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D H Eubanks

Publications and source records attributed to D H Eubanks.

12 recordsLinked to original sources
PubMed1993

Analysis of indications for intensive care unit admission. Clinical efficacy assessment project: American College of Physicians.

OBJECTIVE: To formulate recommendations for the development of intensive care unit (ICU) admission policies. DESIGN: Literature review of published reports over the period 1966 to 1991 pertaining to admission criteria for intensive care or coronary care units (CCUs). PATIENTS: Studies identifying patients least likely to benefit from ICU or CCU admission were analyzed. Patient populations of interest included adults (> or = 18 years of age) with medical conditions possibly requiring intensive care; trauma patients were excluded. MEASUREMENTS AND MAIN RESULTS: Of 970 articles identified as being pertinent to intensive care, only two case-control studies used the direct method of measuring the effect of ICU intervention on mortality. No studies were found that compared outcomes of low-risk patients treated in a CCU vs those treated in alternative hospital locations, and none identified patients with a very high probability of a bad outcome. CONCLUSIONS: The use of decision-making models for ICU and CCU admissions must be tested in prospective, randomized clinical trials. Critical care units and ICUs should be studied separately. Existing studies of early discharge from CCUs need to be summarized and evaluated. The triaging of ICU patients to alternative hospital locations needs to be evaluated, as do existing predictive models for early triage decision-making.

Adult↗
PubMed1993

Analysis of indications for early discharge from the intensive care unit. Clinical efficacy assessment project: American College of Physicians.

OBJECTIVE: To formulate recommendations for the development of early intensive care unit (ICU) discharge criteria for low-risk monitor patients. DESIGN: Literature review of published reports over the period 1966 to 1991 pertaining to ICU discharge criteria. PATIENTS: Studies identifying patients admitted to ICUs who could be characterized as low risk. Patient populations of interest included adults (> or = 18 years of age) with low-risk medical or mixed medical/surgical conditions; cardiac care unit and burn patients were excluded. MEASUREMENTS AND MAIN RESULTS: Of 1,492 articles identified as being pertinent to ICU discharge, only 2 studies (by the same group of investigators) were found that distinguished low-risk populations among medical and mixed medical/surgical ICU patients. The physiologic component of the Acute Physiology and Chronic Health Evaluation (APACHE) was used in both of these studies to ascertain the degree of risk. No studies were found that compared outcomes of low-risk patients remaining in the ICU after 24 h with those transferred to other hospital locations. CONCLUSIONS: Objective methods (such as APACHE III) should be used to identify low-risk patients at 24 h post-ICU admission. A multicenter study should be conducted to compare outcomes on patients identified as low risk who are randomly assigned to alternative hospital locations for treatment versus those assigned to continued ICU treatment until routine ICU discharge. Mortality and quality of life data should be used as outcome measures (prior to ICU admission and 6 months post-ICU discharge).

Adult↗
PubMed1993

Techniques for weaning a patient from mechanical ventilation; when to begin, what method to use, and how to predict outcome.

A variety of methods have been employed to help wean patients from prolonged ventilatory support. Although synchronized intermittent mandatory ventilation is probably the most widely used, it has not been shown to be clearly superior to T piece or pressure support weaning. Regardless of the method you choose, begin weaning before the patient's lung function has returned to normal or baseline levels and end when the patient shows the minimum capacity necessary to sustain himself off the ventilator. The patient's response to the change in the level of ventilatory support governs the rapidity of weaning. The rapid shallow breathing index can be useful in predicting weaning outcome, as is the patient's ability to tolerate a weaning trial.

Contraindications↗
PubMed1992

The technique of instituting mechanical ventilation. Patient preparation; endotracheal intubation; monitoring.

Potential indications for mechanical ventilation include hypoxemia unresponsive to oxygen administration, hypercapnia resulting in acidemia, and an unstable chest wall. For best results, carefully prepare the patient (both physically and emotionally) before instituting ventilation. Sedatives and local anesthesia can facilitate intubation; avoid paralytic agents unless you are experienced at intubation. The oral route is most commonly used. Once the patient circuit is attached to the endotracheal tube, reexamine the patient and double-check the inspiratory flow and I:E ratio; adjust the ventilator's settings as necessary. Monitor the patient frequently to ascertain the adequacy of alveolar ventilation and arterial oxygen.

Animals↗
PubMed1992

Beyond the basics: operating the new generation of ventilator. A look at the features and functions of these units.

Most modern ventilators have several key features in common: microprocessor control of operational and monitoring functions; electromechanical valves to control and adjust gas flow patterns; and extensive monitoring systems. In addition, these machines can provide a number of different modes of ventilation (including pressure support). Though not microprocessor-controlled, the Siemens Servo 900 series ventilators use feedback electronics to adjust inspiratory flow based on expiratory flow to meet preset volumes. In contrast, the Bennett 7200 units use microprocessor-regulated solenoid valves to deliver preset tidal volume. High-frequency ventilators deliver smaller tidal volumes at rates greater than 60 bpm.

