Respiratory care最新文献

{"title":"Efficacy of Mechanical Insufflation-Exsufflation Devices as Analyzed in Lung Models: Systematic Review and Network Meta-Analysis of Peak Expiratory Flow Data.","authors":"Raúl Escudero-Romero, Merete Salveson Engeset, Tiina Maarit Andersen, Aitor Martín-Pintado Zugasti, Juan Nicolás Cuenca-Zaldívar, Myriam Cabrera-Guerra, Jadranka Spahija","doi":"10.1177/19433654261454978","DOIUrl":"10.1177/19433654261454978","url":null,"abstract":"<p><strong>Background: </strong>Mechanical insufflation-exsufflation (MI-E) devices support airway clearance by generating positive and negative pressure cycles that simulate a cough. Bench studies using lung models provide a controlled environment to investigate device performance and optimize settings; however, the lack of methodological standardization limits reproducibility and clinical translation.</p><p><strong>Methods: </strong>A systematic review and network meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (International Prospective Register of Systematic Reviews) (CRD42023486537). Experimental studies using adult mechanical lung models were identified from MEDLINE, Embase, and Web of Science (search updated November 2024). Two reviewers independently extracted data and assessed methodological quality using a customized risk-of-bias tool specifically developed for bench studies of respiratory devices. The primary outcome was peak expiratory flow (PEF); secondary outcomes included insufflation and exsufflation parameters. Random-effects meta-analyses were performed.</p><p><strong>Results: </strong>Eleven studies (2002-2024) met the inclusion criteria, encompassing 6 MI-E devices and a range of simulated lung mechanics. The most frequently used settings were +40/-40 cm H₂O with 3-s insufflation, 1-s exsufflation, and 1-s pause. Higher pressure pairs (+50/-50 cm H₂O) produced significantly greater PEF compared with lower pressures, particularly in obstructive models (mean difference = 134 L/min, 95% CI 2-267). Methodological quality varied widely, with limited information on calibration, sensor characteristics, and study reproducibility.</p><p><strong>Conclusions: </strong>Higher pressure differentials generally enhance PEF, but optimal MI-E settings are not universal. MI-E performance depends on pressure settings and simulated respiratory mechanics. Clinically, these findings support individualized adjustment of MI-E parameters based on patient-specific characteristics. The lack of methodological standardization and calibration reporting limits comparability. A structured protocol for MI-E bench studies is proposed to enhance reproducibility, transparency, and translational relevance.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1179-1190"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318849","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":"Agreement Between Automated and Equation-Derived Mechanical Power in Pediatric Mechanical Ventilation.","authors":"Farhan A Rashid Shaikh, Monesh Kethineni Bhaskaran, Vikas Muppa, Suchit Jogu, Pallavi Charantimath, Kapil B Sachane, Anupama Yerra, Dinesh Kumar Chirla, Shekhar Venkatraman, Martin C J Kneyber","doi":"10.1177/19433654261446287","DOIUrl":"10.1177/19433654261446287","url":null,"abstract":"<p><strong>Background: </strong>Newer ventilators provide automated real-time mechanical power (MP_auto) measurements, but their accuracy in children across ventilation modes remains uncertain. We aimed to evaluate the agreement between the MP_auto measured on the Mindray SV-600 ventilator and the equation-derived MP (MP_calc) across two tidal volume (V_T) settings, ventilation modes, and predefined age groups in ventilated children.</p><p><strong>Methods: </strong>In this prospective observational physiology study, consecutive mechanically ventilated children aged 1 month to 18 years were enrolled between August 2024 and May 2025 in a 30-bed pediatric ICU. MP_auto was compared with MP_calc, using comprehensive and surrogate equations during continuous mandatory volume-control (VC-CMV) and pressure-control (PC-CMV) modes at V_T of 6 and 8 mL/kg body weight. Subgroup analyses considered age and pediatric ARDS. In VC-CMV mode, MP was calculated with Gattinoni's equation (MPVC_comp) and Giosa's equation (MPVC_surr). In PC-CMV mode, Van der Meijden's equation (MPPC_comp) and Becher's equation (MPPC_surr) were used. Bland-Altman analyses evaluated agreement.</p><p><strong>Results: </strong>We included 147 children, with a median (interquartile range [IQR]) age of 49 (16-92) months, of whom 34 (23%) had pediatric ARDS. MP_auto showed strong agreement with MP_calc across ventilation modes and V_T settings. The agreement was highest in VC-CMV, with minimal bias (-0.12 to +0.011 J/min; intra-class correlation [ICC] ≥0.95) and >88% of observations within clinical limits of agreement. In PC-CMV, MP_auto demonstrated a systematic negative bias relative to MP_calc (minimal bias -1.23 to -0.62 J/min; ICC ≥0.92), with similar findings in subjects with pediatric ARDS. Age influenced agreement between MP_auto and MP_calc (slope -0.008 to -0.005), especially in PC-CMV mode (<i>R</i>² = 0.226-0.27). Pediatric ARDS status affected this relationship only in PC-CMV mode (<i>P</i> = .02 for MPPC_comp and <i>P</i> = .006 for MPPC_surr).