Respiratory care最新文献

{"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":"https://doi.org/10.4187/respcare.12080","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-12","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":"Efficacy of Noninvasive Ventilation With Expiratory Washout in Stable COPD Patients.","authors":"Stacey Kung, Alex C Semprini, Louis W Kirton, Jess R Fogarin, Sascha K Zoellner, Richard Beasley, Allie Eathorne, Ruth Ac Semprini","doi":"10.4187/respcare.11876","DOIUrl":"10.4187/respcare.11876","url":null,"abstract":"<p><strong>Background: </strong>A noninvasive ventilation (NIV) mask has been designed to deliver NIV with expiratory washout to improve efficacy of ventilation by optimizing clearance of expired gases from the anatomic dead space. This study compared the performance and comfort of a novel investigational mask with expiratory washout with a conventional mask during NIV therapy.</p><p><strong>Methods: </strong>In this pilot crossover study, participants with severe stable COPD attended a single visit to receive bi-level NIV through 2 masks; the investigational mask with expiratory washout and a conventional mask. The order of mask use was randomly allocated, and each mask was used for 60 min with a 30-60-min washout in between. The primary outcome was transcutaneous carbon dioxide at 60 min. Other physiologic and NIV device variables were also assessed.</p><p><strong>Results: </strong>The mean difference (95% CI) in the transcutaneous carbon dioxide between the investigational and conventional masks at 60 min, adjusted for baseline, was -0.74 mm Hg, 95% CI -2.81 to 1.33 mm Hg (<i>P</i> = .45). The investigational mask with expiratory washout elicited a lower tidal volume (-128.7 mL, 95% CI -190.0 to -67.3 mL; <i>P</i> < .001) and minute ventilation (-2.28 L/min,^, 95% CI -3.12 to -1.43 L/min; <i>P</i> < .001), and a higher leak (7.96 L/min, 95% CI 4.39-11.54 L/min; <i>P</i> < .001) than the conventional mask. There were no differences in other physiologic responses or ratings of dyspnea or comfort.</p><p><strong>Conclusions: </strong>NIV therapy delivered by using a novel mask with expiratory washout was similarly effective at reducing transcutaneous carbon dioxide, whereas the delivered tidal volume and minute ventilation were significantly lower when compared with a conventional mask in participants with severe COPD.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971748","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 Relationship Between Physical Activity Level and Exercise Capacity and Respiratory Parameters in Individuals With Spinal Cord Injury.","authors":"Kubra Kardes, Yunus Emre Tutuneken, Yasemin Buran Cırak, Emine Atıcı, Nurgul Durustkan Elbası","doi":"10.4187/respcare.12060","DOIUrl":"https://doi.org/10.4187/respcare.12060","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injury (SCI) detrimentally impacts individuals' exercise capacity and respiratory parameters depending on sensory, motor, and autonomic dysfunctions. Regular physical activity (PA) positively impacts cardiovascular health and pulmonary function in these individuals. This study determined the relationship between PA and exercise capacity and respiratory parameters in individuals with SCI.</p><p><strong>Methods: </strong>This cross-sectional study included 40 individuals with paraplegia. Assessments included the Physical Activity Scale for Individuals With Physical Disabilities (PASIPD), 6-min manual wheelchair propulsion test (MWPT_6min), MWPT slalom test (MWPT_slalom), 20-m MWPT propulsion test (MWPT_20m), pulmonary function test (FVC, FEV₁, FEV₁/FVC, and peak expiratory flow [PEF]), maximum inspiratory pressure (P_Imax), and maximum expiratory pressure (P_Emax).</p><p><strong>Results: </strong>Subjects' mean age and body mass index were 46 ± 13 y and 26.8 ± 5.2 kg/m², respectively. PASIPD total score was significantly associated with MWPT_6min (r = 0.657, <i>P</i> < .001), MWPT_slalom (r = 0.403, <i>P</i> = .17) and MWPT_20m (r = 0.477, <i>P</i> = .056), FEV₁ (r = 0.552, <i>P</i> < .001), FEV₁/FVC (r = 0.532, <i>P</i> = .02), PEF (r = 0.683, <i>P</i> = .004), P_Imax (r = 0.484, <i>P</i> = .01), and P_Emax (r = 0.481, <i>P</i> = .16). However, PASIPD total score was not significantly associated with FVC (r = 0.168, <i>P</i> = .41).</p><p><strong>Conclusions: </strong>PA level influenced exercise capacity and pulmonary function in individuals with SCI and may play an important role in delimiting physical fitness.