Respiratory care最新文献

{"title":"Malfunction Reporting Patterns in Life-Supporting Versus Noninvasive Ventilators: A Stratified Text-Mining Analysis of the FDA Device MAUDE Database.","authors":"Shuichi Hamasaka","doi":"10.1177/19433654261493652","DOIUrl":"https://doi.org/10.1177/19433654261493652","url":null,"abstract":"<p><strong>Background: </strong>Mechanical ventilators are essential life-support devices, yet evidence regarding device-related vulnerabilities remains limited compared with the extensive literature on human-factor-related adverse events. This study applied text-mining techniques to a large post-market surveillance database to examine ventilator malfunction reporting patterns and the effect of stratifying reports by device category.</p><p><strong>Methods: </strong>Adverse event reports related to mechanical ventilators submitted to the U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database between January 2010 and December 2025 were stratified into life-supporting and noninvasive devices and analyzed using KH Coder. A random sample of the life-supporting reports was drawn for the primary analysis. Frequency analysis, co-occurrence network analysis, hierarchical cluster analysis, and correspondence analysis were performed. Device brand and year were used as external variables in the correspondence analysis.</p><p><strong>Results: </strong>A total of 193,926 reports met the eligibility criteria, of which 177,641 were classified as malfunctions. The analyses were restricted to reports classified as malfunctions. Among life-supporting ventilators, the reported malfunctions spanned several broad themes, including power and battery failures, circuit-board and electronic faults, breathing-circuit and gas-delivery problems, and issues involving monitoring and control functions. Among noninvasive devices, reports were concentrated in terms associated with a single foam-related recall, as well as connector corrosion and patient-reported symptoms. Nearly 1 in 5 malfunction reports did not document a confirmed device failure during patient use.</p><p><strong>Conclusions: </strong>Text mining of ventilator-related adverse event reports revealed distinct reporting patterns across life-supporting and noninvasive devices. These findings are exploratory and do not establish the frequency or causes of device failure. Stratification of reports by device category helped prevent the reporting patterns of individual devices from being obscured by a single recall. This study demonstrates the potential value of combining post-market surveillance data with text-mining methods to support medical device safety surveillance.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261493652"},"PeriodicalIF":2.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207393","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":"Pulmonary Rehabilitation: The Year in Review 2025.","authors":"Brian W Carlin","doi":"10.1177/19433654261490634","DOIUrl":"https://doi.org/10.1177/19433654261490634","url":null,"abstract":"<p><p>Pulmonary rehabilitation (PR) is a cornerstone of therapy for people with chronic lung disease. Over the years, there has been a tremendous amount of research in the field. Researchers have studied improved delivery methods for PR that improve patient outcomes. This article will review several important articles in the field over the last year.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261490634"},"PeriodicalIF":2.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170190","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":"Comparing the Efficacy of Negative-Pressure Ventilation to Noninvasive, Positive-Pressure Ventilation in Children With Acute Respiratory Failure.","authors":"Syeda Zabreen Afzal, Noah Stanco, Ryan K Breuer, Amanda Hassinger, Brian Wrotniak, Robert Welliver","doi":"10.1177/19433654261486084","DOIUrl":"https://doi.org/10.1177/19433654261486084","url":null,"abstract":"<p><strong>Background: </strong>Negative-pressure ventilation (NPV) avoids a positive-pressure facial interface, but contemporary multi-center pediatric data comparing NPV with noninvasive positive-pressure ventilation (NIV) are limited. We describe modern NPV epidemiology and compare outcomes with NIV in children younger than 3 years with acute respiratory failure.