Respiratory care最新文献

{"title":"Respiratory Oscillometry in Patients With Acute Hypoxemic Respiratory Failure: A Feasibility Study.","authors":"Dmitry Ponomarev, Joyce K Y Wu, Zoltán Hantos, Chung-Wai Chow, Ewan Goligher","doi":"10.4187/respcare.12285","DOIUrl":"10.4187/respcare.12285","url":null,"abstract":"<p><strong>Background: </strong>Assessing respiratory mechanics in patients with acute hypoxemic respiratory failure who are not intubated could provide useful information about illness trajectory. Oscillometry is a respiratory function test used to measure total respiratory impedance during tidal breathing, which reveals resistive and elastic properties of the lung. This study assessed the feasibility of oscillometry in patients with acute hypoxemic respiratory failure and described their respiratory mechanics.</p><p><strong>Methods: </strong>Adult participants with acute hypoxemic respiratory failure who were receiving noninvasive respiratory support with [Formula: see text] ≥0.4 and flow ≥6 L/min underwent oscillometry at baseline and after resolution of acute hypoxemic respiratory failure. The primary end point was the number of participants who completed the baseline measurement. The feasibility criterion was in obtaining baseline oscillometry measurements in ≥80% of enrolled participants.</p><p><strong>Results: </strong>Of 183 patients screened between July 2022 and August 2023, 29% were unable to cooperate due to altered mental state, 20% with extreme hypoxemia were excluded because of clinical instability, and 12% declined participation. Of the 10 participants (5.4%) recruited, all tolerated oscillometry measurements. At baseline, the median (minimum, maximum) [Formula: see text] was 0.8 (0.4, 0.8), median oxygen saturation of 94% dropped to a nadir of 82% at the end of oscillometry and recovered within 2 min. Lung reactance was increased, with a reactance area of 25 (15-32) cm H₂O/L. Hypoxemia resolved in 9 participants. After resolution of acute hypoxemic respiratory failure in 8 (6-16) d, the median reactance area dropped to 15 (14-19) cm H₂O/L.</p><p><strong>Conclusions: </strong>Respiratory mechanics in the participants with acute hypoxemic respiratory failure who were not intubated could be assessed by oscillometry in carefully selected cases.</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":"142547137","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":"Prediction of Hospital Readmission Using the CORE and CORE+ Scores in Persons With COPD.","authors":"Ahmad A Elshafei, Guy Nehrenz, Patrick C Hardigan, Ellen A Becker","doi":"10.4187/respcare.11766","DOIUrl":"10.4187/respcare.11766","url":null,"abstract":"<p><strong>Background: </strong>Identifying persons with COPD at high risk for hospital readmission provides opportunities for efficient and appropriate care to lower readmission risk. This study examined 30-d and 60-d hospital readmission prediction of the COPD-readmission (CORE) score and a newly developed CORE+ score. The relationship between CORE and CORE+ scores and ICU admission, endotracheal intubation, and in-hospital noninvasive ventilation (NIV) use was explored.</p><p><strong>Methods: </strong>A retrospective cohort study evaluated participants with spirometry-confirmed COPD from 2 Midwestern academic hospitals. The CORE score variables included eosinophil blood count, FEV₁/FVC (<0.70) and FEV₁ (≤40% of predicted), triple inhaler therapy, previous hospitalization, and presence of neuromuscular disease. Out-of-hospital NIV use and Charlson comorbidity index were added to compose the CORE+ score. Researchers assessed associations between variables and outcomes with chi-square test or Fisher exact test, compared results of CORE and CORE+ scores with Wilcoxon signed-rank test, assessed each score's 30-d and 60-d readmission predictive power with multiple logistic regression, and evaluated predictive accuracy with AUC of receiver operating characteristic using alpha < 0.05.</p><p><strong>Results: </strong>Of 391 participants, the study found a 22% 30-d, all-cause readmission rate and a 16% 60-d, all-cause readmission rate. CORE+ score had better predictive accuracy than the CORE score for 30-d readmission (area under the curve 0.81 [95% CI 0.76-0.86]; AUC 0.73 [95% CI 0.66-0.79], <i>P</i> < .001) and 60-d readmission (AUC 0.77 [95% CI 0.71-0.83]; AUC 0.75 [95% CI 0.69-0.81], <i>P</i> < .001). Participants who used in-hospital NIV had higher median CORE+ scores (<i>P</i> = < .001).