Respiratory care最新文献

{"title":"Respiratory Therapy Leaders' Perceptions of Value of Respiratory Care Services.","authors":"Andrew G Miller, Katlyn L Burr, John S Emberger, Carl R Hinkson, Cheryl A Hoerr, Jerin Juby, Karsten J Roberts, Brian J Smith, Shawna L Strickland, Kyle J Rehder","doi":"10.4187/respcare.12144","DOIUrl":"10.4187/respcare.12144","url":null,"abstract":"<p><p><b>Background:</b> Respiratory care departments are experiencing an increased need to demonstrate value in the care they deliver. Value efficiency is a concept that incorporates the value of individual treatments into the normal operations of a department. The purpose of this study was to describe respiratory care leaders' attitudes about the value of services provided by respiratory care departments. <b>Methods:</b> An electronic survey was distributed via social media, professional networks, and a manager work group. The survey was targeted to directors, managers, and supervisors of respiratory care departments. We asked questions related to value, services, and barriers to implementation of value efficiency. Data analysis was descriptive. <b>Results:</b> We received 116 responses; 86% were from managers or directors. The 5 most valuable services delivered were invasive mechanical ventilation (82%), noninvasive ventilation or CPAP (71%), protocol-driven care (47%), code team (44%), and rapid response team (41%). The 5 least valuable services delivered by respiratory care departments were electrocardiograms (63%), stress testing (44%), lung expansion therapies (41%), sleep studies staffed by the respiratory care department (36%), and smoking cessation education (36%). The primary barrier to value efficiency was physician prescribing practices (68%). There was general agreement that physicians support respiratory therapy protocols (71%), value should be considered when evaluating respiratory care services (95%), and directing resources to more valuable services if possible (73%). Respondents did not agree that hospital administrators understand respiratory therapy workflow and full-time equivalent needs (35%) nor that hospital administrators would be supportive if we reduced services (18%). <b>Conclusions:</b> In a small sample of respiratory therapy leaders, there was limited consensus on what respiratory care services are the most and least valuable. Lack of consensus on high- and low-value services and physician prescribing practice were the primary barriers to value efficiency. Nearly all respondents felt value should be considered when evaluating respiratory care services.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"287-297"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676748","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":"Anesthetic Gas Scavenging System for Gas Evacuation in the ICU.","authors":"Lucie Collet, Mona Assefi, Jean-Michel Constantin","doi":"10.4187/respcare.11662","DOIUrl":"10.4187/respcare.11662","url":null,"abstract":"<p><p><b>Background:</b> Inhaled sedation is increasing in ICUs, with active carbon filters (ACFs) commonly used for evacuating halogenated gases. However, the potential benefits of a waste anesthetic gas system (WAGS) similar to the ones used in operating rooms should be explored. To limit the suction over the flow sensor where the WAGS is connected on ICU ventilators, an anesthetic gas receiving system (AGRS) is required, constituting with the WAGS an active gas receiving and scavenging system (AGRSS). Ensuring that this whole device does not compromise the flow sensor reliability is crucial. The aim of this study was to compare various gas evacuation devices and assess the reliability of AGRSS on ICU ventilators. <b>Methods:</b> In this experimental study, pressures and flows were recorded during the ventilation of a test lung using various ventilator settings and gas evacuation methods: no device (reference condition), ACF, the WAGS alone, AGRSS (WAGS and AGRS together), and the expiratory valve connected to the medical vacuum system with the AGRS in between. Visual comparisons of the pressure and flow curves followed by a statistical analysis comparing median pressures and flows of each device to the reference were performed. <b>Results:</b> The test lung model demonstrated consistent comparability in pressures and flows among all devices, except for the WAGS alone, which exhibited discordance through significant overestimation or underestimation. <b>Conclusions:</b> These findings indicate that using a WAGS with the AGRS system appeared to be reliable for managing gas evacuation in ICUs without compromising pressure or flow delivery. The data from this experimental trial should be confirmed with clinical studies involving human subjects. Given the increasing use of inhaled sedation in ICUs, these results support the daily application of the WAGS with the AGRS for gas evacuation, similar to its established use in anesthesiology.