Respiratory care最新文献

{"title":"Jet Nebulization During Mechanical Ventilation: Mass Balance Analysis.","authors":"Sushant Chaudhary, Ann D Cuccia, Gerald C Smaldone","doi":"10.1177/19433654251376272","DOIUrl":"https://doi.org/10.1177/19433654251376272","url":null,"abstract":"<p><p><b>Background:</b> The interaction between nebulizer technology and mechanical ventilation can be confusing. Mesh technology has recently been quantified using the mass balance, a technique that measures all aerosol delivered and lost in ventilator circuits. Data for jet nebulizers are limited, and ventilator technology has changed over time. The present study was designed to better define aerosol behavior during jet nebulization by testing device position, gas source, humidification, inspiratory time (T_I), and circuit compliance. <b>Methods:</b> Using radiolabeled particles, mass balance and output rate were measured for the AeroTech nebulizer placed close to the ventilator (IP), Y-piece (YP), and proximal to ETT (DY) in aerosol HME or humidified settings. The nebulizer was driven continuously (8 L/m, 50 PSIG) or by breath actuation (BA) during volume control ventilation at two inspiratory times (T_I 0.7 and 0.55 s). Five ventilators and two circuits with different tubing compliance were tested. Radiolabeled saline (3 mL, Tc^99m) was nebulized. A well counter measured filters inhaled and expiratory mass (IM, EM), and nebulizer residual (NR). Tubing deposition was measured with a gamma camera. A shielded ratemeter measured output rate and treatment time. <b>Results:</b> Mass balance ranged from 96 to 104% (no.<i> =</i> 66). IM obtained with IP, HME circuit, continuous nebulization (29.8 ± 5%), IP, and BA (26.8 ± 4%); with humidification, continuous (15 ± 1%), BA (27.1 ± 4). Lowest IM at YP position, HME (8.8 ± .6%). Circuit losses ≤20%. EM was lowest for IP (19.2 ± 2%) and highest for YP and DY (46 ± 3%). NR was higher with BA (43.1 ± 6 vs 37.1 ± 3, <i>P</i> = .002). Higher tubing compliance lowered IM (21.8 ± .7% vs 28.3 ± 3% [no. <i>=</i> 9], <i>P</i> = .01). Treatment time for IP, continuous, HME circuit (10 min), and BA circuit (50 min). Changing T_I (0.55 s) reduced IM and further increased treatment time. <b>Conclusions:</b> Optimal conditions for jet nebulization were IP position, HME circuit, continuous nebulization, and stiff tubing. Humidification should be supplied with an aerosol HME. If active humidification, IP breath-actuated was most efficient but with marked increase in treatment time.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225479","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":"Neonatal Resuscitation Program Versus Pediatric Advanced Life Support: An Examination of Rescue Breaths With Changing Pulmonary Mechanics Using a Simulator.","authors":"Mathavan Sivarajah, Shafeeque Kunhiabdullah, Sreenivas Karnati, Allison Peluso, Hany Aly, Robert Chatburn, Ibrahim Sammour","doi":"10.1089/respcare.11056","DOIUrl":"10.1089/respcare.11056","url":null,"abstract":"<p><p><b>Background:</b> The Neonatal Resuscitation Program (NRP) and Pediatric Advanced Life Support (PALS) differ considerably, and the transition from one to the other has not been well studied. Pulmonary mechanics change markedly with growth, increasing compliance, decreasing airway resistance, and prolonging the time constant. Differences in lung mechanics may warrant different rescue breath strategies. <b>Design/Methods:</b> Using published predictive equations and Centers for Disease Control and Prevention growth nomograms, gender-agnostic pulmonary compliance (Cstat) and resistance (Rrs) were computed for infants at birth and at regular intervals starting at 2 weeks of age. An IngMar ASL 5000 high-fidelity breathing simulator was used to model these infants. A Maquet Servo-i ventilator provided positive pressure peak inspiratory pressure set at 20 and PEEP set at 5 cm H₂O. Inspiratory time was set to 0.5 s for NRP and 1 s for PALS. For NRP, the rate was set to 40, 50, and 60 breaths/min. For PALS it was set to 12, 20, and 30 breaths/min. Inspired tidal volume (V_Ti), PEEP measured at the airway (PEEP_aw) and total PEEP (PEEP_tot) values were extracted. Minute ventilation (V̇_E) was calculated and corrected to the model's weight. Data were analyzed by linear regression. <b>Results:</b> At a set ventilator pressure differential, NRP rescue breaths were associated with a greater decline in corrected V_Ti and V̇_E for age. PALS consistently delivered larger corrected V_Ti regardless of rate than NRP. Increasing the rate from 20 to 30 in PALS led to an expected increase in corrected V̇_E that approached those seen in NRP. Providing breaths at 50 and 60 breaths/min in NRP was associated with significant inadvertent development of PEEP_tot. Providing PALS at 30 and NRP at 40 breaths/min provided comparable PEEP_tot. <b>Conclusions:</b> PALS at 30 breaths/min provides similar corrected V̇_E and PEEP_tot to NRP at 40 breaths/min. Higher rates that can be employed in NRP can lead to a concerning buildup of PEEP_tot in older patients.