Safe and Efficient Practice of Bronchoscopic Sampling from Mechanically Ventilated Patients: A Structured Evaluation of the Ambu Bronchosampler-Ascope 4 Integrated System

Background: Bronchoscopic sampling of bronchoalveolar fluid (BAL) should be safe and effective. Current sampling practice risks loss of sample to the attached negative flow, aerosolisation, or spillage, due to repeated circuit breaks, when replacing sample containers. Such concerns were highlighted during the recent coronavirus pandemic. Objectives: Evaluation of an alternative integrated sampling solution, with the Ambu Bronchosampler with aScope 4, by an experienced bronchoscopist in ICU. Methods: An observational study of 20 sequential bronchoscopic diagnostic sampling procedures was performed on mechanically ventilated patients with suspected ventilator-associated pneumonia. Mixed methods assessment was done. The predefined outcome measures were (1) ease of set up, (2) ease of specimen collection, (3) ease of protecting specimen from loss or spillage, and (4) overall workflow. The duration of the procedure and the % volume of sample retrieved were recorded. Results: The mean (±standard deviation [SD]) time for collecting 1 sample was 2.5 ± 0.8 min. The mean (±SD) specimen yield for instilled miniBAL was 54.2 ± 17.9%. Compared with standard sampling, the set-up was much easier in 18 (90%), or easier in 2 (10%) of procedures, reducing the connection steps. It was much more intuitive to use in 14 (70%), more intuitive in 4 (20%), and no more intuitive to use in 2 (10%). The overall set-up and workflow was much easier in 69% of the 13 intraprocedural connections and easier or as easy in the remaining 31% procedures. All procedures where pre connection was established were much easier (7, 100%). The Ambu Bronchosampler remained upright in all procedures with no loss or spillage of sample. Obtaining a sample was much easier in 60%, easier in 10%, no different in 20%, and worse in 10%. The ability to protect a sample from start to finish compared to standard procedures was much easier in 80%, easier in 15%, and no different in 5% of procedures. Overall workflow was much easier in 14 (70%), easier in 4 (20%), and no different in 2 (10%) of procedures. Conclusions: The Ambu Bronchosampler unit was a reliable, effective, and possibly safer technique for diagnostic sampling in ICU. It may improve safety standards during the coronavirus pandemic. A randomized control trial against the standard sampling technique is warranted.

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CO2-controlled sampling of alveolar gas in mechanically ventilated patients

Journal of Applied Physiology ◽

10.1152/jappl.2001.90.2.486 ◽

2001 ◽

Vol 90 (2) ◽

pp. 486-492 ◽

Cited By ~ 74

Author(s):

Jochen K. Schubert ◽

Karl-Heinz Spittler ◽

Guenther Braun ◽

Klaus Geiger ◽

Josef Guttmann

Keyword(s):

Dead Space ◽

Coefficient Of Variation ◽

Sampling Technique ◽

Sampling Device ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Selective Enrichment ◽

Gas Sampling ◽

End Tidal ◽

Ventilated Patients

A newly designed gas-sampling device using end-tidal CO2to separate dead space gas from alveolar gas was evaluated in 12 mechanically ventilated patients. For that purpose, CO2-controlled sampling was compared with mixed expiratory sampling. Alveolar sampling valves were easily controlled via CO2concentration. Concentrations of four volatile substances were determined in the expired and inspired gas. Isoflurane and isoprene, which did not occur in the inspired air, had ratios of end-tidal to mixed expired concentrations of 1.75 and 1.81, respectively. Acetone and pentane, found in both the inspired and expired air, showed ratios of 0.96 and 1.0, respectively. Precision of concentration measurements was between 2.4% (isoprene) and 11.2% (isoflurane); reproducibility (as coefficient of variation) was 5%. Because the only possible source of isoflurane and isoprene in this setting was patients' blood, selective enrichment of alveolar gas was demonstrated. By using the new sampling technique, sensitivity of breath analysis was nearly doubled.

