Respiratory care最新文献

{"title":"Postextubation Noninvasive Respiratory Support in Children.","authors":"Andrew G Miller, Alexandre T Rotta","doi":"10.1089/respcare.12922","DOIUrl":"https://doi.org/10.1089/respcare.12922","url":null,"abstract":"<p><p>Infants and children frequently require mechanical ventilation. Daily extubation readiness testing is currently recommended to minimize time on mechanical ventilation, which is associated with the development of morbidities. Re-intubation rates vary between patient populations and have been associated with significant adverse patient outcomes, including increased length of stay and mortality. Noninvasive respiratory support (NRS) is often used to help decrease the risk of re-intubation. NRS encompasses high-flow nasal cannula (HFNC), CPAP, noninvasive ventilation, and negative-pressure ventilation. This article will cover risk factors for re-intubation, assessing extubation readiness, rationale for NRS use, delivery systems for NRS, evidence for various NRS modalities, how to choose NRS modalities, practical considerations, and future research opportunities.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Spontaneous Breathing Trial Gap: CPGs Versus Clinical Practice.","authors":"Karsten J Roberts, Megan L Carreon, Corinne M Battey-Muse","doi":"10.1089/respcare.12939","DOIUrl":"https://doi.org/10.1089/respcare.12939","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Flow Nasal Cannula and Swallowing Safety: A Balancing Act in Respiratory Care.","authors":"Megan L Carreon, J Brady Scott","doi":"10.1089/respcare.12934","DOIUrl":"https://doi.org/10.1089/respcare.12934","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Insufflation-Exsufflation in Older In-Patients With Impaired Cough.","authors":"Claire Estenne, Mathilde Pelletier Visa, Bruno Pereira, Alexandra Usclade, Emmanuel Coudeyre, Lech Dobija","doi":"10.1089/respcare.12267","DOIUrl":"https://doi.org/10.1089/respcare.12267","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Oxygen Consumption Ability With Pulmonary Rehabilitation Improves Submaximal Exercise Capacity in Advanced COPD.","authors":"Hitoshi Sumitani, Keisuke Miki, Yukio Yamamoto, Yasuhiro Mihashi, Yuka Nagata, Satoshi Miyamoto, Masashi Yokoyama, Kazuki Hashimoto, Hisako Hashimoto, Hiromi Yanagi, Kazumi Koyama, Yasuyuki Fujimoto, Takuro Nii, Takanori Matsuki, Kazuyuki Tsujino, Hiroshi Kida","doi":"10.1089/respcare.12303","DOIUrl":"https://doi.org/10.1089/respcare.12303","url":null,"abstract":"<p><p><b>Background:</b> Improving the anaerobic threshold (AT) provides benefits by avoiding overload, especially for patients with advanced COPD. However, the variables related to improving AT are poorly known. The aim of this study was to investigate which variables are related to improved AT after pulmonary rehabilitation (PR) using cardiopulmonary exercise testing (CPET). <b>Methods:</b> Stable patients with severe and very severe COPD who performed 4-week PR and whose ATs were identified both before and after PR were selected; they were divided into two groups based on whether the AT increased after PR, and their responses were compared. <b>Results:</b> In the 26 eligible subjects, there was no correlation between the mean change from baseline after PR in the inspired minus expired mean O₂ concentrations (ΔFO₂) and minute ventilation (V˙_E) at peak exercise. Compared with the AT no-increase group, the AT increase group, at peak exercise, showed significant increases in peak oxygen uptake (V˙_O₂) and ΔFO₂ but not in V˙_E, after PR. The increase in V˙_O₂ at the AT after PR was well correlated with the mean change after PR in ΔFO₂ at peak exercise (r = 0.66, <i>P</i> < .001), rather than V˙_E. Of all the peaks and throughout exercise variables, ΔFO₂ at peak exercise was identified as one of the variables more closely correlated with improved AT after PR. <b>Conclusions:</b> Improvement of ΔFO₂ at peak exercise, rather than V˙_E, correlated with an increased AT in subjects with advanced COPD, which suggests that improving ΔFO₂ independent of V˙_E may be a useful strategy to individualize PR.