Research Topics
| D R HessSummaryAffiliation: Massachusetts General Hospital Country: USA Publications
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Publications
Aerosol delivery devices in the treatment of asthmaDean R Hess
Department of Respiratory Care, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA
Respir Care 53:699-723; discussion 723-5. 2008..However, many patients use these devices incorrectly, so proper patient education in their use is critical...- Position of exhalation port and mask design affect CO2 rebreathing during noninvasive positive pressure ventilationGuilherme P P Schettino
Department of Anesthesia and Critical Care and Respiratory Care, Massachusetts General Hospital, Harvard Medical School, Boston, 02214, USA
Crit Care Med 31:2178-82. 2003..Additional studies are necessary to confirm if mask design can clinically affect patient's inspiratory effort during noninvasive positive pressure ventilation... - Retrospective studies and chart reviewsDean R Hess
Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
Respir Care 49:1171-4. 2004..Retrospective study designs are generally considered inferior to prospective study designs. Therefore, a retrospective study design should never be used when a prospective design is feasible... - Heliox and noninvasive positive-pressure ventilation: a role for heliox in exacerbations of chronic obstructive pulmonary disease?Dean R Hess
Department of Respiratory Care, Massachusetts General Hospital, Boston, MA 02114, USA
Respir Care 51:640-50. 2006..Lacking such evidence, the use of heliox in patients with COPD exacerbation cannot be considered standard therapy... - The role of noninvasive ventilation in the ventilator discontinuation processDean R Hess
Respiratory Care Services, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
Respir Care 57:1619-25. 2012..Reintubation should not be delayed if NIV is not immediately successful in reversing the post-extubation respiratory failure. Evidence does not support routine use of NIV post-extubation... 
The growing role of noninvasive ventilation in patients requiring prolonged mechanical ventilationDean R Hess
Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
Respir Care 57:900-18; discussion 918-20. 2012....
Determinants of tracheostomy decannulation: an international surveyHenry Thomas Stelfox
Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, EG23A, 1403 29 Street NW, Calgary, AB, Canada, T2N 2T9
Crit Care 12:R26. 2008..Although tracheostomy is probably the most common surgical procedure performed on critically ill patients, it is unknown when a tracheostomy tube can be safely removed...- The mask for noninvasive ventilation: principles of design and effects on aerosol deliveryDean R Hess
Department of Anesthesia, Harvard Medical School, Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts, USA
J Aerosol Med 20:S85-98; discussion S98-9. 2007..With NPVV, issues related to the optimal interface, ventilator settings, and aerosol generator (nebulizer versus MDI) are largely unexplored... - Metered-dose inhalers and dry powder inhalers in aerosol therapyDean R Hess
Department of Respiratory Care, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 02114, USA
Respir Care 50:1376-83. 2005..The proceedings of this conference provide the current state of the art of metered-dose inhalers and dry powder inhalers... - Training and education challenges for the twenty-first century: respiratory care competency and practiceDean Hess
Harvard Medical School, and Department of Respiratory Care, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
Respir Care Clin N Am 11:531-42. 2005..Each of these factors will affect how respiratory therapists should be trained and educated in the twenty-first century... - Noninvasive positive-pressure ventilation and ventilator-associated pneumoniaDean R Hess
Department of Respiratory Care, Ellison 401, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, Boston Massachusetts 02114, USA
Respir Care 50:924-9; discussion 929-31. 2005..Perhaps "endotracheal-tube-associated pneumonia" is a better term than "ventilator-associated pneumonia.".. - Patient positioning and ventilator-associated pneumoniaDean R Hess
Department of Respiratory Care, Ellison 401, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, Boston Massachusetts 02114, USA
Respir Care 50:892-8; discussion 898-9. 2005..The available evidence suggests that semi-recumbent position should be used routinely, rotational therapy should be considered in selected patients, and prone position should not be used as a technique to reduce the risk of VAP... - Facilitating speech in the patient with a tracheostomyDean R Hess
Department of Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114, USA
Respir Care 50:519-25. 2005..Teamwork between the patient and the patient care team (respiratory therapist, speech-language pathologist, nurse, and physician) can result in effective restoration of speech in many patients with a long-term tracheostomy... - Tracheostomy tubes and related appliancesDean R Hess