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A STUDY TO ASSESS THE EFFECTIVENESS OF COMMUNICATION BOARD ON THE SATISFACTION LEVEL REGARDING COMMUNICATION PATTERN AMONG MECHANICALLY VENTILATED PATIENTS

THE RESEARCH RESERVOIR ◽

10.47211/trr.2020.v06i01.012 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Mrs Irven Kaur kaur ◽

Dr Tarandeep kaur

Keyword(s):

Sampling Technique ◽

Control Group ◽

Communication Pattern ◽

Satisfaction Level ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Significant Difference ◽

Experimental Group ◽

Ventilated Patients ◽

Communication Board

The research statement was titled as “A Study to assess the effectiveness of Communication Board on the Satisfaction level regarding Communication Pattern among Mechanically Ventilated Patients.” The data was collected from 60 mechanically ventilated patients (30 in experimental group and 30 in control group) admitted in selected hospital, Amritsar, Punjab using Purposive sampling technique. Two groups were selected for the study, one experimental and one control group. The experimental group was provided with the communication board as an intervention to meet their communication needs (4-5 times during morning time) by researcher, until they are extubated. The control group was not provided with communication board, they relied on standard care and on the experience of nurses. Modified likert scale was used to assess the post-interventional satisfaction level regarding communication pattern after extubation, in both experimental and control group. Study findings revealed that, according to post-interventional satisfaction level regarding communication pattern, majority (80%) of mechanically ventilated patients in experimental group were satisfied regarding communication pattern, followed by (20%) dissatisfied, whereas in control group majority (88.9%) of mechanically ventilated patients were dissatisfied regarding communication pattern, followed by (11.1%) satisfied. According to comparison of post-interventional satisfaction level regarding communication pattern among mechanically ventilated in control and experimental group, a significant difference was found with t value 7.69 at p<0.05 level of significance.

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The effects of manual hyperflation using self-inflating manual resuscitation bags on arterial oxygen tensions and lung compliance - Ameta-analysis of the literature

South African Journal of Physiotherapy ◽

10.4102/sajp.v56i1.545 ◽

2000 ◽

Vol 56 (1) ◽

pp. 7-16 ◽

Cited By ~ 4

Author(s):

M. Barker ◽

C. J. Eales

Keyword(s):

Meta Analysis ◽

Lung Compliance ◽

Arterial Oxygen ◽

Mean Values ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Therapeutic Value ◽

The Mean ◽

Oxygen Tensions ◽

Ventilated Patients

The self-inflating manual resuscitation bag (MRB) is a modality which is commonly used by physiotherapists to manually hyperinflate the lungs of mechanically ventilated patients. There is limited scientific evidence to support its therapeutic use and the literature is not in agreement as to the effects of manual hyperinflation. A meta-analysis of the current research on humans has been conducted to investigate the effects of this modality on arterial oxygen tensions and lung compliance. All published studies evaluating the effects of manual hyperinflation (or bagging) on arterial oxygen tensions and/or lung compliance on mechanically ventilated patients have been retrieved. Only studies which reported results in terms of mean values and standard deviation or standard error of the mean could be used in this analysis. Eleven studies were identified between the time period 1968 -1995. Seven of these studies fitted the inclusion criteria. The mean and standard error of the mean values for arterial oxygen tensions (Pa02) and lung compliance (CL) have been used to calculate the 95% confidence intervals and these results were plotted on a graph. A comparative analysis has been performed on the results of the seven studies. A generally non-significant association between bagging and the Pa02 and CL values was demonstrated. Great discrepancies were identified in the designs of the seven included studies. Since the seven studies included in this meta-analysis show an overall non-significant association, it is reasonable to assume that the therapeutic value of the self-inflating manual resuscitation bag is questionable. The studies presented such divergent designs that they do not offer conclusive evidence. More standardized, multi-centre studies are required to clarify the therapeutic value of this modality. Other methods of recruiting the lungs of critically ill patients during and after physiotherapy intervention, need to be explored.