</p><p><strong>Conclusions: </strong>CORE and CORE+ scores demonstrated good to very good predictive accuracy for 30-d and 60-d readmission, respectively. Moreover, this study demonstrated a linear relationship between in-hospital NIV use and CORE+ score.</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":"142547136","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":"Use of Laryngeal Ultrasound to Observe Laryngeal Movements During Noninvasive Ventilation in Healthy Volunteers.","authors":"Anne Kristine Brekka, George Ntoumenopoulos, Ola Drange Røksund, Merete Salveson Engeset, Hege Clemm, Thomas Halvorsen, Maria Vollsæter, Tiina Andersen","doi":"10.4187/respcare.12201","DOIUrl":"10.4187/respcare.12201","url":null,"abstract":"<p><strong>Background: </strong>Transnasal fiberoptic laryngoscopy (TFL) has revealed that laryngeal obstruction can hamper assisted ventilation. TFL may be considered invasive, and laryngeal ultrasound (US) could be a noninvasive alternative. The objective of this study was to investigate the feasibility of using laryngeal US to study laryngeal movements in healthy adult volunteers undergoing noninvasive ventilation (NIV) and to compare the observations with those of simultaneous TFL.</p><p><strong>Methods: </strong>In this cross-sectional study, 30 participants (19 females, age 22-65 y) underwent simultaneous video-recorded TFL and laryngeal US, breathing with and without NIV. Laryngeal US was repeated for anterior and both lateral approaches; the last 5 breaths from each assessment were analyzed. The participants rated discomfort using a numeric rating scale (NRS) from 0 (no discomfort)-10 (worst). Two blinded raters separately described and scored the TFL and laryngeal US recordings, and the findings were subsequently compared. The last 10 laryngeal US recordings were tested for interrater reliability.</p><p><strong>Results: </strong>All participants were successfully assessed using the anterior and both lateral laryngeal US approaches during NIV. Both techniques were well tolerated; 5/30 scored 0 on NRS for TFL and 22/30 for laryngeal US. The visualization rate for all recorded breaths was 99.1% for TFL compared to 81.7% for laryngeal US; overall concordance rate was 84.6%. The discordance rate for the TFL versus laryngeal US observations was 11.1% for vocal fold movements and 11.7% for aryepiglottic fold movements. Interrater reliability showed substantial agreement (0.71).</p><p><strong>Conclusions: </strong>Laryngeal US emerged as a feasible method to describe laryngeal movements during NIV, providing high-quality observations and high concordance with TFL.</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":"142547038","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":"Invasive Mechanical Ventilation and Risk of Hospital-Acquired Venous Thromboembolism.","authors":"Elizabeth E Havlicek, Jamie Palumbo, Gerardo Soto-Campos, Neil A Goldenberg, Anthony A Sochet","doi":"10.4187/respcare.11698","DOIUrl":"10.4187/respcare.11698","url":null,"abstract":"<p><strong>Background: </strong>This study sought to estimate the overall cumulative incidence and odds of Hospital-acquired venous thromboembolism (VTE) among critically ill children with and without exposure to invasive ventilation. In doing so, we also aimed to describe the temporal relationship between invasive ventilation and hospital-acquired VTE development.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using Virtual Pediatric Systems (VPS) data from 142 North American pediatric ICUs among children < 18 y of age from January 1, 2016-December 31, 2022. After exclusion criteria were applied, cohorts were identified by presence of invasive ventilation exposure. The primary outcome was cumulative incidence of hospital-acquired VTE, defined as limb/neck deep venous thrombosis or pulmonary embolism. Multivariate logistic regression was used to determine whether invasive ventilation was an independent risk factor for hospital-acquired VTE development.</p><p><strong>Results: </strong>Of 691,118 children studied, 86,922 (12.4%) underwent invasive ventilation. The cumulative incidence of hospital-acquired VTE for those who received invasive ventilation was 1.9% and 0.12% for those who did not (<i>P</i> < .001). The median time to hospital-acquired VTE after endotracheal intubation was 6 (interquartile range 3-14) d. In multivariate models, invasive ventilation exposure and duration were each independently associated with development of hospital-acquired VTE (adjusted odds ratio 1.64 [95% CI 1.42-1.86], <i>P</i> < .001; and adjusted odds ratio 1.03 [95% CI 1.02-1.03], <i>P</i> < .001, respectively).