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Is "Optimized Recruitment" Really Worth the Effort? 优化招聘 "真的值得吗?
IF 2.4 4区 医学
Respiratory care Pub Date : 2024-11-18 DOI: 10.4187/respcare.12463
John J Marini
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引用次数: 0
A Pediatric Bench Model of Continuous Albuterol Delivery Using Heliox. 使用 Heliox 连续输送阿布特罗的儿科工作台模型。
IF 2.4 4区 医学
Respiratory care Pub Date : 2024-11-18 DOI: 10.4187/respcare.11713
Jie Li, Raghad R Abulkhair, Fai A Albuainain
{"title":"A Pediatric Bench Model of Continuous Albuterol Delivery Using Heliox.","authors":"Jie Li, Raghad R Abulkhair, Fai A Albuainain","doi":"10.4187/respcare.11713","DOIUrl":"10.4187/respcare.11713","url":null,"abstract":"<p><strong>Background: </strong>The optimal setup for continuously administering albuterol with heliox remains unclear, especially for pediatric patients. This study aimed to evaluate the efficiency of continuous albuterol delivery with heliox using different nebulizer setups in a pediatric model.</p><p><strong>Methods: </strong>A pediatric manikin with simulated spontaneous breathing was used to receive continuous albuterol (20 mg/h) with heliox (80/20) in 3 setups: (1) The MiniHEART nebulizer, driven by oxygen at 3 L/min, was attached to a Y-piece, linking to a non-rebreather mask and a valved reservoir with 11 L/min heliox; (2) a vibrating mesh nebulizer (VMN) placed at the humidifier inlet of high-flow nasal cannula (HFNC) with 11 L/min heliox and the manikin's mouth sealed; and (3) a VMN placed between a valved reservoir with 11 L/min heliox and a non-rebreather mask. Both tight-fitting and loose-fitting mask configurations were tested in the setup with vibrating mesh nebulizer and mask. Heliox of 70/30 was tested with a VMN and a loose-fitting mask. Albuterol was delivered continuously to the nebulizer via an infusion pump at 8 mL (20 mg)/h for each 20-min run and each experiment was repeated five times. A collecting filter placed between the manikin's trachea and lung model was removed after each run, and the drug was eluted and assayed via ultraviolet spectrophotometry (276 nm).</p><p><strong>Results: </strong>During continuous albuterol nebulization using heliox, the VMN either in line with HFNC or with a tight-fitting mask achieved the highest and similar inhaled dose (8.5 ± 0.4 vs 8.8 ± 0.7%, <i>P</i> = .35), while the MiniHEART nebulizer yielded the lowest aerosol deposition (1.5 ± 0.2%). The inhaled dose was lower with the loose-fitting mask than with the tight-fitting mask (5.9 ± 0.9 vs 8.8 ± 0.7%, <i>P</i> =.009), and heliox of 80/20 delivered a higher inhaled dose than heliox of 70/30 (5.9 ± 0.9 vs 3.9 ± 0.4%, <i>P</i> = .009).</p><p><strong>Conclusions: </strong>When administering continuous albuterol with heliox in a pediatric model, utilizing a VMN in line with HFNC during closed-mouth breathing yielded a higher inhaled dose compared to both the MiniHEART nebulizer and VMN with a loose-fitting mask.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1517-1522"},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976516","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}
引用次数: 0
Long-Term Disabilities in ICU Survivors of COVID-19. COVID-19重症监护室幸存者的长期残疾。
IF 2.4 4区 医学
Respiratory care Pub Date : 2024-11-18 DOI: 10.4187/respcare.12032
Karina Ramiceli Soares da Silva, Dimas Cavalheiro Prazeres, Silvia Gaspar, Felipe Granado de Souza, Luciana D Chiavegato, Camila Ferreira Leite, Shamyr Sulyvan de Castro, Carlos Rr Carvalho, Marcia S Volpe
{"title":"Long-Term Disabilities in ICU Survivors of COVID-19.","authors":"Karina Ramiceli Soares da Silva, Dimas Cavalheiro Prazeres, Silvia Gaspar, Felipe Granado de Souza, Luciana D Chiavegato, Camila Ferreira Leite, Shamyr Sulyvan de Castro, Carlos Rr Carvalho, Marcia S Volpe","doi":"10.4187/respcare.12032","DOIUrl":"10.4187/respcare.12032","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 is associated with prolonged disability, particularly after critical illness. This study aimed to assess and compare disability post-hospital discharge of subjects who were invasively ventilated versus those who were not, following ICU admission due to COVID-19. This study also explored variables associated with long-term disability.</p><p><strong>Methods: </strong>In this prospective cohort study, subjects with COVID-19 who received invasive ventilation, noninvasive ventilation, or high-flow nasal cannula during ICU stay were assessed with the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 at 3 and 6 months post-hospital discharge. Data were analyzed collectively and stratified as subjects with and without invasive mechanical ventilation. Analysis of variance and multiple regression analyses were applied.