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627004","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":"Evaluating the Newly Proposed ARDS Definition in Hospitalized Patients With COVID-19 Treated With High-Flow Nasal Oxygen.","authors":"Shahin Isha, Gustavo Olaizola, Indalecio Carboni Bisso, Lekhya Raavi, Sadhana Jonna, Anna Jenkins, Abby Hanson, Rahul Kashyap, Veronica Monzon, Ivan Huespe, Devang Sanghavi","doi":"10.4187/respcare.11933","DOIUrl":"10.4187/respcare.11933","url":null,"abstract":"<p><strong>Background: </strong>The new Global definition of ARDS recently introduced a subgroup known as non-intubated ARDS. This study aimed to assess the risk of progression from noninvasive oxygen support to intubation and ARDS severity based on the S_pO₂ /F_IO₂ among non-intubated subjects with ARDS.</p><p><strong>Methods: </strong>This retrospective study included subjects with COVID-19 admitted to 7 hospitals (5 in the United States and 2 in Argentina) from January 2020-January 2023. Subjects meeting the new non-intubated ARDS definition (high-flow nasal cannula [HFNC] with an S_pO₂ /F_IO₂ ≤ 315 [with S_pO₂ ≤ 97%] or a P_aO₂ /F_IO₂ ≤ 300 mm Hg while receiving ≥30 L/min O₂ via HFNC) were included. The study evaluated the proportion of subjects who progressed to intubation, severity levels using the S_pO₂ /F_IO₂ cutoff proposed in the new ARDS definition, and mortality.</p><p><strong>Results: </strong>Nine hundred sixty-five non-intubated subjects with ARDS were included, of whom 27% (<i>n =</i> 262) progressed to meet the Berlin criteria within a median of 3 d (interquartile range 2-6). The overall mortality was 23% (95% CI 20-26) (<i>n</i> = 225), and among subjects who progressed to the Berlin criteria, it was 37% (95% CI 31-43) (<i>n</i> = 98). Additionally, the worst S_pO₂ /F_IO₂ within 1 d of ARDS diagnosis was correlated with mortality, with mortality rates of 26% (95% CI 23-30) (<i>n =</i> 177) for subjects with S_pO₂ /F_IO₂ ≤ 148, 17% (95% CI 12-23) (<i>n =</i> 38) for those with S_pO₂ /F_IO₂ between 149-234, and 16% (95% CI 8-28) (<i>n =</i> 10) for subjects maintaining an S_pO₂ /F_IO₂ higher than 235 (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>The non-intubated ARDS criteria encompassed a broader spectrum of subjects with lower in-hospital mortality compared to the Berlin criteria. The S_pO₂ /F_IO₂ and ARDS severity cutoff proposed in the new Global ARDS definition were valuable predictors of in-hospital mortality in these subjects.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547134","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":"Adherence to Lung Protective Ventilation in ARDS: A Mixed Methods Study Using Real-Time Continuously Monitored Ventilation Data.","authors":"Joseph M Plasek, Peter C Hou, Wenyu Zhang, Carlos A Ortega, Daniel Tan, Benjamin J Atkinson, Ya-Wen Chuang, Rebecca M Baron, Li Zhou","doi":"10.4187/respcare.12183","DOIUrl":"https://doi.org/10.4187/respcare.12183","url":null,"abstract":"<p><strong>Background: </strong>Lung-protective ventilation is a standard intervention for mitigating ventilator-induced lung injury in patients with ARDS. Despite its efficacy, adherence to contemporary evidence-based guidelines remains suboptimal. We aimed to identify factors that affect the adherence of staff to applying lung-protective ventilation guidelines by analyzing real-time, continuously monitored ventilation data over a 5-year longitudinal period.</p><p><strong>Methods: </strong>We conducted retrospective cohort and qualitative studies. Subjects with billing code J80 who survived at least 48 h of continuous mandatory ventilation with volume control in critical care settings between January 1, 2018, and December 31, 2022, were eligible. Tidal volume was measured dynamically (1-min resolution) and averaged hourly. The lung-protective ventilation setting studied was ≤ 6 mL/kg predicted body weight. A subgroup analysis was conducted by considering COVID-19 status. Focus groups of critical-care providers were convened to investigate the possible reasons for the non-utilization of lung-protective ventilation.</p><p><strong>Results: </strong>Among 1,055 subjects, 42.4% were on lung-protective ventilation settings at 48 h. Male sex was correlated with lung-protective ventilation (odds ratio [OR] 1.63, 95% CI 1.08-2.47), whereas age ≥ 60 y was associated with no lung-protective ventilation use (OR 0.61, 95% CI 0.39-0.94] in the subjects with non-COVID-19 etiologies. Improved staff adherence was observed in the subjects with COVID-19 early in the pandemic when COVID-19 (OR 1.48, 95% CI 1.07-2.04), male sex (OR 2.42, 95% CI 1.79-3.29), and neuromuscular blocking agent use within 48 h (OR 1.69, 95% CI 1.25-2.29) were correlated with staff placing subjects on lung-protective ventilation. However, lung-protective ventilation use occurred less frequently by staff managing subjects with cancer (OR 0.59, 95% CI 0.35-0.99) and hypertension (OR 0.62, 95% CI 0.45-0.85). Focus groups supported these findings and highlighted the need for an accurate height measurement on unit admission to determine the appropriate target tidal volume.</p><p><strong>Conclusions: </strong>Staff are not yet universally adherent to lung-protective ventilation best practices. Strategies, for example, continuous monitoring, with frequent feedback to clinical teams may help.