Department of Respiratory Care, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114, USA
Respir Care 50:497-510. 2005..It is important for clinicians caring for patients with a tracheostomy tube to understand the nuances of various tracheostomy tube designs and to select a tube that appropriately fits the patient... - Ventilator waveforms and the physiology of pressure support ventilationDean R Hess
Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
Respir Care 50:166-86; discussion 183-6. 2005..The newer generation ventilators offer clinician-adjustable flow-termination during PSV. Ventilator waveforms may be useful to appropriately adjust the ventilator during PSV... - How to write an effective discussionDean R Hess
Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
Respir Care 49:1238-41. 2004..Always write the discussion for the reader; remember that the focus should be to help the reader understand the study and that the highlight should be on the study data... - The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literatureDean R Hess
Department of Respiratory Care, Massachusetts General Hospital, Boston MA 02114, USA
Respir Care 49:810-29. 2004..Inhaled bronchodilators can be administered during NPPV, and NPPV can be delivered with helium-oxygen mixture. Institution-specific practice guidelines may be useful to improve NPPV success... - The history and physics of helioxDean R Hess
Department of Respiratory Care, Massachusetts General Hospital, Boston, MA 02114, USA
Respir Care 51:608-12. 2006..Specifically covered are the Hagen-Poiseuille equation, laminar versus turbulent flow, the Reynolds number, orifice flow, Bernoulli's principle, Graham's law, wave speed, and thermal conductivity... - Approaches to conventional mechanical ventilation of the patient with acute respiratory distress syndromeDean R Hess
Respiratory Care Services, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Respir Care 56:1555-72. 2011..In most, if not all, cases of ALI/ARDS, conventional ventilation strategies can be used effectively to provide lung-protective ventilation strategies... - Patient-ventilator interaction during noninvasive ventilationDean R Hess
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Respir Care 56:153-65; discussion 165-7. 2011..Asynchronies can also be related to the underlying disease process. This paper reviews issues related to asynchrony during NIV and suggests strategies that might be used to correct asynchrony when it occurs... - The value of adding a verbal report to written handoffs on early readmission following prolonged respiratory failureDean R Hess
Department of Respiratory Care, Massachusetts General Hospital, Respiratory Care Services, Boston, MA 02114, USA
Chest 138:1475-9. 2010..002). Supplementing a written report with a verbal telephone report was associated with a significant reduction in cost and an average savings of ∼ $184,000 for every 100 patients discharged, representing added value in delivered care... - A survey of the use of noninvasive ventilation in academic emergency departments in the United StatesDean R Hess
Respiratory Care Services, Ellison 401, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
Respir Care 54:1306-12. 2009.... - How to initiate a noninvasive ventilation program: bringing the evidence to the bedsideDean R Hess
Massachusetts General Hospital, Boston, MA 02114, USA
Respir Care 54:232-43; discussion 243-5. 2009..The NIV program should be a quality-improvement initiative. Following these principles, a successful program can be initiated in any acute-care setting... - Airway clearance: physiology, pharmacology, techniques, and practiceDean R Hess
Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
Respir Care 52:1392-6. 2007..Appropriately powered and methodologically sound research is desperately needed in this area... - Respiratory controversies in the critical care setting. Should noninvasive positive-pressure ventilation be used in all forms of acute respiratory failure?Dean R Hess
Respiratory Care Services, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA
Respir Care 52:568-78; discussion 578-81. 2007..It will assist the clinician to identify both good and poor candidates for NPPV and thereby devote respiratory care resources where they will be most effective, and optimize patient outcomes... - Noninvasive ventilation in neuromuscular disease: equipment and applicationDean R Hess
Department of Respiratory Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
Respir Care 51:896-911; discussion 911-2. 2006..Appropriate selection of equipment and settings for NPPV is paramount to the success of this therapy... - Monitoring during mechanical ventilationDean R Hess
Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
Paediatr Respir Rev 7:S37-8. 2006 - What is evidence-based medicine and why should I care?Dean R Hess
