Monitoring Breathing Effort

Abstract

Editorialsthis is a single-center trial in a teaching hospital in a large city in Canada, which is the major trauma facility for a large metropolitan area in the most populous province in the country-all factors that challenge the overall generalizability of the results. The population in the report was multidisciphnary and accurately reflective, albeit in a single center, of the clinicians working in the ICU. Because of the small population studied in this report, it was not possible to evaluate any difference in attitudes among disciphnes.Despite the single site, the factors described as defining and influencing scarcity in this study are similar to what has been previously described in the literature and demonstrate that scarce factors are common in daily ICU practice, implying and confirming that at least "perception" of scarcity is common for bedside ICU caregivers and that the challenges to decision making are similar. The factors, which are also an important contribution from this study, include multiple patients requiring the same complex technology, bed availability, the need to accommodate specialty programs, staffing, late discharges, competing interests, and inconsistent messages regarding prognosis. The response of clinicians is also important to note: forced prioritization, early discharge, "gaming" the system to admit patients who might not meet severity criteria for admission, and, of course, impaired interactions with families (11).The authors offer some important suggestions for altering the perception of scarcity by caregivers, including improved communication with families, more realistic survival predictions, and improving timely discharge. Most importantly, the study invites the field to take up consideration of significant questions about rationing: Is the rationing process legitimate? Is the rationing process fair?Rationing, by definition, is inevitable in an ICU. Given the alarming rate at which healthcare expenditures are increasing, we are at the day when we cannot afford all potentially beneficial therapies for everyone. We must start talking about it now.

Monitoring Breathing Frequency, Pattern, and Effort

“…On the other hand, decreased breathing effort can cause muscular deconditioning and abnormal gas exchange. 57 The measurement of breathing effort allows clinicians to assess respiratory mechanics in both intubated and nonintubated patients. This knowledge helps guide the application of appropriate medical treatment and therapies to improve respiratory function in patients with respiratory related illnesses.…”