Respiratory Therapy Organizational Changes Are Associated With Increased Respiratory Care Utilization

Parker, Ann M.; Liu, Xinggang; Harris, Anthony D.; Shanholtz, Carl; Smith, Robin L.; Hess, Dean; Reynolds, Marty; Netzer, Giora

doi:10.4187/respcare.01562

Cited by 14 publications

(11 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Administrative data were used to identify patients receiving mechanical ventilation. The overall accuracy of using administrative data was 93% from a random sampling of 461 patients (1.7%) which is consistent with prior reports from our institution [20]. The protocol for the automated screening system is displayed in Figure 1.…”

Section: 1 Materials and Methodssupporting

confidence: 85%

Trauma indices for prediction of acute respiratory distress syndrome

Afshar

Smith

Cooper

et al. 2016

Journal of Surgical Research

View full text Add to dashboard Cite

Background A myriad of trauma indices have been validated to predict probability of trauma survival. We aimed to compare the performance of commonly used indices for the development of the Acute Respiratory Distress Syndrome (ARDS). Materials and Methods Historic, observational cohort study of 27,385 consecutive patients admitted to a statewide referral trauma center between July 11, 2003 and October 31, 2011. A validated algorithm was adapted to identify patients with ARDS. Each trauma index was evaluated in logistic regression using the area under the receiver operating characteristic curve. Results The case-rate for ARDS development was 5.8% (1,594). The receiver operating characteristics for ISS had the best discrimination and had an area under the curve of 0.88 (95% CI 0.87–0.89). Glasgow coma score (0.71, 95% CI 0.70–0.73), A Severity Characterization of Trauma (0.86, 95% CI 0.85–0.87), Revised Trauma Score (0.71, 95% CI 0.70–0.72) and thorax Abbreviated Injury Score (0.73, 95% CI 0.72–0.74) performed worse (p<0.001) and Trauma and Injury Severity Score (0.88, 95% CI 0.87–0.88) performed equivocally (p=0.51) in comparison to ISS. Using a cutoff point ISS greater than or equal to 16, sensitivity and specificity were 84.9% (95% CI 83.0%–86.6%) and 75.6% (95% CI 75.1%–76.2%), respectively. Conclusions Among commonly used trauma indices, ISS has superior or equivocal discriminative ability for development of ARDS. A cutoff point of ISS greater than or equal to 16 provided good sensitivity and specificity. The use of ISS greater than or equal to 16 is a simple method to evaluate ARDS in trauma epidemiology and outcomes research.

show abstract

Section: 1 Materials and Methodssupporting

confidence: 85%

Trauma indices for prediction of acute respiratory distress syndrome

Afshar

Smith

Cooper

et al. 2016

Journal of Surgical Research

View full text Add to dashboard Cite

show abstract

“…Patients receiving mechanical ventilation were identified using administrative data. In a random sample of 461 (1.7%) patients, overall accuracy was 93% for the ventilator administrative data, consistent with prior use of administrative data from our institution 22 . Over 92% of the cohort had chest radiographs performed during initial evaluation in the trauma resuscitation unit however reports were not routinely recorded in the registry.…”

Section: Methodssupporting

confidence: 78%

Blood alcohol content, injury severity, and adult respiratory distress syndrome

Afshar

Smith

Terrin

et al. 2014

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

Background Elevated blood alcohol content is a risk factor for injury. Associations of blood alcohol content with acute respiratory distress syndrome have not been conclusively established. We evaluated the association of a BAC >0 mg/dL with the intermediate outcomes, Injury Severity Score and Glasgow Coma Score, and their association with acute respiratory distress syndrome development. Methods Observational retrospective cohort study of 26,305 primary trauma admissions to a statewide referral trauma center from July 11, 2003 to October 31, 2011. Logistic regression was performed to assess the relationship between Admission blood alcohol content, Injury Severity Score, Glasgow Coma Score, and acute respiratory distress syndrome development within five days of admission. Results The case-rate for acute respiratory distress syndrome was 5.5% (1447). Blood alcohol content >0 mg/dL was associated with acute respiratory distress syndrome development in adjusted analysis (Odds Ratio 1.50; 95% Confidence Interval 1.33–1.71, p<0.001). High Injury Severity Score (≥16) had a stronger association with acute respiratory distress syndrome development (Odds Ratio 17.99; 95% Confidence Interval 15.51–20.86); as did low Glasgow Coma Score (≤8) (Odds Ratio 8.77; 95% Confidence Interval 7.64–10.07, p<0.001). Patients with low Glasgow Coma Score and high Injury Severity Score had the most frequent acute respiratory distress syndrome (33.6%) and the highest case fatality rate without acute respiratory distress syndrome (24.7%). Conclusions Elevated blood alcohol content is associated with acute respiratory distress syndrome development. In the analysis of alcohol exposure, Injury Severity Score and Glasgow Coma Score occur after alcohol ingestion, making them intermediate outcomes. Injury Severity Score and Glasgow Coma Score were strong predictors of acute respiratory distress syndrome and may be useful to identify at-risk patients. Elevated blood alcohol content may increase the frequency of the acute respiratory distress syndrome through influence on injury severity or independent molecular mechanisms which can be discriminated only in experimental models

show abstract

“…Currently, there are no well-established, evidence-based guidelines addressing RT:patient ratio (5). However, some estimate that under standard, nondisaster conditions, an RT can safely manage up to 10 stable patients or 4 ventilated patients independently (6,7). Using this as a basis, a tiered staffing model was developed in which the RTEs report to a single RT, thereby truly extending his/her initial capacity.…”

Section: Discussionmentioning

confidence: 99%

Training and Deployment of Medical Students as Respiratory Therapist Extenders during COVID-19

Hester¹,

Cartwright²,

DiGiovine³

et al. 2020

ATS Scholar

View full text Add to dashboard Cite

Background: Early experience during the coronavirus disease (COVID-19) pandemic and predictive modeling indicate that the need for respiratory therapists (RTs) will exceed the current supply. Objective: We present an implemented model to train and deploy medical students in the novel role of "respiratory therapist extender" (RTE) to address respiratory therapist shortage during the COVID-19 pandemic. Methods: The RTE role was formulated through discussions with respiratory therapists. A three-part training, with both online and in-person components, was developed and delivered to 25 University of Michigan Medical Students. RTEs were trained in basic respiratory care, documentation, equipment preparation, and equipment processing for clinically stable patients. They operate in a tiered staffing model in which RTEs report to a single RT, thereby extending his/her initial capacity. Results: The first cohort of safely trained RTEs was deployed to provide patient care within 1 week of volunteer recruitment. Conclusion: Our experience has demonstrated that healthcare professionals, including medical students, can be quickly trained and deployed in the novel RTE role as a surge strategy during the COVID-19 pandemic. Because we urgently developed and implemented the RTE role, we recognize the need for ongoing monitoring and adaptation to ensure patient and volunteer safety. We are sharing the RTE concept and training openly to help address RT shortages as the pandemic evolves.

show abstract

Respiratory Therapy Organizational Changes Are Associated With Increased Respiratory Care Utilization

Cited by 14 publications

References 43 publications

Trauma indices for prediction of acute respiratory distress syndrome

Trauma indices for prediction of acute respiratory distress syndrome

Blood alcohol content, injury severity, and adult respiratory distress syndrome

Training and Deployment of Medical Students as Respiratory Therapist Extenders during COVID-19

Contact Info

Product

Resources

About