Respiratory care最新文献

{"title":"Decoupling Heat and Humidity to Improve Aerosol Delivery: Innovation or Trade-Off.","authors":"Fai A Albuainain, Jie Li","doi":"10.1177/19433654261444698","DOIUrl":"https://doi.org/10.1177/19433654261444698","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261444698"},"PeriodicalIF":2.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842171","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":"https://doi.org/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":"19433654261444706"},"PeriodicalIF":2.1,"publicationDate":"2026-05-02","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":"Effects of Endotracheal Suctioning With Expiratory Pause in Infants.","authors":"Ana Paula Dattein Peiter, Taila Cristina Piva, Taciana Fassbinder Piccoli, Francisco Bruno, Cinara Andreolio, Camila Wohlgemuth Schaan, Bruna Ziegler","doi":"10.1177/19433654261427697","DOIUrl":"https://doi.org/10.1177/19433654261427697","url":null,"abstract":"<p><strong>Background: </strong>Endotracheal suctioning is a routine procedure in the pediatric ICU (PICU) and can be performed via open or closed systems. Closed-system suctioning has benefits for pressure maintenance in the ventilatory system and oxygen supply during the technique but is less effective. The association of an expiratory pause in closed-system suctioning is an alternative technique. We sought to evaluate the volume of suctioned secretions, respiratory mechanics, and hemodynamic parameters during closed endotracheal suctioning with expiratory pause, compared with conventional closed suctioning.</p><p><strong>Methods: </strong>Randomized crossover pilot trial with infants receiving invasive mechanical ventilation >24 h, with neuromuscular blocker, without cough reflex, randomized to define the order of suctioning techniques (T1-technique 1 conventional suctioning without expiratory pause; T2-technique 2: with expiratory pause), performed with a 2-h interval. Evaluated hemodynamic parameters (heart rate, blood pressure, and peripheral arterial oxygen saturation), respiratory mechanics (static and dynamic compliance, inspiratory and expiratory resistance, driving pressure), and suctioning secretion were weighed on a precision balance. Shapiro-Wilk test for normally distributed variables analysis and generalized estimating equation for effect analysis.</p><p><strong>Results: </strong>Ten infants were included with a median age of 2 months (1.0-3.7). The amount of secretions from the technique with expiratory pause was significantly higher compared with conventional suctioning (mean 1.4 g vs 1.1 g; <i>P</i> < .001). Treatment effect was observed in the analysis of driving pressure (<i>P</i> < .001) and inspiratory resistance (<i>P</i> = .02), with an increase in these variables after suctioning with expiratory pause. There were no significant differences in hemodynamic variables.</p><p><strong>Conclusions: </strong>The closed-system suctioning with expiratory pause was more effective in secretion removal compared with conventional closed suctioning. However, driving pressure and inspiratory resistance increased after suctioning with an expiratory pause.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261427697"},"PeriodicalIF":2.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820109","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 Remotely Supervised, Self-Administered, and Center-Based Sit-to-Stand Tests in Individuals With Chronic Respiratory Diseases.","authors":"Lee Verweel, Matisse LeBouedec, Adam Benoit, Cindy Ellerton, Anastasia N L Newman, Tara Packham, Roger Goldstein, Dina Brooks","doi":"10.1177/19433654251389827","DOIUrl":"10.1177/19433654251389827","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence comparing center and home-based sit-to-stand (STS) tests in individuals with chronic respiratory disease (CRD). This study aimed to estimate the level of agreement and performance differences among center-based, remotely supervised, and self-administered STS tests in individuals with CRD.