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  1. Article ; Online: Measured Versus Estimated Dead-Space Ventilation in ARDS: Does It Matter? Perhaps.

    Kallet, Richard H

    Respiratory care

    2021  Volume 66, Issue 4, Page(s) 703–704

    MeSH term(s) Humans ; Respiration ; Respiratory Dead Space ; Respiratory Distress Syndrome/therapy ; Tidal Volume
    Language English
    Publishing date 2021-01-16
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.08947
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: 2020 Year in Review: Mechanical Ventilation During the First Year of the COVID-19 Pandemic.

    Kallet, Richard H

    Respiratory care

    2021  Volume 66, Issue 8, Page(s) 1341–1362

    Abstract: Coronavirus disease 2019 (COVID-19) represents the greatest medical crisis encountered in the young history of critical care and respiratory care. During the early months of the pandemic, when little was known about the virus, the acute hypoxemic ... ...

    Abstract Coronavirus disease 2019 (COVID-19) represents the greatest medical crisis encountered in the young history of critical care and respiratory care. During the early months of the pandemic, when little was known about the virus, the acute hypoxemic respiratory failure it caused did not appear to fit conveniently or consistently into our classification of ARDS. This not only re-ignited a half-century's long simmering debate over taxonomy, but also fueled similar debates over how PEEP and lung-protective ventilation should be titrated, as well as the appropriate role of noninvasive ventilation in ARDS. COVID-19 ignited other debates on emerging concepts such as ARDS phenotypes and patient self-inflicted lung injury from vigorous spontaneous breathing. Over a year later, these early perplexities have receded into the background without having been reviewed or resolved. With a full year of evidence having been published, this narrative review systematically analyzes whether COVID-19-associated respiratory failure is essentially ARDS, with perhaps a somewhat different course of presentation. This includes a review of the severity of hypoxemia and derangements in pulmonary mechanics, PEEP requirements, recruitment potential, ability to achieve lung-protective ventilation goals, duration of mechanical ventilation, associated mortality, and response to noninvasive ventilation. This paper also reviews the concepts of ARDS phenotypes and patient self-inflicted lung injury as these are crucial to understanding the contentious debate over the nature and management of COVID-19.
    MeSH term(s) COVID-19 ; Humans ; Pandemics ; Respiration, Artificial ; Respiratory Distress Syndrome/epidemiology ; Respiratory Distress Syndrome/therapy ; SARS-CoV-2
    Language English
    Publishing date 2021-05-10
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.09257
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Mechanical Ventilation in ARDS: Quo Vadis?

    Kallet, Richard H

    Respiratory care

    2021  Volume 67, Issue 6, Page(s) 730–749

    Abstract: Contemplating the future should be grounded in history. The rise of post-polio ICUs was inextricably related to mechanical ventilation. Critically ill patients who developed acute respiratory failure often had "congestive atelectasis" (ie, a term used to ...

    Abstract Contemplating the future should be grounded in history. The rise of post-polio ICUs was inextricably related to mechanical ventilation. Critically ill patients who developed acute respiratory failure often had "congestive atelectasis" (ie, a term used to describe ARDS prior to 1967). Initial mechanical ventilation strategies for treating this condition and others inadvertently led to ventilator-induced lung injury. Both injurious ventilation and later use of overly cautious weaning practices resulted from both limited technology and understanding of ARDS and other aspects of critical illness. The resulting misperceptions, misconceptions, and missed opportunities took decades to rectify and in some instances still persist. This suggests a reluctance to acknowledge that all therapeutic strategies reflect the historical period in which they were developed and the corresponding limited understanding of ARDS pathophysiology at that time. We are at the threshold of a revolutionary moment in critical care. The confluence of enormous clinical data production, massive computing power, advances in understanding the biomolecular and genetic aspects of critical illness, and the emergence of neural networks will have enormous impact on how critical care is practiced in the decades to come. Therefore, it is imperative we understand the long-crooked path needed to reach the era of protective ventilation in order to avoid similar mistakes moving forward. The emerging era is as difficult to fathom as our current practices and technologies were to those practicing 60 years ago. This review explores the history of mechanical ventilation in treating ARDS, describes current protective ventilation strategies, and speculates how ARDS management might look 20 years from now.
    MeSH term(s) Critical Care/methods ; Critical Illness ; Humans ; Respiration, Artificial/methods ; Respiratory Distress Syndrome/therapy ; Ventilator-Induced Lung Injury/etiology ; Ventilator-Induced Lung Injury/prevention & control
    Language English
    Publishing date 2021-12-07
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.09832
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Developing a Research Program Within a Respiratory Care Department.

