Respiratory care最新文献

{"title":"A Bench Model of Asynchrony in 6 Ventilators Equipped With Waveform-Guided Options.","authors":"Isabella Maria Bianchi, Eric Arisi, Marco Pozzi, Anita Orlando, Roberta Puce, Giuseppe Maggio, Federico Capra Marzani, Francesco Mojoli","doi":"10.1089/respcare.11422","DOIUrl":"10.1089/respcare.11422","url":null,"abstract":"<p><p><b>Background:</b> Pressure support ventilation is frequently associated with patient-ventilator asynchrony. Algorithms based on ventilator waveforms have been developed to automatically detect patient respiratory activity and to guide triggering and cycling. The aim of this study was to assess the performance in terms of synchronization of 6 mechanical ventilators, all provided with a waveform-guided software. <b>Methods:</b> This was a bench study to compare standard and new-generation systems simulating different respiratory mechanics, levels of assistance, and respiratory efforts. Six mechanical ventilators were tested: Hamilton G5 (G5) and C6 (C6), IMT bellavista1000 (B1000), Mindray SV300, and Philips RespironicsV200 (V200) and V60 (V60). Apart from V60, the other ventilators were tested twice: with default settings for standard triggering and cycling and with the waveform-guided automation. <b>Results:</b> With the automated settings, breaths with trigger delay ≤ 300 ms increased with B1000, G5, and C6. Ineffective efforts decreased with B1000, G5, C6, and V200. Improvement of triggering was mainly driven by findings obtained in the obstructive profile. With the automated settings, breaths with cycling delay > 300 ms decreased with B1000, G5, C6, and V200 while early cycled breaths increased with B1000. Improvement of cycling was mainly driven by findings obtained in the obstructive profile, whereas worsening of cycling was observed in the restrictive profile with 2 ventilators (B100 and V200). With the automated settings, the asynchrony index (AI) was reduced with G5 and C6 when all the profiles were grouped. In the obstructive profile, the AI decreased with B1000, G5, C6, and V200; in the restrictive profile, the AI increased with B1000. <b>Conclusions:</b> Waveforms-based algorithms have the potential to improve patient-ventilator synchronization. Automation had the most favorable impact when obstructive patients were simulated, while caution should be paid with restrictive ones.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449960","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":"Performance of Unmodified Mechanical Ventilators With 2% Hydrogen Gas Mixtures.","authors":"Julia Garcia Mancebo, Kristen Sack, Richard Nguyen, Yifeng Peng, Syndy Sosa, Marc Anders, Dantin J Roddy, John N Kheir","doi":"10.4187/respcare.12371","DOIUrl":"10.4187/respcare.12371","url":null,"abstract":"<p><p><b>Background:</b> Molecular hydrogen (H₂) is a breathable gas that has been shown to have anti-oxidative, anti-inflammatory, and anti-apoptotic properties that may positively impact ischemia-reperfusion injury. The provision of 2% H₂ through unmodified mechanical ventilators may facilitate the clinical translation of H₂ as a therapeutic in critical illness. The effect of 2% H₂ on ventilator performance is unknown. <b>Methods:</b> Unmodified Maquet Servo-i, Maquet Servo-u, Dräger Evita Infinity V500, and Dräger Evita Babylog VN500 ventilators from clinical stock were tested in an experimental closed system using certified, premixed air and O₂ containing 2% H₂ gas. Wall air and O₂ supply were used as control. Ventilator settings were varied across the spectrum of neonatal to adult settings. End points included (1) difference between set and delivered tidal volume (V_T) (Douglas method), (2) difference between set versus delivered O₂ concentration, (3) delivered H₂ concentration (gas chromatography), and (4) ventilator pre-use check malfunction. Correlation between set and measured end points were quantified by linear regression analysis and bias by Bland-Altman analysis. <b>Results:</b> During H₂ administration, the average bias in measured versus set V_T was within ± 10% for all ventilators except for the Babylog VN500, which exhibited an average bias of -89.2% (95% CI -107.0 to -71.3). The average bias in measured F_IO₂ was within ± 10% of set for all ventilators. Except for the Babylog VN500, all ventilators passed the pre-use check. <b>Conclusions:</b> Unmodified Servo-i, Servo-u, and Evita V500 ventilators deliver 2% H₂ mixtures with acceptable accuracy in V_T and F_IO₂. The Babylog VN500, which uses hot-wire anometry and a higher set operating temperature, exhibits unacceptably inaccurate delivery of V_T with H₂ mixtures.