Respiratory Care

We report the evaluation of a cart we created to provide high frequency jet ventilation (HFJV) to neonates during intrahospital or interhospital transport. DESCRIPTION: The cart carries a conventional ventilator, jet ventilator (JV), incubator, gas blender, 3 E cylinders of oxygen and 2 of air, uninterruptible electric power supply (UPS), 2 syringe infusion pumps, cardiac monitor, and oximeter. EVALUATION METHODS: To determine the available operating time of the ventilators, we ran tests with 60% and 100% oxygen, high and low ventilator settings, 2.5-mm and 3.5-mm endotracheal tubes, and lung simulator set for low and high time constants. With five different combinations of these variables, the system was run to exhaustion of its gas supply. To determine the operating time limit of the UPS, we used it to operate the JV until the low-battery alarm sounded. RESULTS: The UPS always provided electrical power for at least 2 hours. In no case did a single cylinder of oxygen fail to power the system for less than 20 min. Because the cart carries 3 cylinders of oxygen and 2 of air, under the conditions tested a minimum of 60 min of continuous operation, using 100% oxygen, should be available during those portions of transports when the system is away from hospital and ambulance bulk power sources and is dependent on its own UPS and E cylinders of gas. EXPERIENCE: We have used the cart on two occasions to transport a 30-week gestational age, 1-kg, HFJV-dependent infant, first from ICU to surgery, then to another hospital for cardiac catheterization. Total transport time was 3 hours; there were no problems. The cart has also been used to transport three patients between hospitals during ECMO, without HFJV. CONCLUSIONS: Our HFJV transport system is adequate to transport an HFJV-dependent infant during the 30 to 60 minutes that may elapse when the cart is away from ambulance or hospital sources of electricity and gas. Available operating time with an HFJV transport system should be estimated conservatively; when an infant is dependent on HFJV, it would be well to have aircraft backup in case of ambulance breakdown or other contingencies.

BACKGROUND: Errors in employee selection and consequent high turnover rates are expensive and can result in poor staff morale and possible harm to patients and personnel. METHOD: We investigated the predictive validity of commonly used application blank items as measures of future performance, absenteeism, tardiness, and tenure (the criterion variables) among 100 hospital-employed respiratory therapists and looked at the relationships among the criterion variables. RESULTS: Regression analysis showed the most significant predictive variables to be grade point average in respiratory therapy school, college education in addition to respiratory therapy training (particularly an associate degree in health sciences or a baccalaureate degree), and, surprisingly, the neatness of the application form itself. No important differences were found among the types of respiratory therapy program attended or the length of previous respiratory therapy experience. CONCLUSION: The data offer cautious evidence for the validity of some application items to predict some employee behaviors. The relatively low correlations among the criterion variables (absenteeism, tardiness, tenure, and performance) suggest that these items may be assessing substantially different aspects of employee behavior.

The introduction of the intensive care unit (ICU) in the 1960s with its demands for management of large volumes of patient data drove the initial introduction of computers into the ICU. Since the mid-1960s computer systems for the ICU have evolved into the highly sophisticated bedside workstations commercially available today. Despite all of the technologic advances in computers, their application in ICUs in the United States continues to spread very slowly. One of the largest problems is justifying the cost of systems primarily designed to automate data charting and generation of care plans. Although the existing commercial systems do an excellent job, few conclusive studies prove that these systems have a favorable cost-to-benefit ratio. Research systems have demonstrated that if one extends these systems to incorporate a fully integrated database, decision-support tools, automation of data acquisition, and more sophisticated display and user-interface technology, then these ICU computer systems can have a significant impact on improving the quality and reducing the costs of patient care. For computers to be embraced in the ICU environment, commercial systems of the future must move beyond merely gathering and displaying information. They must help the clinician at the bedside assimilate the vast array of ICU data and help him to make more effective decisions.

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