Respiratory care practices and requirements for respiratory therapists in Beijing intensive care units.

BACKGROUND: Respiratory therapist (RT) is a nascent career in China, so little information is available about intensive care unit (ICU) respiratory care resources and practices, requirements for RTs, and barriers to recruit RTs. METHODS: Using survey methodology, we designed and mailed a questionnaire to ICU supervisors and staffs at all 106 ICUs within 46 tertiary and university-affiliated hospitals in Beijing. RESULTS: We obtained responses from 72 of 106 ICUs. There were 644 ICU beds, 18 RTs, 464 physicians, and 1,362 nurses in these 72 ICUs. The ratios of invasive and noninvasive ventilators to beds were 0.7/1 and 0.31/1. Nineteen ICUs were not equipped with noninvasive ventilators; 18 had started using noninvasive ventilation only within the last 5 years; 9 had only nasal cannulas for conventional oxygen therapy. Of 194 responders, 57.8% implemented spontaneous breathing trial before extubation; 23.7% never monitored airway temperature while using heated humidifier; 56.7% changed circuits once a week; and 20.6% every 1-3 days. The survey indicated that 91.2% had heard of the profession of RT before, mostly by attending academic conferences; 86.1% believed respiratory care should be provided by RTs. Due to the paucity of trained RTs, only 9.7% (7/72) ICUs had actually recruited RTs. The specific tasks supposed to be assigned to RTs were mechanical ventilation, chest physiotherapy, and airway care. CONCLUSIONS: ICU respiratory care equipment and the knowledge to use them are insufficient. Important differences exist in respiratory care practice, which is mostly provided by nurses and physicians. RTs have been gradually recognized and accepted by ICU staff, while professional training and education are needed.

[Non-invasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a prospective cohort study].

OBJECTIVE: To investigate the clinical effect of non-invasive positive pressure ventilation (NPPV) on acute hypoxemic respiratory failure (AHRF), and to look for predictors of failure of NPPV in patients with AHRF. METHODS: In the cohort study, the clinical data of patients with AHRF in respiratory intensive care unit (RICU) of Beijing Chaoyang Hospital from January 2004 to December 2007 were collected prospectively. Patients were divided into successful group and failure group according to outcome of NPPV. Basic clinical information, NPPV mode and duration, vital signs, arterial blood gas analysis, and oxygenation index (PaO(2)/FiO(2)) before and 2 hours, 24 hours after NPPV were analyzed and compared between two groups. RESULTS: (1)The NPPV successful rate in 59 cases was 62.7% (37/59). (2)Compared with failure group, mean age, the ratio of patients in whom respiratory failure were induced by pulmonary infection were lower in successful group (both P<0.01). There was no difference in PaO(2)/FiO(2)between two groups before NPPV, but PaO(2)/FiO(2) in successful group was markedly higher than those of failure group after 2 hours and 24 hours of NPPV (P<0.05 and P<0.01), while heart rate (HR), respiratory rate (RR) were significantly lower (all P<0.01). (3)Logistic regression analysis identified age > or = 60 years [odds ratio (OR) 8.30, 95% confidence interval (CI) 2.49-27.60, P=0.002], pulmonary infection as underlying disease of respiratory failure (OR 6.19, 95%CI 1.90-20.20, P=0.027), PaO(2)/FiO(2)<150 mm Hg (1 mm Hg=0.133 kPa) after 2 hours of NPPV (OR 3.65, 95%CI 1.20-11.04, P=0.044), HR>100 times/min after 24 hours of NPPV (OR 7.45, 95%CI 2.15-25.58, P=0.010), and RR>30 times/min after 24 hours of NPPV (OR 7.26, 95%CI 1.88-24.49, P=0.018) as risk factors independently associated with failure of NPPV. CONCLUSION: NPPV can be the first line treatment for severe AHRF patients without absolute contraindication, while patients of older age with pulmonary infection, the risk of failure of NPPV is higher. Lack of improvement in cardiorespiratory and oxygenation condition after a short period of NPPV is the predictor of NPPV failure.

[Non-invasive positive pressure ventilation in patients with acute respiratory distress syndrome: a prospective cohort study].

OBJECTIVE: To investigate the efficiency of the application of non-invasive positive pressure ventilation (NPPV) as a first-line intervention in patients with acute respiratory distress syndrome (ARDS). METHODS: A prospective cohort study was designed to analyze the clinical data of patients with ARDS in respiratory intensive care unit (RICU) of Beijing Chaoyang Hospital admitted between January 2004 and December 2007. RESULTS: (1)31 patients, age (49+/-17) years, with acute physiology and chronic health evaluation II (APACHEII) score of 14+/-8 and oxygenation index (PaO(2)/FiO(2) of (123+/-32) mm Hg (1 mm Hg=0.133 kPa), were enrolled in the study. There were 23 males and 8 females. (2)The successful rate of NPPV was 74.2% (23/31) and it was significantly higher in patients without pulmonary infection than that in patients with pulmonary infection (100% vs. 60%, P=0.017). (3)In the successful group, heart rate (HR), respiratory rate (RR) and PaO(2)/FiO(2) were improved significantly at the time of 2 hours and 24 hours of NPPV compared with NPPV before (all P<0.01), while there was no significant improvement observed in the failure group. Furthermore, an increase in arterial partial pressure of carbon dioxide (PaCO(2)) was observed in the latter (P<0.05). No serious complications were seen in association with NPPV in all recruited patients. CONCLUSION: NPPV may be the first-line intervention for a selected group of ARDS patients, while invasive ventilation should be considered for those patients with high risk of NPPV failure as indicated by worsening of vital signs and arterial blood gas analysis after a short time of using NPPV, and also in cases where pulmonary infection is the underlying disease of ARDS.

[A questionnaire survey on the current practices of respiratory care in intensive care unit in 30 provinces].

OBJECTIVE: To investigate respiratory care equipment, operators and conditions of performance in intensive care units (ICU), with the aim of providing data for standardization and developing respiratory care in China. METHODS: A questionnaire survey was performed in one national and two international conferences in August, 2006. Four hundred and ninety-one doctors and nurses from 320 ICUs in 264 tertiary hospitals responded. RESULTS: Ratios of invasive and noninvasive mechanical ventilators to beds were 0.52:1 (2 189/4 185) and 0.16:1 (672/4 185), respectively. Of 320 ICUs, ratios of ICU equipped with ultrasound, jet nebulizers and MDI were 55.9% (179/320), 33.8% (108/320) and 12.1% (39/320), respectively, and percentages of doctors in charge of setting modes and parameters, weaning and extubation were 92.1%, 93.1%, 83.5%, respectively. Suction (93.9%), humidification (90.2%), aerosol therapy (91.6%) and circuit changing (83.7%) were nurses' duties. Among 491 responders, 40.9% of them implemented spontaneous breathing trials (SBT) before weaning, 13.4% were ignorant of it, and 12.8% never. 27.1% of ICU never monitored air temperature during invasive mechanical ventilation, 34.4% provided humidification by instilling or pumping saline continuously for those patients who were weaned from ventilators but not extubated, 55.6% checked ventilator before use. Ventilator circuits were changed once a week in 48.1%, 1-3 days in 25.0% and 3-5 days in 14.7%. CONCLUSION: The quantity of ventilators in the ICU has increased, but other practical respiratory care equipment have not been used widely. Most of respiratory care services are still provided by nurses and doctors, lacking professional staffs. The management is evidently variable but without a standardized guideline.