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450072","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":"Characteristics and Outcomes of Children Hospitalized With COVID-19 During Early Pandemic and Delta Variant.","authors":"L Denise Willis, Beverly J Spray, Erin Henderson, Tera Lloyd, Katherine Irby, Ronald Sanders","doi":"10.1089/respcare.12199","DOIUrl":"10.1089/respcare.12199","url":null,"abstract":"<p><p><b>Background:</b> Children were less affected by severe illness as compared to adults at the start of the COVID-19 pandemic. As the pandemic progressed and variants emerged, pediatric hospitalizations increased, and some previously healthy children developed multisystem inflammatory disorder. The aim of this study was to describe the characteristics and outcomes of children hospitalized with COVID-19 from the beginning of the pandemic through the Δ variant. <b>Methods:</b> Data were collected retrospectively for children hospitalized during March 2020-November 2021 with a diagnosis of COVID-19. Admissions were classified as early pandemic or during the delta variant, and outcomes were compared between the time periods. Primary outcome measures were hospital length of stay and use of respiratory support. The number of admissions/month was the secondary outcome. <b>Results:</b> There were 784 hospital admissions: 400 during early pandemic and 378 during the Δ period. Forty-four percent had an underlying medical condition, and 78% were not eligible for COVID-19 vaccination. Oxygen was the most common respiratory support modality and was required more often during Δ (<i>P</i> < .001). Hospital stay was longer during the Δ period (<i>P</i> < .001), and the number of monthly admissions was higher. A statistically significant but low correlation was identified between body mass index (BMI) Z score and stay (<i>P</i> < .001, r = 0.19). <b>Conclusions:</b> The Δ variant was associated with increased hospital length of stay and use of respiratory support compared to the early pandemic period. Children with preexisting medical conditions were more likely to require respiratory support and have longer hospitalization than others. Higher BMI Z score was also weakly associated with longer length of stay. The reason for admission was attributed to causes other than COVID-19 for the majority of admissions except during the Δ period.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449984","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":"Multidisciplinary Evaluation for COPD Management.","authors":"Avantika Nathani, Abdelrahman Nanah, Mohammed J Al-Jaghbeer, Yvonne M Meli, Danielle Wisen, Lenee Marsili, Scott Marlow, Janet Connolly, Michael Machuzak, Thomas R Gildea, Colin Gillespie, Sudish Murthy, Usman Ahmad, Atul C Mehta, Loutfi S Aboussouan, Ruchi Yadav, Amy Attaway, Vickram Tejwani, James K Stoller, Yifan Wang, Xiaofeng Wang, Umur Hatipoğlu","doi":"10.1089/respcare.12345","DOIUrl":"10.1089/respcare.12345","url":null,"abstract":"<p><p><b>Background:</b> COPD is a heterogeneous disorder. We developed a multidisciplinary evaluation scheme to identify patients with COPD who may benefit from phenotype-specific therapy. <b>Methods:</b> Our team of general and interventional pulmonologists, thoracic surgeons, radiologists, respiratory therapists, and advanced practice nurses meets monthly to discuss patients with advanced COPD. For each patient, pulmonary function tests, imaging, and other pertinent data are reviewed. Emphysema is assessed visually and by quantitative computed tomography modalities. A consensus is sought for medical, bronchoscopic, and/or surgical treatments and recommendations are relayed to the referring physician. <b>Results:</b> The multidisciplinary team reviewed 510 cases between November 2015 and December 2022. Eighty five of 510 patients were found to be appropriate candidates for lung-volume-reduction surgery and 36 underwent the procedure. Patients in the post-multidisciplinary evaluation cohort experienced improvement in mean ± SD FEV₁ of 0.23 ± 0.38 L (<i>P</i> = .52) and mean ± SD reduction in residual volume by 0.78 ± 0.98 L (<i>P</i> = .085) 6 months after surgery, which was similar to the improvements in pre-multidisciplinary evaluation patients (<i>P</i> = .52 and <i>P</i> = .085, respectively). Of the 202 patients referred for bronchoscopic lung volume reduction, 28 patients underwent the procedure. Mean ± SD improvement in FEV₁ was 0.14 ± 0.18 L and mean ± SD reduction in residual volume was 0.68 ± 0.80 L (<i>P</i> = .002 and <i>P</i> = .001, respectively) at 6 months after the procedure. Most patients were not suitable candidates for lung volume reduction due to anatomical, physiologic, or phenotypical exclusions. Management was found to be optimal in the majority of patients who were not candidates for lung volume reduction (53.7%). A survey of meeting attendees indicated high confidence in managing these patients with a high likelihood of changing management decisions after multidisciplinary discussion. <b>Conclusions:</b> Most symptomatic advanced patients are not candidates for lung-volume-reduction interventions. There is an unmet need for novel therapeutic options in this population. The multidisciplinary evaluation consensus recommendations provide assurance and guidance to clinicians.