</p><p><strong>Conclusions: </strong>MP_auto demonstrated strong agreement with equation-derived MP during VC-CMV mode across different age groups. However, MP_auto showed a systematic negative bias relative to equation-derived MP in PC-CMV mode, particularly among younger children and those with pediatric ARDS.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1143-1152"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975079","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 Alternative for Neonatal Resuscitation in a US Safety-Net Hospital.","authors":"Danielle S Roberts, Kirsten Gilliland, Cheri Sims, Carol Cavazos, Patricia Hagan, Karen Albrecht, Renee Starr, Laura J Podewils","doi":"10.1177/19433654261444700","DOIUrl":"10.1177/19433654261444700","url":null,"abstract":"<p><strong>Background: </strong>In the delivery room, newborn respiratory failure precedes cardiac failure, emphasizing the importance of effective ventilation. Face masks for ventilation may cause air leakage around the mask with subsequent suboptimal lung pressure, and intubation requires skilled providers. Laryngeal mask airways (LMA) may provide a more stable airway interface, with improved seal and more consistent ventilation that is less dependent on provider technique. An evaluation of the feasibility, acceptability, and initial outcomes of implementing the laryngeal mask airway as the first-line approach for ventilation in late preterm and term infants was conducted in a high-resource, urban safety-net hospital with a level III neonatal intensive care unit (NICU).</p><p><strong>Methods: </strong>The LMA was introduced and promoted as the firstline for delivery room ventilation in infants ≥35 weeks gestational age and ≥1.5 kg from August 2023 to August 2024. Implementation was supported by comprehensive training, survey feedback, and multidisciplinary involvement. The program evaluation spanned a 2-year period from August 2022 to August 2024. Feasibility and acceptability data were collected via provider surveys, and neonatal outcomes were compared pre- and post-implementation from electronic health record data.</p><p><strong>Results: </strong>During implementation, LMAs were used as first-line in 58.7% of eligible neonates indicated for delivery room ventilation. Provider surveys showed increased knowledge and confidence in LMA use after education and high comfort levels with LMA implementation in the delivery room. NICU admission rates, delivery room endotracheal intubations, chest compressions, and epinephrine use were similar across groups.</p><p><strong>Conclusions: </strong>Providers across experience levels successfully inserted LMAs after brief training. LMA as first-line ventilation yielded similar outcomes to face mask in an urban safety-net hospital. Future research should explore broader applicability.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1086-1094"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975056","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":"Unsupervised Clustering Analysis of Snoring Identifies Acoustic Biomarkers for the Severity of Obstructive Sleep Apnea.","authors":"Shih-Hsing Yang, Chou-Chin Lan, Mei-Chen Yang, Hsien-Chi Kuo, Hui-Ching Chen, Yuh-Chin T Huang, Chin-Pyng Wu","doi":"10.1177/19433654261485034","DOIUrl":"https://doi.org/10.1177/19433654261485034","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea (OSA) is a prevalent public health concern linked to cardiovascular, metabolic, and neurocognitive consequences. Although polysomnography (PSG) is the diagnostic standard, the availability can be limited with long wait time. Snoring is a common symptom of OSA, but all individuals with snoring do not have OSA. In this study, we hypothesized the characteristics of snoring may be used to detect OSA. We applied an unsupervised clustering method to classify snoring patterns and examine their correlations with OSA parameters.</p><p><strong>Methods: </strong>We enrolled 287 adults with snoring symptoms who underwent overnight PSG at 2 teaching hospitals in Taiwan. Snoring sounds were recorded, and the dominant frequency and loudness were analyzed. A K-means clustering model was first developed using a training cohort (<i>n =</i> 50) and applied to classify frequency patterns into 5 clusters. Each cluster was further divided into 2 subclusters based on a loudness threshold (70 dB). An independent validation cohort (<i>n =</i> 237) was used to develop an apnea-hypopnea index (AHI) prediction model and evaluate discriminative performance using receiver operating characteristic analysis.</p><p><strong>Results: </strong>Clusters 1, 2, and 5 were significantly associated with higher AHI, oxygen desaturation index, and apnea index. In contrast, clusters 3 and 4 showed little or no association. An AHI prediction model was developed using age, BMI, and significant acoustic clusters. For PSG-defined OSA thresholds of AHI ≥ 5, ≥15, and ≥30 events/h, the AUC values were 0.90, 0.83, and 0.82, respectively, with sensitivity ranging from 70.5% to 77.5% and specificity ranging from 73.7% to 100%.</p><p><strong>Conclusions: </strong>Our study demonstrates an AI-based clustering analysis of snoring patterns can be used to evaluate OSA severity. The snoring pattern analysis can also be an additional screening tool for OSA.