Respiratory care最新文献

{"title":"Predictors of Retention and Sustained Engagement With a 12-Month Asthma Self-Management App in Underserved Adults.","authors":"Serena Zhang, Atiq M Ahsan, Rishab Agarwal, Katherine H Han, Samuel Green, Jonathan M Feldman, Marina Reznik, Zhaoyuan Su, Kai Zheng, Sunit P Jariwala","doi":"10.1177/19433654261444702","DOIUrl":"10.1177/19433654261444702","url":null,"abstract":"<p><strong>Background: </strong>Long-term retention and engagement with digital asthma self-management tools remain challenging in underserved adults. We examined predictors of study dropout and sustained engagement with ASTHMAXcel PRO, an asthma self-management mobile health app, over 12 months in an underserved adult population.</p><p><strong>Methods: </strong>In this randomized controlled trial, adults with asthma who were on daily controller medications were recruited from 3 Bronx primary care clinics and randomized 1:1 to intervention (ASTHMAXcel PRO plus standard care) or control (standard care alone). Baseline questionnaires collected demographic, clinical (eg, asthma control, exacerbation history, and comorbidity), and health literacy data. Attrition was analyzed using Cox proportional hazards models. Engagement metrics in the intervention arm (logins, chapters read, and subject-reported outcomes) were evaluated with negative binomial mixed models, adjusting sequentially for sociodemographic and clinical covariates.</p><p><strong>Results: </strong>Among 99 participants (77% female; 97% non-White), 39 (39%) dropped out before the fourth study visit. Study dropout was associated with some college or technical education versus high school or less (hazard ratio [HR] 2.11, 95% CI 1.01-4.42, <i>P</i> = .048), assignment to the intervention versus control group (HR 2.11, 95% CI 1.05-4.24, <i>P</i> = .036), and the presence of at least 1 comorbidity (HR 2.14, 95% CI 1.12-4.09, <i>P</i> = .02). Engagement declined over time but was strongly predicted by higher early app use (logins incidence rate ratio [IRR] 40.95; chapters read IRR 7.23; subject-reported outcomes IRR 15.35; all <i>P</i> < .001). Higher educational attainment was also associated with greater sustained engagement across multiple metrics.</p><p><strong>Conclusions: </strong>In this urban underserved cohort, comorbidities and some college/technical education predicted dropout, whereas greater early app use and higher education predicted sustained engagement. These findings highlight the importance of early identification of participants at risk of dropout to enable targeted retention strategies that support sustained self-management behaviors critical to asthma outcomes.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1131-1142"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869374","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 in Subjects Undergoing Endoscopy With Intravenous Sedation.","authors":"Christian Rouphael, Elie Saliba, Marc Moukarzel, Thuraya HajAli, Nicole Saliba, Nizar El Bcherawi, Yasser Shaib, Patrick Maroun, Boudy Roukos, Mohamad El-Khatib","doi":"10.1177/19433654261445979","DOIUrl":"10.1177/19433654261445979","url":null,"abstract":"<p><strong>Background: </strong>High-flow nasal cannula (HFNC) is a noninvasive oxygenation method that delivers humidified and heated oxygen mixtures at high flows while generating a low level of PEEP. Therefore, its use during endoscopic procedures with intravenous deep sedation may help maintain airway patency and oxygenation. This study aims to compare the incidence of reductions in oxygen saturation in subjects receiving HFNC at different flows with that in subjects receiving conventional oxygen therapy during endoscopic retrograde cholangiopancreatography (ERCP). Secondary outcomes include the lowest observed S_pO₂, snoring scores, and satisfaction levels of both subjects and gastroenterologists.</p><p><strong>Methods: </strong>This single-center randomized trial included 60 subjects undergoing ERCP with deep intravenous sedation in the left lateral decubitus position and randomized into 1 of 3 groups Group 0 received 5 L/min of oxygen via nasal cannula, resulting in an F_IO₂ of ∼0.40; Group 1 received HFNC at a flow of 15 L/min and an F_IO₂ of 0.40; and Group 2 received HFNC at a flow of 60 L/min and an F_IO₂ of 0.40. S_pO₂ values were obtained at each 1-min interval from the beginning until the end of anesthesia.</p><p><strong>Results: </strong>The incidence of falls in oxygen saturation and the lowest S_pO₂ during the procedure were not different among the 3 groups. However, the average S_pO₂ throughout the procedure was significantly greater in Group 1 (99.2 ± 0.2%) and Group 2 (99.6 ± 0.3%) than in Group 0 (97.4 ± 0.3%, both <i>P</i> < .001), with no difference between Groups 1 and 2 (<i>P</i> = .26). No significant differences were observed in the duration of procedures, snoring classification scores, and gastroenterologist and subject satisfaction levels among the 3 groups.