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450068","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 Failure of an Auto-Substitution Protocol of Short-Acting Nebulizers for Long-Acting Inhalers to Reduce Cost of Care in a Quaternary Teaching Hospital.","authors":"Rina W Lee, Mark W Millard","doi":"10.1089/respcare.12385","DOIUrl":"10.1089/respcare.12385","url":null,"abstract":"<p><p><b>Background:</b> COPD is a common diagnosis driving in-patient admissions. A major component of in-patient COPD management involves nebulized or inhaled bronchodilators. In many hospitals, the in-patient pharmacy limits medication availability and may auto-substitute short-acting nebulized bronchodilators (SANBs) for long-acting inhalers (LAIs) to cut costs; the effect of such policy change on patient care is unknown. <b>Methods:</b> We performed a retrospective, observational study at a quaternary teaching hospital to analyze respiratory therapy utilization in subjects with COPD on home LAI, who were admitted between December 1, 2022-February 28, 2023. We compared resource utilization between the following groups: SANB only, LAI + as-needed SANB, and LAI + scheduled SANB. <b>Results:</b> We reviewed 302 admissions. There were 97 in SANB group, 99 in LAI + as-needed SANB group, and 106 admissions in LAI + scheduled SANB group. Subjects in LAI + as-needed SANB category utilized significantly fewer treatments overall than SANB or LAI + scheduled SANB groups (1.6/d vs 4.2/d vs 4.5/d, respectively, <i>P</i> < .001) and suffered fewer missed treatments (0.2/d vs 1.7/d vs 1.3/d, respectively, <i>P</i> < .001). There was no significant difference in the length of stay between the 3 groups. Furthermore, overall costs were lowest in LAI + as-needed SANB compared to the SANB and LAI + scheduled SANB groups ($117.62/admission vs $219.71/admission vs $375.35/admission, respectively, <i>P</i> < .001). Within the SANB group, we found that only 36.1% of admissions included orders that complied with the auto-substitution policy. <b>Conclusions:</b> In conclusion, for patients with COPD on home LAI admitted to the hospital, substituting scheduled SANB for LAI resulted in higher costs, more frequent treatment utilization, and more missed doses than the alternative regimens. Moreover, most scheduled SANB orders were not reflective of the actual auto-substitution policy.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450085","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":"Detecting Peripheral Airway Response in Exercise-Induced Bronchoconstriction: The Role of Impulse Oscillometry.","authors":"Kali McKnight, Michael W H Wong, Lung-Chang Chien, Craig Nakamura, Jason E Lang, Tony G Babb, Dharini M Bhammar","doi":"10.4187/respcare.11929","DOIUrl":"10.4187/respcare.11929","url":null,"abstract":"<p><p><b>Background:</b> Exercise-induced bronchoconstriction (EIB) is common in children with asthma, but whether it is a phenomenon of central versus peripheral airway reactivity is unknown. The purpose of this study was to investigate central and peripheral airway responses after an exercise challenge test among children with asthma. <b>Methods:</b> Sixteen children with asthma underwent exercise challenge testing on 2 separate visits: one without any medications (control) and another with pretreatment with 180 µg albuterol (bronchodilator). Central airway EIB was defined as a >10% reduction in FEV₁ after exercise assessed with spirometry. Peripheral airway EIB was assessed as a >40% increase in resistance between 5 Hz and 20 Hz with impulse oscillometry. Spirometry and impulse oscillometry were measured before the condition and periodically for up to 30 min after exercise. <b>Results:</b> Three of 16 children (19%) experienced only central airway EIB. Ten of 16 children (62%), including all 3 who experienced central airway EIB, experienced peripheral airway EIB. Among children who experienced EIB, resistance between 5 Hz and 20 Hz increased by 119.67 ± 102.56% after exercise during the control condition compared with an average decrease of -10.38 ± 34.97% during the bronchodilator condition, which suggests that albuterol was effective in preventing EIB (<i>P</i> = .003, paired <i>t</i> test). <b>Conclusions:</b> Peripheral airway EIB may occur frequently in children with asthma. Spirometry-based testing alone may miss peripheral airway EIB in some children. Impulse oscillometry could be used in conjunction with spirometry to detect peripheral airway EIB in children with asthma.