Respiratory care最新文献

{"title":"Hierarchy of Preferred Patient Outcomes Among Survivors of Acute Respiratory Failure.","authors":"Somnath Bose, Lena Novack, Samantha Harrison, Valerie Goodspeed, Krystal Capers, Margaret M Hayes, Victor D Dinglas, Dale M Needham, Samuel M Brown","doi":"10.1089/respcare.13083","DOIUrl":"https://doi.org/10.1089/respcare.13083","url":null,"abstract":"<p><p><b>Background:</b> Surviving acute respiratory failure (ARF) in the ICU is often a life-changing event. Most survivors face endure impairments across several domains, termed as post-intensive care syndrome (PICS). There is limited investigation on how survivors and their caregivers perceive recovery from their own lived experiences. The objective of this study was to characterize which domains of recovery matter most to ARF survivors and their caregivers. <b>Methods:</b> A single-center, prospective observational study nested within 2 contiguous cohort studies: Addressing Post-Intensive Care Syndrome (APICS)-01 and APICS-COVID that enrolled ARF survivors who were admitted to ICU and discharged home. Survivors and caregivers were asked to prioritize following 9 domains of recovery using a custom-made survey: cognition, pain, physical function, pulmonary function, muscle/nerve function, mental health, fatigue, return to work or prior activities, and survival. These domains were chosen based on prior literature and modified based on input from a patient and family advisory council at the study site. The order of prioritization of domains of recovery was assessed at hospital discharge and at 3- and 6-month follow-up. <b>Results:</b> Forty eligible study subjects and 10 caregivers were recruited between 2019 and 2022. Mean age was 51.0 (SD 13.8) years, more than two thirds were male, and approximately one-third were non-white. Of the 9 domains surveyed, survival was consistently ranked the highest at each of the 3 time points. Cognitive recovery and physical function were ranked as the next 2 most important domains of recovery. <b>Conclusions:</b> ARF survivors who were discharged to home prioritized survival and then physical and cognitive recovery over 6 other domains. Understanding what matters most to survivors is a key step toward identifying priority areas for care in ICUs and rehabilitation after critical illness. Future studies should include survivors and caregivers from diverse backgrounds to obtain a comprehensive assessment of their perspective of recovery.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609206","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":"Protocols and Pathways in Pediatric Critical Asthma: A Systematic Review and Meta-Analysis.","authors":"Danielle K Maue, L Denise Willis, Jesslyn Lenox, Joel Glogowski, Lynda Goodfellow, Benjamin White, Samer Abu-Sultaneh, Andrew Miller","doi":"10.1089/respcare.12885","DOIUrl":"https://doi.org/10.1089/respcare.12885","url":null,"abstract":"<p><p><b>Background:</b> Pediatric critical asthma is one of the most frequent reasons for presentation to the emergency department and admission to the floor or pediatric ICU (PICU) in pediatric patients. Clinical pathways and protocols have been used frequently in respiratory care, and many have been associated with an improvement in outcomes. We performed a systematic review on the use of protocols or pathways in the treatment of critical asthma. <b>Methods:</b> MEDLINE, Embase, and CINAHL were searched with no date limits; last search was completed in July 2024 to identify randomized controlled trials, crossover studies, observational studies, and quality improvement (QI) studies comparing the use of a protocol or pathway in the treatment of pediatric critical asthma to the standard of care. Abstracts were screened by a subgroup of the clinical practice guidelines committee, and subsequently full-text articles were screened and data were extracted. A fixed-effect meta-analysis was performed for each outcome. <b>Results:</b> We included 23 studies, with the majority being observational or QI studies. The outcomes included in this analysis were hospital stay, PICU stay, intubation rate, noninvasive respiratory support (NRS) usage, and rate of escalation of respiratory support. Use of clinical pathways and/or protocols was associated with a shorter hospital stay (mean difference [MD] -0.77 d [95% CI -0.81 to -0.73]) and PICU stay (MD -0.31 d [95% CI -0.37 to -0.26]). There was a decreased incidence of the need for increased respiratory support (odds ratio [OR] 0.59 [95% CI 0.39-0.59]). There was no change in the need for intubation (OR 0.4 [95% CI 0.12-1.34]) or incidence of NRS usage (OR 1.12 [95% CI 0.76-1.63]). <b>Conclusions:</b> Pediatric asthma protocols were associated with reductions in hospital stay, PICU stay, and decreased need for respiratory support escalation but not intubation or NRS use.