</p><p><strong>Methods: </strong>A repeated-measures design was used to compare the 30-s and 1-min STS across 3 test conditions. The sample size was one of convenience and included subjects with CRD from an out-patient pulmonary rehabilitation program in Toronto, Canada. Bland-Altman analysis was used to estimate STS agreement across conditions, reporting mean difference and 95% limits of agreement (LoA). Analysis of variance was used to estimate differences in STS performance across conditions, controlling for testing order. Secondary measures included indicators of safety and acceptability of the remotely supervised and self-administered conditions. All analyses were completed using Stata/BE 17.0 with a significance level of <i>P</i> ≤ .05.</p><p><strong>Results: </strong>Twenty-seven participants (mean age 69.4 ± 11.8 years, 52% female) completed STS testing in all 3 conditions. Bland-Altman plots revealed limited bias across all comparisons (mean difference < 1 repetition). LoA illustrated individual variation across comparisons for the 30-s STS (LoA -3.4 to 4.1) and 1-min STS (LoA: -7.4 to 8.6). Analysis of variance models indicated no effect of test condition on either 30-s STS (<i>P</i> = .12) or 1-min STS (<i>P</i> = .33). There was an observed order effect for the 30-s STS (<i>P</i> = .005) and 1-min STS (<i>P</i> = .005). There were no serious adverse events for remotely supervised and self-administered tests. The majority (≥ 80%) of participants found the instructions clear, and felt safe and confident while performing the remotely supervised and self-administered STS.</p><p><strong>Conclusions: </strong>Performance on the 30-s and 1-min STS did not differ across test conditions. Remotely supervised and self-administered tests may be safe and acceptable.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"486-495"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041365","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 During Endobronchial Ultrasound: New Physiologic Insights From a Randomized Trial.","authors":"Paul R Harper, William E Thinnes, Prema Nanavaty, J Brady Scott","doi":"10.1177/19433654261437782","DOIUrl":"10.1177/19433654261437782","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"543-545"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582394","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 Reduces Ventilatory Requirements During Endobronchial Ultrasound.","authors":"Jeffrey Miechels, Niels J M Claessens, Mark V Koning","doi":"10.1177/19433654251412342","DOIUrl":"10.1177/19433654251412342","url":null,"abstract":"<p><strong>Background: </strong>High-flow nasal cannula (HFNC) reduces dead-space ventilation, but this effect is diminished by open-mouth breathing and partial airway obstruction. Consequently, it is uncertain whether HFNC provides respiratory support during endobronchial ultrasound (EBUS) procedures.</p><p><strong>Methods: </strong>A single-center randomized controlled crossover study was conducted at the Rijnstate Hospital, Arnhem, the Netherlands, from November 2022 to August 2024.Patients with severe COPD (Gold III/IV) were evaluated to determine if HFNC reduces dead space ventilation during an EBUS procedure. Exclusion criteria were known neurodegenerative conditions, allergies to propofol or esketamine, pregnancy, upper-airway obstructions, or severe pulmonary hypertension.Subjects received two sequences of HFNC flow (30 and 70 L/min or vice versa) during EBUS.The primary outcome was CO₂ washout, determined by a 60-s capnography trace with and without HFNC flow to measure the difference in inspiratory, end-tidal CO₂, and β-angle.</p><p><strong>Results: </strong>Twenty subjects with severe COPD (Gold III/IV) were included (Group A <i>n</i> = 10; Group B <i>n</i> = 10), of which one could not complete the bronchial measurements because of an obstructing carcinoma. CO₂ washout at carina was observed at 70 L/min of HFNC flow, demonstrated by a reduced inspiratory CO₂ of mean 6.0 mm Hg (95% CI: 4.5-8.3, <i>P</i> < .001) and end-tidal CO₂ of 5.3 mm Hg (95% CI: 2.3-7.5, <i>P</i> = .002), but not at 30 L/min of HFNC flow (mean inspiratory CO₂ difference of 1.5 mm Hg (95% CI: -2.3 to 6.0, <i>P</i> = .69) and mean end-tidal CO₂ difference of 0.8 mm Hg (95% CI: -2.3 to 3.0, <i>P</i> = .35). A flow of 70 L/min reduced inspiratory CO₂ in the left main bronchus (mean = 5.3 mm Hg; 95% CI: 2.3-8.3, <i>P</i> < .001), but not the end-tidal CO₂ (mean = 3.0 mm Hg; 95% CI: 0.0-6.0, <i>P</i> = .07).</p><p><strong>Conclusions: </strong>An HFNC flow of 70 L/min reduced dead-space ventilation in subjects with severe COPD undergoing EBUS procedures during deep sedation, suggesting respiratory support during this procedure.