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1267-1274"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120592","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":"The Challenge of Noninvasive Assessment of Inspiratory Effort During Assisted Ventilation.","authors":"Giorgio Antonio Iotti, Francesca Porta","doi":"10.1177/19433654251366896","DOIUrl":"10.1177/19433654251366896","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1347-1349"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966755","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":"Flow Index as a Noninvasive Method to Evaluate Inspiratory Effort in Patients on Pressure Support Ventilation.","authors":"Federica Fusina, Filippo Albani, Heder J de Vries, Luigi Pisani, Giuseppe Natalini, Pieter R Tuinman, Leo Heunks","doi":"10.1089/respcare.12671","DOIUrl":"10.1089/respcare.12671","url":null,"abstract":"<p><p><b>Background:</b> The Flow Index was recently developed as a bedside method based on flow waveforms to assess patient inspiratory effort during invasive mechanical ventilation. The aim of this study is to externally validate the Flow Index by assessing its ability to identify low and high inspiratory effort breaths. <b>Methods:</b> Secondary analysis of a randomized controlled trial. The association between Flow Index and patient inspiratory effort (pressure generated by the respiratory muscles [ΔP_mus] and pressure-time product from the start of inspiratory flow [PTP_insp]) was evaluated using linear mixed effects models. The discrimination capacity (area under the curve [AUC]) of the Flow Index to identify low and high inspiratory effort breaths was analyzed. <b>Results:</b> A total of 1,095 breaths from 38 subjects were included in the analysis. Flow Index had moderate discriminatory power in identifying low inspiratory effort breaths (AUC of 0.73 and 0.77 for low inspiratory effort defined with ΔP_mus and PTP_insp, respectively). Discriminatory power in identifying high inspiratory effort breaths was low (AUC of 0.68 and 0.65 for ΔP_mus and PTP_insp, respectively). <b>Conclusions:</b> Flow Index demonstrated moderate discriminatory power in identifying low inspiratory effort breaths, whereas discriminatory power in identifying high inspiratory effort breaths was low.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1201-1206"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120530","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":"Neurodevelopmental Outcomes and Health Care Utilization in Very Low Birth Weight Infants After Treatment With Bubble CPAP.","authors":"Alexander D Yuen, Lorenzo Zaffiri, Victor Tapson, Reinaldo Rampolla, Yuri Matusov","doi":"10.1089/respcare.12900","DOIUrl":"10.1089/respcare.12900","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1301-1304"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981396","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":"Airway Obstruction in Patients With Left-Ventricular Hypertrophy.","authors":"Priyavardhan Mishra, Anant Patil, Nikhil Sarangdhar, Pannag Bhushan Biswal, Mohit Kondisetti, Girija Nair","doi":"10.1089/respcare.12550","DOIUrl":"10.1089/respcare.12550","url":null,"abstract":"<p><p><b>Background:</b> The relationship between left-ventricular hypertrophy (LVH), left-ventricular mass index (LVMI), body mass index (BMI), and their corresponding pulmonary function test parameters remains unknown. <b>Methods:</b> In this prospective observational study, we assessed the pulmonary function of subjects with LVH. The severity of airway obstruction was graded into five levels using the FEV₁% predicted value and the prevalence of obstruction with left-ventricular mass was also correlated. <b>Results:</b> Our study included 289 subjects [142 (49.1%) LVH and 147 (50.8%) non-LVH]. The mean age of subjects with LVH was 56 ± 17.8 years. Sixty-two subjects with normal BMI had LVH. One-hundred forty-two subjects with LVH underwent spirometry; 9 (6.3%), 16 (11.3%), 18 (12.7%), 49 (34.5%), and 48 (33.8%) had mild, moderate, moderately severe, severe, and very severe obstruction before the administration of bronchodilator, respectively. After bronchodilator administration, the numbers (n%) were 13 (9.15%), 17 (11.9%), 27 (19%), 52 (36.6%), and 30 (21.1%), respectively. There was a strong inverse relationship (r = -0.87, r = -0.86) for pre bronchodilator and post bronchodilator, respectively; R² = 0.76 and R² = 0.74 for pre and post bronchodilator respectively, <i>P</i> < .001 for both) between LVMI and FEV₁%. <b>Conclusions:</b> LVH was associated with high prevalence of obstructive pulmonary disease. The severity of obstruction was correlated with left-ventricular mass. The early screening of such underlying obstruction may help to reduce the risk of further complications.