Respiratory care最新文献

{"title":"Aerosol Delivery to Simulated Spontaneously Breathing Tracheostomized Adult Patients With Heated Humidified High Flow Oxygenation.","authors":"Xiukai Chen, Fai A Albuainain, Jie Li","doi":"10.1089/respcare.12467","DOIUrl":"10.1089/respcare.12467","url":null,"abstract":"<p><p><b>Background:</b> Heated and humidified high-flow (HHHF) oxygen therapy is frequently used for spontaneous breathing tracheostomized patients. However, the efficacy of in-line placement of nebulizer via HHHF remains unclear. We aimed to assess the impact of nebulizer placements, flow settings, and interfaces on aerosol delivery using a vibrating mesh nebulizer with HHHF in a tracheostomized model. <b>Methods:</b> A simulated spontaneous breathing model of a tracheostomized adult with tracheostomy tube size 8.0 mm was utilized. A collecting filter was placed between the tracheostomy tube and the model lung. Albuterol sulfate (2.5 mg/3 mL) was aerosolized via a vibrating mesh nebulizer in-line with HHHF (Airvo2). The aerosol delivery was evaluated with the nebulizer placed distally (near the humidifier) and proximally to the airway, using tracheostomy adapter and tracheostomy collar at gas flows of 15, 30, and 45 L/min. Each condition was tested five times. The drug was eluted from the collecting filter and assayed with ultraviolet spectrophotometry (276 nm). <b>Results:</b> When delivering aerosol via an in-line vibrating mesh nebulizer with HHHF in a tracheostomized model, the inhaled dose increased as flow decreased, regardless of the interfaces and nebulizer placements (all <i>P</i> < .05). With the tracheostomy adapter, distal placement resulted in higher inhaled doses than the proximal placement at all flows (all <i>P</i> < .05). With the tracheostomy collar, inhaled doses were lower with distal placement than proximal placement, except at 15 L/min (21.3 ± 1.9 vs 16.4 ± 2.1%, <i>P</i> = .009). Compared with the tracheostomy adapter, the tracheostomy collar had higher inhaled doses with the vibrating mesh nebulizer placed proximally at 30 and 45 L/min but a lower inhaled dose with the vibrating mesh nebulizer placed distally at 30 L/min. <b>Conclusions:</b> During aerosol delivery via in-line placement of vibrating mesh nebulizer with HHHF in a tracheostomized model, the inhaled dose increased as flow decreased. Distal nebulizer placement resulted in higher inhaled doses than proximal placement with the tracheostomy adapter at all flows and with the tracheostomy collar at 15 L/min.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"873-878"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557711","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":"Clinical Features of Patients With Bronchiolitis Prior to the Initiation of Noninvasive Respiratory Support.","authors":"Lindsey L Scheller, Coral N Crandall, Kristen E Carlin, Missy A Lein, Robert M DiBlasi","doi":"10.1089/respcare.11922","DOIUrl":"10.1089/respcare.11922","url":null,"abstract":"<p><p><b>Background:</b> Effective management of infants hospitalized with bronchiolitis depends on clinician assessment of disease severity. Although environmental and demographic risk factors help identify severe cases, there is limited research on specific clinical and physiological characteristics associated with respiratory deterioration. This study aimed to identify physiologic variables and clinical parameters associated with respiratory deterioration in hospitalized infants with bronchiolitis. <b>Methods:</b> A single-center retrospective cohort study included previously healthy infants <2 years of age hospitalized for bronchiolitis. The primary outcome measure, deterioration, was defined as respiratory distress requiring noninvasive (including high-flow nasal cannula) or invasive respiratory support within 48 h of admission. A multivariable logistic regression analysis with preselected factors was used to assess the odds of deterioration. Variables included sex, age, affect and behavior, nasopharyngeal suctioning, number, location of retractions, S_pO₂/F_IO₂ (S/F ratio), breathing frequency, pulse rate, and respiratory severity score. A secondary analysis assessed retraction locations. <b>Results:</b> Of the 584 eligible patients, 154 (26%) experienced a deterioration event and required noninvasive or invasive respiratory support. Respiratory score (odds ratio [OR] 1.9 [95% CI 1.5-2.4]), total number of retractions (OR: 2.5 [95% CI 1.6-3.8]), S/F ratio (OR: 1.0 [95% CI 0.99-0.998), pulse rate (OR: 1.0 [95% CI 1.0-1.1]), nasopharyngeal suctioning (OR: 5.5 [95% CI 2.6-11.7]), and positive affect and behavior descriptors (OR: 0.3 [95% CI 0.1-0.7]) were associated with deterioration. Age, sex, negative affect and behavior descriptors, and breathing frequency were not statistically significant. <b>Conclusions:</b> These variables may be used to design predictive algorithms that alert clinicians of impending respiratory deterioration in infants with bronchiolitis.