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609207","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":"Factors Influencing Aerosol Delivery During Invasive Ventilation.","authors":"Fai A Albuainain, Xiaoyan Man, Omar Alamoudi, Jie Li","doi":"10.1089/respcare.12942","DOIUrl":"https://doi.org/10.1089/respcare.12942","url":null,"abstract":"<p><p><b>Background:</b> Several factors influence aerosol delivery during mechanical ventilation, such as patient characteristics, device configuration, and ventilator settings. This study aimed to evaluate how ventilator settings, humidification, nebulizer positions, bias flows, and circuit adapters affected aerosol delivery during invasive ventilation. <b>Methods:</b> Using an in vitro model, aerosol delivery of albuterol (2.5 mg/3 mL) via a vibrating mesh nebulizer was tested under 28 conditions during invasive ventilation. A systematic stepwise ruling-out approach was taken over 3 phases: (1) dry circuit, (2) dry circuit with exhaled humidity, and (3) heated and humidified circuit with exhaled humidity. Variables included ventilator settings (high vs low), nebulizer positions (proximal to the endotracheal tube vs distal), bias flows (2 vs 5 L/min), and circuit adapters (Y- vs V-shaped). The variables deemed unimportant were progressively excluded in later phases. Each condition was tested 5 times. Drug deposition was collected on filters, eluted, and quantified using ultraviolet spectrophotometry at 276 nm. <b>Results:</b> High ventilator settings significantly increased inhaled doses compared with lower settings across most conditions (all <i>P</i> < .05), with the greatest absolute increase of inhaled dose was observed in dry circuits without exhaled humidity (11-22%). This effect was reduced to 4-7% with the use of exhaled humidity in both dry and heated humidified circuits. Proximal nebulizer placement yielded higher doses than distal placement under high settings in dry circuits without exhaled humidity, but this difference was diminished or absent when exhaled humidity or heated humidification were introduced. Bias flow and adapter type had minimal impact on inhaled dose, except in specific conditions under dry circuit without exhaled humidity. <b>Conclusions:</b> In dry circuits without exhaled humidity, aerosol delivery was substantially affected by ventilator settings and nebulizer placement, whereas bias flow and circuit adapter types had no notable impact. However, the effects of ventilator settings and nebulizer placement diminished in circuits with exhaled humidity or heated humidification.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554340","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":"It Takes a Village-Evolving Role for Dedicated Teams for COPD Management.","authors":"Neil R MacIntyre","doi":"10.1089/respcare.13160","DOIUrl":"10.1089/respcare.13160","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"928-929"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111830","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":"Influence of Prone Position on Regional Ventilation/Perfusion Matching in Patients With ARDS Over Time.","authors":"Yuxian Wang, Jieqiong Song, Shengyao Lin, Xin Zheng, Zhanqi Zhao, Ming Zhong","doi":"10.1089/respcare.12247","DOIUrl":"10.1089/respcare.12247","url":null,"abstract":"<p><p><b>Background:</b> We sought to investigate the short- and long-term effects of prone positioning (PP) on ventilation/perfusion matching in patients with ARDS using contrast-enhanced electrical impedance tomography (EIT). <b>Methods:</b> EIT measurements were performed in 18 mechanically ventilated subjects with ARDS before PP (supine position [SP]), 1 h after turning subjects to PP (PP₁), 3 h after PP (PP₃), 9 h after (PP₉), 16 h after PP (PP₁₆; the end of PP), and 3 h after returning to the supine position (Re-SP₃). <b>Results:</b> The <math><mrow><mrow><msub><mi>P</mi><mrow><mi>a</mi><mrow><msub><mi>O</mi><mn>2</mn></msub></mrow></mrow></msub></mrow></mrow></math>/<math><mrow><mrow><msub><mi>F</mi><mrow><mi>I</mi><mrow><msub><mi>O</mi><mn>2</mn></msub></mrow></mrow></msub></mrow></mrow></math> increased gradually during the PP period (110.68 vs 158.44 vs 210.15 vs 215.22 vs 236.04 vs 163.77 mm Hg, mean values at SP, PP₁, PP₃, PP₉, PP₁₆, and Re-SP₃, respectively<i>, P</i> < .001). Global ventilation/perfusion matched percent significantly increased within PP duration (54.13% vs 63.15% vs 63.02% vs 63.75% vs 66.63% vs 57.42, <i>P</i> < .005). Compared with SP, dorsal ventilation significantly increased at PP₁ (<i>P</i> < .001) and increased gradually during PP. However, the dorsal flow commenced to improve at PP₉ and persisted in enhancement until PP₁₆ (40.61% vs 48.78% vs 50.56%, mean values at PP₃, PP₉, and PP₁₆, respectively<i>, P</i> < .05). There was a significant reduction in global Shunt-EIT percentage within PP duration, primarily localized in the dorsal area. Dead Space-EIT percentage remained unchanged during PP. <b>Conclusions:</b> Oxygenation remained improved or maintained throughout the 16-h duration of PP. Ventilation is susceptible to immediate gravitational effects; however, changes in blood flow may occur later after 9 h, which supports prolonged PP treatment. The shunt continuously decreases, but no significant changes were observed for dead space. <b>Trial registration:</b> ClinicalTrials.gov, NCT04725227. Registered on January 25, 2021.