How to implement NIV in the ICU?

2012 ◽  
Vol 19 (3) ◽  
pp. 206-209
Author(s):  
Jean-Michel Arnal
Keyword(s):  
Respiratory Failure ◽  
Practical Training ◽  
Respiratory Therapist ◽  
Continuous Training ◽  
Session Duration ◽  
Number Of Patients ◽  
Different Types ◽  
And Training ◽  
Ventilator Settings ◽  
Humidification Devices

NIV is widely used in the ICU for different types of respiratory failure. However, there is no recommendation on the method to implement successfully the NIV program in the ICU. The three keys are equipment, caregiver’s education and training, and organisation. Equipment should be considered purchasing the appropriate ventilators according to the number of patients and the type of patients admitted. Interface selection is very important and should not be neglected. Humidification devices should also be appropriate. Physician, nurses and respiratory therapist have to get education, practical training and a continuous training program. Organisation of NIV in the ICU is improved if there is a local developed protocol with precise indication criteria, initiation method, mask selection, ventilator settings, NIV session duration and monitoring.

scholarly journals A multicenter randomized trial to assess the efficacy of CONvalescent plasma therapy in patients with Invasive COVID-19 and acute respiratory failure treated with mechanical ventilation: the CONFIDENT trial protocol

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Benoît Misset ◽  
Eric Hoste ◽  
Anne-Françoise Donneau ◽  
David Grimaldi ◽  
Geert Meyfroidt ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Neutralizing Antibodies ◽  
Ethical Issues ◽  
High Titer ◽  
Passive Immunization ◽  
University Hospital ◽  
Optimal Time ◽  
Relative Reduction ◽  
Number Of Patients

Abstract Background The COVID-19 pandemic reached Europe in early 2020. Convalescent plasma is used without a consistent evidence of efficacy. Our hypothesis is that passive immunization with plasma collected from patients having contracted COVID-19 and developed specific neutralizing antibodies may alleviate symptoms and reduce mortality in patients treated with mechanical ventilation for severe respiratory failure during the evolution of SARS-CoV-2 pneumonia. Methods We plan to include 500 adult patients, hospitalized in 16 Belgian intensive care units between September 2020 and 2022, diagnosed with SARS-CoV-2 pneumonia, under mechanical ventilation for less than 5 days and a clinical frailty scale less than 6. The study treatment will be compared to standard of care and allocated by randomization in a 1 to 1 ratio without blinding. The main endpoint will be mortality at day 28. We will perform an intention to treat analysis. The number of patients to include is based on an expected mortality rate at day 28 of 40 percent and an expected relative reduction with study intervention of 30 percent with α risk of 5 percent and β risk of 20 percent. Discussion This study will assess the efficacy of plasma in the population of mechanically ventilated patients. A stratification on the delay from mechanical ventilation and inclusion will allow to approach the optimal time use. Selecting convalescent plasmas with a high titer of neutralizing antibodies against SARS-CoV-2 will allow a homogeneous study treatment. The inclusion in the study is based on the consent of the patient or his/her legal representative, and the approval of the Investigational Review Board of the University hospital of Liège, Belgium. A data safety monitoring board (DSMB) has been implemented. Interim analyses have been planned at 100, 2002, 300 and 400 inclusions in order to decide whether the trail should be discontinued prematurely for ethical issues. We plan to publish our results in a peer-reviewed journal and to present them at national and international conferences. Funding and registration The trial is funded by the Belgian Health Care Knowledge Center KCE # COV201004 Trial registration Clinicaltrials.gov registration number NCT04558476. Registered 14 September 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04558476

scholarly journals APHACHE Score as a Predictive Indices for Weanability from Mechanical Ventilation

2013 ◽  
Vol 1 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Md Sayedul Islam
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Private Hospital ◽  
Total Duration ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Apache Score ◽  
Number Of Patients ◽  
Weaning Outcome

