Teresa A Volsko

Akron Children's Hospital · Nursing Administration

In the absence of an indwelling arterial catheter, capillary blood gas sampling may be used to evaluate the acid/base and ventilation status of neonatal and pediatric patients with cardiorespiratory conditions. These guidelines were developed from a comprehensive review of the literature to provide guidance for the collection, handling, and interpr...

Purpose: To develop, internally validate, and assess the utility of implementing a regression model for determining endotracheal tube (ETT) insertion depth. Research methods: We recorded height, weight, age, sex, ETT internal diameter (ID), lip marking, and tracheal position from the electronic record from a random subset of 2,000 intubated subj...

Children requiring a tracheostomy to maintain airway patency or to facilitate long-term mechanical ventilatory support require comprehensive care and committed, trained, direct caregivers to manage their complex needs safely. These guidelines were developed from a comprehensive review of the literature to provide guidance for the selection of the t...

Purpose of Review We compare the effectiveness of a conventional mode of ventilation, airway pressure release ventilation with non-conventional high frequency ventilation in achieving safety, comfort and liberation in infants and children requiring mechanical ventilation. Recent Findings Mechanical ventilatory support is important to the care of i...

Background: Confirmation of endotracheal tube (ETT) tip position and timely identification and correction of malposition is an essential component of care for endotracheally intubated and mechanically ventilated children. We evaluated the ability of a prototype optoacoustic medical device to determine ETT tip position. We hypothesized that the pre...

Background: Adherence to guidelines for endotracheal tube (ETT) insertion depth may not be sufficient to prevent malposition or harm to the patient. To obtain an estimate of ETT malpositioning, we evaluated initial postintubation chest radiographs and hypothesized that many ETTs in multiple intubation settings would be malpositioned despite adhere...

Background: The American Academy of Pediatrics Section on Transport recommends the use of portable ventilators during the transport of patients with advanced airways. We sought to identify knowledge gaps and evaluate the effectiveness of a transport ventilator competency boot camp. Methods: Electronic health records of children requiring ventila...

Objective: This study sought to validate pediatric models with normal and altered pulmonary mechanics. Methods: PubMed and CINAHL databases were searched for studies directly measuring pulmonary mechanics of healthy infants and children, infants with severe bronchopulmonary dysplasia and neuromuscular disease. The ASL 5000 was used to construct...

Background: Oscillatory positive expiratory pressure (OPEP) is an airway clearance therapy that delivers positive pressure and air-flow oscillations during exhalation. This study described functional characteristic differences of 4 OPEP devices during an active exhalation in a simulated model. We hypothesized peak pressure (Ppeak), positive expira...

Background: Unplanned extubations can lead to iatrogenic injury and have the potential to contribute to serious safety events. We adopted lean methodology to reduce the unplanned extubation rate in a Level 3b NICU. We hypothesized that the use of a rapid-cycle PDSA (plan, do, study, act) initiative would reduce the unplanned extubation rate. Meth...

Background: Bubble CPAP, used for spontaneously breathing infants to avoid intubation or postextubation support, can be delivered with different interface types. This study compared the effect that interfaces had on CPAP delivery. We hypothesized that there would be no difference between set and measured levels between interface types. Methods:...

Aerosolized medications are used as airway clearance therapy to treat a variety of airway diseases. These guidelines were developed from a systematic review with the purpose of determining whether the use of these medications to promote airway clearance improves oxygenation and respiratory mechanics, reduces ventilator time and ICU stay, and/or res...

Background: Interdisciplinary rounding is used to establish and communicate patient care goals and monitor progress toward goal attainment. This study describes staff satisfaction and process outcomes associated with respiratory therapist (RT)-led interdisciplinary rounds in the neonatal ICU. We hypothesized improved staff satisfaction, execution...