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450009","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 Noninvasive Ventilation Nasal Mask Interface Pressure and the Inter-Individual Variation of Mask Placement.","authors":"Anne D Zakrajsek, Lissy Kesterson, Marty O Visscher, Vivek Narendran, Orlando S Hoilett, Eric A Nauman","doi":"10.4187/respcare.12217","DOIUrl":"10.4187/respcare.12217","url":null,"abstract":"<p><p><b>Background:</b> The 2014 American Academy of Pediatrics recommendation for CPAP as an alternative to mechanical ventilation for treatment of neonatal respiratory distress prompted a rapid shift to noninvasive respiratory support. Since most patients receive nasal bubble CPAP a concomitant increase in nasal pressure injuries followed. This prospective observational study aimed to develop strategies to reduce nasal mask pressure injury in neonates by (1) quantifying CPAP mask-interface pressure and (2) assessing placement variability. <b>Methods:</b> A micro-electromechanical systems pressure sensor was modified for contact pressure measurements with silicone embedding and calibrated. The CPAP generator and interface components were sized for a 24-week neonatal simulator. Thirteen neonatal ICU staff placed the simulator on CPAP at 6 cm H₂O and 8 L/min of flow with no humidification. Pressure was measured at 3 locations (the forehead, nasal bridge, and philtrum) in triplicate (3 measurements/site). Descriptive statistics; a location-specific, one-way analysis of variance with a Tukey post hoc test; and a 2-sample paired <i>t</i> test of the means of the first and last triplicate were performed. <b>Results:</b> Pressure ranged from 12-377.3 mm Hg. The mean [SD] interface pressure at the philtrum was significantly higher than both the nasal bridge and the forehead (philtrum 173.9 [101.3], nasal bridge 67.8 [28.9], and forehead 79.0 [36.9], <i>P</i> < .001). CPAP fixation varied, including bonnet placement, trunk angle, mask compression, use of hook and loop extenders, and level of vigorous bubble feedback achieved. <b>Conclusions:</b> This study developed a modified pressure sensor for quantifying the pressure exerted by a nasal mask on facial skin. Maximum pressures were higher than those previously reported. Inter-individual differences were present in both quantitative and qualitative measures of pressure. Reduction of NIV-associated pressure injuries may be achieved through NIV fixation technique training and improved nasal mask stability and size increments.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392830","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 Effect of Respiratory Therapist Case Managers Integrated into COPD Clinical Care.","authors":"Krystal M Craddock, Jimmy Nguyen, Michael Schivo, Samuel Louie, Nicholas J Kenyon, Brooks T Kuhn","doi":"10.1089/respcare.11728","DOIUrl":"10.1089/respcare.11728","url":null,"abstract":"<p><p><b>Background:</b> Personalized education and treatment selection can improve health behaviors and outcomes in patients with COPD. However, many patients with COPD have incomplete knowledge of their disease, which leads to undertreated symptoms. We hypothesized that an interdisciplinary care approach to COPD with respiratory therapists (RTs) integrated in our dedicated clinic will significantly affect care as measured by COPD Assessment Test (CAT) scores, exacerbation rates, and COPD-related hospitalizations. <b>Methods:</b> This study was a retrospective analysis of patients enrolled in the UC Davis Comprehensive COPD Clinic registry. Between January 2018-January 2020, 241 patients were seen. Patients screened (<i>n =</i> 101) had been followed 12 months post initial COPD clinic visit. Two subjects were excluded from analysis due to discrepancies in CAT assessments, leaving 99 subjects in total. The clinic RT provided assessment, education, and treatment recommendations. We collected CAT scores, exacerbation rates, and those that required hospitalization in the 12 months prior to and after the initial COPD clinic visit. Analysis for CAT is reported as median and interquartile range (IQR), with differences determined by Wilcoxon test. Summary data are reported as percentages, 95% CI, and chi-square test. <b>Results:</b> The initial median CAT score was 22 (IQR 7-34), and 2-month follow-up CAT median was 19 (IQR 11-24, <i>P</i> < .001). There were 115 exacerbations in the 12-month period prior to the initial clinic visit and 63 exacerbations in the 12 months post clinic visit (<i>P</i> = .006). In the 12-month period prior to the clinic visit, there were 44 hospital admissions for COPD exacerbations compared to 20 hospital admissions for COPD exacerbations in the 12 months after initial clinic visit (<i>P</i> = .06). <b>Conclusions:</b> Our retrospective study demonstrated significant improvements in symptoms and exacerbation rates and a non-significant reduction in hospitalizations for COPD. This suggests that an RT-facilitated program may improve meaningful clinical outcomes.