Respiratory care : the official journal of the American Association for Respiratory Therapy

Respiratory care : the official journal of the American Association for Respiratory Therapy


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OCTOBER 1999VOLUME 44NUMBER 100020-1324-RECACPISSNJOURNALA MONTHLY SCIENCE195644TH YEAR—ESTABLISHEDCONTRIBUTIONSORIGINALJ^Common VentilatorsVentilator Malfunction in SixA Study ofProtocol for Placement ofImpact of a StandardizedRespiratory Congress45th InternationalArterial CathetersIndwelling• NevadaDecember 13-16 Las Vegas,SPECIAL ARTICLESDataAnalysis of Failure TimeGRAPHICS CORNERwithTransplant RecipientCapnography in a Double-LungFailureRespiratoryABSTRACTS1999 OPEN FORUM51'®^'MS*L*«^' Ni«;^LEADING INSTITUTIONS^^LHAVE RELIED ONTHE ACCURACYOF ASTECH INSTRUMENTS,-r^,""'""-^!^~i<^\^ ^,FOR YEARS.*^: MkA^.. \: ^as ancient institutions relied on the AztecJustcalendar for vital measurements of time, today'sleading medical institutions rely on ASTECH Peakm^m^mK:Flow Meters for vital patient measurements*Because more accurate information leads to moreeffective therapy.Entrust the health of your patients to the peakflow meter trusted by some of the leading medicalhospitals for pulmonary medicine.The ASTECH Peak Flow Meter. A precision instru-ment with a record of accuracy and reproducibilitythat has stood the test of time in the mostdemanding environments.800-527-4278Call today for really accurate infor-mation about a really accurate peak flow meter.ASTECH' PEAK FLOW METER,DEY.'-'i' J'-yf*l^JiI'ii''P!(Sfi£,Zi-i^»/a©1999 DEY. All righis reseived./^Ag^09-733-00 1/99'^^EP-'Circle tS3on reader service card' Wbrld Repon.AWARD'978?B ...


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OCTOBER 1999 VOLUME 44 NUMBER 10 0020-1324-RECACPISSN JOURNALA MONTHLY SCIENCE 195644TH YEAR—ESTABLISHED CONTRIBUTIONSORIGINALJ^ Common VentilatorsVentilator Malfunction in SixA Study of Protocol for Placement ofImpact of a StandardizedRespiratory Congress45th International Arterial CathetersIndwelling • NevadaDecember 13-16 Las Vegas, SPECIAL ARTICLES DataAnalysis of Failure Time GRAPHICS CORNER withTransplant RecipientCapnography in a Double-Lung FailureRespiratory ABSTRACTS1999 OPEN FORUM 51 ' ®^'MS*L*«^' Ni«;^ LEADING INSTITUTIONS^^ LHAVE RELIED ONTHE ACCURACY OF ASTECH INSTRUMENTS,-r^, " "'""- ^!^~i<^\^ ^ ,FOR YEARS.* ^: MkA^ .. \: ^ as ancient institutions relied on the AztecJust calendar for vital measurements of time, today's leading medical institutions rely on ASTECH Peak m^m^mK: Flow Meters for vital patient measurements* Because more accurate information leads to more effective therapy. Entrust the health of your patients to the peak flow meter trusted by some of the leading medical hospitals for pulmonary medicine. The ASTECH Peak Flow Meter. A precision instru- ment with a record of accuracy and reproducibility that has stood the test of time in the most demanding environments. 800-527-4278Call today for really accurate infor- mation about a really accurate peak flow meter. ASTECH' PEAK FLOW METER ,DEY. '-'i' J'-yf*l^JiI'ii''P!