Topic: Research

Topic: Research

Pages: 4, Double spaced
Sources: 1

Order type: Research Paper
Subject: Healthcare

Style: MLA
Language: English (U.S.)

Order Description

Literature Review needed

Pediatric Extracorporeal Membrane Oxygenation (ECMO)
In this project, Extraсorporeal membrane oxуgenation (ECMO) for pediatriс is chosen. Under the ECMO topic, the following subtopics will be analyzed in details. This will help to understand the process and its significance in children. The subtopics covered will be indications, relative contraindications, technique, patient selection, initiation, cannulation, titration, maintenance, cardiac failure, respiratory failure, survival, special considerations, weaning from ECMO, complications, bleeding, thromboembolism, neurological and lastly VA ECMO specific complications.
The importance of this study to respiratory care is evident as acute respiratory failure has increased mortality rate of children. The study indicates that ECMO has increased the survival rate of many individuals, thus it is important to understand every aspect in this topic. The research has indicated that ECMO is the only method of life support system on those acute fatal illness compared to other tried methods. Thus it is significant to study the topic to help the individual with a respiratory system in the society.

Extracorporeal Membrane Oxygenation (ECMO) is an established life-saving machine, which acts as lungs and heart to support the child while recovering from a disease or when having a surgical procedure. Extra corporeal refers to outside the body while membrane oxygenator is an equipment delivering oxygen to the child’s blood. That means ECMO is a membrane situated outside the body that adds oxygen to the blood and continues to pump this blood to the rest of the body. It was successfully used in the USA in 1976 for the first time and has continued supporting babies and children. It is used for children and babies who have severe heart or lung failure meaning it can take place of a heart when it fails and also lungs when they fail to give the heart and lung time to heal and rest. Other diseases that can be treated with ECMO include Meconium Aspiration Syndrome, Status Asthmaticus, Congenital Diaphragmatic Hernia, Myocarditis, Persistent Pulmonary Hypertension, Acute Respiratory Distress Syndrome and Post Cardiotomy Syndrome. ECMO machine has several parts which include a blood warmer, pump to circulate blood through the tubing, a monitoring device to make sure operation is safe and an artificial lung to add oxygen and remove carbon dioxide. There are two classifications: Veno –arterial (VA) which uses an artery and a vein, and venovenous(vv) which uses veins (Bartlett906).
ECMO may be started in the intensive care units or in the operating theatre after surgery. If the child needs ECMO after cardiac operation, cannulae or tubes are thereby inserted directly through the chest to the heart as the operation is going on. If it is in intensive care unit, cannulae connect the patient to the circuit and are aligned directly on the neck side into the blood vessels. This is a bedside operation. For a child to feel no pain a light anesthetic is given and a tube is put into a large vein on the neck side. A second tube is also inserted into an artery in the side of the neck and once completed the cannulae are then connected to the ECMO machine and circuit. Once it starts to work, dark blood drains through the tube into the vein from the child and is pumped through the artificial lung where oxygen is added and carbon dioxide removed. The blood is warmed by the warmer in the system and returned to the body and the process continues. The average time a child can be on ECMO is ten days but some stay longer depending on the type of problem. Regular observation and monitoring show how the child is recovering and indicates when the child has recovered fully to be removed from this. At placement of ECMO, there is high pump flow meaning the machine does more work. As the child improves the flow of ECMO is reduced to make the child heart and lungs to work for their own. The child improvement is measured by improving heart function, blood samples, improving chest x-rays and observation of chest movement. Once this is detected the flow of ECMO is reduced as the child is weaned off ECMO for a short time. If the condition remains stable, the cannulae are removed and the child was taken to intensive care units for observation, more tests are done to make sure the healing process is taking place.
Indications for ECMO
Pediatric having the following two main neonatal diagnoses need the application of ECMO: congenital diaphragmatic hernia and primary diagnoses influenced by pediatric primary pulmonary hypertension (PPHN) such as idiopathic PPHN, respiratory distress syndrome, meconium aspiration syndrome, asphyxia, and sepsis. Selection methods for neonates include; gestational age ranging from 34 weeks above, 2000g or more birth weight, uncontrolled bleeding or no significant coagulopathy, no significant intracranial hemorrhage, reversible lung injury, mechanical ventilation, no significant untreatable cardiac malformation and no lethal malformations.

Work cited
Bartlett, Robert H., et al. “Extracorporeal life support: the University of Michigan experience.” Jama 283.7 (2000): 904-908 (Bartlett 906).