</p><p><strong>Conclusions: </strong>In low-risk subjects undergoing ERCP, oxygen therapy with HFNC with an F_IO₂ of 0.40 did not reduce the rate of oxygen saturation reductions or the lowest measured oxygen saturation compared with standard low-flow oxygen cannula at 5 L/min.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1115-1122"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway Secretion Volume and Physiological Effects of High-Flow Nasal Cannula in Acute Respiratory Failure Caused by Bronchiectasis.","authors":"Nicolás Colaianni-Alfonso, Guillermo Montiel, Catalina Siroti, Mauro Castro-Sayat, Luigi Vetrugno, Claudia Crimi","doi":"10.1177/19433654261437778","DOIUrl":"10.1177/19433654261437778","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory failure (ARF) in bronchiectasis is frequently accompanied by excessive airway secretions. High-flow nasal cannula (HFNC) delivers heated, humidified gas and may improve respiratory mechanics, but quantitatively measured secretion burden during HFNC in bronchiectasis-related ARF is poorly described.</p><p><strong>Methods: </strong>We conducted a prospective, single-center pilot cohort study in a respiratory intermediate care unit including adults with computed tomography-confirmed bronchiectasis admitted with ARF and treated with HFNC as first-line therapy. The primary outcome was cumulative secretion volume (operationally defined as supervised collection of expectorated sputum, with measures to minimize saliva contamination) during the first 3 days of HFNC exposure. Physiologic variables, gas exchange, dyspnea, and clinical outcomes were assessed descriptively.</p><p><strong>Results: </strong>Twenty-six subjects were enrolled (median age 67 years, 54% female), predominantly with moderate-to-severe bronchiectasis. Median cumulative secretion volume over 72 h was 510 mL (436-743), and daily secretion volume increased from Day 1 to Day 3 (<i>P</i> < .001). Breathing frequency, oxygenation, dyspnea (Borg scale), and selected gas-exchange variables changed significantly over time. No subject required escalation to noninvasive ventilation or endotracheal intubation. In-hospital mortality was 11.5% (3/26), occurring exclusively in subjects with preestablished do-not-intubate directives.</p><p><strong>Conclusions: </strong>In this pilot cohort of bronchiectasis-related ARF, structured quantification of secretion volume during HFNC was feasible and documented a large early secretion burden over 72 h. Given the uncontrolled design, these findings are descriptive and should not be interpreted as evidence of treatment effect.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1095-1101"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779621","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":"Development and Validation of the Respiratory Secretion Scale (RESES) in Mechanically Ventilated Patients.","authors":"Gabriela Ferrari, Jéssica Magnante, Laura Maito Mantelli, Alana Cristina Gonçalves, Rafhaela Mocelin, Polyana Karla Belotto, Roberta Fleck Bazzo, Gustavo Bruno Rático, Silvano Altair do Nascimento, Wan Cley Rabuske, Luis Felipe da Fonseca Reis, Diego de Carvalho, Antuani Rafael Baptistella","doi":"10.1177/19433654261447876","DOIUrl":"10.1177/19433654261447876","url":null,"abstract":"<p><strong>Background: </strong>Respiratory secretions are a common complication in patients receiving invasive mechanical ventilation, yet no validated tool is available to classify secretion type and amount in this setting.</p><p><strong>Methods: </strong>We conducted a prospective study in 2 mixed ICUs in southern Brazil (January 2022-January 2024). Adult patients intubated for >24 h and requiring suctioning were eligible. Secretions were collected during routine suctioning, photographed, and classified using the newly developed Respiratory Secretion Scale (RESES). The scale categorizes secretions into 7 types (mucoid, mucopurulent-1, mucopurulent-2, purulent, bloody-mucoid, bloody, bloody-purulent) and 3 amounts (small, medium, large). Inter-observer reliability was evaluated using Cohen's kappa. Associations between secretion characteristics and clinical variables were analyzed using chi-square, <i>t</i> test, analysis of variance (ANOVA) test, and multinomial logistic regression.</p><p><strong>Results: </strong>Among 70 subjects included in the validation phase, inter-observer agreement was excellent (kappa type = 0.87; amount = 0.85; combined = 0.82). In 398 subjects analyzed for clinical associations, purulent and bloody-mucoid secretions were more frequent among nonsurvivors, whereas mucoid secretions predominated among survivors <i>(P</i> = .03). Large secretion amounts were associated with respiratory disease, pulmonary infection focus, and longer duration of mechanical ventilation (all <i>P</i> < .05). In the multinomial logistic regression, the diagnosis and the pulmonary infection focus remained significantly associated with both secretion type (Relative Risks [RR] = 1.28, 95% CI: 1.05-1.56, <i>P</i> = .02; RR = 1.55, 95% CI: 1.12-2.14, <i>P</i> = .008, respectively) and amount (RR = 1.62, 95% CI: 1.08-2.44, <i>P</i> < .02; RR = 1.71, 95% CI: 1.09-2.68, <i>P</i> = .02, respectively), although chest imaging with consolidation was associated only with secretion amount (RR = 1.05, 95% CI: 1.01-1.09, <i>P</i> < .007).