    Kallet, Richard H

    Respiratory care

    2020  Volume 65, Issue 3, Page(s) 388–399

    Abstract: Scientific research traditionally has been the domain of graduate school training, and it is based on higher cognitive levels associated with reflective thought. Such skills differ markedly from those needed to train competent respiratory therapists at ... ...

    Abstract Scientific research traditionally has been the domain of graduate school training, and it is based on higher cognitive levels associated with reflective thought. Such skills differ markedly from those needed to train competent respiratory therapists at the undergraduate level. Trainees at the undergraduate level need to acquire, comprehend, and apply large amounts of functional knowledge within a relatively brief time period. As a consequence, there is a pragmatic restriction on the level of complexity that characterizes pathophysiology, therapeutics, and associated technology that can be taught without causing confusion and thereby impeding the learning process. The era of evidence-based medicine is characterized both by the increasing complexity of medical technology and therapeutics. Because respiratory care is fundamentally a technology-driven profession, cultivating research skills among a select group of motivated practitioners is essential. Moreover, it is incumbent on all respiratory therapists to possess a rudimentary understanding of scientific methodology and a familiarity with the processes of reflective thought to become more discerning consumers of medical information. Organizing and implementing a research program within a respiratory care department or training program require forethought and devoted leadership. Crucial to this endeavor is developing mentors to guide those with little or no exposure to scientific inquiry. This article provides an overview of the pedagogical issues that underlie this predicament and then describes practical steps that can be taken to slowly build such a program.
    MeSH term(s) Curriculum ; Humans ; Leadership ; Mentors ; Research/education ; Respiratory Therapy/education ; Writing
    Language English
    Publishing date 2020-02-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.07478
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Postextubation Stridor in COVID-19: Should We Be Worried?

    Pangilinan, Lance / Kallet, Richard H

    Respiratory care

    2022  Volume 67, Issue 6, Page(s) 772–773

    MeSH term(s) COVID-19/complications ; Humans ; Intubation, Intratracheal/adverse effects ; Respiratory Sounds/etiology ; Risk Factors
    Language English
    Publishing date 2022-05-19
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.10134
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Creating a Process of Research in Respiratory Care.

    Branson, Richard D / Kallet, Richard H

    Respiratory care

    2021  Volume 66, Issue 8, Page(s) 1363–1364

    MeSH term(s) Humans ; Respiratory Therapy
    Language English
    Publishing date 2021-07-22
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.09367
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Expanding the Use of Inhaled Vasodilators in Managing Right Ventricular Dysfunction in the Emergency and Critical Care Setting: Should We Broaden Our Vision?

    Kallet, Richard H

    Respiratory care

    2019  Volume 64, Issue 7, Page(s) 864–865

    MeSH term(s) Critical Care ; Epoprostenol ; Heart Transplantation ; Humans ; Iloprost ; Vasodilator Agents ; Ventricular Dysfunction, Right
    Chemical Substances Vasodilator Agents ; Epoprostenol (DCR9Z582X0) ; Iloprost (JED5K35YGL)
    Language English
    Publishing date 2019-06-26
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.06979
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Ventilator Bundles in Transition: From Prevention of Ventilator-Associated Pneumonia to Prevention of Ventilator-Associated Events.

    Kallet, Richard H

    Respiratory care

    2019  Volume 64, Issue 8, Page(s) 994–1006

    Abstract: Implementation of ventilator bundles is associated with reductions in ventilator-associated pneumonia (VAP). However, the new surveillance model of ventilator-associated events (VAEs) has shifted the focus from VAP to objective, generalized signs of ... ...

