Respiratory care最新文献

{"title":"Pressure Control Surrogate Formula for Estimating Mechanical Power in ARDS Is Associated With Mortality.","authors":"Richard H Kallet, Michael S Lipnick","doi":"10.4187/respcare.12269","DOIUrl":"10.4187/respcare.12269","url":null,"abstract":"<p><p><b>Background:</b> Mechanical power (MP) applied to the respiratory system (MP_RS) is associated with ventilator-induced lung injury (VILI) and ARDS mortality. Absent automated ventilator MP_RS measurements, the alternative is clinically unwieldy equations. However, simplified surrogate formulas are now available and accurately reflect values produced by airway pressure-volume curves. This retrospective, observational study examined whether the surrogate pressure -control equation alone could accurately assess mortality risk in subjects with ARDS managed almost exclusively with volume control (VC) ventilation. <b>Methods:</b> Nine hundred and forty-eight subjects were studied in whom invasive mechanical ventilation and implementation of ARDS Network ventilator protocols commenced ≤ 24 h after ARDS onset and who survived > 24 h. MP_RS was calculated as 0.098 x breathing frequency x tidal volume x (PEEP + driving pressure). MP_RS was assessed as a risk factor for hospital mortality and compared between non-survivors and survivors across Berlin definition classifications. In addition, mortality was compared across 4 MP_RS thresholds associated with VILI or mortality (ie, 15, 20, 25, and 30 J/min). <b>Results:</b> MP_RS was associated with increased mortality risk: odds ratio (95% CI) of 1.06 (1.04-1.07) J/min (<i>P</i> < .001). Median MP_RS differentiated non-survivors from survivors in mild (24.7 J/min vs 18.5 J/min, respectively, <i>P</i> = .034), moderate (25.7 J/min vs 21.3 J/min, respectively, <i>P</i> < .001), and severe ARDS (28.7 J/min vs 23.5 J/min, respectively, <i>P</i> < .001). Across 4 MP_RS thresholds, mortality increased from 23-29% when MP_RS was ≤ threshold versus 38-51% when MP_RS was > threshold (<i>P</i> < .001). In the > cohort, the odds ratio (95% CI) increased from 2.03 (1.34-3.12) to 2.51 (1.87-3.33). <b>Conclusion:</b> The pressure control surrogate formula is sufficiently accurate to assess mortality in ARDS, even when using VC ventilation. In our subjects when MP_RS exceeds established cutoff values for VILI or mortality risk, we found mortality risk consistently increased by a factor of > 2.0.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"427-433"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146147","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":"Estimating Patient Breathing Effort During Noninvasive Ventilation: Is It Possible?","authors":"Thomas Piraino, L Felipe Damiani","doi":"10.1089/respcare.12880","DOIUrl":"10.1089/respcare.12880","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"460-462"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449975","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":"Delivering Specialty Gases for Potential Therapeutic Effect-Ventilator Validation of Safety Is Paramount.","authors":"John Davies, Mark Sollars","doi":"10.1089/respcare.12839","DOIUrl":"10.1089/respcare.12839","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"463-464"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449993","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":"Tracheal Stoma Closure and Healing Time in a Post-Acute Setting.","authors":"Linda L Morris, Katherine Earnest, Ann Bines, Audrone Hogue, Allison Kessler, Sarah McCarter-Koppes, Maricela Ontiveros, Mat Peltier, Manasi Sheth","doi":"10.1089/respcare.12149","DOIUrl":"10.1089/respcare.12149","url":null,"abstract":"<p><p><b>Background:</b> Complications can arise after removal of tracheostomies, including delayed or failed spontaneous closure. Little is known about the healing time after decannulation, especially for decannulation that occurs outside of the acute-care setting. This study aimed to establish the average time required for stoma closure after decannulation in an in-patient rehabilitation setting and explores patient factors that may impact healing time. <b>Methods:</b> In this prospective observational study, clinicians measured and photographed the stoma on decannulation, every 8 h until initial stoma closure, and every 24 h until complete healing of the skin over the stoma site. Additional data, including personal characteristics, medical diagnoses, and medications taken, were collected through medical record review and participant self-report. <b>Results:</b> A total of: 104 sets of data were included in the analysis. The median (interquartile range [IQR]) cannulation time in this sample was 54 (35-70) d. The median (IQR) days to stoma closure were 5 (2-9) d. The median (IQR) days to complete healing of the stoma site were 16 (10-18) d. The days to closure and days to complete healing were positively correlated. Factors positively correlated with increased days to closure included stoma size, increasing age, diabetes, and steroid use. <b>Conclusions:</b> These findings provide evidence that clinicians may consider when advising patients on what to expect after decannulation.