A Preventative Respiratory Protocol to Identify Trauma Subjects at Risk for Respiratory Compromise on a General In-Patient Ward

Abstract

Study results suggest that a preventive respiratory protocol had a beneficial effect on patient outcomes; receiving the protocol reduced hospital days and eliminated unplanned admission to the ICU.

Utilizing Respiratory Therapists to Reduce Costs of Care

“…All 28 studies demonstrated cost savings. The included studies covered a wide variety of respiratory care practices, which included the topics of ventilators (9); [16][17][18][19][20][21][22][23][24] multiple therapies (7); [25][26][27][28][29][30][31] disease management (4); [32][33][34][35][36] invasive procedures (3), [line insertion (2) for arterial 37 and internal jugu- 40,41 and oxygen (2). 42,43 Sixteen of the studies (57%) utilized protocols.…”

“…Almost all studies were conducted in acute critical-care settings (11) [16][17][18][19][20][22][23][24][37][38][39] or acute non-ICU settings (13). 21,[25][26][27][28][29][30][31][33][34][35]40,41 There were 3 studies conducted in ambulatory care, 32,36,42 and 1 study was conducted in a long-term care setting. 43 Most studies addressed the adult population (24), with 2 each studying pediatric 32,34 and neonatal populations.…”

“…Twelve studies used a non-concurrent cohort study design. 16,19,[21][22][23]26,27,29,31,34,40,41 A before-andafter design was used in 4 studies, 32,38,42,43 and a crosssectional design was used in 3 studies, 25,28,37 as well as a controlled before-and-after study, 24 a non-comparative design, 39 and a retrospective cohort study. 18 Given the focus of this study on cost savings, it was not surprising that the most frequently studied topic related to mechanical ventilation management/liberation protocols.…”

“…Slightly more than half of the studies included in this review utilized respiratory care protocols. There were protocols related to ventilator management, aerosol therapy, 20 Randomized controlled trial Ventilator Yes Acute: critical care Adult Kelleghan et al (1993) 19 Non-concurrent cohort study Ventilator No Acute: critical care Adult Dasgupta et al (1999) 21 Non-concurrent cohort study Ventilator No Acute: non-ICU Adult Burns et al (2003) 16 Non-concurrent cohort study Ventilator Yes Acute: critical care Adult Cohen et al (1991) 22 Non-concurrent cohort study Ventilator Yes Acute: critical care Adult Hermeto et al (2009) 23 Non-concurrent cohort study Ventilator Yes Acute: critical care Neonates Arroliga et al (2012) 24 Controlled before and after study Ventilator No Acute: critical care Adult Gupta et al (2014) 18 Retrospective cohort study Ventilator Yes Acute: critical care Adult Stoller et al (1998) 30 Randomized controlled trial Multiple Yes Acute: non-ICU Adult Harbrecht et al (2009) 27 Non-concurrent cohort study Multiple Yes Acute: non-ICU Adult Kollef et al (2000) 26 Non-concurrent cohort study Multiple Yes Acute: non-ICU Adult Nyland et al (2016) 29 Non-concurrent cohort study Multiple Yes Acute: non-ICU Adult Stoller et al (1996) 31 Non-concurrent cohort study Multiple Yes Acute: non-ICU Adult Kallam et al (2013) 25 Cross-sectional study Multiple Yes Acute: non-ICU Adult Werre et al (2015) 28 Cross-sectional study Multiple Yes Acute: non-ICU Adult Rice et al (2010) 35 Randomized 40 Non-concurrent cohort study Aerosolized medication Yes Acute: non-ICU Adult Tenholder et al (1992) 41 Non-concurrent cohort study Aerosolized medication Yes Acute: non-ICU Adult* Chaney et al (2002) 42 Before and after study Oxygen No Ambulatory care Adult Christman et al (2006) 43 Before and after study Oxygen Yes Long-term care Adult * Did not explicitly state an adult population, but adult population is assumed in reviewing the study description. disease management, and oxygen therapy, and studies that included multiple therapies indicate that protocols span a broad range of respiratory care practices.…”

Respiratory Complications in Trauma Patients: A Multidisciplinary Approach to Prevention

“…The study by Nyland et al 7 in this issue of RESPIRATORY CARE highlights several important aspects of this effort. First is the importance of recognizing risk factors among patients who otherwise may not have been at risk of respiratory failure and instituting a program of increased vigilance and proactive measures to identify and mitigate risk factors for respiratory embarrassment and resultant complications.…”