</p><p><strong>Conclusions: </strong>The RESES is a simple, visual tool that standardized secretion assessment in mechanically ventilated subjects, improving clinical communication and providing a foundation for future research.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1069-1077"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942747","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":"Implementation of a Respiratory Therapy-Driven Alpha-1 Testing Program in a Rural Setting.","authors":"Julie Mayne, Aryaman Sriram, Leonard Riley, Heather Hicks","doi":"10.1177/19433654261453036","DOIUrl":"10.1177/19433654261453036","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1153-1155"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway Secretions During Mechanical Ventilation: What We See, What We Measure, and What We Still Do Not Know.","authors":"George Ntoumenopoulos","doi":"10.1177/19433654261478397","DOIUrl":"10.1177/19433654261478397","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1191-1194"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808918","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":"In Vitro Study of Nebulizer Position Effects on Colistimethate Sodium Administration, Drug Deposition, and Filter Pressure Drop in Mechanical Ventilation.","authors":"Meng-Fang Wu, Meng-Jer Hsieh, Yin-Chi Wu, Ming-Hui Chen, Wei-Ren Ke, Hui-Ling Lin","doi":"10.1177/19433654261445030","DOIUrl":"10.1177/19433654261445030","url":null,"abstract":"<p><strong>Background: </strong>Colistimethate sodium (colistin) is increasingly being administered as aerosol therapy in mechanically ventilated patients. Although vibrating-mesh nebulizers (VMNs) are commonly used, the impact of repeated high-dose colistin administration on expiratory filter loading and circuit pressure drop has not been well defined. This study evaluated circuit deposition patterns and changes in expiratory filter pressure drop according to the nebulizer position.</p><p><strong>Methods: </strong>A ventilator with adult settings and heated humidification was connected to an endotracheal tube and test lung. A VMN was positioned either at the Y-adapter or at the humidifier inlet. Two colistin vials (160 mg each) were diluted in 6 mL of saline and nebulized. Fourteen treatments were administered over 7 days in 5 independent experiments per group (no. <i>=</i> 5). Drug deposition was quantified by high-performance liquid chromatography. Pressure drop, defined as the difference between upstream and downstream pressure across the expiratory high-efficiency particulate air filter, was measured over repeated administrations and analyzed using a mixed repeated-measures model.</p><p><strong>Results: </strong>The nebulizer position significantly altered deposition within the ventilator circuit. Placement at the Y-adapter resulted in greater exhalation valve deposition (28.35 ± 4.83 mg vs 5.83 ± 1.51 mg, <i>P</i> < .001) and increased pressure drop over time. A significant time-by-position interaction was observed (<i>P</i> = .01), with higher pressure drop after 14 treatments. In contrast, humidifier-inlet placement was associated with greater drug accumulation within the humidifier chamber (35.59 ± 6.21%) and a smaller increase in pressure drop.</p><p><strong>Conclusions: </strong>During repeated high-dose colistin administration, the nebulizer position influenced circuit deposition patterns and expiratory filter pressure drop. Placement at the Y-adapter was associated with greater expiratory limb deposition and increased filter pressure drop over time, whereas humidifier-inlet placement shifted the drug accumulation proximally within the circuit.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1123-1130"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869378","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":"Carbon Dioxide During First-Intention High-Frequency Jet Ventilation: A Narrow Therapeutic Window.","authors":"Adanna Nwaneri, C Michael Cotten, Kevin Williams","doi":"10.1177/19433654261459022","DOIUrl":"10.1177/19433654261459022","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1195-1197"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148302873","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":"Editor's Commentary October 2026.","authors":"","doi":"10.1177/19433654261484108","DOIUrl":"10.1177/19433654261484108","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"71 10","pages":"i-iii"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128163","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":"Laryngeal Mask Airway: An Underutilized Option for Neonatal Resuscitation.","authors":"Steven Conlon, Ibrahim Sammour","doi":"10.1177/19433654261471809","DOIUrl":"10.1177/19433654261471809","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1198-1199"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713548","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}