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home Monitoring of High-Risk Individuals Receiving Opioids Post Orthopedic Surgery.","authors":"Robert L Mazzola, Kim J Bennion, Megan J Hepworth, Greg G Petersen, Gaylinn Breeze, Kelly C Jensen, Megan Jensen, Vanessa Henriksen, Lisa Bagley, Chance Keddington, Gregory L Snow, Tom Belnap, Carrie M Winberg, Shawna B Papenfuss, Tom V Cloward","doi":"10.1089/respcare.11783","DOIUrl":"https://doi.org/10.1089/respcare.11783","url":null,"abstract":"<p><p><b>Background:</b> Postoperative patients receiving opioids are at risk for morbidity and mortality caused by opioid-induced respiratory depression (OIRD). Guidelines advocate electronic monitoring for OIRD during postoperative hospitalization, but the utility of home monitoring following ambulatory surgery has not been assessed. We describe the utilization of capnography and pulse oximetry in an ambulatory orthopedic cohort to determine subject/home caregiver acceptance and utility of continuous monitors at home. The specific aims of this initiative were to (1) determine the subject/home caregiver acceptance of home monitoring to detect OIRD in patients after hospital discharge following orthopedic surgery, (2) determine the rate of OIRD and associated morbidity after hospital discharge following orthopedic surgery, and (3) determine patient understanding of the risk of OIRD. <b>Methods:</b> This prospective, subject/home caregiver acceptance quality improvement initiative was conducted from September 28, 2019, to October 31, 2020. Ambulatory subjects undergoing orthopedic surgical procedures had cardiorespiratory data monitored with a commercially available device at home for 4 days while napping/sleeping. Recorded data were analyzed for reliability comparing end-tidal carbon dioxide pressure (P_ETCO₂), S_pO₂, breathing frequency (f), and heart rate (beats/min). <b>Results:</b> Three hundred fifty-nine subjects were enrolled and had complete data. Two hundred fifty-two (70%) were discharged with supplemental oxygen. When comparing audible alarms with/without delays, there were 4,770/22,409 low P_ETCO₂, 1,601/6,246 high P_ETCO₂, 460/4,211 low frequency, 1,572/6,547 low heart rate, and 462/5,520 low S_pO₂ alarms. Twenty-six (7.2%) subjects visited the emergency department in response to low S_pO₂ audible alarms. Of these, 14 (3.9%) were diagnosed with a clinically relevant opioid-induced event, 95% CI 2.1%-6.5%, and 1 subject was administered naloxone by home caregivers. <b>Conclusions:</b> This study demonstrates home monitoring of oxygenation (S_pO₂), but not respiration (P_ETCO₂), following ambulatory orthopedic procedures is feasible. Subjects at risk for clinically relevant opioid events may experience higher rates of postoperative complications, hospital readmissions, clinically relevant events, or death.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training Intensity Needed for Volume Linearity and Syringe D_LCO Check Quality Control.","authors":"Ellen A Becker, Ellen M Moran, Jason B Blonshine, Vanessa I Rodriguez, Susan B Blonshine","doi":"10.1089/respcare.12565","DOIUrl":"https://doi.org/10.1089/respcare.12565","url":null,"abstract":"<p><p><b>Background:</b> Technologists must assure the accuracy and precision of pulmonary function equipment prior to testing patients. This study aimed to identify the sources of failure and unacceptable submission rates for spirometry volume linearity and syringe diffusing capacity of the lung for carbon monoxide (D_LCO) check quality control (QC). In addition, we explored whether the time between training and first QC submission affected overall percentage of unacceptable submissions. <b>Methods:</b> Participants in a cross-sectional global study submitted QC for evaluation from October 2014 to May 2018 from 114 laboratories. Descriptive statistics summarized the percentage of unacceptable submissions and sources of failure for volume linearity and syringe D_LCO check maneuvers. Spearman's rho described the correlation between site-specific unacceptable submission rates, and both days between