(Sfi£,Zi-i^ »/a ©1999 DEY. All righis reseived./^Ag^ 09-733-00 1/99'^^EP-'Circle tS3on reader service card ' Wbrld Repon.AWARD'978?B Naiionai Jewish Medicd! and Research Cenier (ranked*! for pulmonary dwases b\' U.S. Nem and AARC Booths 929, 933 in Vegas Astech Flow Meter exclusively.Xisit 931, Las July 1998) and other thought leaders use the Peak f^ Why youneed to attend the International Hi Respiratory Congress December 13-16, 1999 ~^^^^S&*" Saturation Recorded During Rubbing Motion Maf^mo SET aaurately tracks the d'^dtmat^^^^^Mesatuiat. while till; Oxismnrf prnduct missis ttte'^ttt^^fic event. This :-tui!y uas j)er^Fme(lor ndiiltvolunmers. Data courirsv Dr. Steven BUm^T'h.D., M.D., Professoi^nd Chairman,of D'/iurt!!!' n^^fAriesthesiology, University Aeizonaof 16 Minutes Masimo SET N-3000 (OXISMART) Reference (N-200) Motion Hand Motion Hand Non-Motion Hand the proof is in fehe performance motion st:udy low perfusion study OXISMARTOXISMART SpOjSystem N-3000 N-200SpOjSystem N-3000 N-200 0.8% 9.9% 17.8%Drop Out RateFalse Alarms 0% 36% 30% True Hypoxemias Missed 33.3% 33.3%0%True Hypoxemias Missed 0% 16% 1% Source: Barker Novak fulorgan S. The Performance of Three Pulse Oximeters DuringSJ, S,Source: Barker SJ, Shah NK. The Effects of (^lotion on the Performance of Pulse Oximeters Low Perfusion in Volunteers. /Inesfhes/o/ogy 1997;87(3A) Volunteers. .4nes//7es/o/ogy 1997;86(1}:101-108. The facts about Masimo SET pulse oximetry: Prior to the introduction ofMasimo SET, conventional pulse oximeters could only be relied upon for accurate The only pulse oximetry technology clinically measurement during ideal conditions. Masimo SET reliablyproven accurate during motion and low perfusion and continuously tracks changes in saturation and pulse rate, Virtually eliminates false alarms giving you accurate monitoringwhen you need it most, even More reliable in detecting true alarms when your patients are moving or have low perfusion. Continuous monitoring (no freezing) — Masimo SET pulse oximetryProve it to yourself take perform confirmingOver the past two years, approximately one-third of the to your toughest patients and a Masimo SET pulse oximeterworldV pulse oximetry suppliers have adopted Masimo SET CO-OximeterABG. If the from the CO-Oximeteras their pulse solution. Now, more than twenty measurement is further other non-Masimo SET pulsepatient monitors are available from leading patient than any reimburse the cost of your test.*monitoring companies with Masimo SET pulse oximetry. oximeter, we will for more informat:ian on Masimo SET pulse aximet:rv or to schedule a free trial evaluation! contact us by phone or internet masimo .com1 -S77-4-IVIASIIVia v\fvi/v\/. Circle 106 on reader service card VisitAARC Booth 1202 In Las Vegas technology are identified with the Masimo SET logo.Instruments and sensors containing Masimo SET accurate pulse oximetry when needed most.Look for the Masimo SET designation to ensure * CO-Oximeter tf-st must be with more wavelengths (e.g., IL 482 or Radiometer 0SM3), Certain other rules and restrictions apply. Contact Masimo for more details.performed on a calibrated CO-Oximeter four or C 1999 Mjiaimo Corporation, Masimo, SET and are federally registered trademarks ofMasimo Corporation, N.3000,OXISMART and N-200 are trademarks of Nellcor Puritan Bennett,Q OCTOBER 1999 / VOLUME 44 / NUMBER 10 INFORMATION,FOR CONTACT: AARC Membership or Other AARC ORIGINAL CONTRIBUTIONS Services American Association for Ventilator ComparativeMechanical Malfunctions: A Descriptive and Respiratory Care Study of 6 Common Ventilator Brands 11 030 Abies Ln —Gainesville, Floridaby Paul B Blanch 1183 Dailas TX 75229-4593 243-2272 • 484-2720(972) Fax (972) IndwellingThe Impact of a Standardized Protocol for Placement of Arterial Catheters —by ErinM Charlie Strange, and GerardA Silvestri Charleston. South CarolinaOzgun,RegistrationTherapist or 1193 Technician Certification Nationai Board for Respiratory Care SPECIAL ARTICLES 8310Nieman Rd LenexaKS 66214 Analysis of Failure Time Data: An Introduction to Survival Analysis 599-4200 • Fax 541-0156 —(913) (913) by NareshM