</p><p><strong>Conclusions: </strong>In this multi-center retrospective review from the VPS registry, invasive ventilation exposure and duration were independent risk factors for hospital-acquired VTE among critically ill children. Children undergoing invasive ventilation represent an important target population for risk-stratified thromboprophylaxis trials.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1392-1399"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Web-Based and On-Site Lung Simulators for Education in Mechanical Ventilation.","authors":"Sami Safadi, Megan Acho, Stephanie I Maximous, Michael B Keller, Eric Kriner, Christian J Woods, Junfeng Sun, Bashar S Staitieh, Burton W Lee, Nitin Seam","doi":"10.4187/respcare.12072","DOIUrl":"10.4187/respcare.12072","url":null,"abstract":"<p><strong>Background: </strong>Training in mechanical ventilation is a key goal in critical care fellowship education. Web-based simulators offer a cost-effective and readily available alternative to traditional on-site simulators. However, it is unclear how effective they are as teaching tools. In this study, we evaluated the test scores of fellows who underwent mechanical ventilation training by using a web-based simulator compared with fellows who used an on-site simulator during a mechanical ventilation course.</p><p><strong>Methods: </strong>This was a nonrandomized controlled trial conducted as part of a mechanical ventilation course that involved 70 first-year critical care fellows. The course was identical except for the simulation technology used. One group of instructors used a traditional on-site simulator, the ASL 5000 Lung Solution (<i>n =</i> 39). The second group was instructed in using a web-based simulator, VentSim (<i>n =</i> 31). Each fellow completed a pre-course test and a post-course test by using a validated, case-based ventilator waveform examination that consisted of 5 questions with a total possible score of 100. The primary outcome was a comparison of the mean scores on the posttest between the 2 groups. The study was designed as a non-inferiority trial with a predetermined margin of 10 points.</p><p><strong>Results: </strong>There was no significant difference in the mean ± SD pretest scores between the web-based and the on-site groups (21.1 ± 12.6 and 26.9 ± 13.6 respectively; <i>P</i> = .11). The mean ± SD posttest scores were 45.6 ± 25.0 for the web-based simulator and 43.4 ± 16.5 for on-site simulator (mean difference 2.2; one-sided 95% CI -7.0 to ∞; <i>P</i> _{non-inferiority} = .02 [non-inferiority confirmed]). Changes in mean ± SD scores (posttest - pretest) were 25.9 ± 20.9 for the web-based simulator and 16.5 ± 15.9 for the on-site simulator (mean difference 9.4, one-sided 95% CI 0.9 to ∞; <i>P</i> _{non-inferiority} < .001 [non-inferiority confirmed]).</p><p><strong>Conclusions: </strong>In the education of first-year critical care fellows on mechanical ventilation waveform analysis, a web-based mechanical ventilation simulator was non-inferior to a traditional on-site mechanical ventilation simulator.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1353-1360"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Delivering 5-Day Normobaric Hypoxia Breathing in a Hospital Setting.","authors":"Lorenzo Berra, Kyle J Medeiros, Francesco Marrazzo, Sarvagna Patel, David Imber, Emanuele Rezoagli, Binglan Yu, Abraham Sonny, Edward A Bittner, Daniel Fisher, Daniel Chipman, Rohit Sharma, Hardik Shah, Brianna E Gray, N Stuart Harris, Fumito Ichinose, Vamsi K Mootha","doi":"10.4187/respcare.11928","DOIUrl":"10.4187/respcare.11928","url":null,"abstract":"<p><strong>Background: </strong>Beneficial effects of breathing at [Formula: see text] < 0.21 on disease outcomes have been reported in previous preclinical and clinical studies. However, the safety and intra-hospital feasibility of breathing hypoxic gas for 5 d have not been established. In this study, we examined the physiologic effects of breathing a gas mixture with [Formula: see text] as low as 0.11 in 5 healthy volunteers.