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"821-829"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557813","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":"Effect of Noninvasive Ventilation Mask Design on Upper Airway Washout: A Computational Fluid Dynamics Model.","authors":"Alys R Clark, Lomani A O'Hagan, Jessica R Fogarin, James A Gordon, James C D Miller, Ashani M Perera, S Ali Mirjalili","doi":"10.1089/respcare.12421","DOIUrl":"10.1089/respcare.12421","url":null,"abstract":"<p><p><b>Background:</b> Noninvasive ventilation (NIV) is a primary treatment for patients with acute hypercapnic respiratory failure. Mask choice is fundamental in the success of NIV. Mask design can influence the fit, comfort, and venting of the instrumental dead space. A new mask has been designed to reduce effect of anatomical dead space by washing out the airway of expired gases at end expiration. The aim of this investigation was to use computational fluid mechanics to model upper airway washout with different NIV mask designs. <b>Methods:</b> A 3D-printed head that represents the face and upper airways was used to construct 3D air space maps to be analyzed by computer simulation software when an individual is using each mask design. The 3D-printed head was mounted on a desktop lung simulator, measuring air flow and pressure at the mask and at the tracheal level during noninvasive therapies. Computational fluid dynamics was used to simulate air flow and CO₂ distribution within the airway geometry and used to predict the impact of mask design on CO₂ distribution within the upper airways. <b>Results:</b> The models predict distributions of CO₂ through the upper airway geometry and show that because of the washout of expired gas in the nasal cavity, the novel mask improved CO₂ concentrations at end expiration compared with conventional NIV. In simulations where the mouth and nasopharynx were both open, a 44% decrease in CO₂ in the nasal cavities and a 28% decrease in CO₂ over the entire upper airway geometry was predicted to result from this washout. <b>Conclusions:</b> Mask design can influence CO₂ clearance in the upper airway. NIV with airway washout resulted in more CO₂ clearance from the airway compared with a conventional NIV mask. Improved CO₂ clearance may facilitate improved alveolar ventilation and subsequent gas exchange.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"801-809"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543269","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":"Clinical Features of Patients With Bronchiolitis Prior to the Initiation of Noninvasive Respiratory Support.","authors":"Lindsey L Scheller, Coral N Crandall, Kristen E Carlin, Missy A Lein, Robert M DiBlasi","doi":"10.1089/respcare.11922","DOIUrl":"10.1089/respcare.11922","url":null,"abstract":"<p><p><b>Background:</b> Effective management of infants hospitalized with bronchiolitis depends on clinician assessment of disease severity. Although environmental and demographic risk factors help identify severe cases, there is limited research on specific clinical and physiological characteristics associated with respiratory deterioration. This study aimed to identify physiologic variables and clinical parameters associated with respiratory deterioration in hospitalized infants with bronchiolitis. <b>Methods:</b> A single-center retrospective cohort study included previously healthy infants <2 years of age hospitalized for bronchiolitis. The primary outcome measure, deterioration, was defined as respiratory distress requiring noninvasive (including high-flow nasal cannula) or invasive respiratory support within 48 h of admission. A multivariable logistic regression analysis with preselected factors was used to assess the odds of deterioration. Variables included sex, age, affect and behavior, nasopharyngeal suctioning, number, location of retractions, S_pO₂/F_IO₂ (S/F ratio), breathing frequency, pulse rate, and respiratory severity score. A secondary analysis assessed retraction locations. <b>Results:</b> Of the 584 eligible patients, 154 (26%) experienced a deterioration event and required noninvasive or invasive respiratory support. Respiratory score (odds ratio [OR] 1.9 [95% CI 1.5-2.4]), total number of retractions (OR: 2.5 [95% CI 1.6-3.8]), S/F ratio (OR: 1.0 [95% CI 0.99-0.998), pulse rate (OR: 1.0 [95% CI 1.0-1.1]), nasopharyngeal suctioning (OR: 5.5 [95% CI 2.6-11.7]), and positive affect and behavior descriptors (OR: 0.3 [95% CI 0.1-0.7]) were associated with deterioration. Age, sex, negative affect and behavior descriptors, and breathing frequency were not statistically significant. <b>Conclusions:</b> These variables may be used to design predictive algorithms that alert clinicians of impending respiratory deterioration in infants with bronchiolitis.