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Clinical Characteristics of Mechanically Ventilated Patients Treated in Non-ICU Settings in Japan: A Retrospective Analysis

10.21203/rs.3.rs-136891/v1 ◽

2020 ◽

Author(s):

Yoshiaki Iwashita ◽

Shinnosuke Morimoto ◽

Sukenari Koyabu ◽

Kazuo Maruyama ◽

Hiroshi Imai

Keyword(s):

Clinical Characteristics ◽

Inspiratory Time ◽

Predicted Body Weight ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Number Of Patients ◽

The Mean ◽

Icu Physicians ◽

Ventilated Patients ◽

Overall Mortality

Abstract Background:The number of patients requiring mechanical ventilation (MV) is increasing worldwide. Patients requiring MV are commonly managed in an intensive care unit (ICU); however, Japan is unique in that many of these patients are treated in non-ICU settings. The characteristics of these patients, nevertheless, are unknown. We sought to identify disease severity and MV settings of patients in non-ICU settings in Japan.Methods: We retrospectively analyzed the clinical data of Kinan Hospital and Owase General Hospital, where there are no ICUs or ICU physicians. Data for adult patients who required MV for more than 3 d from January through December 2018 in those hospitals were collected.Results:A total of 171 patients received MV; 29 patients were treated for more than 3 d. Of that subset, the mortality rate was 44.8% (13 patients). Thirteen patients survived to discharge, and three were transferred to a higher-level facility. The median age of patients treated for more than 3 d was 80 (72–84) years. The mean Acute Physiologic Assessment and Chronic Health Evaluation II score was 20.9 ± 8.1, and predicted mortality was 0.42 ± 0.25. Tidal volume per predicted body weight was 8.8 ± 2.1 mL/kg; set inspiratory time was 1.6 ± 0.3 sec. Preventable non-ICU death (patients who might have been saved if treated in an ICU setting), was 10.3%.Conclusions:The overall mortality of patients treated with MV in a non-ICU setting in the East Kishu area was not inferior to the mortality if they had been treated in an ICU; however, MV settings should be improved.

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Financial impact of an analgosedation protocol for mechanically ventilated patients in a cardiovascular intensive care unit

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz265 ◽

2019 ◽

Vol 77 (1) ◽

pp. 14-21

Author(s):

Sandeep Devabhakthuni ◽

Karan Kapoor ◽

Avelino C Verceles ◽

Giora Netzer ◽

Jonathan Ludmir ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Primary Objective ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Quasi Experimental ◽

Patient Doses ◽

The Mean ◽

The Impact ◽

Ventilated Patients

Abstract Purpose The primary objective was to evaluate the impact of an analgosedation protocol in a cardiac intensive care unit (CICU) on daily doses and costs of analgesic, sedative, and antipsychotic medications. Methods We conducted a single-center quasi-experimental study in 363 mechanically ventilated patients admitted to our CICU from March 1, 2011, to April 13, 2013. On March 1, 2012, an analgosedation protocol was implemented. Patients in the pre-implementation group were managed at the cardiologist’s discretion, which consisted of a continuous sedative-hypnotic approach and opioids as needed. Patients in the implementation group were managed using this protocol. Results The mean ± S.D. per-patient doses (mg/day) of propofol, lorazepam, and clonazepam decreased with the use of an analgosedation protocol (propofol 132,265.7 ± 12,951 versus 87,980.5 ± 10,564 [p = 0.03]; lorazepam 10.5 ± 7.3 versus 3.3 ± 4.0 [p < 0.001]; clonazepam 9.9 ± 8.3 versus 1.1 ± 0.5 [p = 0.03]). The mean daily cost of propofol and lorazepam also significantly decreased (33.5% reduction in propofol cost [p = 0.03]; 69.0% reduction in lorazepam cost [p < 0.001]). The per-patient dose and cost of fentanyl (mcg/day) declined with analgosedation protocol use (fentanyl 2,274.2 ± 2317.4 versus 1,026.7 ± 981.4 [p < 0.001]; 54.8% decrease in fentanyl cost [p < 0.001]). Conclusion The implementation of an analgosedation protocol significantly decreased both the use and cost of propofol, lorazepam, and fentanyl. Further investigation of the clinical impact and cost-effectiveness of a critical care consultation service with implementation of an analgosedation protocol is warranted in the CICU.

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