training and the first unacceptable submission and the days between training and first submission. <b>Results:</b> The unacceptable submission rate from 5,083 volume linearity assessments was 10% compared with a 6.2% rate from 4,992 syringe D_LCO check maneuvers. Aggregate volume linearity rates of procedural errors (5.8%) and equipment errors (6.2%) were similar, whereas there were more syringe D_LCO check equipment errors (5.9%) than procedural errors (0.78%). The time between training and submitting a QC test was not related to overall unacceptable submission rates for volume linearity and syringe D_LCO check, <i>r_sp</i> = 0.11, <i>P</i> = .27 and <i>r_sp</i> = 0.19, <i>P</i> = .052, respectively. Higher unacceptable rates occurred when the first QC failure occurred close to the completion of training for volume linearity and syringe D_LCO check, <i>r_sp</i> = -0.41, <i>P</i> < .001 and <i>r_sp</i> = -0.38, <i>P</i> < .001, respectively. <b>Conclusions:</b> A single QC training session does not adequately prepare technologists to conduct QC. Technologists need clear and consistent guidelines for conducting QC procedures and regular follow-up from experts to properly interpret QC findings, resolve equipment problems, and assure their testing systems are in-control.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Power: Using Ideal Body Weight to Identify Injurious Mechanical Ventilation Thresholds.","authors":"William M LeTourneau, Alice Gallo De Moraes","doi":"10.1089/respcare.11815","DOIUrl":"https://doi.org/10.1089/respcare.11815","url":null,"abstract":"<p><p>Identifying the mechanisms of ventilator/ventilation-induced lung injury requires an understanding of the pulmonary physiology involved in the mechanical properties of the lung along with the involvement of the inflammatory cascade. Accurately measuring parameters that represent physiologic lung stress and lung strain at the bedside can be clinically challenging. Although surrogates for lung stress and strain have been proposed, such as plateau pressure and driving pressure, these values only represent a static variable in the ventilator breath. It has been proposed that a single variable could be used as a unifying parameter to identify a threshold for the safe application of mechanical ventilation. The concept of \"mechanical power\" applies an energy load transfer designation to the ventilator settings and output of tidal volume, airway pressures, and flow. However, there is a potential disconnect between the use of \"absolute\" mechanical power and the variability of body weight throughout a mixed medical population. Using ideal body weight as an influential factor to express mechanical power can potentially allow for a more accurate depiction of energy applied to the lungs and a potentially reliable injurious mechanical ventilation threshold indicator.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Functional Decline and Relationship With Quality of Life.","authors":"Camila Dietrich, Caroline Cabral Robinson, Daniel Sganzerla, Maicon Falavigna, Daniel Schneider, Juliana Rezende Cardoso, Francine Hoffmann Dutra, Denise Souza, Gabriela Soares Rech, Maicon Quadro de Oliveira, Luisa Barbosa Anzolin, Sâmia Faria da Silva, Rosa da Rosa Minho Santos, Renata Kochhann, Mariana Martins S Santos, Lúcio Couto de Oliveira Júnior, Juliana Mara Stormosvski de Andrade, Lívia Correa E Castro, Cinthia Mucci Ribeiro, Rafael Trevizoli Neves, Juçara Gasparetto Maccari, Mariana Mattioni, José Mário Meira Teles, Regis Goulart Rosa, Cassiano Teixeira","doi":"10.1089/respcare.12146","DOIUrl":"https://doi.org/10.1089/respcare.12146","url":null,"abstract":"<p><p><b>Background:</b> Certain aspects of intensive care unit admission and care, including patient acuity and treatments to manage acute critical illnesses, can intensify loss of functionality and decrease quality of life after hospital discharge. We sought to identify the risk factors associated with functional decline following critical illness and explore its impact on health-related quality of life in a post hoc analysis of a prospective