</p><p><strong>Methods: </strong>We conducted a multi-center retrospective cohort study using the Virtual Pediatric Systems (VPS) database. Children younger than 3 years who received NPV or NIV during a pediatric ICU (PICU) admission for acute or acute-on-chronic respiratory failure were included; outpatient use of either modality was excluded. Subjects were categorized according to initial respiratory support modality. The primary outcome was endotracheal intubation after initiation of noninvasive respiratory support. The primary analysis used multivariable mixed-effects logistic regression with center included as a random intercept. Propensity-score matching using Pediatric Risk of Mortality III score, age, sex, weight, diagnostic variables, and center was performed as a sensitivity analysis.</p><p><strong>Results: </strong>Crude intubation rates were higher in the NPV group than in the NIV group (27.3% vs 10.4%, <i>P</i> < .001). After adjustment for measured subject-level factors and center-level clustering, ventilation modality was not independently associated with intubation (NIV vs NPV adjusted OR 0.675, 95% CI 0.393-1.158, <i>P</i> = .154). In the propensity-score-matched cohort, intubation remained numerically higher in the NPV group but was not statistically significant (NPV vs NIV OR 1.64, 95% CI 0.92-2.93, <i>P</i> = .12).</p><p><strong>Conclusions: </strong>In this multi-center retrospective cohort, NPV was used in a small minority of children younger than 3 years with acute respiratory failure. After adjustment for measured confounders and center-level clustering, ventilation modality was not independently associated with intubation. Prospective studies are needed to define optimal patient selection and the role of NPV in pediatric acute respiratory failure.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261486084"},"PeriodicalIF":2.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127879","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":"Carbon Dioxide Levels in Extremely Preterm Neonates Ventilated With High Frequency Jet Ventilation.","authors":"Dimitrios Rallis, Danielle Ben-David, Kendra Woo, Jordan Murphy, Jill Robinson, Laura Bernardini, Elisa Abdulhayoglu, Elizabeth Flanigan, Helen Christou","doi":"10.1177/19433654261436794","DOIUrl":"10.1177/19433654261436794","url":null,"abstract":"<p><strong>Background: </strong>Close monitoring of carbon dioxide (CO₂) levels is crucial in extremely preterm neonates; however, a consensus on optimal CO₂ thresholds is lacking. We aimed to evaluate the impact of P_aCO₂ levels during the first 24 h of life on the outcomes of extremely preterm neonates ventilated with first-intention high frequency jet ventilation (HFJV).</p><p><strong>Methods: </strong>We retrospectively examined neonates ≤26 weeks of gestational age who were ventilated with first-intention HFJV, during 2022-2024, comparing the lowest P_aCO₂, peak P_aCO₂, P_aCO₂ fluctuations, and P_aCO₂ deviation from the target (40-50 mm Hg) during the first 24 h of life between neonates who survived without severe intraventricular hemorrhage (IVH) and neonates who developed severe IVH or died.</p><p><strong>Results: </strong>Among 50 extremely preterm neonates of gestational age 24.3 ± 1.5 weeks and birthweight 656 ± 170 g, 33 (66%) survived without severe IVH. Neonates who survived without severe IVH were of greater gestational age (24.7 ± 1.3 vs 23.6 ± 1.5 weeks, <i>P</i> = .01) and birthweight (696 ± 159 vs 577 ± 167 g, <i>P</i> = .02), compared to neonates who developed severe IVH or died. The latter had significantly higher peak P_aCO₂ (66.7 ± 17.0 vs 54.6 ± 10.2 mm Hg, <i>P</i> = .006), P_aCO₂ fluctuations (30.8 ± 17.3 vs 16.6 ± 8.8 mm Hg, <i>P</i> = .001), and P_aCO₂ deviation from the target (20.0 ± 14.9 vs 9.7 ± 7.3 mm Hg, <i>P</i> = .003), compared to neonates who survived without severe IVH. A higher peak P_aCO₂, P_aCO₂ fluctuation, and P_aCO₂ deviation from the target were significantly associated with severe IVH, death, or severe IVH/death. A cutoff of a peak P_aCO₂ <65 mm Hg, P_aCO₂ fluctuation <25 mm Hg, and P_aCO₂ deviation <15 mm Hg from the target had the best sensitivity and specificity for survival, absence of severe IVH, and survival without severe IVH.</p><p><strong>Conclusions: </strong>In extremely preterm neonates ventilated with first-intention HFJV, maintaining peak P_aCO₂ of <65 mm Hg, P_aCO₂ fluctuations <25 mm Hg, and P_aCO₂ deviation from target <15 mm Hg was significantly associated with survival without severe IVH.