Objective: To determine the significance of acute physiology and chronic health evaluation (APACHE) score as an important parameter of weaning outcome for mechanical ventilation. Design: prospective, observational. Setting: The medical ICU of a modernized private hospital, Dhaka. Method: The study was carried out during the period of 2008 to 2009 in a specialized private hospital Dhaka. Critical care physicians were asked to filled up the data sheets having detail problem of the patients including the APACHE II score. The APACHE II score is divided into three steps High score>25, Medium score 20-24 and Low score < 20. The clinicians were suggested to predict whether it would take < 3 days or 4to 7days or >8days to wean each patients from mechanical ventilation. The cause of respiratory failure and total duration of weaning were recorded. The significance was set at p<.05. Result: Total number of patients included in this study were 40. Male were 22 (55%) and female were 18 (45%), the mean age of the patients were 51.1±13.9. The most common cause of respiratory failure were COPD 11(24.5%) and next common were pneumonia and ARDS due to sepsis 8 (20%) each. Among the studied population 20 (50%) having low APACHE score (<20), 12 (30%) were medium score (20-24) and 8 (20%) patients were high score (>25). Total 25 (62.5%) of the patients were successfully weaned from mechanical ventilation, 10 (25%) of the patient died and 5 (12.5%) of the patent were shifted to other low cost hospital. The successfully weaned groups 17 (68%) had lower APACHE II score than the unsuccessfully (failure) group which were statistically significant ÷2 =.8546, df =2, p-value >.005. Conclusions: The overall severity of illness as assessed by APACHE II score correlates better with weaning outcome. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14360 Bangladesh Crit Care J March 2013; 1: 18-22

scholarly journals Assessment of health promotion content in undergraduate physiotherapy curricula

2015 ◽  
Vol 71 (1) ◽  
Author(s):  
Kebogile Mokwena ◽  
Koketso Phetlhe
Keyword(s):  
Health Promotion ◽  
Descriptive Study ◽  
Practical Training ◽  
Undergraduate Training ◽  
Undergraduate Level ◽  
Minimum Standards ◽  
Rural Settings ◽  
Training Programmes ◽  
Depth Interviews ◽  
And Training

Background: The integration of health promotion in the treatment of patients should be included in all academic curricula in primary training of health professionals. However, the extent to which health promotion is included in the various curricula at undergraduate level is not known.Objective: To assess the extent to which health promotion content is integrated in undergraduate physiotherapy training programmes in South Africa. Method: This was a qualitative and descriptive study, using in-depth interviews with representatives of physiotherapy academic departments.Results: All universities have some content of health promotion, with the weighting varying between 12% and 40%. Health promotion is taught at various levels of study, and health promotion training blocks are in both urban and rural settings and include communities, schools and old-age homes. The theories of advocacy, enabling and mediation are covered, but there is limited practical training on these elements. There are limited human resources trained in health promotion, as well as a lack of clear processes of developing and reviewing teaching and training materials.Conclusion: There is lack of consensus on the weighting of health promotion, the level at which it is taught and how it is evaluated across universities. Challenges to integrate health promotion in physiotherapy curricula include lack of frequent curricula reviews, inadequate training of lecturers and lack of conducive practical sites.The physiotherapy profession needs to reach a consensus on minimum standards for integration of health promotion in undergraduate training, and the physiotherapy professional board has the potential to provide the required leadership.

Keeping Them Honest

1992 ◽  
Vol 14 (3) ◽  
pp. 25-28
Author(s):  
Molly Schuchat
Keyword(s):  
Human Services ◽  
School Personnel ◽  
Discussion Groups ◽  
Youth Services ◽  
Continuous Training ◽  
Tutoring Program ◽  
Preparatory Course ◽  
Substance Abuse Education ◽  
The City ◽  
And Training

Greenbelt CARES Youth Services Bureau (CARES) is the human services arm of the city of Greenbelt, Maryland, offering direct services to children and their families living in or near this suburb of Washington. CARES has operated for eighteen years, providing formal and informal counseling, crisis intervention, suicide prevention, substance abuse education and prevention, information, referral services, a job bank, a tutoring program, a general equivalency diploma preparatory course, a family clinic, school discussion groups, and training of school personnel. Two-thirds of the services are supplied by qualified volunteers who receive continuous training, technical support, and feedback from a group of peers and mentors.

scholarly journals Shunt Technology in Pediatric Neurosurgery: Current options and Scientific Evidence

2020 ◽  
Vol 2 (2(May-August)) ◽  
pp. e342020
Author(s):  
Luciano Lopes Furlanetti ◽  
Matheus Fernando Manzolli Ballestero ◽  
Ricardo Santos De Oliveira
Keyword(s):  
Scientific Evidence ◽  
Pediatric Neurosurgery ◽  
Inclusion Criteria ◽  
Working Mechanism ◽  
Research Education ◽  
Pubmed Database ◽  
Different Types ◽  
And Training ◽  
Underlying Pathology