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"453-459"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114042","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":"Advancing Telehealth Pulmonary Rehabilitation for COPD: Bridging Current Practices, Individual Experiences, and Future Needs: A Scoping Review.","authors":"Pooja Arora, Phuong Quach, Byron Lai, Abebaw M Yohannes, Surya P Bhatt, James H Rimmer","doi":"10.1177/19433654251401473","DOIUrl":"https://doi.org/10.1177/19433654251401473","url":null,"abstract":"<p><p>Telehealth pulmonary rehabilitation (PR) expands access to rehabilitation services for individuals with COPD by addressing barriers to participation in center-based programs. However, it remains important to assess whether these programs follow an intervention framework that effectively enhances the well-being of individuals with COPD. This scoping review analyzed current literature on telehealth PR to identify trends and gaps in program components, delivery methods, remote monitoring, use of telehealth technology, program effectiveness, participants' subjective perceptions, and recommendations. A systematic search of databases such as PubMed, Web of Science, and Embase identified relevant studies published between January 2010 and June 2024. Eligible studies included adults (≥18 years) with COPD and used randomized controlled trials, quasi-experimental, observational, qualitative, or mixed-method designs. This review highlighted considerable heterogeneity in reporting of the baseline sociodemographic and clinical characteristics. About 50% of studies employed hybrid models combining asynchronous and synchronous interventions. Remote monitoring with Bluetooth-enabled devices was included in 46% of studies to track vital signs and activity levels. Common interventions included aerobic and resistance training (94%), aerobic training alone (34%), self-management education (70%), and health coaching (43%). Theoretically grounded health coaching showed promise in supporting self-management of symptoms and health behaviors. Despite these advances, significant gaps remain in remote assessment of functional outcomes and tailored interventions that account for diverse sociodemographic and clinical profiles. Overall, telehealth PR demonstrated noninferiority to center-based PR. The programs using a multimodal approach including exercise training, self-management education, health coaching, health care professionals, and peer support were effective in improving program adherence, health outcomes and reducing health care burden. The qualitative findings emphasized the importance of baseline technical training, tailoring programs to disease severity, and continuous support from health care providers and peers to sustain positive health behaviors.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"71 5","pages":"511-526"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820089","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":"Identifying Patients at Risk for Unplanned Extubation in a Pediatric ICU.","authors":"Cheryl Dominick, Laura Oldehoff, Amanda Rolfe, Ryan Griffin, Dagemawi Alemayehu, Amy Oxenreiter, Danielle Traynor, Akira Nishisaki","doi":"10.1177/19433654261424873","DOIUrl":"10.1177/19433654261424873","url":null,"abstract":"<p><strong>Background: </strong>Unplanned extubation (UE) poses a substantial risk, potentially resulting in clinical instability, cardiac arrest, and need for re-intubation. Our objective was to develop a UE risk assessment scoring (UERAS) tool to identify contributing factors, facilitate mitigation strategies, and decrease UE. We hypothesized that our UERAS would demonstrate high reliability and UERAS implementation would be associated with UE reduction.</p><p><strong>Methods: </strong>In a 75-bed pediatric ICU, we developed the UERAS with the range score at 0-18. We predetermined UERAS <i>≥</i> 6 as high risk. For inter-rater reliability (IRR), the UERAS was piloted in a 24-bed section of the PICU, where 2 respiratory therapists (RTs) independently evaluated patients undergoing invasive mechanical ventilation. Upon demonstrating high IRR, UERAS was expanded across the 75 beds. Standardized mitigation actions for high-risk patients were developed including immediate clinician alerts via electronic health record chat function and interdisciplinary bedside huddles within 1 h.