</p><p><strong>Results: </strong>The subjects (<i>N</i> = 43) were mainly male, middle age, and overweight. Subjects who were invasively ventilated (<i>n</i> = 21) had decreased physical function compared to those who were not during hospital assessments. From 3-6 months after discharge, all WHODAS domains and the overall score decreased in both groups (<i>P</i> < .001), indicating disability recovery. The participation domain, which assesses joining in society, was the only domain that remained worse in the ventilation group compared to the no ventilation group (<i>P</i> = .01). No interaction was found between time and the study groups, suggesting that the recovery trajectory was similar. At 6 months, considering the entire cohort, 70% and 56% had no disability in self-care and getting along domains, respectively, while 42% exhibited moderate to severe disability in the participation domain. According to the overall WHODAS score, 86% of subjects still had some level of disability at 6 months. In multivariate analyses, the overall WHODAS score along with the household and participation domains showed significant positive correlations, indicating higher disability, with corticosteroid use.</p><p><strong>Conclusions: </strong>Disability persisted at 6 month post-hospital discharge for ICU survivors of COVID-19, regardless of the need for invasive mechanical ventilation. Participation was the only domain that showed higher disability among those who received invasive ventilation.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1508-1516"},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506912","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}
引用次数: 0
Author Response: Let It Breathe: Mastering Spontaneous Breathing Trials. 作者回复:让它呼吸:掌握自发呼吸试验。
IF 2.4 4区 医学
Respiratory care Pub Date : 2024-11-18 DOI: 10.4187/respcare.12426
Karsten J Roberts, Lynda T Goodfellow, Corinne M Battey-Muse, Cheryl A Hoerr, Megan L Carreon, Timothy D Girard, Neil R MacIntyre, Dean R Hess
{"title":"Author Response: Let It Breathe: Mastering Spontaneous Breathing Trials.","authors":"Karsten J Roberts, Lynda T Goodfellow, Corinne M Battey-Muse, Cheryl A Hoerr, Megan L Carreon, Timothy D Girard, Neil R MacIntyre, Dean R Hess","doi":"10.4187/respcare.12426","DOIUrl":"10.4187/respcare.12426","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"69 12","pages":"1617-1618"},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668876","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}
引用次数: 0
Role of Alveolar-Arterial Difference in Estimation of Extravascular Lung Water in COVID-19-Related ARDS. 肺泡-动脉差异在估算 COVID-19 引起的 ARDS 中血管外肺水量中的作用
IF 2.4 4区 医学
Respiratory care Pub Date : 2024-11-18 DOI: 10.4187/respcare.11804
Martin Kutej, Jiri Sagan, Tereza Ekrtova, Hana Strakova, Marek Buzga, Michal Burda, Jan Maca
{"title":"Role of Alveolar-Arterial Difference in Estimation of Extravascular Lung Water in COVID-19-Related ARDS.","authors":"Martin Kutej, Jiri Sagan, Tereza Ekrtova, Hana Strakova, Marek Buzga, Michal Burda, Jan Maca","doi":"10.4187/respcare.11804","DOIUrl":"10.4187/respcare.11804","url":null,"abstract":"<p><strong>Background: </strong>The dominant feature of COVID-19-associated ARDS is gas exchange impairment. Extravascular lung water index is a surrogate for lung edema and reflects the level of alveolocapillary disruption. The primary aim was the prediction of extravascular lung water index by the alveolar-arterial oxygen difference. The secondary aims were in determining the relationship between the extravascular lung water index and other oxygenation parameters, the [Formula: see text], end-tidal oxygen concentration, pulmonary oxygen gradient ([Formula: see text] minus end-tidal oxygen concentration), and [Formula: see text].</p><p><strong>Methods: </strong>This observational prospective single-center study was performed at the Department of Anaesthesiology and Intensive Care, The University Hospital in Ostrava, The Czech Republic, during the COVID-19 pandemic, from March 20, 2020, until May 24, 2021.</p><p><strong>Results: </strong>The relationship between the extravascular lung water index and alveolar-arterial oxygen difference showed only a mild-to-moderate correlation (r = 0.33, <i>P</i> < .001). Other extravascular lung water index correlations were as follows: [Formula: see text] (r = 0.33, <i>P</i> < .001), end-tidal oxygen concentration (r = 0.26, <i>P</i> = .0032), [Formula: see text] minus end-tidal oxygen concentration (r = 0.15, <i>P</i> = .0624), and [Formula: see text] (r = -0.15, <i>P</i> = .01).</p><p><strong>Conclusions: </strong>The alveolar-arterial oxygen difference does not reliably correlate with the extravascular lung water index and the degree of lung edema in COVID-19-associated ARDS.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1548-1554"},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752566","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}