Course Description:
Designed to provide students with the opportunity for advanced work in a special area on an individual basis. It is designed to provide the student the opportunity to explore areas in respiratory care or other health related areas that is of specific interest. It also provides the student with the opportunity to improve their writing skills with the potential for publication in the GSRC newsletter or the Lambda Beta Society.

Student should meet with the course instructor prior to beginning any project or paper. Student should meet with course instructor to discuss what will be completed for this course.


At the end of this course the student should be able to:

1. Explain ideas or concepts of a topic related to respiratory care, respiratory physiology or other health related area.
2. Use new knowledge that is related to the practice of respiratory care.
3. Write in a style similar to the journal “Respiratory Care” or other peer-reviewed scientific journal.
4. Use learned material in a new and concrete situation that is beneficial to lifelong learning.
5. Explain a new study that is used to diagnose a specific respiratory disease.
6. Describe new technology that is used in the treatment and care of a patient with a diagnosed respiratory disease.
7. Complete a project (i.e. Protocol) in conjunction with student’s respiratory care department.

You may choose to do a Project, Term Paper, or 20 Annotated Bibliographies. Only choose one.

1. Project Construction

If you choose to do a project, you will come up with a problem encountered in your work place (i.e. Hospital, Department). You will the decide how to fix this problem. You will use peer-reviewed literature and the internet to come up with a strategy to fix your problem.

The project you choose should have the following components that you will be graded on upon completion.

Literature review: At least 15 references should be used. Peer reviewed journals should be considered. i.e. Respiratory Care, Chest, Respiratory Physiology and Neurobiology, Respiration, European Respiratory Journal, American Journal of Respiratory and Critical Care Medicine. A maximum of 5 internet web-site links can be used for the project. A maximum of 2 Textbook citations can be used for the project.

The journals listed in the following URL link provides a list of the peer-reviewed scientific journals in the respiratory system area:

The journals listed in the following URL link provides a list of the peer-reviewed scientific journals in the General Medicine Category:

Design: This should clearly describe using appropriate terminology and terms that are specific for the project.

Implementation: How will this project be implemented into the specific area you have decided to use such as: Respiratory Therapy department, home care, sleep clinic etc.

Report: A report showing the design of the project. Literature review can be used here as well especially the references. You may also cite other departments that you may have gained information to complete your project.

Your completed project paper may include the following:

Title Page
Opening Statement: why this project was chosen
Introduction: A brief description of the project (1 page)
Implementation Report (where will this be used or presented and how it will be implemented). This can be on the same page with Introduction.
Literature Review or objectives (if using power point slides)

The Project Description

Reference page: At least 15 peer-reviewed scientific references should be used.

Other options for projects will be discussed with the course professor in order to determine the validity of the project to respiratory care or other health related areas.

You will be graded according to the following criteria for the course project

Grading: Total of 24 points are available. Your grade is determined based on those total points.

A = 22 to 24; B = 18 to 21; C = 16 to 20; F < 16

Assignment dates

Each assignment must be submitted electronically. The assignment should be submitted by the dates below no later than 5 pm. Projects submitted will be deducted 10% for each day late. Four dates will be determined following our meeting to discuss what you will be doing. These dates apply if you are doing a project or doing a paper.

1. Sept 1 – Project/topic with a one page narrative of what the project will cover and how this is important to the field of Respiratory Care.
2. September 30th – First draft, e-mail me the draft to my e-mail address
3. October 30th – Second Draft, e-mail me the draft to my e-mail address
4. November 30th – Final project/paper due. Submit on-line in DROP BOX in iCollege
5. Presentation – To be Determined from December 1 – 12.

2. Term Paper

If you choose to do a term paper, it will be a 25 page research paper (double spaced) done in the style of the journal “Respiratory Care” or other scientific journal) on a respiratory care topic associated with adult, pediatric or newborn population. As well, you could write a paper on a pulmonary physiology topic, or pulmonary pathophysiology topic.

If you decide to write about a pulmonary disease it may be a chronic disease such as emphysema, congestive heart failure, or chronic obstructive pulmonary disease, or asthma, or an acute problem such as croup, pneumothorax or pleural effusion.

You may also write about any other topic concerning respiratory therapy such as mechanical ventilation, aerosol and humidity therapy, or even pulmonary rehabilitation. Your content section should follow the topic you choose.