Punjabi Baltimore, Maryland 1198 Accreditation of Education PFT NUGGETS Programs Committee on Accreditation for An 82-Year-Old Man with Amyotrophic Lateral Sclerosis Respiratory Care —by Loutfi SAboussouan Detroit. Michigan 1203 1701 W Euless Blvd, Suite 300 Euless TX 76040 A 59-Year-Old Man with Gradually Increasing Dyspnea283-2835 • 354-8519(817) Fax (817) —by OmarA Minai and Eugene J Sullivan Cleveland, Ohio 1205 Grants, Scholarships, Community Projects GRAPHICS CORNER American Respiratory Care Capnography in a Double-Lung Transplant Recipient with Respiratory FailureFoundation ^ ^nn—by AlexanderG Duarte, Scott Lick, andAkhil Bidani Galveston, Texas 11 030 Abies Ln 1 t 7U Dallas TX 75229-4593 243-2272 • 484-2720(972) Fax (972) LETTERS—Government Affairs Cheryl IVIHA (703-548-8506)West A Medical Myth —by Wayne C Anderson Cranberry Township, Pennsylvania — Response by John W Salyer. Salt Lake City, UtahState Government Affairs 1209 Jill Eicher IVIPA (703-548-8538) 1225 King St, Second Floor Diffusing Capacity and the Vasodilatory Response to INO Alexandria VA 22314 —by JeffreyM Haynes Nashua, New Hampshire 548-8499Fax (703) Richard Diego. CaliforniaResponse by Gordon L Yung and N Channick, San 1210 BOOKS, FILMS, TAPES & SOFTWARE Respiratory Care Anatomy and Physiology: Foundations for Clinical Practice —reviewed by Robert L Wiikins Loma Linda, California 1212 Conquering Asthma: An Illustrated Guide to Understanding andRESPIRATORY CARE (ISSN 0020-1324. USPS 0489- 190) is published monthly by Daedalus Enterprises Inc, at Care for Adults 2nd edition 1 1030 Abies Lane, DallasTX 75229^593. for the Amer- —Sinclair Seattle, Washingtonreviewed by Scott 1212 ican Association for Respiratory Care. One volume is published per year beginning each January. Subscription rates are $75 per year in the US; S90 in all other countries Conquering Childhood Asthma: An Illustrated Guide to Understanding (for airmail, add S94). and Control of Asthma The contents of the Journal are indexed in Hospital and —reviewed Kennerly Dallas, Texasby Rose Boehm andDonaldHealth Administration Index, Cumulative Index to Nurs- 1213 ing and Allied Health Literature, EMBASE/ExerptaMed- ica. and RNdex Library versionsEdition. Abridged of The Case Manager's Handbook 2nd editionRESPIRATORY CARE are also published in Italian, —reviewed by Man Jones Memphis, TennesseeFrench, and Japanese, with permission from Daedalus En- 1213 terprises Inc. Periodicals postage paid at Dallas TX and at additional mailing offices. POSTMASTER: Send address changes to RESPIRATORY Care, Membership Office, Daedalus En- terprises Inc, 11030 Abies Lane, DallasTX 75229-4593. Printed in the United States ofAmerica Copyright© 1999, by Daedalus Enterprises Inc. False alarms and lost signals are challenges she can hve without. Whether it's the neonatal The Oxi-Reader system virtually ehminates the signal unit or the OR recovery difficulties of active patients, bright ambient hght, low room, accurate pulse perfusion and electrosurgical interference. And oximetry signals are critical Oxi-Reader sensors are available in a variety of models to the well-being of your and sizes, including single patient use adult, pediatric patients. Yet, in the past, and neonatal so many products gave sensors and a false alarms, while miss- reusable adult ing the real warning signals, that it was hard to trust sensor. Choose your monitor. Now, there's the Oxi-Reader™ continuous, the Oxi-Reader noninvasive monitor and sensors powered by system for signalSp02 Masimo SET® technology. The system is cUnically proven accuracyyou to find and display an