引用次数: 0
Optimal Postextubation Support in Critically Ill Patients: One Size Does Not Fit All. 重症患者拔管后的最佳支持:不能一刀切。
IF 2.4 4区 医学
Respiratory care Pub Date : 2024-11-18 DOI: 10.4187/respcare.12282
Marina García-de-Acilu, Armand Sellas, Gonzalo Hernandez, Oriol Roca
{"title":"Optimal Postextubation Support in Critically Ill Patients: One Size Does Not Fit All.","authors":"Marina García-de-Acilu, Armand Sellas, Gonzalo Hernandez, Oriol Roca","doi":"10.4187/respcare.12282","DOIUrl":"10.4187/respcare.12282","url":null,"abstract":"<p><p>Extubation is a crucial step in the weaning process of critically ill mechanically ventilated patients. Some patients may develop postextubation respiratory failure that may lead to the need for re-intubation, which is associated with increased morbidity and mortality. This review comprehensively explores postextubation respiratory support strategies, focusing on the efficacy of high-flow nasal cannula (HFNC) oxygen therapy and noninvasive ventilation (NIV) in reducing re-intubation rates among various patient populations. HFNC improves oxygenation and reduces the work of breathing. However, its effectiveness in preventing re-intubation varies according to the patient's characteristics and the predefined risk for re-intubation. NIV, alternatively, appears to provide substantial advantages in reducing the rates of re-intubation and respiratory failure, especially in patients with obesity and patients with hypercapnia. Therefore, the indiscriminate application of these support strategies without consideration of individual patient characteristics may not improve outcomes, highlighting the need for careful patient selection and tailored therapeutic strategies based on specific risk factors and clinical conditions. By aligning postextubation respiratory support strategies with patient-specific needs, we may improve the success rates of extubation, enhance overall recovery, and reduce the burden of reintubations in the intensive care setting.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1564-1572"},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352893","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}
引用次数: 0
Effect of Continuous Lateral Rotation Therapy on Clinical Outcomes in Mechanically Ventilated Critically Ill Adults. 机械通气重症成人持续侧旋疗法对临床疗效的影响
IF 2.4 4区 医学
Respiratory care Pub Date : 2024-11-18 DOI: 10.4187/respcare.11781
Anna Luísa A Brito, Amanda Caroline A Ferreira, Layane Santana P Costa, Emanuel Fernandes F Silva Júnior, Shirley Lima Campos
{"title":"Effect of Continuous Lateral Rotation Therapy on Clinical Outcomes in Mechanically Ventilated Critically Ill Adults.","authors":"Anna Luísa A Brito, Amanda Caroline A Ferreira, Layane Santana P Costa, Emanuel Fernandes F Silva Júnior, Shirley Lima Campos","doi":"10.4187/respcare.11781","DOIUrl":"10.4187/respcare.11781","url":null,"abstract":"<p><strong>Background: </strong>This Population, Intervention, Comparison, and Outcomes-guided systematic review assesses continuous lateral rotation therapy versus conventional position changes in mechanically ventilated critically ill adults, evaluating mortality, ICU length of stay (LOS), and hospital LOS as primary outcomes and respiratory function, mechanical ventilation duration, pulmonary complications, and adverse events as secondary outcomes.</p><p><strong>Methods: </strong>This systematic review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (International Prospective Register of Systematic Reviews CRD42022384258). Searches spanned databases MEDLINE/PubMed, Embase, Scopus, ScienceDirect, Cochrane, CINAHL, and Web of Science, without language or publication year restrictions. Inclusion criteria involved randomized controlled trials (RCTs) and quasi-randomized trials, comparing continuous lateral rotation therapy (intervention) with conventional position changes (control). Risk of bias and quality of evidence for RCTs were assessed using the Cochrane Collaboration and Grading of Recommendations Assessment, Development, and Evaluation tools. For the quasi-randomized trials, the Risk of Bias in Non-Randomized Studies-of Interventions tool was used.