Adult↗
PubMed1992

Understanding and operating the Bennett MA-1 ventilator. Tips on adjusting the controls to avoid problems.

The Bennett MA-1 ventilator is a volume-cycled, constant flow generator that can act as an assistor, controller, or assist-controller. It is one of the most commonly used ventilators in clinical practice. With this unit, inspiration continues until a preset tidal volume is delivered to the patient--unless impedances to gas flow increase system pressures to a preselected limit. Thus, setting the maximum inspiratory pressure too low limits the ability of the ventilator to deliver the tidal volume, causing it to function as a pressure-cycled device. Other basic controls allow you to establish the sensitivity of the ventilator to spontaneous breathing attempts, the maximum flow rate, the frequency of respirations, and the oxygen percentage. Special controls permit delivery of a sigh breath and slowing of exhalation.

Equipment Design↗
PubMed1992

A clinician's guide to ventilators: how they work and why they can fail. A classification system to make sense of available options.

To select a ventilator (or a ventilatory mode), consider the most basic characteristics: How is tidal volume generated (with a constant or nonconstant flow or pressure generator)? How does the ventilator trigger a changeover from exhalation to inhalation and cycle back to exhalation? How is tidal volume delivered to the patient (either directly from a power source or indirectly from an intermediate chamber)? What special functions are available? The answers to these questions will not only let you make the best selection but will also help you troubleshoot when a ventilator fails to function properly.

Equipment Design↗
PubMed1992

Second- and third-generation ventilators: sorting through available options. When, and for which patients, are special functions needed?

Currently available ventilators offer a number of special options to meet the needs of critically ill patients. Intermittent mandatory ventilation allows a patient to breathe spontaneously without assistance. CPAP and PEEP ensure that the patient breathes at an elevated pressure either constantly or during expiration. Pressure support ventilation allows patients to participate in breathing but provides inspiratory assistance and is most useful during weaning. Airway pressure release ventilation facilitates venous return and decreases airway pressure. Sophisticated monitors provide detailed information on the patient's status, but alarm features are somewhat unreliable. Thorough knowledge of the controls on modern ventilators can help you provide the optimum form of respiratory support.

Equipment Design↗
PubMed1991

The basis and basics of mechanical ventilation.

The development of mechanical ventilators and the procedures for their application began with the simple foot pump developed by Fell O'Dwyer in 1888. Ventilators have progressed through three generations, beginning with intermittent positive pressure breathing units such as the Bird and Bennett device in the 1960s. These were followed by second-generation units--represented by the Bennett MA-2 ventilator--in the 1970s, and the third-generation microprocessor-controlled units of today. During this evolutionary process clinicians recognized Types I and II respiratory failure as being indicators for mechanical ventilatory support. More recently investigators have expanded, clarified, and clinically applied the physiology of the work of breathing (described by Julius Comroe and other pioneers) to muscle fatigue, requiring ventilatory support. A ventilator classification system can help the clinician understand how ventilators function and under what conditions they may fail to operate as desired. Pressure-support ventilation is an example of how industry has responded to a clinical need--that is, to unload the work of breathing. All positive pressure ventilators generate tidal volumes by using power sources such as medical gas cylinders, air compressors, electrically driven turbines, or piston driven motors. Positive end-expiratory pressures, synchronized intermittent mandatory ventilation, pressure support ventilation, pressure release ventilation, and mandatory minute ventilation, are examples of the special functions available on modern ventilators. Modern third-generation ventilators use microprocessors to control operational functions and monitors. Because these units have incorporated the experience learned from earlier ventilators, it is imperative that clinicians understand basic ventilator operation and application in order to most effectively prescribe and assess their use.

Equipment Design↗
PubMed1988

An aging society: implications for health care needs and impacts on allied health practice.

The first report of the National Task Force on Gerontology and Geriatric Care Education, excerpted herein, raises many more questions than it answers. Through its broad-brush articulation of the health care needs of older people, the report sets the environment for gauging the impact of these needs on allied health practice. Responses to a number of the implications for health care needs are now underway, yet much remains undone. In the coming year the task force will develop an action plan that addresses directly the many implications for allied health.

Aged↗
PubMed1986

Iatrogenic pulmonary overpressure accident.

An unconscious victim of an overdose was intubated with an endotracheal tube to prevent aspiration. The respiratory therapist deflated the cuff of the endotracheal tube to allow for a retrograde oral air leak and then tightly attached the oxygen tube directly to the endotracheal tube. Seconds later there was a loud pop as the oxygen tube blew off the end of the endotracheal tube. The patient sustained both a hemodynamic and a neurologic decompensation as the result of marked pulmonary overinflation, with bilateral pneumothoraces and probable cerebral and coronary artery air emboli. We present the case in the hope that it will help avoid any such future occurrences.

Adult↗