While portable, supplemental oxygen is often necessary for patients with chronic obstructive pulmonary disease (COPD) to retain independence, it may provide functional limitations because of the increased workload imposed. This issue may result in nonuse, creating a need to identify carrying modalities that optimize transport. This study assessed t...

Abstract Airway clearance therapy (ACT) is used in a variety of settings for a variety of ailments. These guidelines were developed from a systematic review with the purpose of determining whether the use of nonpharmacologic ACT improves oxygenation, reduces length of time on the ventilator, reduces stay in the ICU, resolves atelectasis/consolidat...

Airway clearance therapy (ACT) is used in a variety of settings for a variety of ailments. These guidelines were developed from a systematic review with the purpose of determining whether the use of nonpharmacologic ACT improves oxygenation, reduces length of time on the ventilator, reduces stay in the ICU, resolves atelectasis/consolidation, and/o...

Disease processes can impair ciliary function, alter secretion production and mucus rheology, and interfere with the cough reflex. Airway clearance therapy has been a cornerstone of therapy aimed at minimizing the devastating effects of airway obstruction, infection, and inflammation due to mucus stasis on the conducting airways and lung parenchyma...

BACKGROUND: The purpose of this study was to explore the prevalence, setting, sources, and types of disruptive behavior respiratory therapists experience. Three hypotheses were tested: (1) respiratory therapists experience disruptive behavior in the workplace; (2) verbal disruptive behavior is the most common form reported by respiratory therapists...

Approximately 6 years ago, the American Association for Respiratory Care (AARC) established a task force to identify the evolving role of the respiratory therapist (RT). The members of this task force acknowledged the complexities of providing medical interventions along the continuum of care, and

For the busy clinician, educator, or manager, it is becoming an increasing challenge to filter the literature to what is relevant to one's practice and then update one's practice based on the current evidence. The purpose of this paper is to review the recent literature related to invasive mechanical ventilation, noninvasive ventilation, and cystic...

In pulmonary rehabilitation (PR) effective measures have been taken while in analyzing a patient's intervention with the help of entry to exit evaluations. The absence of an objective and quantifiable scale are limitations of PR that allow analyzing of a patient's self reported symptoms throughout PR. The Breathlessness, Cough and Sputum Scale (BCS...

Background: Carefully designed educational programs can improve asthma knowledge, management practices, and health outcomes. We used pre-post testing to determine if the curriculum provided in the Girl Scouts of the USA Asthma Awareness Patch Program improved recipients' knowledge of basic respiratory system function, asthma pathophysiology, trigg...

Technological advances have increased ventilator mode complexity and risk of operator error. To compare differences in volume control (VC) ventilation with set-point and dual targeting. Two hypotheses were tested: tidal volume (V(T)) delivery is different with VC using set-point versus dual targeting during active versus passive breathing; VC with...

Mechanical ventilation technology has evolved rapidly over the last 30 years. One consequence is the creation of an unmanageable number of names to describe modes of ventilation. The proliferation of names makes education of end users difficult, potentially compromising the quality of patient care. To determine if stakeholders are familiar enough w...

Limited data are available to describe the CPAP effects that can be expected when using high flow with a traditional nasal cannula. To describe the relationship between the pressure generated at the airway opening and flow through a nasal cannula using a simulated infant model. We hypothesized that positive pressure generated by a standard cannula...

As hospitals begin to implement electronic medical records, the inadequacies of legacy paper charting systems will become more evident. One area of particular concern for respiratory therapists is the charting of mechanical ventilator settings. Our profession's lack of a standardized and generally accepted taxonomy for mechanical ventilation leaves...

The role of the respiratory therapist in the care of patients with cystic fibrosis has expanded throughout the years. As key members of the multidisciplinary team, respiratory therapists actively participate in the medical management of patients with cystic fibrosis along the continuum of care, from acute in-patient stays to the out-patient clinic...

A substantial amount of consumer health-related information is available on the Internet. Studies suggest that consumer comprehension may be compromised if content exceeds a 7th-grade reading level, which is the average American reading level identified by the United States Department of Health and Human Services (USDHHS). To determine the readabil...