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"838-846"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543264","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":"Increased Oxygen Consumption Ability With Pulmonary Rehabilitation Improves Submaximal Exercise Capacity in Advanced COPD.","authors":"Hitoshi Sumitani, Keisuke Miki, Yukio Yamamoto, Yasuhiro Mihashi, Yuka Nagata, Satoshi Miyamoto, Masashi Yokoyama, Kazuki Hashimoto, Hisako Hashimoto, Hiromi Yanagi, Kazumi Koyama, Yasuyuki Fujimoto, Takuro Nii, Takanori Matsuki, Kazuyuki Tsujino, Hiroshi Kida","doi":"10.1089/respcare.12303","DOIUrl":"10.1089/respcare.12303","url":null,"abstract":"<p><p><b>Background:</b> Improving the anaerobic threshold (AT) provides benefits by avoiding overload, especially for patients with advanced COPD. However, the variables related to improving AT are poorly known. The aim of this study was to investigate which variables are related to improved AT after pulmonary rehabilitation (PR) using cardiopulmonary exercise testing (CPET). <b>Methods:</b> Stable patients with severe and very severe COPD who performed 4-week PR and whose ATs were identified both before and after PR were selected; they were divided into two groups based on whether the AT increased after PR, and their responses were compared. <b>Results:</b> In the 26 eligible subjects, there was no correlation between the mean change from baseline after PR in the inspired minus expired mean O₂ concentrations (ΔFO₂) and minute ventilation (V˙_E) at peak exercise. Compared with the AT no-increase group, the AT increase group, at peak exercise, showed significant increases in peak oxygen uptake (V˙_O₂) and ΔFO₂ but not in V˙_E, after PR. The increase in V˙_O₂ at the AT after PR was well correlated with the mean change after PR in ΔFO₂ at peak exercise (r = 0.66, <i>P</i> < .001), rather than V˙_E. Of all the peaks and throughout exercise variables, ΔFO₂ at peak exercise was identified as one of the variables more closely correlated with improved AT after PR. <b>Conclusions:</b> Improvement of ΔFO₂ at peak exercise, rather than V˙_E, correlated with an increased AT in subjects with advanced COPD, which suggests that improving ΔFO₂ independent of V˙_E may be a useful strategy to individualize PR.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"887-895"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606277","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":"Fluid-Filled Tracheal Tube Cuffs: Implications for Speech, Sealing, and Safety.","authors":"Thomas C Blakeman","doi":"10.1089/respcare.13184","DOIUrl":"10.1089/respcare.13184","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"930-932"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209388","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":"Association of Preserved Ratio Impaired Spirometry and Mortality Outcomes Compared With Normal Spirometry: A Meta-Analysis.","authors":"Viraj Panchal, Shubhika Jain, Aasa Deepika Kuditipudi, Sravya Sri Kuchipudi, Rahul Vyas, Bhavya Vyas, Saketh Palasamudram Shekar","doi":"10.1089/respcare.11653","DOIUrl":"10.1089/respcare.11653","url":null,"abstract":"<p><p><b>Background:</b> One of the leading causes of death in the United States is chronic lung disease, with COPD being the most common. One of the hallmarks of COPD is spirometric obstruction as evidenced by a reduced FEV₁/FVC ratio. Preserved ratio impaired spirometry (PRISm) is a spirometric pattern characterized as a low FEV₁ coupled with a preserved FEV₁/FVC ratio. This systematic review and meta-analysis sought to understand better the relationship between PRISm and cardiovascular, respiratory, and all-cause mortality. <b>Methods:</b> We systematically searched PubMed and clinicaltrials.gov for articles published between 2014 and 2023, providing data regarding the association of PRISm compared with normal spirometry in terms of morality outcomes. The generic inverse variance method was used to assess the pooled hazard ratio value at a 95% CI, and forest plots