness of the demand valve. The clinical evaluation was accomplished by comparing arterial blood gas values and ventilator settings in the intensive care unit before transport to those during transport. RESULTS: As lung compliance was reduced from 0.1 to 0.02 mL/cm H2O [1.0 to 0.20 L/kPa], a slight, statistically insignificant decrease in delivered tidal volume was observed. All alarm systems operated according to manufacturer's specifications. The demand valve triggered appropriately with PEEP from 0 to 20 cm H2O [0 to 1.96 kPa]. Sensitivity settings < −6 cm H2O [-0.59 kPa] sometimes resulted in inability to trig-ger the demand valve. During patient transport, arterial blood gas values and ven-tilator settings were comparable to those observed in the ICU. Because an FIO2 of 1.0 was used during transport, mean (SD) PaO2 was significantly greater 89 (26) vs 341 (78) [11.8 (3.5) vs 45.3 (10.4) kPa]. CONCLUSIONS: The Uni-Vent 750 is a reliable transport ventilator, capable of maintaining adequate oxygenation and ventilation in a majority of mechanically ventilated patients. The Uni-Vent 750's ability to (1) provide CMV, AMV, and SIMV; (2) provide low and high pressure alarms; and (3) provide PEEP compensation is unique among portable ventilators.

BACKGROUND: Because of our concern for the safety of bedside caregivers who care for infants receiving ribavirin for long periods of time each day for many days, we evaluated the effectiveness of a double-tent enclosure with vacuum scavengers during simulated and actual patient administration. MATERIALS & METHODS: Part 1—We sought to determine whether two or three scavenging pumps were necessary, by 3 8-h trials with 2 pumps and 3 8-h trials with 3 pumps. Entry into and replacement of mannequin occurred according to protocol. Continuous samples were obtained from three locations in the room. Part 2—The double-tent, double-pump scavenger system was evaluated with patient simulation for a 16-h period. Part 3—The double-tent, double-pump system was evaluated during actual patient use. Air samples were also collected during ribavirin administration via mechanical ventilator circuit with filters in the expiratory limb. Coded environmental samples were analyzed by liquid chromatography. RESULTS: Environmental levels were effectively decreased below published maximal acceptable levels. CONCLUSIONS: Use of a double-enclosure, double-pump scavenging system and implementation of entry protocols ensure reduction of environmental ribavirin levels below recommended maximum levels during administration to spontaneously breathing patients. Use of expiratory filters adequately controls environmental ribavirin levels during mechanical ventilation.

BACKGROUND: Increased stress, burnout, and lack of job satisfaction may contribute to a decline in work performance, absenteeism, and intent to leave one's job or field. We undertook to determine organizational, job-specific, and personal predictors of level of burnout among respiratory care practitioners (RCPS). We also examined the relationships among burnout, job satisfaction (JS), absenteeism, and RCPs' intent to leave their job or the field. METHODS: A pilot-tested assessment instrument was mailed to all active NBRC-credentialed RCPs in Georgia (n = 788). There were 458 usable returns (58% response rate). A random sample of 10% of the nonrespondents (n = 33) was then surveyed by telephone, and the results were compared to those of the mail respondents. Variables were compared to burnout and JS scores by correlational analysis, which was followed by stepwise multiple regression analyses to determine the ability of the independent variables to predict burnout and JS scores when used in combination. RESULTS: There were no significant differences between respondents and sampled nonrespondents in burnout scores (p = 0.56) or JS (p = 0.24). Prediction of burnout: The coefficient of multiple correlation, R2, indicated that in combination the independent variables accounted for 61% of the variance in burnout scores. The strongest predictor of burnout was job stress. Other job-related predictors of burnout were size of department, satisfaction with work, satisfaction with co-workers and co-worker support, job independence and job control, recognition by nursing, and role clarity. Personal-variable predictors were age, number of previous jobs held, social support, and intent to leave the field of respiratory care. Prediction of job satisfaction: Rβ indicated that, in combination, the independent variables accounted for 63% of the variance observed in satisfaction with work, 36% of the variance observed in satisfaction with pay, 36% of the variance observed in satisfaction with promotions, 62% of the variance in satisfaction with supervision, and 48% of the variance in satisfaction with co-workers. Predictors of work-satisfaction level were recognition by physicians and nursing, age, burnout level, absenteeism, and intent to leave the field. Predictors of level of satisfaction with pay were actual salary, job independence, organizational climate, ease of obtaining time off, job stress, absenteeism, intent to leave the field, and number of dependent children. Predictors of level of satisfaction with promotions were recognition by nursing, participation in decision making, job stress, intent to leave the field, past turnover rates, and absenteeism. Predictors of level of satisfaction with supervision included supervisor support, role clarity, independence, and ease of obtaining time off. The strongest predictor of level of satisfaction with co-workers was co-worker support. As overall level of JS increased, level of burnout decreased significantly (r = -0.59, p < 0.001). As burnout level increased, increases occurred in absenteeism (r = 0.22, p < 0.001), intent to leave the job (r = 0.48, p < 0.001), and intent to leave the field (r = 0.51, p < 0.001). CONCLUSIONS: Reduced job stress, increased job independence and job control, improved role clarity, and higher levels of JS were all associated with lower levels of burnout. Managerial attention to these factors may improve patient care and reduce absenteeism and turnover among RCPs.

BACKGROUND: Spacers devices are commonly used in aerosol therapy; how- ever, they are bulky and require regular cleaning. A compact open spacer (OS, Synchroner, Fisons, UK) has been developed to overcome this problem. We com- pared bronchodilator efficacy associated with its use to efficacy of same dose via three other spacers: Volumatic (Glaxo Laboratories), Nebuhaler (Astra Labor- atories), Inspirease (Key Pharmaceuticals). MATERIALS & METHODS: Sixteen asthmatics (> 20% reversibility of FEV1) took part in the study. In random order, they used a different device on each of the 4 study days to inhale 2 puffs of a com- bination aerosol (1 mg reproterol and 2 mg sodium cromoglycate, Aarane). We recorded results of spirometry before and 5, 30, and 60 minutes after bron- chodilator inhalation. RESULTS: At each time, we found no significant difference in bronchodilation. CONCLUSION: OS is as efficient as other commonly used spacers to produce bronchodilation resulting from a conventional dose of repro- terol.

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