The 2005 American Association for Respiratory Care Human Resources Survey suggested that the national demand for respiratory therapists (RTs) exceeds the supply. At the Cleveland Clinic an expected hospital expansion of 350 beds by 2008 has increased the need for RT staff. This report describes a strategy by which we developed a plan, in concert wi...

The purpose of this study was to determine the effect of protocol-directed recommendations for oxygen therapy implemented by respiratory therapists in skilled nursing facilities. We hypothesized that the use of an oxygen protocol would reduce the number of missing and incomplete orders and unnecessary oxygen use in skilled nursing facilities. We st...

Personal digital assistants (PDAs) have had a tremendous impact in the clinical setting, as they have in business and education environments. This report explores the health care application of PDAs, compares available PDA devices and software, and discusses PDA use for tracking patients, documenting clinical procedures, medical education, research...

Oscillatory positive expiratory pressure (PEP) with the Flutter device facilitates secretion removal. In the Flutter a steel ball vibrates inside a cone, causing air flow vibration. A new device, the Acapella, uses a counterweighted plug and magnet to create air flow oscillation. The Acapella comes in 2 models: one for patients with expiratory flow...

The successful management of pediatric thoracic injuries includes immediate and careful evaluation of the injury type and severity. Early treatment can be conservative in nature or require surgical management. Prompt intervention can reduce morbidity and mortality rates, associated complications, and ensure optimal outcomes.

Pediatric perineal impalement injuries are relatively uncommon. There may be difficulty in recognizing or properly treating such injuries, because their severity may not be reflected accurately by the external appearance of the perineum, The authors describe 3 case reports of patients with perineal impalement injuries and their management. The auth...

The selection and titration of pharmacologic agents are essential in the treatment of asthma. This Article focuses on the primary medications used in the treatment of reactive airway disease. The recent advances in the technology of devices used to administer aerosolized medications are also reviewed.

We sought to determine if properly restrained children, less than 13 years of age, placed in the front passenger seat are at greater risk for trauma from airbag deployment than unrestrained children. The charts of children treated at any of 3 regional pediatric trauma centers in Ohio were reviewed for airbag injuries sustained in motor vehicle cras...

Despite trauma being the most common cause of pediatric pancreatitis, the diagnosis and management is often difficult. The hospital course, diagnostic and surgical procedures, and complications for all children with traumatic pancreatitis evaluated at a Regional Level I Trauma Center were reviewed retrospectively. Twelve of 3,500 children (0.35%, m...

I sought to determine whether a physician-directed medical plan integrated with self-management education could reduce emergency department (ED) visits, hospitalizations, and costs related to pediatric asthma care. METHODS: Patients entered into the clinic pilot program were 1-18 years old with a history of asthma and no documented medical treatmen...

INTRODUCTION: Securing the uncuffed endotracheal tubes of infants requiring mechanical ventilation is imperative to avoid the complications that often accompany unplanned extubation. We evaluated the effect of two methods of securing the endotracheal tube on the incidence of spontaneous extubation. MATERIALS and METHOD: We prospectively studied the...

Leaks associated with uncuffed endotracheal tubes (ETTs) complicate mechanical ventilation of the neonate. The variable nature of leaks and the possibility of different modes of ventilation suggest an optimal strategy for stability of tidal volume (V(T)). This study evaluated the effect of leak on V(T) during pressure-controlled ventilation (PCV) o...

Pulse oximeters are unique among patient monitors in that they cannot be calibrated nor can calibration be verified. The purpose of this study was to determine whether an inexpensive commercial device simulating a human finger could produce measurements of oxygen saturation (S(pO 2)) within the error specifications supplied by pulse oximeter manufa...

Thesis (M.H.H.S.)--Youngstown State University, 2004. Includes bibliographical references (leaves 38-41).