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"440-445"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450087","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":"Detecting Peripheral Airway Response in Exercise-Induced Bronchoconstriction: The Role of Impulse Oscillometry.","authors":"Kali McKnight, Michael W H Wong, Lung-Chang Chien, Craig Nakamura, Jason E Lang, Tony G Babb, Dharini M Bhammar","doi":"10.4187/respcare.11929","DOIUrl":"10.4187/respcare.11929","url":null,"abstract":"<p><p><b>Background:</b> Exercise-induced bronchoconstriction (EIB) is common in children with asthma, but whether it is a phenomenon of central versus peripheral airway reactivity is unknown. The purpose of this study was to investigate central and peripheral airway responses after an exercise challenge test among children with asthma. <b>Methods:</b> Sixteen children with asthma underwent exercise challenge testing on 2 separate visits: one without any medications (control) and another with pretreatment with 180 µg albuterol (bronchodilator). Central airway EIB was defined as a >10% reduction in FEV₁ after exercise assessed with spirometry. Peripheral airway EIB was assessed as a >40% increase in resistance between 5 Hz and 20 Hz with impulse oscillometry. Spirometry and impulse oscillometry were measured before the condition and periodically for up to 30 min after exercise. <b>Results:</b> Three of 16 children (19%) experienced only central airway EIB. Ten of 16 children (62%), including all 3 who experienced central airway EIB, experienced peripheral airway EIB. Among children who experienced EIB, resistance between 5 Hz and 20 Hz increased by 119.67 ± 102.56% after exercise during the control condition compared with an average decrease of -10.38 ± 34.97% during the bronchodilator condition, which suggests that albuterol was effective in preventing EIB (<i>P</i> = .003, paired <i>t</i> test). <b>Conclusions:</b> Peripheral airway EIB may occur frequently in children with asthma. Spirometry-based testing alone may miss peripheral airway EIB in some children. Impulse oscillometry could be used in conjunction with spirometry to detect peripheral airway EIB in children with asthma.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"400-407"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450009","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":"Postextubation Noninvasive Respiratory Support in Children.","authors":"Andrew G Miller, Alexandre T Rotta","doi":"10.1089/respcare.12922","DOIUrl":"https://doi.org/10.1089/respcare.12922","url":null,"abstract":"<p><p>Infants and children frequently require mechanical ventilation. Daily extubation readiness testing is currently recommended to minimize time on mechanical ventilation, which is associated with the development of morbidities. Re-intubation rates vary between patient populations and have been associated with significant adverse patient outcomes, including increased length of stay and mortality. Noninvasive respiratory support (NRS) is often used to help decrease the risk of re-intubation. NRS encompasses high-flow nasal cannula (HFNC), CPAP, noninvasive ventilation, and negative-pressure ventilation. This article will cover risk factors for re-intubation, assessing extubation readiness, rationale for NRS use, delivery systems for NRS, evidence for various NRS modalities, how to choose NRS modalities, practical considerations, and future research opportunities.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731327","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":"Bridging the Spontaneous Breathing Trial Gap: CPGs Versus Clinical Practice.","authors":"Karsten J Roberts, Megan L Carreon, Corinne M Battey-Muse","doi":"10.1089/respcare.12939","DOIUrl":"https://doi.org/10.1089/respcare.12939","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731268","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":"High-Flow Nasal Cannula and Swallowing Safety: A Balancing Act in Respiratory Care.","authors":"Megan L Carreon, J Brady Scott","doi":"10.1089/respcare.12934","DOIUrl":"https://doi.org/10.1089/respcare.12934","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731209","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":"Mechanical Insufflation-Exsufflation in Older In-Patients With Impaired Cough.","authors":"Claire Estenne, Mathilde Pelletier Visa, Bruno Pereira, Alexandra Usclade, Emmanuel Coudeyre, Lech Dobija","doi":"10.1089/respcare.12267","DOIUrl":"https://doi.org/10.1089/respcare.12267","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731192","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":"https://doi.org/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":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-11","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}