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1294-1300"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051132","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":"Neurodevelopmental Outcomes and Health Care Utilization in Very Low Birth Weight Infants After Treatment With Bubble CPAP.","authors":"Jennifer M Estanilla, Jieun David, J Brady Scott, Aloka L Patel, Kousiki Patra","doi":"10.1089/respcare.12099","DOIUrl":"10.1089/respcare.12099","url":null,"abstract":"<p><p><b>Background:</b> Bronchopulmonary dysplasia (BPD) and prolonged invasive mechanical ventilation in preterm infants are associated with an increased risk for respiratory morbidity and adverse neurodevelopmental (ND) outcomes in early childhood. The use of nasal CPAP has been shown to reduce the duration of mechanical ventilation and risk for BPD. Bubble CPAP has physiologic properties that decrease lung injury, which may lead to better respiratory and developmental outcomes through prevention of BPD. To date, there is no study that reports the ND and health outcomes of infants treated with bubble CPAP. <b>Methods:</b> One hundred twenty infants treated with bubble CPAP were compared with 114 infants treated with infant flow driver (IFD) CPAP. Outcomes included Bayley-III scores, hospitalizations, emergency department visits, subspecialists, and therapies through the age of 2 years. Multiple regression analyses adjusted for effects of social and neonatal risk factors on outcomes. <b>Results:</b> Infants in the bubble CPAP group had lower rates of intubation (<i>P</i> = .02), need for surfactant administration (<i>P</i> < .001), and noninvasive ventilation (<i>P</i> < .001) as compared with infants treated with IFD CPAP. In extremely low birthweight infants (<1,000 g), treatment with bubble CPAP was predictive of higher cognitive scores at 20 months corrected age (CA) (<i>P</i> = .02). <b>Conclusions:</b> Use of bubble CPAP was associated with higher cognitive scores at 20 months CA in extremely low birthweight infants but not for infants with birthweight >1,000 g.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1232-1239"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042451","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":"Effects of Trigger Algorithms on Trigger Performance and Patient-Ventilator Synchrony.","authors":"Keisuke Morinishi, Taiga Itagaki, Yusuke Akimoto, Yusuke Chikata, Jun Oto","doi":"10.1089/respcare.12694","DOIUrl":"10.1089/respcare.12694","url":null,"abstract":"<p><p><b>Background:</b> Patient-ventilator synchrony is essential for successful patient-triggered ventilation. This study compared the ability of a trigger algorithm, based on detailed analysis of flow changes (IntelliSync+, Hamilton Medical), to trigger patient breaths with conventional algorithms. <b>Methods:</b> Three models with different lung mechanics (normal, ARDS, and COPD) at 3 severities were simulated with a lung model ventilated in pressure control continuous mandatory ventilation or pressure control continuous spontaneous ventilation (PC-CSV). Inspiratory pressure above PEEP was set at 15 cm H₂O and PEEP at 5 cm H₂O. Inspiratory trigger was selected from IntelliSync+ (IS+insp), flow trigger (1- 5 L/min), or pressure trigger (-1 to -5 cm H₂O). In PC-CSV, expiratory trigger was set at IntelliSync+ (IS+exp) or cycling criteria (5%, 25%, and 40% for ARDS, normal, and COPD, respectively). Measurements were performed with and without leak (50% inspiratory tidal volume). Five breaths per condition were collected to calculate trigger delay time and asynchronous events. <b>Results:</b> For pressure trigger, none of the conditions resulted in 3 successfully triggered consecutive breaths. Overall trigger delay time was significantly longer with flow trigger than with IS+insp in normal (99 vs 81 ms without leak, <i>P</i> < .001; 98 vs 80 ms with leak, <i>P</i> < .001) and ARDS models (334 vs 223 ms without leak, <i>P</i> < .001; 320 vs 236 ms with leak, <i>P</i> = .02). Across all conditions, ineffective efforts occurred more frequently with flow trigger than with IS+insp (7.3% vs 1.5% without leak, <i>P</i> = .01; 10.8% vs 3.0% with leak, <i>P</i> = .01). In PC-CSV, overall cycling delay time with IS+exp was equivalent or longer compared with cycling criteria. <b>Conclusions:</b> In this lung model study, IS+insp demonstrated similar trigger time and fewer ineffective efforts compared with flow trigger even in simulated respiratory conditions, whereas cycling delay time was unaffected by IS+exp because of large variations between conditions.