Respiratory care最新文献

{"title":"Respiratory Therapists as Primary Disease Managers.","authors":"Brian W Carlin","doi":"10.1089/respcare.12910","DOIUrl":"10.1089/respcare.12910","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"458-459"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aerosol Generation During Spirometry and Simulated Bronchodilator Challenge Testing in the Pulmonary Function Laboratory.","authors":"Cameron G Gmehlin, Pavol Sajgalik, Matthew E Hainy, Chul-Ho Kim, Bruce D Johnson, Thomas G Allison, Kaiser Lim, Alexander S Niven","doi":"10.1089/respcare.12506","DOIUrl":"10.1089/respcare.12506","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"446-449"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449927","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":"Review of Ventilation in Traumatic Brain Injury.","authors":"Ellen R Becker, Gregory C Wetmore, Michael D Goodman, Dario Rodriquez, Richard D Branson","doi":"10.1089/respcare.12796","DOIUrl":"10.1089/respcare.12796","url":null,"abstract":"<p><p>Acute brain injury is a prominent admitting diagnosis of critically ill patients, often requiring endotracheal intubation to protect the airway and resulting in respiratory failure and the need for mechanical ventilation. Following brain injury, a primary focus is avoidance of secondary insults including both hypercarbia and hypoxemia. Hyperoxemia may also result in unanticipated neurologic consequences. Brain-lung crosstalk refers to complex relationships that drive iatrogenic injury in both organs, mediated by inflammation, immunosuppression, and autonomic dysfunction. In an effort to further reduce secondary brain injury, care must be taken from time of intubation to extubation to preserve cerebral blood flow and adequate oxygen delivery. This review describes timing and methodology for intubation of a patient with brain injury, the controversies and current recommendations related to mechanical ventilation settings, and the difficulty of decision-making with extubation and tracheostomy.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"450-457"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543283","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":"Graduate Students' Perspectives on Obtaining a Master's of Science in Respiratory Care.","authors":"Megan S Koster, Kristen L McHenry, Benjamin G Caldwell-Chadwick, Megan M Null","doi":"10.1089/respcare.11570","DOIUrl":"https://doi.org/10.1089/respcare.11570","url":null,"abstract":"<p><p><b>Background:</b> There has been a push toward degree advancement throughout respiratory care (RC), with many academic institutions creating graduate-level programs. However, many practitioners are apprehensive about advancing their degrees past the entry-into-practice level. Little research exists regarding the benefits of a graduate-level degree in RC. <b>Methods:</b> A web-based survey was developed to identify the perceived benefits of completing a master's of science in RC (MSRC) program. Graduates from 7 MSRC programs were asked to identify how efficacious the program was in preparing them for new or expanded roles, what types of financial support were received, whether there exists a financial benefit to obtain the degree, and whether the degree supported professional advancement. Two hundred ninety-nine graduates were invited to complete the anonymous web-based survey. One hundred one surveys were initiated, and 98 (32.8%) responses were analyzed. <b>Results:</b> Seventy-two percent of respondents indicated personal motivation for pursuing a graduate-level degree as well as a desire to stay in the field; 89% of respondents indicated that the program prepared them to assume new or expanded roles, and 58% had experienced advancement. Forty-five percent of respondents did not receive tuition reimbursement for degree advancement, and 88% did not receive any scholarship support toward the degree. Finally, graduates reported an average increase in salary of approximately $12,000. <b>Conclusions:</b> Attainment of a graduate-level RC degree through degree advancement remains reliant on intrinsic motivation. Although over half of respondents indicated receiving tuition support through an employer, opportunities continue to exist to increase financial support for clinicians to advance their education beyond the clinical requirements of licensure. Graduates indicated that earning the degree supported educational development, contributed to new or advanced roles, and contributed to a tangible increase in annual salary.