</p><p><strong>Results: </strong>In 18 studies with 1,466 participants (intervention, <i>n =</i> 700, 47.7%; control, <i>n =</i> 766, 52.2%), continuous lateral rotation therapy was predominantly used for prophylactic purposes, with protocols varying from 10-24 h/d. Meta-analysis (16 RCTs) favored continuous lateral rotation therapy for reduced mechanical ventilation duration (standardized mean difference [SMD] -0.17 [CI -0.29 to -0.04] d, <i>P</i> = .008) and lower nosocomial pneumonia incidence (odds ratio 0.39 [CI 0.29-0.52], <i>P</i> < .001). Continuous lateral rotation therapy showed no significant impact on mortality (odds ratio 1.04 [CI 0.80-1.34], <i>P</i> = .77), ICU LOS (SMD -0.11 [CI -0.25 to 0.02] d, <i>P</i> = .11), hospital LOS (SMD -0.10 [CI -0.31 to 0.11] d, <i>P</i> = .33), and incidence of pressure ulcers (odds ratio 0.73 [CI 0.34-1.60], <i>P</i> = .44).</p><p><strong>Conclusions: </strong>Continuous lateral rotation therapy showed no significant difference in primary outcomes (mortality, ICU and hospital LOS) but revealed significant differences in secondary outcomes (consistently reduced nosocomial pneumonia, with a minor effect on mechanical ventilation duration), supported by moderate certainty. Very low certainty for other outcomes highlights the need for current studies in diverse clinical settings and protocols to assess continuous lateral rotation therapy effectiveness.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1592-1606"},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922388","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}
引用次数: 0
A Survey of Cystic Fibrosis Center Recommendations for Nebulizer Cleaning and Disinfection. 囊性纤维化中心关于雾化器清洁和消毒建议的调查。
IF 2.4 4区 医学
Respiratory care Pub Date : 2024-11-18 DOI: 10.4187/respcare.11760
Zubin J Kenkare, Justin Rearick, Craig M Schramm, Thomas S Murray, Melanie S Collins
{"title":"A Survey of Cystic Fibrosis Center Recommendations for Nebulizer Cleaning and Disinfection.","authors":"Zubin J Kenkare, Justin Rearick, Craig M Schramm, Thomas S Murray, Melanie S Collins","doi":"10.4187/respcare.11760","DOIUrl":"10.4187/respcare.11760","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in cystic fibrosis (CF) therapeutics, the persistence of chronic infections necessitates continued use of nebulized therapies. Though the Cystic Fibrosis Foundation recommends well-defined cleaning and disinfection of nebulizers to mitigate pathogen exposure risks, discrepancies between Cystic Fibrosis Foundation guidelines, manufacturers' instructions, and variability in center recommendations contribute to confusion and non-standardized practices.</p><p><strong>Methods: </strong>A digital survey was distributed to directors, associate directors, and care coordinators of CF centers across the United States to investigate the methods, frequency, and educational practices surrounding nebulizer care they provide patients. Responses were analyzed using descriptive techniques and chi-square analyses.</p><p><strong>Results: </strong>Of 855 distributed surveys, 129 respondents provided insights into nebulizer care recommendations. Discrepancies in disinfection frequency were notable, with 18% of respondents recommending disinfecting nebulizers less than daily. Approximately 20% of respondents were unsure if their recommendations aligned with Cystic Fibrosis Foundation guidelines while 73% reported that their recommendations strictly adhered to the published guidelines. Of this 73%, all recommended at least daily cleaning, with 69% specifying cleaning before reuse; and 88% recommended disinfection at least daily, with 36% specifying disinfection before reuse. Only 10% recommended both cleaning and disinfection after every use. Disinfection less than daily was recommended by 11% of the respondents who felt they were strictly following the guidelines. We also highlight respondents who cited barriers to strict adhesion to the published guidelines.</p><p><strong>Conclusions: </strong>The highlighted variations in CF centers' recommendations for nebulizer care with deviations from Cystic Fibrosis Foundation guidelines underscore the necessity for developing clear and practical guidelines that consider both efficacy and the realities of patient adherence. Collaboration among CF care centers, patients, guideline committees, and other stakeholders is essential to develop recommendations that effectively address the challenges faced by the CF community, ensuring the safe and effective nebulizer use.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1543-1547"},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627531","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}
引用次数: 0