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261485034"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114280","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":"Pressure Support Does Not Guarantee Flow Matching: Lessons From Ventilated Children.","authors":"Rodrigo Adasme-Jeria, Fernando Bustos-Gajardo, Iván I Ramírez","doi":"10.1177/19433654261488961","DOIUrl":"https://doi.org/10.1177/19433654261488961","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261488961"},"PeriodicalIF":2.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064252","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 Mechanical Insufflation-Exsufflation on Endotracheal Suctioning: Case Closed or Verdict Pending?","authors":"L Denise Willis","doi":"10.1177/19433654261491413","DOIUrl":"https://doi.org/10.1177/19433654261491413","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261491413"},"PeriodicalIF":2.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064262","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":"RVSP Response After Inhaled Nitric Oxide in COVID-19 ARDS, Measuring RV Off-Load or Recruitable Pulmonary Vascular Bed.","authors":"Alejandro Chapa-Rodriguez, Durga Prathyusha Goswami, Satyanarayana Vaidya","doi":"10.1177/19433654261488166","DOIUrl":"https://doi.org/10.1177/19433654261488166","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261488166"},"PeriodicalIF":2.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064235","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":"<i>Letter:</i> Response to \"Awareness Is Not Integration: Interpreting Utilization of a Physiology-Based Critical Care Team Through Survey Methodology and Implementation Science\".","authors":"Anna Caggioni, Lorenzo Berra, Edward A Bittner, Roberta Ribeiro De Santis Santiago","doi":"10.1177/19433654261491415","DOIUrl":"https://doi.org/10.1177/19433654261491415","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261491415"},"PeriodicalIF":2.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063888","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 Response of Dorsal Lung Compliance to Prone Positioning Differs by Body Mass Index in ARDS.","authors":"Timothy G Gaulton, Caio César Araújo Morais, Roberta Ribeiro De Santis Santiago, Glasiele C Alcala, Carolyn J LaVita, Marcelo Britto Passos Amato, Maurizio Cereda, Lorenzo Berra","doi":"10.1177/19433654261487238","DOIUrl":"https://doi.org/10.1177/19433654261487238","url":null,"abstract":"<p><strong>Background: </strong>Excess adipose tissue compresses dorsal lung regions that PEEP may not fully reverse in the supine position. Prone positioning, in combination with PEEP, can unload the lung, but whether regional responses differ by obesity is unknown.</p><p><strong>Methods: </strong>We measured regional lung compliance using electrical impedance tomography in 14 mechanically ventilated subjects with COVID-19 ARDS (6 with BMI ≥35 kg/m² and 8 with BMI <30 kg/m²). Measurements were taken during decremental PEEP titration in supine and prone positions, following recruitment maneuvers. Regional compliance was derived from pixel-level impedance change within each region of interest, divided by driving pressure and predicted body weight. Bayesian multilevel gamma regression models with patient-level random effects estimated the 3-way interaction between position, BMI group, and lung region on regional compliance, adjusted for age.</p><p><strong>Results: </strong>The overall cohort had a median P_aO₂/F_IO₂ of 108 mm Hg and median respiratory system compliance of 29 mL/cm H₂O in the supine position. At the PEEP that produced the highest total respiratory system compliance in each position, the increase in dorsal regional compliance with prone positioning was greater in subjects with BMI ≥35 kg/m² compared with subjects with BMI <30 kg/m² (difference-in-differences: 0.16 mL/cm H₂O/kg, 95% credible interval: 0.01 to 0.37; posterior probability: 98.0%). Regional compliance in ventral and central lung regions did not credibly differ between BMI groups. The direction and magnitude of the change in dorsal lung compliance between BMI groups were consistent across PEEP levels.</p><p><strong>Conclusions: </strong>Prone positioning was associated with a greater increase in dorsal lung compliance in subjects with BMI ≥35 kg/m² compared with subjects with BMI <30 kg/m². Our findings suggest that the response of regional compliance to prone positioning in ARDS differs by body mass index, identifying obesity as a population in whom positional unloading may be more effective.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261487238"},"PeriodicalIF":2.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026064","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":"Awareness Is Not Integration: Interpreting Utilization of a Physiology-Based Critical Care Team Through Survey Methodology and Implementation Science.","authors":"Shi Shu, Xiang-Dong Liu","doi":"10.1177/19433654261487242","DOIUrl":"https://doi.org/10.1177/19433654261487242","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"19433654261487242"},"PeriodicalIF":2.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017341","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}