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1078-1085"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634066","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":"AARC Clinical Practice Guideline: Adult Patients Transitioning From the Hospital on Oxygen.","authors":"Krystal Craddock, Michael Hess, Lynda Goodfellow, Leanne Richardson, Chris Garvey, Joel Glogowski, Eugene Macogay, Chrysalis Ashton, John Linnell, Jean Rommes, Dean R Hess","doi":"10.1177/19433654261472990","DOIUrl":"10.1177/19433654261472990","url":null,"abstract":"<p><p>To assist clinicians transitioning patients from the hospital through the continuum of their ambulatory oxygen care needs, a multidisciplinary team of clinicians and patients used the Grading of Recommendations, Assessment, Development, and Evaluation methodology to make the following recommendations: (1) We recommend disease management for patients who are transitioning from the hospital to the home or domiciliary care on newly prescribed long-term oxygen therapy (LTOT) (strong recommendation, low certainty); (2) We recommend regular reassessments to determine the appropriateness of LTOT in adults who were recently discharged from the hospital setting (conditional recommendation, moderate certainty); (3) We suggest implementing a discharge coordination program to support the safe transition of adult patients requiring oxygen therapy (conditional recommendation, low certainty); (4) We suggest that assessments of the oxygen setting and device during rest and activity be conducted before the transition of an adult patient from the hospital to home or domiciliary care with an oxygen prescription (conditional recommendation, low certainty); (5) We suggest an evaluation of the domiciliary environment and activities of daily living, including an assessment of the risk of burns related to tobacco smoking or other ignition sources, for adult patients transitioning to home or domiciliary settings with a new oxygen prescription (conditional recommendation, low certainty); (6) We suggest offering peri-discharge education focused on the oxygen prescription to improve understanding and adherence to LTOT (conditional recommendation, low certainty).</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1156-1169"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913286","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":"From Bench to Bedside-and Back Again. The Evolving Role of Bench Studies in Mechanical Insufflation-Exsufflation.","authors":"Mathieu Delorme, Nicolas Audag","doi":"10.1177/19433654261471220","DOIUrl":"10.1177/19433654261471220","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1200-1202"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536663","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":"Scope and Scan Led Airway Care: Therapist Laryngeal Visualization.","authors":"George Ntoumenopoulos, Anne Kristine Brekka, Tiina Andersen","doi":"10.1177/19433654261444706","DOIUrl":"10.1177/19433654261444706","url":null,"abstract":"<p><p>Dysphagia and impaired vocal fold motion are common complications following endotracheal intubation in critically ill patients and are associated with adverse clinical outcomes. In the ICU setting, laryngeal dysfunction complicates core physiotherapy and respiratory therapy tasks, including noninvasive therapies, cough evaluation, and airway clearance. This clinically oriented narrative synthesis outlines how bedside visualization with transnasal fiberoptic laryngoscopy (TFL) and translaryngeal ultrasound (TLU) can improve individualized airway clearance strategies and optimization of noninvasive ventilation when laryngeal dysfunction is suspected. Both modalities enable direct assessment of secretion pooling, penetration and aspiration, cough function, and mucosal trauma. In difficult cases, TFL can confirm that a nasotracheal suction catheter has traversed the vocal folds when blind nasotracheal attempts fail, facilitating an effective cough. Within interprofessional workflows, TLU can serve as an accessible screening tool, whereas targeted TFL-supported assessments add diagnostic and therapeutic value in challenging cases. Safe implementation, particularly of TFL, requires appropriate skills, adherence to infection-prevention protocols, and structured local training and credentialing. Existing clinician-performed ultrasound frameworks may be adapted to support competence in TLU. Embedding these modalities into credentialed and audited clinical pathways may enhance safety and efficiency, although pragmatic implementation and outcome studies remain key priorities.