Introduction: Hydrocephalus is the most common neurosurgical condition among children worldwide and shunt diversion of the cerebral-spinal fluid (CSF) has been widely available. The aim of the present study was to perform a systematic review on types and models of shunt devices available and critically evaluate scientific evidence in favor of the usage of specific technologies. Methods: Searches of the PubMed database were performed for relevant articles published from until March 2020. Appropriate keywords were used to identify all studies, including: “shunt”, “technology”, “hydrocephalus”, “children”, “pediatric”. The indications and scientific evidence in favor of the usage of specific shunt technology for the treatment of hydrocephalus according to age, underlying pathology and other features of specific patients were discussed under the light of the current literature. Results: A total of 178 peer-reviewed papers were found. Out of them, only 21 matched our inclusion criteria and were finally selected. The papers were reviewed and described technology discussed below. A summary of the main types of shunts commercially available worldwide, including their respective working mechanism and construction was also included. Conclusion:Shunt technology has evolved during the last decades and continues to be intensively developed. Despite of the huge arsenal of different types of shunt systems currently available on the market, the treatment of hydrocephalus remains challenging. Investment in research, education and training, as well as prospective randomized multicentric controlled trials evaluating the role of specific valves in the treatment of individual group of hydrocephalic pediatric patients are urgently needed.

scholarly journals Audio Description from a discourse perspective: a socially relevant framework for research and training

2021 ◽  
Vol 6 ◽  
Author(s):  
Sabine Braun
Keyword(s):  
Empirical Research ◽  
Research Training ◽  
Audio Description ◽  
Global Coherence ◽  
Different Types ◽  
Socially Relevant ◽  
Partially Sighted ◽  
And Training

The topic of this paper is Audio Description (AD) for blind and partially sighted people. I will outline a discourse-based approach to AD focussing on the role of mental modelling, local and global coherence, and different types of inferences (explicatures and implicatures). Applying these concepts to AD, I will discuss initial insights and outline questions for empirical research. My main aim is to show that a discourse-based approach to AD can provide an informed framework for research, training and practice.

scholarly journals The Determinants Of Primary Employment In U.S. States

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Halil Dincer Kaya
Keyword(s):  
Small Business ◽  
Technology Use ◽  
Health And Safety ◽  
Business Owners ◽  
The Internet ◽  
Safety Regulations ◽  
Zoning Regulations ◽  
Different Types ◽  
Main Components ◽  
And Training

We examine the relationship between `primary employment` and `business friendliness` of U.S. states. Do states with a low score in `business friendliness` worry small business owners too much and hence force them to run their business as their primary job? We look at several main components of `business friendliness` including `Ease of start`, `Ease of hire`, `Overall regulations`, and `Training and networking`. We also look at subcomponents including the different types of regulations and technology use. How does each of these factors affect a business owner’s decision to focus mainly on his/her business? We use the `United States Small Business Friendliness Survey` done by Kauffman Foundation and Thumptack.com in 2013 and converted the letter scores ranging from A+ to F in the survey to numerical scores ranging from 12 to 1 (i.e. 1 being the lowest score which corresponds to F). Therefore, after the conversion, each state has a numerical score on each business-friendliness category. The survey also asks business owners if they use the internet when starting a business, when paying their taxes, or when licensing. For each state, we compute the percentage of owners in each state using the internet when starting a business, when paying their taxes, or when licensing. We call these three percentage numbers for each state their `Internetstart`, `Internettax`, and `Internetlicensing` scores. Then, using the mean score for all states for each type of regulation or internet score, we divide the states into two groups: the `high-score states` and the `low-score states`. In our analysis, we use non-parametric tests to compare the `high-score states` to the `low-score states`. Our non-parametric tests show that although none of the main components (i.e. `Ease of start`, `Ease of hire`, `Overall regulations`, and `Training and networking`) seem to affect `primary employment`, the overall business friendliness score of a state significantly affects `primary employment`. When we examine the different types of regulations, we find that `Health and safety regulations`, `Licensing regulations`, and `Zoning regulations` affect `primary employment`. `Employment regulations`, `Tax code`, or `Environmental regulations` does not have a significant impact. These findings may indicate that business owners are more worried with regard to Health and safety regulations, Licensing regulations, and Zoning regulations, therefore more of them choose to take matters into their own hands. Another possible explanation may be the relative complexity of the tasks associated with these regulations. Finally, our results show that technology use in the entrepreneurial process does not affect `Primary employment`.

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