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"838-846"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543264","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":"Aerosol Delivery to Simulated Spontaneously Breathing Tracheostomized Adult Patients With Heated Humidified High Flow Oxygenation.","authors":"Xiukai Chen, Fai A Albuainain, Jie Li","doi":"10.1089/respcare.12467","DOIUrl":"10.1089/respcare.12467","url":null,"abstract":"<p><p><b>Background:</b> Heated and humidified high-flow (HHHF) oxygen therapy is frequently used for spontaneous breathing tracheostomized patients. However, the efficacy of in-line placement of nebulizer via HHHF remains unclear. We aimed to assess the impact of nebulizer placements, flow settings, and interfaces on aerosol delivery using a vibrating mesh nebulizer with HHHF in a tracheostomized model. <b>Methods:</b> A simulated spontaneous breathing model of a tracheostomized adult with tracheostomy tube size 8.0 mm was utilized. A collecting filter was placed between the tracheostomy tube and the model lung. Albuterol sulfate (2.5 mg/3 mL) was aerosolized via a vibrating mesh nebulizer in-line with HHHF (Airvo2). The aerosol delivery was evaluated with the nebulizer placed distally (near the humidifier) and proximally to the airway, using tracheostomy adapter and tracheostomy collar at gas flows of 15, 30, and 45 L/min. Each condition was tested five times. The drug was eluted from the collecting filter and assayed with ultraviolet spectrophotometry (276 nm). <b>Results:</b> When delivering aerosol via an in-line vibrating mesh nebulizer with HHHF in a tracheostomized model, the inhaled dose increased as flow decreased, regardless of the interfaces and nebulizer placements (all <i>P</i> < .05). With the tracheostomy adapter, distal placement resulted in higher inhaled doses than the proximal placement at all flows (all <i>P</i> < .05). With the tracheostomy collar, inhaled doses were lower with distal placement than proximal placement, except at 15 L/min (21.3 ± 1.9 vs 16.4 ± 2.1%, <i>P</i> = .009). Compared with the tracheostomy adapter, the tracheostomy collar had higher inhaled doses with the vibrating mesh nebulizer placed proximally at 30 and 45 L/min but a lower inhaled dose with the vibrating mesh nebulizer placed distally at 30 L/min. <b>Conclusions:</b> During aerosol delivery via in-line placement of vibrating mesh nebulizer with HHHF in a tracheostomized model, the inhaled dose increased as flow decreased. Distal nebulizer placement resulted in higher inhaled doses than proximal placement with the tracheostomy adapter at all flows and with the tracheostomy collar at 15 L/min.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"873-878"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557711","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":"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":"887-895"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","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":"Association of Preserved Ratio Impaired Spirometry and Mortality Outcomes Compared With Normal Spirometry: A Meta-Analysis.","authors":"Viraj Panchal, Shubhika Jain, Aasa Deepika Kuditipudi, Sravya Sri Kuchipudi, Rahul Vyas, Bhavya Vyas, Saketh Palasamudram Shekar","doi":"10.1089/respcare.11653","DOIUrl":"10.1089/respcare.11653","url":null,"abstract":"<p><p><b>Background:</b> One of the leading causes of death in the United States is chronic lung disease, with COPD being the most common. One of the hallmarks of COPD is spirometric obstruction as evidenced by a reduced FEV₁/FVC ratio. Preserved ratio impaired spirometry (PRISm) is a spirometric pattern characterized as a low FEV₁ coupled with a preserved FEV₁/FVC ratio. This systematic review and meta-analysis sought to understand better the relationship between PRISm and cardiovascular, respiratory, and all-cause mortality. <b>Methods:</b> We systematically searched PubMed and clinicaltrials.gov for articles published between 2014 and 2023, providing data regarding the association of PRISm compared with normal spirometry in terms of morality outcomes. The generic inverse variance method was used to assess the pooled hazard ratio value at a 95% CI, and forest plots were created using RevMan for analysis. <i>P</i> < .05 was considered to be significant. <b>Results:</b> Our analysis included 690,015 subjects from four prospective studies and three retrospective studies. The pooled hazard ratio for all-cause, cardiovascular, and respiratory-related mortality was 1.70, 1.95, and 5.70 for all prospective studies, respectively, and 1.62, 1.66, and 3.35, in combined prospective and retrospective studies, respectively, which were statistically significant in the random effect model (<i>P</i> < .001). However, 76% heterogeneity was observed in respiratory-related mortality (<i>P</i> = .009). After excluding studies associated with publication bias, a \"leave-out\" sensitive analysis resulted in a significant pooled hazard ratio of 1.98 with a high significance (<i>P</i> < .001). <b>Conclusions:</b> PRISm, often labeled as GOLD-U, is associated with mortality outcomes and should not be overlooked while treating patients with chronic lung diseases. This meta-analysis provides a stronger correlation of PRISm with all-cause mortality, cardiovascular mortality, and respiratory mortality compared with normal spirometry.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"914-921"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036809","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}