Department of Respiratory Care, Massachusetts General Hospital, Boston MA 02114, USA
Respir Care 49:730-41. 2004..Although not all tenets of evidence-based medicine are universally accepted, the principles of evidence-based medicine nonetheless provide a valuable approach to respiratory care practice... - Information retrieval in respiratory care: tips to locate what you need to knowDean R Hess
Department of Respiratory Care, Massachusetts General Hospital, Boston, USA
Respir Care 49:389-99; discussion 399-400. 2004..However, there is also much information available on the Internet that has not been validated or subjected to peer review. Thus, it is important not only to find information but also to separate useful from useless information... - Noninvasive pressure support ventilationD Hess
Anaesthesia, Harvard Medical School, Respiratory Care, Massachusetts General Hospital, Boston, MA, USA
Minerva Anestesiol 68:337-40. 2002..Despite these issues, pressure support ventilation has been used successfully for noninvasive ventilation in thousands of patients with acute respiratory failure... - Infection control in the intensive care unit. The role of the ventilator circuitD Hess
Respiratory Care, Massachusetts General Hospital, Anesthesia, Harvard Medical School Boston, MA, USA
Minerva Anestesiol 68:356-9. 2002..There is also accumulating evidence that passive humidifiers and closed suction catheters do not need to be changed on a daily basis... - High-frequency ventilation design and equipment issuesD Hess
Respiratory Care, Harvard Medical School, Massachussetts General Hospital, Boston 02114, USA
Respir Care Clin N Am 7:577-98. 2001..Of these, HFOV is used most commonly. As high-frequency ventilation becomes increasingly used in the care of adult patients, the technical issues related to this therapy will become increasingly important... - Lung recruitment: the role of recruitment maneuversDean R Hess
Department of Respiratory Care Services, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 02114, USA
Respir Care 47:308-17; discussion 317-8. 2002..There have been a number of recent reports describing improvements in arterial oxygenation with the use of recruitment maneuvers. However, the impact of recruitment maneuvers on patient-important outcomes such as survival is unknown... - The evidence for secretion clearance techniquesD R Hess
Department of Respiratory Care, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 2696, USA
Respir Care 46:1276-93. 2001.... - Mechanical ventilation strategies: what's new and what's worth keeping?Dean R Hess
Department of Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 2696, USA
Respir Care 47:1007-17. 2002..When new mechanical ventilation technology and strategies are introduced, a question we need to ask ourselves is whether these are solutions for problems or whether these are simply solutions in search of problems... - The effect of heliox on nebulizer function using a beta-agonist bronchodilatorD R Hess
Department of Respiratory Care, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA
Chest 115:184-9. 1999..To evaluate nebulizer performance when heliox was used to power the nebulizer... - Aerosol delivery during mechanical ventilationD Hess
Respiratory Care, Massachusetts General Hospital, Anaesthesia, Harvard Medical School, Boston, MA, USA
Minerva Anestesiol 68:321-5. 2002..Aerosols can be delivered during mechanical ventilation using either a nebulizer or MDI. The MDI is the most efficient method of aerosol delivery, whereas the greatest absolute amount of drug delivery is with the nebulizer... - Liquid nebulization: emerging technologies conference summaryDean R Hess
Department of Respiratory Care, Massachusetts General Hospital, Boston, MA 02114 2696, USA
Respir Care 47:1471-6. 2002..This provides, in a complete and cogent manner, the scientific basis for which clinicians can improve their knowledge of the new generation of nebulizers... - In vitro evaluation of aerosol bronchodilator delivery during mechanical ventilation: pressure-control vs. volume control ventilationDean R Hess
Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
Intensive Care Med 29:1145-50. 2003..To determine the effect of inspiratory time and inspiratory flow pattern on albuterol delivery by aerosol during mechanical ventilation... - Tracheal gas insufflation and related techniques to introduce gas flow into the tracheaD R Hess
Department of Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114 2696, USA
Respir Care 46:119-29. 2001..Although some of these techniques are promising adjuncts to mechanical ventilation and may help reduce ventilator-associated lung injury, much remains to be learned about their role in the care of patients with acute lung injury... - Ventilator modes used in weaningD Hess
Respiratory Care, Massachusetts General Hospital, Boston, MA 02114, USA