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1170-1178"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820052","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":"<i>Corrigendum to:</i> Transpulmonary Driving Pressure, End-Expiratory Transpulmonary Pressure, and Mortality in Pediatric ARDS.","authors":"","doi":"10.1177/19433654261495894","DOIUrl":"https://doi.org/10.1177/19433654261495894","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261495894"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114275","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":"Understanding the Barriers to Care for Individuals Receiving In-Patient Polysomnography.","authors":"James R Vallerand, Phuong Uyen Nguyen, Adam G D'Souza, Sachin R Pendharkar, Tetyana Kendzerska, Marcus Povitz","doi":"10.1177/19433654261444693","DOIUrl":"10.1177/19433654261444693","url":null,"abstract":"<p><strong>Background: </strong>Fragmented care models for sleep medicine in Canada disadvantage individuals with socioeconomic barriers. This can lead to delays in diagnoses, treatment, and increased health care utilization. This study aimed to explore whether subjects who receive polysomnography (PSG) during hospitalization represent a marginalized population.</p><p><strong>Methods: </strong>We identified subjects who underwent PSG during hospitalization (inpatient PSG) at an academic hospital in Canada, from January 1, 2019, to December 31, 2021. Time, age- and sex-matched control groups were derived in a 2:1 allocation ratio inclusive of: hospitalized individuals who did not undergo PSG (inpatient control) and individuals referred to an ambulatory sleep medicine clinic (clinic control). Comorbidities, socioeconomic deprivation and marginalization indices, rurality, and health care utilization within the preceding year to enrollment, were compared between groups.</p><p><strong>Results: </strong>We matched 275 inpatient PSG with 550 inpatient control and 550 clinic control subjects. Compared to both control groups, the inpatient PSG group had greater burden of comorbidities and more frequent specialist physician appointments. They had greater marginalization index, social assistance use, and lower income levels compared to clinic control subjects. More frequent emergency department visits, acute care admissions, and days in hospital were observed in the inpatient PSG group compared to clinic control subjects. Inpatient PSG subjects had more severe sleep disordered breathing (SDB) compared to clinic control subjects.</p><p><strong>Conclusions: </strong>Subjects evaluated with in-patient PSG had a greater multimorbidity, social disadvantages, and health care usage. Future prospective trials are needed to determine whether routine use of in-patient PSGs can reduce complications associated with untreated SDB.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1108-1114"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779615","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":"Correlation Between Mechanical Power and the Viscoelastic Properties of the Lung.","authors":"Liran Statlender, Eyal Robinson, Ilya Kagan","doi":"10.1177/19433654261433946","DOIUrl":"10.1177/19433654261433946","url":null,"abstract":"<p><strong>Background: </strong>Lung protective ventilation strategy, aiming to decrease ventilation-induced lung injury, is based on 2 major principles: (1) ventilation at a narrow range of volume, with low plateau and driving pressures, while (2) keeping the lung open, to avoid tidal alveolar recruitment/de-recruitment. Mechanical power (MP) was developed as a single value describing energy transfer to the lungs. Energy transfer to the lung parenchyma during ventilation is associated with the viscoelastic properties of the lung. This study aimed to describe the correlation between MP and the viscoelastic properties of the lung.</p><p><strong>Methods: </strong>An exploratory prospective study in an 18-bed mixed ICU of a university-affiliated tertiary hospital. Immediately after percutaneous tracheostomy was performed, 2 inspiratory holds were performed, with 2 different constant flows. Based on the ventilator settings, inspiratory hold measurements [including peak pressure, plateau pressure (P_plat), tidal volume], and resistive elements, viscoelastic properties of the lungs (viscoelastic resistance, R₂; viscoelastic compliance, C₂; and viscoelastic time constant, τ₂) and MP were calculated for each inspiratory hold. Those measurements were compared. MP was correlated with the viscoelastic properties of the lung.</p><p><strong>Results: </strong>Nine subjects were included in the study. No differences were noted in the viscoelastic properties of the lung between the 2 inspiratory hold measurements. The MP increased in the higher flow inspiratory hold. No correlation was found between either R₂ or C₂ and MP. A moderate negative correlation was found between τ₂ and MP.</p><p><strong>Conclusions: </strong>MP was found to be negatively correlated with τ₂, but not with R₂ or C₂. The clinical implication of this finding has yet to be defined.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1102-1107"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779638","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}