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450078","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":"Comparison of Spontaneous Breathing Trials in Clinical Practice and Current Clinical Practice Guidelines.","authors":"Morgan E Sorg, Kristen L McHenry","doi":"10.1089/respcare.12478","DOIUrl":"10.1089/respcare.12478","url":null,"abstract":"<p><p><b>Background:</b> The literature suggests there is variability in the clinical practice of spontaneous breathing trials (SBTs). Evidence-based literature and clinical practice guidelines (CPGs) have been published over time to address various aspects of SBT implementation. It can take many years for evidence-based recommendations to be adopted into clinical practice. The American Association for Respiratory Care recently published a CPG addressing 4 aspects of SBT implementation. <b>Methods:</b> This study evaluated how the clinical practice of SBTs compares to the recommendations of the CPG. An online survey was developed to assess how hospitals with SBT protocols perform different components of SBTs. Descriptive statistics were used in the data analysis. <b>Results:</b> A total of 26 representatives from different health care institutions in the United States met the criteria for data analysis; 61.5% of reported protocols use rapid shallow breathing index, which is not in alignment with the current recommendation; 77% reported the use of pressure support (PS); 11.5% specified the use of a T-piece, and 11% specified the option of either PS or T-piece during the SBT. The responses were 100% in alignment with the current recommendation of performing a SBT with or without support; 73.1% aligned with having a standardized approach to performing SBTs by specifying when the SBT will be initiated; 65.4% perform an SBT during the day, though it was not specified if it occurs before noon each day; 53.8% allow for an increase in F_IO₂ during an SBT, which is not in alignment with the current recommendations. <b>Conclusions:</b> The reported hospitals' protocols demonstrated moderate alignment with the 4 CPG recommendations. Identifying current discrepancies between clinical practice and CPGs will allow for the assessment of the adoption of recommendations into clinical practice over time. Further assessment could be performed to determine if there is an impact on patient outcomes.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449987","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":"Classification of Patients Based on Dyspnea and Desaturation During Exercise in Interstitial Lung Disease.","authors":"Kohei Otake, Shogo Misu, Akio Yamamoto, Takumi Yamaguchi, Chisato Nagatani, Hideki Sakai, Masahiro Kaneko, Akira Ishikawa, Hiromi Tomioka","doi":"10.1089/respcare.11712","DOIUrl":"10.1089/respcare.11712","url":null,"abstract":"<p><p><b>Background:</b> Dyspnea and desaturation during exercise are essential assessment items for pulmonary rehabilitation. Characterizing patients using these 2 factors may be important for providing more effective pulmonary rehabilitation. This study aimed to categorize subjects with interstitial lung disease (ILD) using dyspnea and desaturation at the end of the 6-min walk test (6MWT). <b>Methods:</b> This was a retrospective study including 230 stable subjects with ILD who underwent 6MWT in our out-patient department at a general hospital in Japan. The modified Borg scale and oxygen saturation determined by S_pO₂ at the end of the 6MWT were used for cluster analysis using the <i>k</i>-means method with <i>k</i> = 4. <b>Results:</b> Subjects were classified into 4 characteristic clusters. S_pO₂ at the end of the 6MWT was lower in cluster 4 (80.5 ± 3.0%) than in clusters 1 (94.3 ± 2.0%), 2 (94.3 ± 1.9%), and 3 (87.9 ± 1.8%) and was lower in cluster 3 than in clusters 1 and 2. The modified Borg scale score at the end of the 6MWT was higher in clusters 2 (4 [3-8]), 3 (3 [0-9]), and 4 (4 [0-7]) than in cluster 1 (0.5 [0-2.0]) and was higher in cluster 2 than in cluster 3. <b>Conclusions:</b> Subjects with ILD were classified into 4 characteristic clusters using dyspnea and S_pO₂ at the end of the 6MWT. The 4 clusters are characterized as follows: Cluster 1 had mild desaturation and mild dyspnea; cluster 2 had mild desaturation and severe dyspnea; cluster 3 had both moderate desaturation and dyspnea, and cluster 4 had both severe desaturation and dyspnea. These classification data offer insight for individualized pulmonary rehabilitation for patients with ILD.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 1","pages":"56-64"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11824878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449843","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}