Chest 120:474S-6S. 2001..Noninvasive positive-pressure ventilation also has been reported to facilitate weaning, but the ability to generalize these findings remains to be determined... - Care of the ventilator circuit and its relation to ventilator-associated pneumoniaDean R Hess
Respiratory Care, Massachusetts General Hospital, Boston, MA 02114, USA
Respir Care 48:869-79. 2003..Clinicians caring for mechanically ventilated patients should be aware of risk factors for VAP (eg, nebulizer therapy, manual ventilation, and patient transport)... - Detection and monitoring of hypoxemia and oxygen therapyD Hess
Respiratory Care Services, Massachusetts General Hospital, Boston 02114, USA
Respir Care 45:65-80; discussion 80-3. 2000..Monitoring of oxygenation should not be done just because it is technically feasible. The decision to monitor, like any other clinical decision, should be based on therapeutic objectives... - Ventilators and weaning modesD Hess
Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
Respir Care Clin N Am 6:407-35;v-vi. 2000..Prospective, randomized clinical studies are required to examine whether such modalities are superior to existing approaches... - Nebulizers: principles and performanceD R Hess
Respiratory Care, Massachusetts General Hospital and Harvard Medical School, Boston, USA
Respir Care 45:609-22. 2000..Several new designs have recently become available that improve the performance of the nebulizer, but their cost-effectiveness remains to be determined... - Ventilator-induced lung injury and the evolution of lung-protective strategies in acute respiratory distress syndromeM A Gillette
Pulmonary and Critical Care Unit, Bullfinch 148, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114 2696, USA
Respir Care 46:130-48. 2001..Tracheal gas insufflation is considered as a means to reconcile the clinical goals of ventilatory reduction and control of acidosis... - Heliox delivery with noninvasive positive pressure ventilation: a laboratory studyS Chatmongkolchart
Department of Respiratory Care, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
Respir Care 46:248-54. 2001..With heliox there was a potential for ventilator malfunction in some conditions. The clinical implications of these findings remain to be determined... - Albuterol delivery during noninvasive ventilationMatthew P Branconnier
Department of Respiratory Care, Massachusetts General Hospital, Boston, 02114, USA
Respir Care 50:1649-53. 2005..CONCLUSIONS: Albuterol delivery with noninvasive positive-pressure ventilation was affected by the type of aerosol delivery device, by the location of the leak port, and by actuating the MDI at the proper time in the respiratory cycle... - An objective analysis of the pressure-volume curve in the acute respiratory distress syndromeR S Harris
Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
Am J Respir Crit Care Med 161:432-9. 2000..Calculating objective parameters such as P(mci,i) or P(inf,d) from curve-fitted P-V data can minimize this large variability... - Albuterol delivery via tracheostomy tubeChristopher M Piccuito
Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
Respir Care 50:1071-6. 2005..001). The effect of humidity was unclear from the results of this study. CONCLUSIONS: Albuterol delivery via tracheostomy was affected by the delivery device (nebulizer vs inhaler), bias gas flow, and the patient interface... - Inhaled agonists of soluble guanylate cyclase induce selective pulmonary vasodilationOleg V Evgenov
Department of Anesthesia and Critical Care, Massachusetts General Hospital, 55 Fruit Street, Gray Bigelow 444, Boston, MA 02114, USA
Am J Respir Crit Care Med 176:1138-45. 2007..Nitric oxide-independent agonists of soluble guanylate cyclase (sGC) have been developed... - Pulmonary artery occlusion increases the ratio of diffusing capacity for nitric oxide to carbon monoxide in prone sheepR Scott Harris
Pulmonary and Critical Care Unit, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USAL
Chest 126:559-65. 2004..To test the hypothesis that the ratio of diffusing capacity of the lung for nitric oxide (DLno) to diffusing capacity of the lung for carbon monoxide (DLco) would be affected by occlusion of a fraction of the pulmonary vascular bed... - Do newer monitors of exhaled gases, mechanics, and esophageal pressure add value?Robert L Owens
Department of Medicine, Pulmonary and Critical Care Unit, Cox 2, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
Clin Chest Med 29:297-312, vi-vii. 2008..The authors explore the concepts, benefits, difficulties, and relevant clinical trials of each... - Are inhaled vasodilators useful in acute lung injury and acute respiratory distress syndrome?Mark S Siobal
Respiratory Care Services, NH GA2, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco CA 94110, USA
Respir Care 55:144-57; discussion 157-61. 2010..There is no role for the routine use of inhaled vasodilators in patients with ARDS. Inhaled vasodilator as a rescue therapy for severe refractory hypoxemia in patients with ARDS may be reasonable, but is controversial... - Factors affecting oxygen delivery with bi-level positive airway pressureAndrew R Schwartz
Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
Respir Care 49:270-5. 2004..Because of this, it is important to continuously measure arterial oxygen saturation via pulse oximetry with patients in acute respiratory failure who are receiving noninvasive ventilation from a bi-level ventilator... - Evaluation of inspiratory rise time and inspiration termination criteria in new-generation mechanical ventilators: a lung model studyS Chatmongkolchart
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
Respir Care 46:666-77. 2001..Inspiration termination criteria adjustment markedly affects transition to exhalation in the Puritan Bennett 840... - Effect of the chest wall on pressure-volume curve analysis of acute respiratory distress syndrome lungsRobert L Owens
Departments of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Crit Care Med 36:2980-5. 2008..We sought to quantify the effect of the chest wall by considering the chest wall and lung in series... - The chest wall in acute lung injury/acute respiratory distress syndromeDean R Hess
Respiratory Care, Massachusetts General Hospital, Boston 02114, Massachusetts, USA
Curr Opin Crit Care 14:94-102. 2008..The purpose of this review is to address relevant issues related to the chest wall and mechanical ventilation, particularly in patients with acute lung injury/acute respiratory distress syndrome... - Urgent tracheal intubation in general hospital units: an observational studyWilliam J Benedetto
Department of Anesthesia and Critical Care, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA
J Clin Anesth 19:20-4. 2007..To determine the frequency of complications and outcomes of urgent intubations in general hospital units... - Conventional mechanical ventilation in acute lung injury and acute respiratory distress syndromeVenktesh R Ramnath
Pulmonary and Critical Care Unit, Department of Medicine, Bulfinch 148, Massachusetts General Hospital, Boston, MA 02114, USA
Clin Chest Med 27:601-13; abstract viii. 2006..This article examines the evidence supporting lung-protective ventilation strategies and addresses the methods, outcomes, and potential obstacles to implementation of such approaches... - Capnography for procedural sedation and analgesia in the emergency departmentBaruch Krauss
Division of Emergency Medicine, Children s Hospital, Boston, MA 02115, USA
Ann Emerg Med 50:172-81. 2007.... - Tracheomalacia in an adult with respiratory failure and Morquio syndromeCarolyn J Pelley
Respiratory Care Department, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
Respir Care 52:278-82. 2007..Mechanical ventilation may be difficult because of upper-airway obstruction or low compliance imposed by the restrictive chest wall. Complete tracheal collapse can occur in these patients, especially with fixed head flexion... - Noninvasive positive-pressure ventilation: a silver bullet for extubation failure?Dean R Hess
Respir Care 52:1454-6. 2007 - Device selection and outcomes of aerosol therapy: Evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and ImmunologyMyrna B Dolovich
Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
Chest 127:335-71. 2005..There are advantages and disadvantages associated with each device category. Evidence-based guidelines for the selection of the appropriate aerosol delivery device in specific clinical settings are needed... - In vitro evaluation of aerosol bronchodilator delivery during noninvasive positive pressure ventilation: effect of ventilator settings and nebulizer positionSunisa Chatmongkolchart
Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Thailand
Crit Care Med 30:2515-9. 2002.... - Liberation from mechanical ventilation: weaning the patient or weaning old-fashioned ideas?Dean R Hess
Crit Care Med 30:2154-5. 2002 - Respiratory controversies in the critical care setting. Does high-frequency ventilation offer benefits over conventional ventilation in adult patients with acute respiratory distress syndrome?Henry E Fessler
Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 Monument Street, Baltimore, MD 21287, USA
Respir Care 52:595-605; discussion 606-8. 2007.... - Patient-ventilator dyssynchrony during lung protective ventilation: what's a clinician to do?Dean R Hess
Crit Care Med 34:231-3. 2006 - Evidence-based clinical practice guidelines: where's the evidence and what do I do with it?Dean R Hess
Respir Care 48:838-9. 2003 - Guidelines for preventing health-care-associated pneumonia, 2003: buyer beware!Dean R Hess
Respir Care 49:891-3. 2004 - Secretion clearance techniques: absence of proof or proof of absence?Dean R Hess
Respir Care 47:757-8. 2002 - Inhaled nitric oxide for treatment of sickle cell strokePedro Montero-Huerta
Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, Georgia, USA
Anesthesiology 105:619-21. 2006