You may also write about a topic related to pulmonary function testing (i.e. spirometry, pulmonary diffusing capacity, respiratory muscle strength testing, negative expiratory pressure, determination of static lung volumes, etc…), or a new technology related to the assessment of respiration.

Other options for projects will be discussed with the course professor in order to determine the validity of the project to respiratory care or other health related areas.

The subject matter should be of interest to you. The paper’s content should follow this format.

Title Page – should include course number and name, your name, title of paper

Table of Contents – 1 page

Introduction – 1 to 2 pages, include an opening statement of why you chose this topic.

Etiology – cause of the disease

Pathophysiology – is the study of the disturbance of normal mechanical, physical, and biochemical functions, either caused by a disease or resulting from a disease or abnormal syndrome or condition that may not qualify to be called a disease.

Treatments – highlighting specific respiratory treatments.

Prognosis – the likely progress or outcome of the disease.

References – At least 15 references from peer-reviewed scientific journals in the respiratory system area or general medicine category. The journals listed in the following URL link provides a list of the peer-reviewed scientific journals in the respiratory system area:

The journals listed in the following URL link provides a list of the peer-reviewed scientific journals in the General Medicine Category:

Title Page
Table of Contents

Grading: Total of 30 points is available for this paper.

A = 27 to 30; B = 24 to 26; C = 20 to 23; F < 20

Term papers will be deducted 10% for each day late.

3. Annotated Bibliography
A bibliography is a list of sources (books, journals, Web sites, periodicals, etc.) one has used for researching a topic. Bibliographies are sometimes called “References” or “Works Cited” depending on the style format you are using. A bibliography usually just includes the bibliographic information (i.e., the author, title, publisher, etc.).
An annotation is a summary and/or evaluation. Therefore, an annotated bibliography includes a summary and/or evaluation of each of the sources. Depending on your project or the assignment, your annotations may do one or more of the following. After deciding what you will be researching (i.e. Instillation of normal saline into the endotracheal tube of an intubated adult patient) then you will complete the annotated bibliography in the following manner:
• Summarize: Some annotations merely summarize the source. What are the main arguments? What is the point of this book or article? What topics are covered? If someone asked what this article/book is about, what would you say? The length of your annotations will determine how detailed your summary is.
• Assess: After summarizing a source, it may be helpful to evaluate it. Is it a useful source? How does it compare with other sources in your bibliography? Is the information reliable? Is this source biased or objective? What is the goal of this source?
• Reflect: Once you’ve summarized and assessed a source, you need to ask how it fits into your research. Was this source helpful to you? How does it help you shape your argument? How can you use this source in your research project? Has it changed how you think about your topic?
An annotated bibliography is a list of citations to books, articles, and documents. Each citation is followed by a brief (usually about 150 words) descriptive and evaluative paragraph, the annotation. The purpose of the annotation is to inform the reader of the relevance, accuracy, and quality of the sources cited.
Abstracts are the purely descriptive summaries often found at the beginning of scholarly journal articles or in periodical indexes. Annotations are descriptive and critical; they expose the author’s point of view, clarity and appropriateness of expression, and authority.
The following example uses the American Psychological Association (APA) format for the journal citation. NOTE: APA requires double spacing within citations of no more than 150-200 words. (The following abstract is not double spaced in order to save paper space).
The researchers at Georgia State University conducted a study to evaluate the accuracy and consistency of jet nebulizers (JN) in delivering continuous Albuterol in pediatric mechanical ventilation. JN is commonly used for continuous nebulization during mechanical ventilation. The JN was placed 6 inches from the wye adaptor and operated continuously at 2.5 L/min with Albuterol sulfate formulated to 10 mg/hr per label. The ventilator was set at Vt 100 mL, PEEP 5 cm H2O, frequency 20/min, biasflow 2 lpm, Tinsp 1.0 seconds, descending flow with a heated humidified circuit attached to a 5 mm ID ETT and pediatric lung model. Nebulizers were operated for 15 min, with drug collected for 5 min intervals on filter distal to ETT (n=3). Gravametric output (mL ± SD) varied between nebulizers from 0.17 to 0.44 mL (p < 0.05) but was consistent for each unit at 5 min intervals. The researchers found that output varied between nebulizers and delivered doses was not proportional to change from 10 to 15 mg/hour.
Grading will be based on the following criteria.

Grade: A = 27 to 30; B = 24 to 26; C = 20 to 23; F < 20