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"304-312"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506909","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":"Respiratory Residency: Establishing Excellence for the Newly Licensed Respiratory Therapist.","authors":"Jessica L Patel, Carly A Grzehowiak, Laura O Douglas, Anna D Dunahoe, Jody Y Collins, Angela R Cushman, Heidi E Gilroy","doi":"10.4187/respcare.12108","DOIUrl":"10.4187/respcare.12108","url":null,"abstract":"<p><p><b>Background:</b> Workforce issues have highlighted the fact that newly graduated respiratory therapists (RTs) need more support during their transition to practice; however, there are few data on best practices for RT residency programs. <b>Methods:</b> The aim of this project was to evaluate the feasibility and effectiveness of a residency program for licensed RTs with < 1 y of experience post graduation. The approach to improve new graduate transition to practice included a streamlined clinical-based orientation, didactic learning, evidence-based practice plan, and incorporated simulation. Data were collected in a secure electronic database at a multi-campus health care system utilizing anonymous questionnaires. The participants responded to questions about demographic information, overall confidence, clinical skills, and knowledge base topic confidence. <b>Results:</b> Participant responses reported an increase in their overall factor score measures for role confidence, clinical skills, and knowledge-based topics. <b>Conclusions:</b> The collected responses showed an increase in a wide range of clinical skills and other soft skills. These results indicate that a respiratory care residency program adds value to the training, overall well-being, and retention of the newly graduated RT.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"268-277"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506914","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":"Investigating Dose Level and Duration of Rehabilitation of Mechanically Ventilated Patients in the ICU.","authors":"Shinichi Watanabe, Keibun Liu, Yoshie Hirota, Yuji Naito, Naoya Sato, Shunsuke Ishii, Hiroyoshi Yano, Ryota Ogata, Yasuki Koyanagi, Daisetsu Yasumura, Kota Yamauchi, Keisuke Suzuki, Hajime Katsukawa, Yasunari Morita, Matthias Eikermann","doi":"10.1089/respcare.12122","DOIUrl":"10.1089/respcare.12122","url":null,"abstract":"<p><p><b>Background:</b> The dose level and duration needed for early rehabilitation of mechanically ventilated patients in the ICU need to be characterized. Therefore, this study aimed to assess the association between mobilization level, rehabilitation time, and dose (defined as the mean mobilization quantification score [MQS]) during ICU admission and the end point walking independence at hospital discharge in subjects needing ICU admission. <b>Methods:</b> This prospective, multi-center, cohort study included 9 ICUs. Consecutive subjects admitted to the ICU between September 2022-March 2023 receiving mechanical ventilation for >48 h were included in the study. The mean MQS score, highest ICU mobility score (IMS) during the ICU stay, time to the first mobilization day, ICU rehabilitation time (minutes of each rehabilitation physical activity from start to finish), frequency/d, baseline characteristics, and walking independence at hospital discharge were assessed. <b>Results:</b> Among the 116 subjects, 64 did and 51 did not walk independently at hospital discharge, respectively. Multiple logistic regression analysis revealed that the mean MQS and time to first mobilization were significantly associated with walking independence at hospital discharge. We observed that mean MQS was better than IMS, rehabilitation time, frequency, and time to first mobilization predicted walking independence based on receiver operating characteristic (ROC) curve comparison. Comparison of the mean MQS with that on the first mobilization day revealed superior predicting power of the mean MQS. The ROC curve cutoff value for the mean MQS was 4.0. <b>Conclusions:</b> This study shows that in subjects mechanically ventilated for >48 h the dose of rehabilitation calculated using the mean MQS during ICU was a better predictor of walking independence at hospital discharge than intensity, duration, or frequency of the mobilization therapy. Mean MQS during ICU stay may be used to measure and titrate optimal mobilization therapy.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"278-286"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Positive Expiratory Pressure Device on Gas Exchange, Atelectasis, Hemodynamics, and Dyspnea in Spontaneously Breathing Critically Ill Subjects.","authors":"Raffaella Bellini","doi":"10.1089/respcare.12787","DOIUrl":"10.1089/respcare.12787","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"352-354"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450017","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":"Accuracy of Real-Time Data Provided by Mechanical Insufflation-Exsufflation Devices.","authors":"Roberto Martínez-Alejos, Emeline Fresnel, Alice Vuillermoz, François Beloncle, Marius Lebret","doi":"10.4187/respcare.12221","DOIUrl":"10.4187/respcare.12221","url":null,"abstract":"<p><p><b>Background:</b> Mechanical insufflation-exsufflation (MI-E) is crucial to assist patients with impaired cough, especially those with neuromuscular diseases. Despite recent advancements that enable real-time display of peak expiratory flow (PEF) and inspiratory volume, accurately monitoring these parameters with MI-E devices during treatment can still present challenges. <b>Methods:</b> A bench study that used a mechanical lung