Respiratory care

A Tidal volume calculator to improve lung protective ventilation in COVID-19 related Acute Respiratory Distress Syndrome (ARDS) (2020)

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Type of publication:
Conference abstract

Author(s):
*Blair J.; *Hester S.; Baldwin A.; Ali T.

Citation:
Intensive Care Medicine Experimental; 2020; vol. 8

Abstract:
Introduction: Routine use of lower tidal volumes (TVs) for the mechanical ventilation of patients with ARDS results in decreased mortality and increases the number of days without ventilator use [1]. Severe COVID-19 pneumonia has been associated with the development of ARDS as characterised by the Berlin definition [2]. A multi-centre preliminary audit was undertaken to identify whether ventilated COVID-19 related ARDS patients were receiving optimal TVs, as recommended by the Faculty of Intensive Care Medicine (FICM) and Intensive Care Society (ICS) ARDS management guidelines [3]. Objective(s): As a result of the audit, three main areas for improvement were identified. 1. To achieve accurate calculations for ideal body weight (IBW) and target TV 2. To improve documentation of IBW and target TV 3. To achieve TVs no greater than 6 ml/kg Methods: A 'tidal volume calculator' tool was developed using Microsoft Excel, which was simple, colour coded and kept on all Intensive Care Unit (ICU) computer desktops. This tool was designed to use height to calculate IBW and, if the patient's height was unavailable, could also be utilised to calculate height from ulna length. IBW was subsequently used to calculate a target TV. Staff received training on how to apply the tool. Two snapshot audits were carried out in April and May 2020 at two ICUs. The first was conducted prior to the tool's introduction with the second two weeks after its implementation. All patients receiving mechanical ventilation, except those spontaneously breathing, were included. Data was extracted from patient notes, charts and ventilator settings. Result(s): The initial audit included 14 patients. Six patients did not have an IBW documented. Three patients had documented IBWs that were 12 kg, 15 kg and 23 kg greater than the weight calculated using the tool, leading to increased tidal volume targets. Only three patients were achieving TVs of 4-6 ml/kg. Eleven patients were achieving a TV greater than 6 ml/kg, with two of these achieving a TV of greater than 8 ml/kg. The follow-up audit included ten patients. This revealed that all patients had an IBW clearly documented. Moreover, nine patients were achieving TVs within 4-6 ml/kg, with only one patient found to be achieving a TV greater than 6 ml/kg. Conclusion(s): This audit cycle revealed that initially adherence to lung protective ventilation and documentation of IBW was poor. In some instances, documented IBW was vastly different to the calculated IBW, suggesting that in these situations actual body weight may have been used. In a time when clinicians were being redeployed to support ICU, this simple tool was shown to support staff by clearly calculating and displaying IBW and target TV for reference. This directly led to improved adherence to lung protective ventilation and optimisation of patient care. Limitations include that no consideration was made for overall patient outcome, and only a snapshot of achieved TVs from ventilators were recorded; daily/weekly trends were not studied.

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Bronchiectasis in primary care (2020)

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Type of publication:
Journal article

Author(s):
*Pickstock, Shirley

Citation:
Journal of Community Nursing; Feb 2020; vol. 34 (no. 1); p. 51-54

Abstract:
Non-cystic fibrosis (CF) (bronchiectasis) is a common chronic lung condition, which occurs due to damage to the airways leading to persistent cough, sputum production and recurrent chest infections (Hill et al, 2018). This article focuses on the adult patient and describes the pathophysiology, aetiology, investigation, and management of bronchiectasis in the primary care setting. The aim is to raise awareness of this disease, which is increasing in prevalence and to empower community nurses with information to support patients through the bronchiectasis disease trajectory.

Link to full-text [NHS OpenAthens account required]

Patent foramen ovale causing breathlessness and platypnoea-orthodeoxia syndrome in an older patient (2018)

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Type of publication:
Journal article

Author(s):
*Madden, Katy; *MacKintosh, Abigail; *Mike, Nigel

Citation:
Age and Ageing; Jan 2019; vol. 48, no. 1, p.157-159

Abstract:
An 82-year-old male presented with a week's history of shortness of breath on exertion, particularly when bending to tie his shoe laces. The breathlessness worsened on standing and was relieved by lying. His oxygen saturations were noted to fluctuate based on position dropping to 82% on standing. This was suggestive of platypnoea-orthodeoxia syndrome (POS), an uncommon but potentially reversible diagnosis. As the population ages we may be more likely to see patients with persisting patent foramen ovale decompensate and develop POS.

Quality improvement project for emergency oxygen delivery on a respiratory ward (2016)

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Type of publication:
Conference abstract

Author(s):
*Hutchinson K.E.; *Craik S.; *Srinivasan K.; *Moudgil H.; *Ahmad N.

Citation:
Thorax; Dec 2016; vol. 71, Supplement 3

Abstract:
Background British Thoracic Society (BTS) guidelines state that oxygen should be used to treat hypoxaemia and prescribed to a target saturation range.1 Patients at risk of type 2 respiratory failure should target 88-92%, with the rest 94-98%. In the BTS national audit in 2013, out of 6214 patients, 55% had oxygen prescribed and 52% were prescribed and delivered to within a target saturation range.2 Methods We ran a Quality Improvement Project (QIP) involving three PDSA cycles to improve the delivery of oxygen to patients on the Respiratory Ward at the Princess Royal Hospital, Telford. We set our standards as: 1. 90% of patients receiving oxygen have it prescribed on a drug chart 2. 100% of patients prescribed oxygen have a documented target saturation range 3. 100% of patients have oxygen delivered appropriately to target The QIP process
commenced in Autumn 2015. After the first cycle we used bedside prompt cards and delivered teaching sessions with doctors, nurses and healthcare assistants (HCAs). After the second cycle we appointed a nurse, HCA and two FY1 doctors as 'O2 Ninjas'. Data were collected at three points after each cycle from drug charts and VitalPaC. Results See Table (Table Presented) Conclusions Our QIP shows that education and empowerment of 'grass root' healthcare workers can improve oxygen prescription on a Respiratory ward. We suggest this QIP is replicated in other trusts and specialties to improve safe oxygen delivery.

Consultant-led, collaborative service for people suffering from respiratory conditions (2016)

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Type of publication:
Post on the Academy of Fab NHS Stuff website

Author(s):
Nawaid Ahmad

Citation:
Academy of Fab NHS Stuff (www.fabnhsstuff.net/), January 2016

Abstract:
This Future Hospital Programme case study from The Shrewsbury and Telford Hospital NHS Trust outlines the benefits of having a consultant- led service for respiratory medicine.

Key recommendations:

Establish a series of multidisciplinary team (MDT) meetings to discuss the needs of patients with long-term conditions. The MDT should incorporate primary care physicians, mental health, social services and palliative care services to provide a collaborative and exceptional level of care.
Run community-based clinics to reduce hospital admissions as well as help with accurate diagnosis
Propose a long-term management plan for more patients with more complicated health needs and to help with advanced care planning for those patients who are especially ill.

Link to more details or full-text: http://www.fabnhsstuff.net/2016/01/25/your-story-consultant-led-collaborative-service-for-people-suffering-from-respiratory-conditions/