were created using RevMan for analysis. <i>P</i> < .05 was considered to be significant. <b>Results:</b> Our analysis included 690,015 subjects from four prospective studies and three retrospective studies. The pooled hazard ratio for all-cause, cardiovascular, and respiratory-related mortality was 1.70, 1.95, and 5.70 for all prospective studies, respectively, and 1.62, 1.66, and 3.35, in combined prospective and retrospective studies, respectively, which were statistically significant in the random effect model (<i>P</i> < .001). However, 76% heterogeneity was observed in respiratory-related mortality (<i>P</i> = .009). After excluding studies associated with publication bias, a \"leave-out\" sensitive analysis resulted in a significant pooled hazard ratio of 1.98 with a high significance (<i>P</i> < .001). <b>Conclusions:</b> PRISm, often labeled as GOLD-U, is associated with mortality outcomes and should not be overlooked while treating patients with chronic lung diseases. This meta-analysis provides a stronger correlation of PRISm with all-cause mortality, cardiovascular mortality, and respiratory mortality compared with normal spirometry.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"914-921"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036809","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":"Outcomes of Prone Positioning in Mechanically Ventilated COVID-19 Patients.","authors":"Jonathan K Chandler, Badr Jandali, Katie Joyce, Dale Smith, Lynn Chollet-Hinton, Isuru Ratnayake, Kyle R Brownback","doi":"10.1089/respcare.11259","DOIUrl":"10.1089/respcare.11259","url":null,"abstract":"<p><p><b>Background:</b> Prone positioning in mechanically ventilated patients with severe ARDS is associated with reduced mortality. COVID-19 causes variable pulmonary involvement in some patients suffering from severe respiratory failure and ARDS. Although proning in the COVID-19 patient population is increasingly common, more data are needed to fully understand its utility in those with ARDS due to COVID-19. <b>Methods:</b> We conducted a single-center retrospective study, inclusive of 100 consecutive subjects intubated for ARDS from COVID-19, admitted to the ICU from September 2020 to December 2020. Data were collected daily from time of intubation for 7 d along with 30-d outcomes. <b>Results:</b> The study included a total of 53 subjects proned and 47 nonproned during their hospitalization. Proned subjects had a mean age of 61.8 years and 56.6% were male, compared with a mean age of 66.3 years and 57.4% male in the nonproned group. Age, sex, other baseline characteristics, and treatments were similar between groups, except that proned subjects had a higher body mass index than nonproned subjects (34.1 ± 7.5 vs 30.5 ± 7.4, kg/m² <i>P</i> = .02) and lower initial P/F ratios (119.1 ± 54.5 vs 154.0 ± 92.7 mm Hg, <i>P</i> = .047). Proned subjects received more neuromuscular blockade (OR 6.63, 95% CI 3.25-13.12, <i>P</i> < .001) and higher sedation levels (two sedatives: OR = 3.00, 95% CI 1.77-5.08; ≥3 sedatives: OR = 7.13, 95% CI 3.96-12.81) with similar ICU stays, ventilator days, newly initiated renal replacement therapy, and 30-d outcomes including being alive, out of the ICU, or discharged from the hospital when compared with nonproned subjects. There were a total of 15 (28.3%) complications related to proning. Proned subjects were reintubated significantly less than the nonproned group (1.9% vs 19.1%, <i>P</i> = .006). <b>Conclusions:</b> Proning mechanically ventilated COVID-19 subjects was associated with more frequent use of neuromuscular blockade and sedation, and lower rates of re-intubation, for respiratory failure when compared with nonproned subjects.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"830-837"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543280","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":"2024 Year in Review: Fugitive Aerosols-Keeping the Air Clear for Patients and Staff.","authors":"Michael D Davis","doi":"10.1089/respcare.12933","DOIUrl":"10.1089/respcare.12933","url":null,"abstract":"<p><p>Although concerns about and precautions to prevent transmission of diseases through the air have existed since Hippocrates, renewed interest in risks and prevention strategies grew significantly since the onset of the COVID-19 pandemic. This altered respiratory care practice globally owing to concerns that some respiratory care procedures may generate or disperse aerosols that could spread pathogens. A paucity of evidence, as well as a lack of general consensus, existed at the pandemic onset to determine the associated risks of these procedures and best practices for mitigating those risks. This is a review of key peer-reviewed manuscripts from 2023 to 2024 discussing aerosol generation and dispersion from respiratory care procedures, as well as the mitigation of associated risks. A brief discussion of different forms of aerosols, and the risks associated with each, is also included.