connected to 3 MI-E devices (EOVE-70; E-70 and Comfort Cough II) was conducted to evaluate PEF and inspiratory volume monitoring accuracy. Two clinical conditions were tested, low and normal compliance, with 6 different MI-E settings tested: +20/-20, +30/-30, +40/-40, +40/-50, +40/-60, and +40/-70 cm H₂O. PEF (L/min) and inspiratory volume (mL) displayed on the screen were recorded cycle by cycle, while a pneumotachograph connected to the mechanical lung was used to measure the actual PEF and inspiratory volume for data comparison. Flow bias was assessed by calculating the difference (PEF - peak inspiratory flow) and ratio (PEF to peak inspiratory flow) between flows. <b>Results:</b> All devices systematically underestimated PEF, with device A showing the smallest estimation error (-7.4 [-10.1; -6] %). Devices B and C exhibited larger errors (-26.5 [-29.2; -25.6] and (-29.9 [-30.7; -28.7] %, respectively). All the devices underestimated inspiratory volume, with device B showing the smallest estimation error (-15.1 [-21.2; -12.3] %). Device A exhibited a significantly larger error (-26.9 [-30.3; -24.8] %). The error from device C (-17.7 [-34.5; -13.8] %) was not statistically different from device B. Device type, high pressure settings (>+40/-40 cm H₂O), and a lung model compliance of 60 mL/cm H₂O were the main contributors to error in estimating PEF and inspiratory volume. Finally, we observed differences of PEF-to-peak inspiratory flow ratio and PEF minus peak inspiratory flow differences achieved. <b>Conclusions:</b> Our study highlighted consistent underestimation of PEF and inspiratory volume across MI-E devices. Improving device monitoring is essential for guiding MI-E therapy and ensuring patient safety.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"313-318"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547131","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 Convenience of Online Surveys Versus the Science of Quality Improvement.","authors":"Lynda T Goodfellow","doi":"10.1089/respcare.12604","DOIUrl":"https://doi.org/10.1089/respcare.12604","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 3","pages":"355-356"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543303","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":"Improving Outcomes for Patients With Tracheostomy Through Implementation of AARC Clinical Practice Guidelines.","authors":"Candice J Devlin, Rory S O'Bryan, Hope Williams, Kellie M Capes, Tiffany McCants, Eric Schoolcraft","doi":"10.4187/respcare.12080","DOIUrl":"10.4187/respcare.12080","url":null,"abstract":"<p><p><b>Background:</b> The COVID-19 global pandemic dramatically increased our institution's tracheostomy census. Comparing our existing protocols with American Association for Respiratory Care (AARC) January 2021 clinical practice guideline (CPG) relevant to caring for adult patients with tracheostomy in the acute care setting revealed numerous opportunities for improving our care of those patients. We assembled an interdisciplinary tracheostomy team to implement AARC CPG recommendations and manage all patients with tracheostomy in our hospital. <b>Methods:</b> We examined the effect our interdisciplinary team approach and implementation of AARC CPG recommendations had on the following metrics: average patient length of stay (LOS); ICU LOS; percentage of ventilator days; percentage of tracheostomy mask days; tracheostomy tube changes; decannulations; average time to decannulation; mortality; 30-d readmissions; and consultations for speech-language pathology (SLP), one-way speaking valves, physical therapy, and occupational therapy. <b>Results:</b> A total of 203 subjects with tracheostomy were followed in a quality improvement study from June 2019-June 2023 (94 in the pre-intervention group, 109 in the post group). There were significant increases between before and after intervention groups in percentage of decannulations in acutely patients with tracheostomy/not present on admission, non-COVID subjects who survived hospitalization (11.8% vs 33.3%, <i>P</i> = .043), percentage of SLP consults (53.2% vs 89.0%, <i>P</i> < .001), and percentage of one-way speaking valve consults (17.0% vs 32.1%, <i>P</i> = .02). <b>Conclusions:</b> Establishment of an interdisciplinary tracheostomy team and implementation of AARC CPG recommendations for care of adult patients with tracheostomy in the acute care setting resulted in positive, statistically significant outcomes.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"243-248"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627002","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.","authors":"","doi":"10.1089/respcare.70031.ec","DOIUrl":"https://doi.org/10.1089/respcare.70031.ec","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 3","pages":"i-ii"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543251","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":"New Methods for Evaluating Passive Humidifiers Highlight Problems With Current ISO Standards.","authors":"François Lellouche","doi":"10.1089/respcare.12623","DOIUrl":"10.1089/respcare.12623","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"359-361"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450069","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}