    Abstract Implementation of ventilator bundles is associated with reductions in ventilator-associated pneumonia (VAP). However, the new surveillance model of ventilator-associated events (VAEs) has shifted the focus from VAP to objective, generalized signs of pulmonary decompensation not specific to VAP. This raises the question of whether the ventilator bundle also is effective in reducing VAE. This narrative review examined 6 studies published since 2013 that assessed the impact of ventilator bundles on the incidence of VAE, and a seventh study that examined its impact on mortality. All 7 studies were low-level evidence, and only 1 study was prospective. The findings among the studies were inconsistent, and the only prospective study found no difference in bundle adherence between those who did and did not develop VAE. However numerous factors may explain the apparent lack of efficacy. Most of these factors were related to the retrospective nature of the studies, such as suboptimal documentation of bundle procedures and the presence of potential non-modifiable risk factors, as well as insufficient performance of most bundle components. In some studies, low VAE incidence also raised uncertainty about the veracity of results. Despite these limitations, there was evidence suggesting that stress ulcer prophylaxis may increase VAE risk, and oral care with chlorhexidine may increase both VAE and mortality risk. The largest study found significant reductions in duration of intubation with weaning, sedation, and head of bed elevation, as well as reduced mortality risk with weaning and sedation bundle elements. Nonetheless, these studies should be useful in designing future prospective controlled studies to determine what elements of a future prevention bundle might be effective in reducing VAEs. At this juncture, and based on the limited evidence to date, it appears that incorporating daily sedation interruptions and spontaneous breathing trials are the factors most likely to reduce VAEs.
    MeSH term(s) Humans ; Iatrogenic Disease/prevention & control ; Patient Care Bundles ; Pneumonia, Ventilator-Associated/prevention & control ; Prospective Studies ; Respiration, Artificial/adverse effects ; Respiration, Artificial/methods ; Retrospective Studies ; Risk Factors ; Ventilator Weaning/methods ; Ventilators, Mechanical/adverse effects
    Language English
    Publishing date 2019-07-25
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.06966
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Respiratory Drive, Dyspnea, and Silent Hypoxemia: A Physiological Review in the Context of COVID-19.

    Kallet, Richard H / Branson, Richard D / Lipnick, Michael S

    Respiratory care

    2022  Volume 67, Issue 10, Page(s) 1343–1360

    Abstract: Infection with SARS-CoV-2 in select individuals results in viral sepsis, pneumonia, and hypoxemic respiratory failure, collectively known as COVID-19. In the early months of the pandemic, the combination of novel disease presentation, enormous surges of ... ...

    Abstract Infection with SARS-CoV-2 in select individuals results in viral sepsis, pneumonia, and hypoxemic respiratory failure, collectively known as COVID-19. In the early months of the pandemic, the combination of novel disease presentation, enormous surges of critically ill patients, and severity of illness lent to early observations and pronouncements regarding COVID-19 that could not be scientifically validated owing to crisis circumstances. One of these was a phenomenon referred to as "happy hypoxia." Widely discussed in the lay press, it was thought to represent a novel and perplexing phenomenon: severe hypoxemia coupled with the absence of respiratory distress and dyspnea. Silent hypoxemia is the preferred term describing an apparent lack of distress in the presence of hypoxemia. However, the phenomenon is well known among respiratory physiologists as hypoxic ventilatory decline. Silent hypoxemia can be explained by physiologic mechanisms governing the control of breathing, breathing perception, and cardiovascular compensation. This narrative review examines silent hypoxemia during COVID-19 as well as hypotheses that viral infection of the central and peripheral nervous system may be implicated. Moreover, the credulous embrace of happy hypoxia and the novel hypotheses proposed to explain it has exposed significant misunderstandings among clinicians regarding the physiologic mechanisms governing both the control of breathing and the modulation of breathing sensations. Therefore, a substantial focus of this paper is to provide an in-depth review of these topics.
    MeSH term(s) COVID-19/complications ; Dyspnea/etiology ; Humans ; Hypoxia/epidemiology ; Hypoxia/etiology ; Pandemics ; SARS-CoV-2
    Language English
    Publishing date 2022-05-02
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.10075
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Book ; Collection: Acute respiratory distress syndrome

    Kallet, Richard H.

    (Respiratory care clinics of North America ; ...)

    2003  

    Author's details Richard H. Kallet ..., guest ed
    Series title Respiratory care clinics of North America
    ...
    Language English
    Dates of publication 2003-9999
    Publisher Saunders
    Publishing place Philadelphia u.a.
    Publishing country United States
    Document type Book ; Collection (display volumes)
    HBZ-ID HT013830567
    Database Catalogue ZB MED Medicine, Health

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