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 4","pages":"384-392"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804149","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":"Treatment Intensity and Outcomes in Elderly Mechanically Ventilated ICU Patients.","authors":"Maria Doroti Sousa da Rosa, Gabriela Rech, Regis Goulart Rosa, Henrique Mezzomo Pasqual, Cassiano Teixeira","doi":"10.4187/respcare.12317","DOIUrl":"10.4187/respcare.12317","url":null,"abstract":"<p><p><b>Background:</b> The global population is aging, and the proportion of elderly patients admitted to ICUs is increasing. In this scenario, achieving a balance between judicious utilization of a limited and high-cost resource and providing optimal intensity of care presents a challenge given that in very elderly patients the value of ICU care is uncertain. The aim of our study was to evaluate the survival of older subjects admitted to ICU who require mechanical ventilation at different levels of treatment intensity. <b>Methods:</b> A comprehensive longitudinal ICU database was retrospectively analyzed at a single tertiary center, from January 2008-December 2014, of ICU subjects 80 y old or older who required mechanical ventilation. <b>Results:</b> From January 2009-December 2014, 482 subjects were admitted to the ICU and required mechanical ventilation. Among them, 376 (78%) were age 80-89 y; and 106 (22%) were age ≥ 90 y, with a mean age of 85.84 (4.56). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 21.53 (7.42), and the mean Sequential Organ Failure Assessment score was 5.75 (3.38). The total mortality during ICU admission was 46%, and the hospital mortality was 58%. Only age higher than 90 y (1.41 [1.05-1.91], <i>P</i> = .02) and APACHE score (1.03 [1.01-1.05], <i>P</i> < .001) were associated with mortality after adjustments. The Therapeutic Intervention Scoring System score was analyzed in tertiles and was not related to mortality in univariate analysis or after adjustments. <b>Conclusions:</b> Our data indicate that in older subjects who received mechanical ventilation higher intensity of treatment does not seem to translate into a survival benefit. This finding highlights the importance of considering individualized treatment plans for elderly patients in the ICU.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"434-439"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352904","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":"Decades Under the Influence in ARDS: Shifting to PEEP or Shifting to Early Spontaneous Breathing?","authors":"Fabrice Petitjeans, Dan Longrois, Jean-Michel Constantin, Marco Ghignone, Luc Quintin","doi":"10.4187/respcare.12642","DOIUrl":"10.4187/respcare.12642","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"465-467"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449990","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":"Mobility Levels of Critically Ill Adult Patients and Extubation Success.","authors":"Camila Pal, Carolina Fu, Carlos Roberto Ribeiro de Carvalho, José Otávio Costa Auler Júnior, Liria Yuri Yamauchi","doi":"10.4187/respcare.12250","DOIUrl":"10.4187/respcare.12250","url":null,"abstract":"<p><p><b>Background:</b> Reduced mobility in patients who are critically ill is still a reality in many ICUs. This study aimed to investigate if the mobility level is associated with an extubation outcome in adult subjects. <b>Methods:</b> This was a prospective cohort study composed of adults who had undergone initial invasive mechanical ventilation for > 24 h and who were independently mobile before hospitalization. Subject progress was monitored from ICU admission to discharge. Data were collected daily from medical records and multidisciplinary teams by considering variables such as age, sex, body mass index, Simplified Acute Physiology Score III, type of ICU admission, comorbidities, sedation, use of vasoactive drugs, neuromuscular blockers, duration of mechanical ventilation, and ICU Mobility Scale. The primary outcome was the success of extubation. <b>Results:</b> ICU Mobility Scale values was not directly associated with extubation outcome. Older subjects demonstrated a reduced tendency for high ICU Mobility Scale values, as did those on prolonged usage of vasoactive drugs or mechanical ventilation. Subjects with higher ICU Mobility Scale values achieved successful extubation earlier, which suggests a link between mobility and faster extubation success. <b>Conclusions:</b> The level of mobility assessed 24 h after extubation was not associated with extubation success. The following characteristics were associated with a lower propensity to present a high ICU Mobility Scale value: older age, greater number of days of use of vasoactive drugs and mechanical ventilation. Subjects with higher levels of mobility had a successful extubation event earlier in the ICU course. Studies that assess mobility on a continuous basis would be more precise in identifying this association.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"393-399"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081327","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":"363-367"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","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":"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":"377-383"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","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":"Editor's Commentary.","authors":"","doi":"10.1089/respcare.70041.ec","DOIUrl":"https://doi.org/10.1089/respcare.70041.ec","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 4","pages":"i-ii"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804146","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}