</p><p><strong>Results: </strong>During March to April 2023, a sample of 50 paired observations by 16 RTs showed a Pearson's correlation coefficient of 0.997 (<i>P</i> < .001). During March 2023 to May 2024, 3,206 subsequent assessments in 476 subjects (median age 5 years [interquartile range (IQR) 1-13]) were reported with the UERAS score median 2 (IQR 0-4). Three hundred twenty-eight assessments (10.2%) met high-risk criteria (UERAS ≥ 6), including 302 assessments that scored at risk for sedation concerns. One hundred twenty-one high-risk subjects (36.8%) experienced an increased sedative as part of mitigation actions. Compared to the preimplementation phase (July 2022 to March 2023), UERAS implementation phase (July 2023 to March 2024) had significantly lower UE events: 0.44/100 ventilator days (13 UEs) versus 0.14/100 ventilator days (6 UEs), absolute difference 0.28/100 UE events, 95% CI 0.003-0.563, <i>P</i> = .049. However, the UERAS tool demonstrated limited efficacy in predicting UE. Although many high-risk scores did not correspond to events, some UEs occurred in subjects not identified as high risk.</p><p><strong>Conclusions: </strong>The UERAS scores showed high IRR. Implementation of the UERAS with mitigation actions was associated with a reduction in UEs.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"435-441"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514470","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":"Alpha-1 Antitrypsin Replacement Improves Walking Capacity in Subjects With Severe Deficiency.","authors":"Alessandra Marchese, Annalisa Frizzelli, Alessandro De Simoni, Olha Bondarenko, Roberta Pisi, Agnese Aluia, Giovanna Pelà, Roberta Eufrasia Ledda, Gaetano Caramori, Alfredo Chetta, Marina Aiello","doi":"10.1177/19433654251412331","DOIUrl":"10.1177/19433654251412331","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"496-500"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147675968","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":"Sleep Quality in ICU Subjects Receiving Noninvasive Respiratory Support: A Prospective Observational Study.","authors":"Wenhui Hu, Mengyi Ma, Linfu Bai, Yiwei Min, Yueling Hong, Jun Duan","doi":"10.1177/19433654251412330","DOIUrl":"https://doi.org/10.1177/19433654251412330","url":null,"abstract":"<p><strong>Background: </strong>Sleep deprivation is common in critically ill patients because of disease severity and ICU conditions, yet sleep quality in those requiring noninvasive respiratory support remains understudied.</p><p><strong>Methods: </strong>This prospective observational study in a teaching hospital ICU enrolled subjects on noninvasive ventilation (NIV) or high-flow nasal cannula (HFNC) who could tolerate overnight polysomnography (PSG). Sleep was assessed using standard PSG from 22:00 in the evening until 08:00 the following morning. The primary outcome was to evaluate sleep quantity and quality.</p><p><strong>Results: </strong>A total of 72 subjects (43 NIV and 29 HFNC) were included in the study. Compared with healthy adults, subjects receiving noninvasive respiratory support exhibited significantly shorter total sleep time (median 396.0 vs 279.5 min), lower sleep efficiency (85.7% vs 45.9%), longer wake after sleep onset (48.2 vs 297.1 min), higher stage 1 of non-rapid-eye movement (non-REM) sleep (N1, 7.9% vs 37.8%), lower stage 3 of non-REM sleep (N3, 20.4% vs 4.9%), lower REM sleep (19.0% vs 9.4%), longer REM latency (97.4 vs 171.7 min), and a higher arousal index (AI, 12.6 vs 39.2 per hour; all <i>P</i> < .01). No significant differences were found between NIV and HFNC subgroups. However, clinically improved subjects (<i>n =</i> 60) had lower N1 (35.6% vs 50.0%, <i>P</i> < .01) and higher REM sleep (10.3% vs 4.9%, <i>P</i> = .02) than this without clinical improvement (<i>n =</i> 12).</p><p><strong>Conclusions: </strong>In the ICU setting, noninvasive respiratory support subjects experienced poor sleep quality, with no modality difference (NIV vs HFNC). However, subjects with clinical improvement demonstrated relatively better sleep quality than those without improvement.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"71 5","pages":"480-485"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820160","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}