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"908-913"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996393","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":"Upper Airway CO₂ Clearance During Noninvasive Ventilation: A Perspective on Mask Design Using Computational Fluid Dynamics.","authors":"Emmanuel A Akor, Bing Han, David W Kaczka","doi":"10.1089/respcare.13153","DOIUrl":"10.1089/respcare.13153","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"925-927"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120636","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":"Translating Recent ARDS Criteria and Practice Guidelines Into Effective Clinical Interventions.","authors":"Peter E Morris","doi":"10.1089/respcare.13168","DOIUrl":"10.1089/respcare.13168","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"922-924"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151552","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 Predictive Value of Baseline Spirometry, Age, and Gender for Airway Hyper-Responsiveness in Adults With Suspected Asthma.","authors":"Sulan Wei, Zhen Zhao, Guiping Zhu, Chong Lu, Daozhen Jiao, Ling Ye, Yuanlin Song, Meiling Jin, Jian Wang, Hui Cai","doi":"10.1089/respcare.12039","DOIUrl":"10.1089/respcare.12039","url":null,"abstract":"<p><p><b>Background:</b> Bronchial provocation test (BPT) plays a crucial role in diagnosing airway hyper-responsiveness (AHR) among patients with asthma-like symptoms. Given that BPT may induce severe bronchospasm, baseline spirometric parameters are expected to help predict a positive outcome, guiding the decision of referring a patient to BPT. <b>Methods:</b> Baseline spirometry and BPT conducted on suspected asthmatics between July 2011 and 2013 at Department of Pulmonary Medicine, Zhongshan Hospital, were retrospectively collected. Baseline characteristics from positive and negative BPT groups were compared. The predictive accuracy of single parameter for AHR was evaluated by plotting receiver operating characteristic curve, and a composite model was developed to improve the accuracy by the logistic regression. The relationships of FEV₁/FVC, FEV₁ %predicted, and forced expiratory flow at 50% of FVC exhaled (FEF₅₀ %predicted) with the provocation dose causing a 20% fall in FEV₁ (PD₂₀-FEV₁) were examined. <b>Results:</b> The positive BPT group exhibited reduced FEV₁ %predicted, FEV₁/FVC, and small airway function parameters compared with the negative group. Among these parameters, FEF₅₀ %predicted, forced expiratory flow at 75% of FVC exhaled (FEF₇₅ %predicted), and forced expiratory flow between 25% and 75% (FEF_25-75 %predicted) demonstrated significant accuracy. Notably, females and younger subjects were more prone to a positive outcome. A predictive model that combined FEV₁ %predicted (cutoff 98.65%, area under the curve 0.714, sensitivity 39.10%, specificity 88.10%), FEV₁/FVC (cutoff 79.22%, area under the curve 0.690, sensitivity 32.80%, specificity 90.50%), and FEF₅₀ %predicted (cutoff 74.45%, area under the curve 0.761, sensitivity 50.50%, specificity 84.60%) with age and gender was found to enhance the accuracy for a positive BPT (area under the curve 0.786, 95% CI 0.758-0.814, sensitivity 52.27%, specificity 86.14%). Moreover, FEV₁/FVC, FEF₅₀ %predicted, and FEF_25-75 %predicted showed differences among groups with varying AHR levels. The significant correlations between these 3 parameters and PD₂₀-FEV₁ were exclusively demonstrated in the severe AHR group. <b>Conclusions:</b> This study revealed that FEV₁ %predicted, FEV₁/FVC, and FEF₅₀ %predicted along with age and gender were predictors of AHR in subjects with suspected asthma. Their combination improved the predictive accuracy over using FEF₅₀ %predicted alone, thus offering a complement for clinical decision-making regarding referrals to BPT.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"847-854"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543286","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}