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1285-1293"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023444","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":"Impact of Weight-Based High-Flow Nasal Cannula Flow Limits on Intensive Care Unit Utilization in Bronchiolitis.","authors":"Gerald B Moody, Sachin Shah, Ali Hasan, A Paige Davis Volk","doi":"10.1089/respcare.12525","DOIUrl":"10.1089/respcare.12525","url":null,"abstract":"<p><p><b>Background:</b> High-flow nasal cannula (HFNC) is a common respiratory support device utilized in the management of children hospitalized with bronchiolitis. Early adoption in many pediatric wards was developed using age-based flow limits. However, age-based limits do not align with current evidence and potentially contribute to ICU admissions. To align with current evidence and improve ICU bed allocation, we implemented weight-based flow limits within our wards. The primary objective of this study was to evaluate the impact of these changes on ICU utilization. <b>Methods:</b> This retrospective study was conducted at Children's Medical Center in Plano, Texas, a free-standing, community-based hospital affiliated with an academic quaternary center. Subjects were patients < 2 years of age admitted for bronchiolitis and supported via HFNC in the 12 months before and after implementation of weight-based flow limits. Primary outcomes were ED disposition and ICU transfer rates. Secondary outcomes were evaluation of adverse respiratory events and stay. <b>Results:</b> A total of 1,207 subjects met inclusion criteria; 558 pre- and 649 post-implementation. There were no differences between groups in age, weight, or gender. Compared with the pre-implementation group, we observed an 8.6% absolute decrease in ICU admissions [92 (16.5%) vs 51 (7.9%)<i>, P</i> < .001], a 3% absolute decrease in ward to ICU transfers [28 (6%) vs 19 (3%)<i>, P</i> = .034], and no difference in escalation of respiratory support [6 (1.1%) vs 4 (0.6%)<i>, P</i> = .38] or escalation within one hour of transfer [0 (0%) vs 2 (50%)<i>, P</i> > .99]. Overall median stay decreased by 15.9 h in the post-implementation group, [59.4 (IQR 39.1- 85.9) vs 43.5 (IQR 26.9-67.2)<i>, P</i> < .001]. <b>Conclusions:</b> These findings suggest that for hospital systems utilizing similar age-based HFNC flow limits, transitioning to weight-based flows, with safeguards in place, may improve ICU bed utilization while maintaining comparable patient outcomes.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1240-1247"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044884","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":"Exploring the Influence of Respiratory Therapy Students in Interprofessional Simulations for Critical Care Patient Mobilization.","authors":"Denise Campbell, Angela Smith, Julie Jacob, Nicholas Prush, Leslie M Smith","doi":"10.1089/respcare.12786","DOIUrl":"10.1089/respcare.12786","url":null,"abstract":"<p><p><b>Background:</b> Early mobility (EM) of mechanically ventilated patients in ICUs is essential to improve patient outcomes, yet its adoption faces barriers. Interprofessional education (IPE) simulations offer a controlled environment for health care students to develop skills in airway management and foster teamwork, which are crucial for implementing EM practices. Including respiratory therapists in these simulations is particularly important, as they bring specialized expertise in airway management. Their involvement ensures that all team members are proficient in critical skills, enhancing patient safety and the effectiveness of EM strategies in ICU settings. <b>Methods:</b> This mixed-methods study included students from nursing, physical therapy, occupational therapy, and respiratory therapy programs participating in a simulation-based IPE program. Data were collected through pre- and postsimulation Student Perceptions of Interprofessional Clinical Education-Revised Version 2 (SPICE-R2) surveys, reflective papers, postsimulation worksheets, and video analysis. Quantitative data were analyzed using descriptive statistics and the Wilcoxon signed-rank test. Qualitative reflections were thematically coded, and video reviews assessed airway management practices. <b>Results:</b> SPICE-R2 scores demonstrated a significant increase in students' attitudes toward interprofessional collaboration following the simulation (<i>P</i> < .001). Qualitative analysis revealed three key themes: the vital role of RTs in airway management, the importance of advanced preparation, and the value of interprofessional collaboration. Video analysis highlighted variability in team composition and performance, with groups that included RTs generally demonstrating stronger airway management practices. However, challenges included limited representation of all four disciplines in reviewed videos. <b>Conclusions:</b> The IPE simulation enhanced health care students' attitudes and skills related to EM and airway management in an ICU setting. The participation of RTs heightened students' awareness of the critical importance of airway management in mechanically ventilated patients.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1217-1224"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216752","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}