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547132","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":"Delivery Efficiency of Albuterol Pressurized Metered Dose Inhaler Through Small Size Laryngeal Mask Airways in an Infant and Child Model.","authors":"Ariel Berlinski, Jessica Fonzie, L Denise Willis","doi":"10.4187/respcare.12055","DOIUrl":"https://doi.org/10.4187/respcare.12055","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative bronchospasm in pediatric patients supported through laryngeal mask airways (LMAs) is commonly treated with pressurized metered-dose inhaler (pMDI) albuterol. The aim of the study was to evaluate delivery of pMDI albuterol through LMAs under different conditions in a model of infant/child supported with a ventilator.</p><p><strong>Methods: </strong>We compared drug delivery efficiency of 4 actuations of albuterol pMDI (captured on a filter placed between the LMA and a test lung), drug deposition in the circuit (elbow) and in the LMA under different experimental conditions. Outcomes were expressed of percentage of nominal dose. We compared devices (valved holding chamber [VHC] and adapter), timing of administration (inspiration and expiration), tidal volumes (50 mL and 100 mL), mode of actuation (single and multiple), and LMA sizes (1, 1.5, and 2). Multiple regression analysis was used to evaluate the contribution of each to these components to the outcomes. <i>P</i> < .05 was considered statistically significant.</p><p><strong>Results: </strong>Results are expressed as median (interquartile range) of pooled data. Drug delivery efficiency was 0% (0-1.1) and 6.3% (3.2-14.7) for adapter and VHC, respectively. Elbow deposition was 25.8% (19.2-63.3) and 2.9% (1.4-6.4) for adapter and VHC, respectively. LMA deposition was 2.6% (1.3-4.6) and 4.6% (2.9-6.1) for adapter and VHC, respectively. Multiple regression analysis showed that device, timing of actuation, and LMA size explained 33%, 17%, and 8% of the observed variation in delivery efficiency (R² 0.63), respectively. Multiple regression analysis showed that device and timing of actuation explained 52% and 16% of the observed variation, respectively (R² 0.70). Multiple regression analysis poorly explained factors associated with LMA deposition (R² 0.22).</p><p><strong>Conclusions: </strong>Using a VHC, actuating the pMDI during exhalation, and using a small LMA size increased drug delivery efficiency. The adapter was an inefficient add-on device for aerosol delivery with a pMDI through an LMA that caused significant circuit deposition.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547133","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":"Impact of High-Flow Nasal Cannula Oxygen Therapy on the Pressure of the Airway System in Humans.","authors":"Darío S Villalba, Amelia Matesa, Sabrina Boni, Facundo J Gutiérrez, Roque Moracci, Gustavo A Plotnikow","doi":"10.4187/respcare.12082","DOIUrl":"https://doi.org/10.4187/respcare.12082","url":null,"abstract":"<p><strong>Background: </strong>The understanding of how pharyngeal pressure is transmitted to the trachea with high-flow nasal cannula (HFNC) implementation and the behavior of tracheal pressure in the presence of mouth leaks remains limited. This study aimed to assess the impact of HFNC administration on tracheal pressure by comparing measurements taken with open and closed mouth with varying flows.</p><p><strong>Methods: </strong>A crossover study was conducted between March 2019 and June 2023. Subjects age > 18 years, with a tracheostomy and who were in the process of decannulation were included. Tracheal and pharyngeal pressures were measured by using specific devices, with different HFNC flows and mouth conditions.</p><p><strong>Results: </strong>Nine subjects were assessed: 77% women, with an average age of 60.5 years. Tracheal pressure was significantly higher than pharyngeal pressure only in baseline conditions (<i>P</i> = .03). With regard to the rest of the scenarios, there were no significant differences between both pressures. Tracheal pressure was higher than the baseline condition both with an open mouth and a closed mouth (<i>P</i> = .02). The tracheal pressure at 60 L/min with an open mouth was higher than at 40 L/min (<i>P</i> = .042). The median pharyngeal pressure with a closed mouth was higher than with an open mouth, both with 40 and 60 L/min of flow (<i>P</i> = .048 and <i>P</i> < .001, respectively). Pharyngeal pressure at 60 L/min with an open mouth was higher than both baseline condition and at 40 L/min (<i>P</i> = .002 and <i>P</i> = .043, respectively). However, pharyngeal pressure with the closed mouth was significantly higher than with the open mouth both with 40 and 60 L/min of flow (<i>P</i> = .031 and <i>P</i> = .02 respectively).