</p><p><strong>Methods: </strong>All 5 subjects completed the study, spending 5 consecutive days in a hypoxic tent, where the ambient oxygen level was lowered in a stepwise manner over 5 d, from [Formula: see text] of 0.16 on the first day to [Formula: see text] of 0.11 on the fifth day of the study. All the subjects returned to an environment at room air on the sixth day. The subjects' [Formula: see text], heart rate, and breathing frequency were continuously recorded, along with daily blood sampling, neurologic evaluations, transthoracic echocardiography, and mental status assessments.</p><p><strong>Results: </strong>Breathing hypoxia concentration dependently caused profound physiologic changes, including decreased [Formula: see text] and increased heart rate. At [Formula: see text] of 0.14, the mean [Formula: see text] was 92%; at [Formula: see text] of 0.13, the mean [Formula: see text] was 93%; at [Formula: see text] of 0.12, the mean [Formula: see text] was 88%; at [Formula: see text] of 0.11, the mean [Formula: see text] was 85%; and, finally, at an [Formula: see text] of 0.21, the mean [Formula: see text] was 98%. These changes were accompanied by increased erythropoietin levels and reticulocyte counts in blood. All 5 subjects concluded the study with no adverse events. No subjects exhibited signs of mental status changes or pulmonary hypertension.</p><p><strong>Conclusions: </strong>Results of the current physiologic study suggests that, within a hospital setting, delivering [Formula: see text] as low as 0.11 is feasible and safe in healthy subjects, and provides the foundation for future studies in which therapeutic effects of hypoxia breathing are tested.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1400-1408"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Increased PEEP on Hemodynamics, Respiratory Mechanics, and Oxygenation in Pediatric ARDS.","authors":"Fernanda Md Junqueira, Isabel S Ferraz, Fábio J Campos, Toshio Matsumoto, Marcelo B Brandão, Roberto Jn Nogueira, Tiago H de Souza","doi":"10.4187/respcare.12005","DOIUrl":"10.4187/respcare.12005","url":null,"abstract":"<p><strong>Background: </strong>PEEP is a cornerstone treatment for children with pediatric ARDS. Unfortunately, its titration is often performed solely by evaluating oxygen saturation, which can lead to inadequate PEEP level settings and consequent adverse effects. This study aimed to assess the impact of increasing PEEP on hemodynamics, respiratory system mechanics, and oxygenation in children with ARDS.</p><p><strong>Methods: </strong>Children receiving mechanical ventilation and on pressure-controlled volume-guaranteed mode were prospectively assessed for inclusion. PEEP was sequentially changed to 5, 12, 10, 8 cm H₂O, and again to 5 cm H₂O. After 10 min at each PEEP level, hemodynamic, ventilatory, and oxygenation variables were collected.</p><p><strong>Results: </strong>A total of 31 subjects were included, with median age and weight of 6 months and 6.3 kg, respectively. The main reasons for pediatric ICU admission were respiratory failure caused by acute viral bronchiolitis (45%) and community-acquired pneumonia (32%). Most subjects had mild or moderate ARDS (45% and 42%, respectively), with a median (interquartile range) oxygenation index of 8.4 (5.8-12.7). Oxygen saturation improved significantly when PEEP was increased. However, although no significant changes in blood pressure were observed, the median cardiac index at PEEP of 12 cm H₂O was significantly lower than that observed at any other PEEP level (<i>P</i> = .001). Fourteen participants (45%) experienced a reduction in cardiac index of > 10% when PEEP was increased to 12 cm H₂O. Also, the estimated oxygen delivery was significantly lower, at 12 cm H₂O PEEP. Finally, respiratory system compliance significantly reduced when PEEP was increased. At a PEEP of 12 cm H₂O, static compliance had a median reduction of 25% in relation to the initial assessment (PEEP of 5 cm H₂O).</p><p><strong>Conclusions: </strong>Although it may improve arterial oxygen saturation, inappropriately high PEEP levels may reduce cardiac output, oxygen delivery, and respiratory system compliance in pediatric subjects with ARDS with low potential for lung recruitability.