Weaning Neonates from Mechanical Ventilation: Is there a right way?
By Stephanie Carlisle Larsen, BS, RRT
Respiratory distress is a common cause of morbidity in the preterm infant population. The March of Dimes reported in 2007 that premature birth rates have decreased, yet the decline is minor.1 Nationally, premature birth rates are currently at 12.7%, an overall 36% increase from the 1980s.1 Regardless, the preterm population requiring intubation is substantial. Some infants are intubated for a short period of time and others are intubated at length, depending on gestational age, lung maturity, and severity of disease. Consequently, many avenues of weaning are explored in this population to limit exposure. Even in the best-case scenario of a neonate who experiences a successful short-term extubation, reintubation or continuous positive airway pressure (CPAP) may be required because of apnea or respiratory distress. These complications could result in additional ventilator-induced lung injury (VILI). The ideal situation would be to maintain the infant on the ventilator for exactly the right amount of time to halt the progression of disease before VILI can be induced, followed by a successful transition to unassisted breathing. Although there are various issues to be explored in neonatal mechanical ventilation, the weaning phase is the aspect that will be dissected in this article.

Care of the Child with Long-term Tracheostomy
By Cynthia Bissell, RN
A tracheotomy is a surgical procedure that is usually performed in the operating room with the patient under general anesthesia. A tracheotomy is an incision into the trachea that forms a temporary or permanent opening called a tracheostomy. Sometimes the terms "tracheotomy" and "tracheostomy" are used interchangeably. The opening or hole is called a stoma. The incision is usually vertical in children and runs from the second to the fourth tracheal ring. A tube is inserted through the opening to allow for the passage of air and removal of secretions. Instead of breathing through the nose and mouth, the child will now breathe through the tracheostomy tube.

 

Respiratory Care of the Morbidly Obese Patient
Michael A. Gentile RRT FAARC FCCM

Approximately two thirds of US adults are overweight or obese.1 Overweight may be defined as a body mass index (BMI) 25–29.9 kg/m2, obesity >30 kg/m2 and morbid obesity refers to those with a BMI >40 kg/m2. BMI is not an ideal measure of body weight distribution because it includes muscle, but it is a universally accepted measurement, useful and simple to apply. The prevalence of obesity is increasing at an alarming rate worldwide. Many public health experts consider obesity an epidemic, with a 10% increase in prevalence as compared with the previous decade. Also alarming is that childhood obesity rates have nearly tripled since 1980, from 6.5% to 16.3%.2

Tracheotomy in the Obese Patient
Tim Op’t Holt, EdD, RRT, AE-C, FAARC

Obesity is defined by the National Institutes of Health (NIH) as a body mass index (BMI) of > 40 or > 35 with life-threatening comorbidities.1 According to the Centers for Disease Control and Prevention (CDC), the prevalence of obesity (BMI ≥ 30) continues to be a health concern for adults, children and adolescents in the United States. Data from the most recent NHANES survey shows that among adult men, the prevalence of obesity was 31.1% in 2003—2004, and 33.3% in 2005—2006, a small and not significant change.2 Among adult women, the prevalence of obesity in 2003—2004 was 33.2%, and in 2005—2006 was 35.3%, again a small and not significant change. Obesity represents a significant challenge to the healthcare system, particularly when the patient requires mechanical ventilation.

Get Help from the Experts: Preventing Catheter-Associated Urinary Tract Infections (CAUTI)

Urinary tract infections account for approximately 40% of all hospital-acquired infections annually and fully 80% of these can be attributed to indwelling urethral catheters. The Centers for Medicare & Medicaid Services (CMS) put into effect a new rule that states that, if a patient develops a CAUTI while hospitalized, the hospital will not be reimbursed for the UTI complication. 

Perspectives has assembled a panel of experts in epidemiology, infection control and nursing to help you reduce the levels of CAUTI at your facility. Here’s how.