</p><p><strong>Conclusions: </strong>The implementation of HFNC changes airway pressures with values that impact at a tracheal level as the flow used increases. Our data contribute to the difficult interpretation of the existing interrelation between the programmed flow and its effects on the respiratory system.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547135","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":"Implementation of Nasal CPAP Weaning Guidelines in Preterm Infants.","authors":"Shivani N Mattikalli, Kimberly Wisecup, Heather Stephens, Ann Donnelly, Jennifer Erkinger, Sandeep Pradhan, Shaili Amatya","doi":"10.4187/respcare.11915","DOIUrl":"10.4187/respcare.11915","url":null,"abstract":"<p><strong>Background: </strong>CPAP benefits preterm infants with respiratory distress, including reduced bronchopulmonary dysplasia (BPD) incidence, surfactant use, and extubation failure. Successful CPAP weaning also promotes oral feeding. However, there is no consensus on the optimal weaning of CPAP in neonates. This study aimed to determine the effects of CPAP weaning guideline implementation on neonatal outcomes.</p><p><strong>Methods: </strong>CPAP gradual pressure weaning guidelines were implemented in the Penn State Children's Hospital neonatal ICU in 2020. We included baseline data from infants (epoch 1) before guideline implementation in 2018-2019. We included infants (epoch 2) after implementing the guidelines during 2020-2021. The inclusion criteria were infants < 32 weeks gestation with CPAP support. Adherence with the CPAP weaning guidelines was the primary process measure. Primary outcome measures included successful CPAP wean on the first attempt. Balancing measures used were total days on respiratory support and hospital length of stay.</p><p><strong>Results: </strong>One hundred ninety-five infants were included in this study, 95 infants in epoch 1 before guideline implementation and 100 infants in epoch 2 after implementing guidelines. Infants in the 2 epochs were similar in median gestational age at 29 weeks versus 30 weeks (<i>P</i> = .47) and were similar in median birthweight at 1,190 g versus 1,130 g (<i>P</i> = .73). After implementing weaning guidelines, the successful weaning off CPAP improved from 9.5% to 54% (<i>P</i> < .001). The total days needed to achieve full oral feeds decreased by 7 d (29 median d vs 22 median d, <i>P</i> < .001). The BPD incidence was not significantly different between the 2 epochs at 17% versus 16%, <i>P</i> = .87. There was no difference in total days of respiratory support, total length of stay, the number of infants discharged on home nasogastric feeding, and demographic variables.</p><p><strong>Conclusions: </strong>The implementation of the bubble CPAP weaning guideline improved the successful weaning of CPAP and promoted oral feeding in preterm infants.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749026","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, age and outcome in mechanical ventilated very old patients admitted to Intensive Care Unit.","authors":"Maria Doroti Sousa da Rosa, Gabriela Rech, Regis Gourlart Rosa, Henrique Mezzomo Pasqual, Cassiano Teixeira","doi":"10.4187/respcare.12317","DOIUrl":"10.4187/respcare.12317","url":null,"abstract":"<p><strong>Background: </strong>The global population is aging, and the proportion of elderly patients admitted to Intensive Care Units (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 is to evaluate the survival of older patients admitted to ICU who require mechanical ventilation (MV) at different levels of treatment intensity.</p><p><strong>Methods: </strong>A comprehensive longitudinal ICU database was retrospectively analyzed at a single tertiary center, from January 2008 to December 2014, of ICU subjects 80 years old or older who required mechanical ventilation.</p><p><strong>Results: </strong>From January 2009 to December 2014, 482 subjects were admitted to the ICU and required mechanical ventilation. Among them, 376 (78%) were aged between 80 to 89 years, and 106 (22%) were aged 90 years or older, with a mean age of 85.84 (4.56). The mean APACHE II score was 21.53 (7.42), and the mean SOFA 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 years (1.41(1.05;1.91), P = .02) and APACHE score (1.03(1.01;1.05), P < .001) were associated with mortality after adjustments. The TISS score was analyzed in tertiles and was not related to mortality in univariate analysis or after adjustments.</p><p><strong>Conclusions: </strong>Our data indicate that in older subjects using MV, 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":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-29","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":"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":"https://doi.org/10.4187/respcare.12221","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-29","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}