multi-center cohort study. <b>Methods:</b> The study involved 1,301 critically ill subjects who were assessed 3 months after their discharge from the ICU. The subjects were selected from 10 representative hospitals located across the 5 regions of Brazil, and the assessment period ranged from May 2014 to December 2018. <b>Results:</b> Subjects who were previously able to independently manage their activities of daily living (Barthel score of ≥76) were assessed during their ICU stay and 3 months following ICU discharge. Out of the 954 subjects considered in the analysis, 562 (58.9%) experienced functional decline. The study identified several risk factors associated with functional decline (<i>P</i> < .05), including age ≥65 years (relative risk, 1.179; 95% CI 1.06-1.31), lower educational level (relative risk, 1.14; 95% CI 1.00-1.31), high risk of death in the ICU (relative risk, 1.003; 95% CI 1.001-1.005), and the development of symptoms such as anxiety, depression, or ICU-acquired weakness during ICU stay. Functional decline was also associated with lower scores in both the physical domain (34.7 vs 44.0, <i>P</i> < .001) and the mental domain (48.3 vs 54.1, <i>P</i> < .001) of the Short-Form Health Survey score that measured health-related quality of life. <b>Conclusions:</b> Functional decline is a common outcome following ICU stay, and it is associated with characteristics presented before ICU admission and with the severity of the critical illness. Furthermore, functional decline impacts the quality of life of ICU survivors.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Ultrasound Training for Respiratory Therapists.","authors":"Ling Luo, Tyler Weiss, Andrea D Zorce, Sara Mirza, Jacob Rintz, Xiukai Chen, Jie Li","doi":"10.1089/respcare.12291","DOIUrl":"https://doi.org/10.1089/respcare.12291","url":null,"abstract":"<p><p><b>Background:</b> Bedside ultrasound is widely utilized for critically ill patients, yet there is no standardized approach for teaching lung ultrasound to medical staff, particularly respiratory therapists (RTs), in the United States. Thus, we aimed to evaluate the efficacy of a lung ultrasound training program designed for RTs. <b>Methods:</b> With approval from the ethics committee, we recruited RTs with over 3 months of experience at Rush University Medical Center to participate in our lung ultrasound training program. The program comprised of a 1-h didactic lecture followed by hands-on practice on a healthy volunteer. A refresher training session was provided 6-9 months later for those who remained interested in lung ultrasound and were still employed at Rush University Medical Center. Pre- and post-training assessments were conducted to evaluate the effectiveness of the training and identify areas requiring further knowledge development. <b>Results:</b> Between October 2022 and April 2023, 23 RTs completed the initial training, and 7 attended both the initial and the refresher training sessions. Following the initial session, total scores significantly improved (post-training 11.0 [9.0-14.0] versus pre-training 1.0 [0-2.0], <i>P</i> < .001), with the subgroup focusing on \"identification of patterns\" achieving the highest percentage of correct answers. Among the 7 RTs who attended the refresher training, total scores significantly decreased over 6-9 months (12.9 ± 2.3 vs 4.4 ± 1.8, <i>P</i> = .001). However, scores significantly rebounded after the refresher training (post-training 11.3 ± 3.1 vs pre-training 4.4 ± 1.8, <i>P</i> = .008), with no significant difference in post-training total scores between the initial and the refresher sessions. <b>Conclusions:</b> Both the initial and refresher training sessions of our lung ultrasound training programs effectively improved participants' knowledge. The observed decline in knowledge retention over 6-9 months highlights the necessity for periodic refresher courses and ongoing use of lung ultrasound in clinical practice to maintain skills. Incorporating a visual format may be beneficial for acquiring and retaining knowledge.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}