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1409-1416"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on Using Race in Pulmonary Function Testing: A National Survey Fellows and Program Directors.","authors":"Debasree Banerjee, Sara Aijaz, Nicholas J Nassikas, Parvati Singh, Sneha Lakshman, Chelsea Boyd, Quincy Brown, Amy Mathew, Rochelle K Rosen, Ryan Lantini, Sarah B Andrea, Stephen R Walsh, Eric J Gartman, Andrew Levinson, Gerardo Carino, Lundy Braun","doi":"10.4187/respcare.11734","DOIUrl":"10.4187/respcare.11734","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary function tests (PFTs) have historically used race-specific prediction equations. The recent American Thoracic Society guidelines recommend the use of a race-neutral approach in prediction equations. There are limited studies centering the opinions of practicing pulmonologists on the use of race in spirometry. Provider opinion will impact adoption of the new guideline. The aim of this study was to ascertain the beliefs of academic pulmonary and critical care providers regarding the use of race as a variable in spirometry prediction equations.</p><p><strong>Methods: </strong>We report data from 151 open-ended responses from a voluntary, nationwide survey (distributed by the Association of Pulmonary Critical Care Medicine Program Directors) of academic pulmonary and critical care providers regarding the use of race in PFT prediction equations. Responses were coded using inductive and deductive methods, and a thematic content analysis was conducted.</p><p><strong>Results: </strong>There was a balanced distribution of opinions among respondents supporting, opposing, or being unsure about the incorporation of race in spirometry prediction equations. Responses demonstrated a wide array of understanding related to the concept and definition of race and its relationship to physiology.</p><p><strong>Conclusions: </strong>There was no consensus among providers regarding the use of race in spirometry prediction equations. Concepts of race having biologic implications persist among pulmonary providers and will likely affect the uptake of the Global Lung Function Initiative per the American Thoracic Society guidelines.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1371-1379"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Downstream Effects of Market Changes on Inhalers: Impacts on Individuals With Chronic Lung Disease.","authors":"Joyce A Baker, Mitzi L Cardona, Laney D Brennan","doi":"10.4187/respcare.12024","DOIUrl":"10.4187/respcare.12024","url":null,"abstract":"<p><p>COPD and asthma are two of the most common chronic lung diseases, affecting over 545 million people globally and 34 million in the United States. Annual health care costs related to chronic lung disease are estimated at €380 billion in the European Union, and $24-$50 billion in the United States averaging to $4,000 in out-of-pocket costs per person in the U.S. A full-text literature search was conducted for English publications between January 1, 2005-March 18, 2024. It returned over 5,000 publications that were further narrowed using key search words, resulting in 172 peer-reviewed articles. Using their experience and subject expertise, the authors further narrowed the peer-reviewed articles to 55 that were in their opinion relevant. Also, 38 recently published industry reports and news articles specific to downstream effects of inhaler market changes and the future impact were included. The literature suggests that individuals with chronic lung disease face increased challenges with access to inhaled medication due to rising medication costs, discontinuation of branded medications, introduction of generic medications not covered by insurance, exclusionary preferred drug list tactics that force health care providers into non-medical switching of medication or devices, and ongoing medication shortages. Providers experience ongoing hurdles in prescribing appropriate inhaled medications for individuals with chronic lung disease, including increased time and costs spent on administrative tasks due to inhaler denials, a loss of patient trust, and limits on their ability to prescribe appropriate inhaled medication for individuals with chronic lung disease.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"69 11","pages":"1448-1456"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation in Mechanical Ventilation Training: Integrating Best Practices for Effective Education.","authors":"Eduardo Mireles-Cabodevila, Kimber Catullo, Robert L Chatburn","doi":"10.4187/respcare.12551","DOIUrl":"10.4187/respcare.12551","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"69 11","pages":"1468-1476"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}