accurate signal when you need can live with. it most. order, contactyourAllegianceFor information or to Sales Representative or call 1-800-964-5227. Oxi-Reader © Copyright 1999, Allegiance Healthcare Corporation, rightsAll reserved. js a trademark of Allegiance Healthcare Corporation Masimo isSET a registered trademark ot Masimo Corporation. Seeing is believing. Visit us atAARC, '"Allegiance booth 101, fora live demonstration. Circle 105 on reader service card VisitAARC Booths 101, 103 in Las Vegas Spanddin ^L 8RAND STERILIZING SOLUTION AND HIGH LEVEL DISINFECTANT EVENBETTER Lowest Glutaraldehyde Level • High level disinfection in 20 minutes with less than I% glutaraldehyde. Other products require 2.4 to 3.4% • Will not cloud lenses nor clog air/water channels. • Original active system. m Distributor to Order TodayCall Your Sporicidin InternationalSpanddin Montrose Rd.590 1 20852Rockville, Md. 800-424-3733Telephone: STERILIZING Circle 125 on reader service cardSOUmONDiSINFEGTING EDITOR IN CHIEFEDITORIAL OFFICE 600 Ninth Avenue, Suite 702 David J PiersonMD SeattleWA 98104 Harborview Medical Center University Washington223-0558 of(206) Seattle, Washington Fax 223-0563(206) EDITORSASSOCIATEMANAGING EDITOR FAARCRichard D Branson RRT Dean R Hess PhD RRTRay MasferrerRRT University ofCincinnati Massachusetts General Hospital Cincinnati, Ohio Harvard University Boston, Massachusetts ASSISTANT EDITOR CharlesG Durbin JrMD James K StollerMD Katherine Kreilkamp University Virginia The Cleveland Clinic Foundationof Charlottesville, Cleveland, Ohio EDITORIAL EDITORIAL BOARD ASSISTANT Thomas A Barnes EdD RRT LeonardD HudsonMD Shelley C Mishoe PhD RRTLinda Barcus Northeastern University University Washingtonof FAARC Boston, Massachusetts Seattle, Washington Medical College ofGeorgia Augusta, GeorgiaCOPY EDITOR Michael J BishopMD RobertM Kacmarek PhD RRTMatthew Merc University Washington FAARCof PhD RRTJoseph L Rau Washington Massachusetts General HospitalSeattle, Georgia State University Harvard University GeorgiaPRODUCTION Atlanta, Boston, Massachusetts Bartolome R CeUiMD Kelly Piotrowski Tufts University SassoonMDCatherine SH Boston, Massachusetts Toshihiko KogaMD University California Irvineof Koga Hospital PUBLISHER Long Beach, Kurume, Japan Robert L Chatbum RRT Sam P GiordanoMBARRT FAARC Arthur S SlutskyMD University Hospitals ofCleveland Marin H KoliefMD University TorontoofCase Western Reserve University Washington University MARKETING Ontario, CanadaToronto,Cleveland, Ohio St Louis, Missouri Dale L Griffiths Director ofMarketing Martin TobinMDJLuciano GattinoniMD Patrick LegerMD Loyola UniversityUniversity Milan Clinique Medicale Edouard RistTim Goldsbury of Milan, Italy Paris, France Maywood, IllinoisDirector, Advertising Sales Beth Binkley Advertising Assistant John E HeffnerMD Neil R MaclntyreMDFAARC Medical University South Carolina Duke Universityof Charleston, South Carolina Durham, North Carolina STATISTICAL CONSULTANTRE/PIRATORy Gordon D RubenfeldMDMark J HeuiittMD John J MariniMD University WashingtonUniversity Arkansas University Minnesota ofof ofQiRE Little Rock, St Paul, Minnesota Seattle. Washington A Monthly Science Journal Established in 1956 SECTION EDITORS The Official Journal of the Hugh S MathewsonMD CharlesG Irvin PhD Richard D Branson RRT Joseph L Rau PhD RRT Gregg L Ruppel MEd RRT RPFT FAARC Robert S Campbell RRTAmerican Association for Drug Capsule PFT Corner Kittredge's Comer Respiratory Care Jon Nilsesluen PhD RRT FAARC Patricia Ann Doorley MS RRT Charles G Durbin JrMDKen Hargett RRT Graphics Corner Test Your Radiologic Skill TRIITTHE