Respiratory care最新文献

{"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":"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":"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":2.1,"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}

{"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":"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":"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":"Fluid-Filled Tracheal Tube Cuffs: Implications for Speech, Sealing, and Safety.","authors":"Thomas C Blakeman","doi":"10.1089/respcare.13184","DOIUrl":"10.1089/respcare.13184","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"930-932"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209388","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":"Outcomes of Prone Positioning in Mechanically Ventilated COVID-19 Patients.","authors":"Jonathan K Chandler, Badr Jandali, Katie Joyce, Dale Smith, Lynn Chollet-Hinton, Isuru Ratnayake, Kyle R Brownback","doi":"10.1089/respcare.11259","DOIUrl":"10.1089/respcare.11259","url":null,"abstract":"<p><p><b>Background:</b> Prone positioning in mechanically ventilated patients with severe ARDS is associated with reduced mortality. COVID-19 causes variable pulmonary involvement in some patients suffering from severe respiratory failure and ARDS. Although proning in the COVID-19 patient population is increasingly common, more data are needed to fully understand its utility in those with ARDS due to COVID-19. <b>Methods:</b> We conducted a single-center retrospective study, inclusive of 100 consecutive subjects intubated for ARDS from COVID-19, admitted to the ICU from September 2020 to December 2020. Data were collected daily from time of intubation for 7 d along with 30-d outcomes. <b>Results:</b> The study included a total of 53 subjects proned and 47 nonproned during their hospitalization. Proned subjects had a mean age of 61.8 years and 56.6% were male, compared with a mean age of 66.3 years and 57.4% male in the nonproned group. Age, sex, other baseline characteristics, and treatments were similar between groups, except that proned subjects had a higher body mass index than nonproned subjects (34.1 ± 7.5 vs 30.5 ± 7.4, kg/m² <i>P</i> = .02) and lower initial P/F ratios (119.1 ± 54.5 vs 154.0 ± 92.7 mm Hg, <i>P</i> = .047). Proned subjects received more neuromuscular blockade (OR 6.63, 95% CI 3.25-13.12, <i>P</i> < .001) and higher sedation levels (two sedatives: OR = 3.00, 95% CI 1.77-5.08; ≥3 sedatives: OR = 7.13, 95% CI 3.96-12.81) with similar ICU stays, ventilator days, newly initiated renal replacement therapy, and 30-d outcomes including being alive, out of the ICU, or discharged from the hospital when compared with nonproned subjects. There were a total of 15 (28.3%) complications related to proning. Proned subjects were reintubated significantly less than the nonproned group (1.9% vs 19.1%, <i>P</i> = .006). <b>Conclusions:</b> Proning mechanically ventilated COVID-19 subjects was associated with more frequent use of neuromuscular blockade and sedation, and lower rates of re-intubation, for respiratory failure when compared with nonproned subjects.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"830-837"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543280","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":"2024 Year in Review: Fugitive Aerosols-Keeping the Air Clear for Patients and Staff.","authors":"Michael D Davis","doi":"10.1089/respcare.12933","DOIUrl":"10.1089/respcare.12933","url":null,"abstract":"<p><p>Although concerns about and precautions to prevent transmission of diseases through the air have existed since Hippocrates, renewed interest in risks and prevention strategies grew significantly since the onset of the COVID-19 pandemic. This altered respiratory care practice globally owing to concerns that some respiratory care procedures may generate or disperse aerosols that could spread pathogens. A paucity of evidence, as well as a lack of general consensus, existed at the pandemic onset to determine the associated risks of these procedures and best practices for mitigating those risks. This is a review of key peer-reviewed manuscripts from 2023 to 2024 discussing aerosol generation and dispersion from respiratory care procedures, as well as the mitigation of associated risks. A brief discussion of different forms of aerosols, and the risks associated with each, is also included.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"908-913"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12369796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upper Airway CO₂ Clearance During Noninvasive Ventilation: A Perspective on Mask Design Using Computational Fluid Dynamics.","authors":"Emmanuel A Akor, Bing Han, David W Kaczka","doi":"10.1089/respcare.13153","DOIUrl":"10.1089/respcare.13153","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"925-927"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120636","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}