Respiratory Effects of Maximal Lung Recruitment Maneuvers Using Single-Breath Estimation in ARDS. 使用单次呼吸估算法对 ARDS 患者进行最大肺募集动作的呼吸影响
IF 2.4 4区 医学
Respiratory care Pub Date : 2024-11-18 DOI: 10.4187/respcare.11948
Amaury Lhermitte, Emilien Pugliesi, Damiano Cerasuolo, Augustin Delcampe, Antoine Cabart, Damien Du Cheyron, Jean-Luc Hanouz, Cédric Daubin
{"title":"Respiratory Effects of Maximal Lung Recruitment Maneuvers Using Single-Breath Estimation in ARDS.","authors":"Amaury Lhermitte, Emilien Pugliesi, Damiano Cerasuolo, Augustin Delcampe, Antoine Cabart, Damien Du Cheyron, Jean-Luc Hanouz, Cédric Daubin","doi":"10.4187/respcare.11948","DOIUrl":"10.4187/respcare.11948","url":null,"abstract":"<p><strong>Background: </strong>Determining which patients with ARDS are most likely to benefit from lung recruitment maneuvers is challenging for physicians. The aim of this study was to assess whether the single-breath simplified decremental PEEP maneuver, which evaluates potential lung recruitment, may predict a subject's response to lung recruitment maneuvers, followed by PEEP titration.</p><p><strong>Methods: </strong>We conducted a pilot prospective single-center cohort study with a 3-step protocol that defined sequential measurements. First, potential lung recruitment was assessed by the single-breath maneuver in the volume controlled mode. Second, the lung recruitment maneuver was performed in the pressure controlled mode, with a fixed driving pressure of 15 cm H<sub>2</sub>O and a maximum PEEP of 30 cm H<sub>2</sub>O. Third, the lung recruitment maneuver was followed by decremental PEEP titration to determine the optimal PEEP, defined as the lowest driving pressure. Responders to the lung recruitment maneuver were defined by an improvement in [Formula: see text]/[Formula: see text] > 20% between the baseline state and the end of the PEEP titration phase.</p><p><strong>Results: </strong>Forty-two subjects with moderate-to-severe ARDS were included. The mean ± SD lung recruitment was 149 ± 104 mL. A threshold lung recruitment of 195 mL (area under the receiver operator characteristic curve 0.62, 95% CI 0.43-0.80) predicted a positive response to the maximal lung recruitment maneuver. The lung recruitment maneuver, followed by PEEP titration, resulted in a modification of PEEP in 74% of the subjects. PEEP was increased in more than two thirds of the responders and decreased in almost half of the non-responders to the lung recruitment maneuver. In addition, a decrease in driving pressure and an increase in respiratory system compliance were reported in 62% and 67% of the subjects, respectively.</p><p><strong>Conclusions: </strong>The single-breath maneuver for evaluating lung recruitability predicted, with poor accuracy, the subjects who responded to the lung recruitment maneuver based on [Formula: see text]/[Formula: see text] improvement. Nevertheless, the lung recruitment maneuver, followed by PEEP titration, improved ventilator settings and respiratory mechanics in a majority of subjects.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1499-1507"},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506913","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}
引用次数: 0
2023 Year in Review: High-Flow Nasal Cannula for COVID-19. 2023 年回顾:用于 COVID-19 的高流量鼻导管。
IF 2.4 4区 医学
Respiratory care Pub Date : 2024-11-18 DOI: 10.4187/respcare.12580
Michael D Davis
{"title":"2023 Year in Review: High-Flow Nasal Cannula for COVID-19.","authors":"Michael D Davis","doi":"10.4187/respcare.12580","DOIUrl":"10.4187/respcare.12580","url":null,"abstract":"<p><p>COVID-19, caused by SARS-CoV-2 infection, led to a pandemic of acute respiratory illness that is ongoing. High-flow nasal cannula (HFNC) is a commonly used form of respiratory support during acute respiratory distress and is used to treat patients with COVID-19 in many centers. Due to the novel nature of COVID-19 at the onset of the pandemic, evidence to support the use and best practices of HFNC for treating patients with COVID-19 was lacking. This is a review of key peer-reviewed manuscripts from 2022-2023 discussing the efficacy and best practices for using HFNC for patients with COVID-19. Efficacy of HFNC for COVID-19, the use of the respiratory oxygenation index to guide HFNC for COVID-19, and concerns of generated/fugitive aerosols when using HFNC for COVID-19 are emphasized.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"69 12","pages":"1587-1591"},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668841","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}
引用次数: 0
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