Respiratory care最新文献

{"title":"Seeing in Synchrony: Toward Personalized Noninvasive Ventilation in Amyotrophic Lateral Sclerosis Through Dynamic Upper-Airway Visualization.","authors":"Tiina M Andersen, Bebiana Conde, Maria Vollsæter","doi":"10.1089/respcare.13193","DOIUrl":"10.1089/respcare.13193","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1193-1195"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286358","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 Conundrum of Race and Lung Function Won't Be Solved With a Reference Equation.","authors":"Jeffrey M Haynes, Robert Joyner, David A Kaminsky","doi":"10.1177/19433654251362698","DOIUrl":"10.1177/19433654251362698","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1198-1200"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144848583","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":"Editor's Commentary.","authors":"","doi":"10.1177/19433654251372298","DOIUrl":"10.1177/19433654251372298","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 9","pages":"i-ii"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966831","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":"Evaluation of a New Device for Clearing Secretions From Lower Airways.","authors":"Luigi Vivona, Fabiana Madotto, Eleonora Carlesso, Gaetano Florio, Stephen E Rees, Dan S Karbing, Federico Sodi, Irene Zainaghi, Veronica Rossi, Mauro Panigada, Alberto Zanella, Giacomo Grasselli","doi":"10.1089/respcare.12637","DOIUrl":"10.1089/respcare.12637","url":null,"abstract":"<p><p><b>Background:</b> Endotracheal intubation promotes the retention of secretions in the lower airways, potentially leading to infections and obstructions. A novel endotracheal cuff controller, synchronized with the ventilator, is designed to remove secretions from both above and below the endotracheal tube (ETT) cuff by generating a semi-automatic \"artificial cough\" through brief ETT cuff deflation during the inspiratory phase of a ventilator breath. This study assessed, first, in vitro, the accuracy of a computation for estimating the cough flow and, subsequently, in subjects, the device's effectiveness in moving secretions from lower airways toward the mouth during invasive ventilation. <b>Methods:</b> In the in vitro study, the mean cough flow estimated by the ratio between the expiratory volume lost and the duration of the cuff deflation was compared with the actual cough flow measured using flow meters. In the clinical study, we enrolled subjects admitted to the ICU. Three artificial cough maneuvers were performed within 3 min during a sigh (inspiratory pressure of 35 cm H₂O for ∼1.8 s). Aspiration of the oral cavity was conducted before the first maneuver and after the third maneuver. <b>Results:</b> A strong linear association was found between actual and computed cough flow (Pearson's correlation coefficient 0.991, 95% CI: 0.987-0.994). Twenty-eight subjects were enrolled. After device activation, oral secretions were detected in 78.6% of subjects (responders). Cough flow was similar in both responders and nonresponders, with a mean highest value of 23.3 ± 11.5 L/min. Demographic, physiological, and ventilatory parameters before and after the maneuvers were also similar. No relevant adverse events were recorded, except for one transient episode of hypotension. <b>Conclusions:</b> The cough flow can be accurately estimated from the expiratory volume lost. The device successfully generated effective cough flows in all subjects, clearing secretions from the trachea to the mouth in nearly 80% of cases.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1110-1119"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050959","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":"Ability of Turbine-Based Ventilators to Maintain Tidal Volume Following Transient Conditions.","authors":"Vincent Delord, Isabelle Vaugier, Hélène Prigent, Bruno Louis, Frédéric Lofaso","doi":"10.1177/19433654251367413","DOIUrl":"https://doi.org/10.1177/19433654251367413","url":null,"abstract":"<p><p><b>Background:</b> This study aimed to evaluate the efficacy and reliability of maintaining a constant tidal volume (V_T) using a square-wave flow pattern in currently available turbine-based ventilators (TBVs) compared with a bellows-based ventilator (BBV), under conditions of abrupt changes in ventilator load. Such changes frequently occur in ventilator-dependent patients during mouthpiece ventilation and sleep with a mask, including events such as air stacking (AS), leakage, disconnection for speaking or eating/drinking, and complete obstruction. <b>Methods:</b> Five TBVs and one BBV were assessed in a bench test simulating 4 distinct transient events (AS, leakage, disconnection, and complete obstruction) across 3 consecutive cycles. <b>Results:</b> During AS, only one TBV maintained V_T as effectively as the BBV, whereas the others showed a significant decrease in V_T when the elastic load increased because of the preceding stacked breath(s). During leakage, the same TBV again maintained V_T as effectively as the BBV, both during and after the leak. In contrast, the other TBVs exhibited a transient increase in delivered V_T at the onset of leakage, followed by a decrease once it ended. Except for the BBV, disconnection resulted in continuous air flow, with flow peaks occurring at the moments when V_T was expected to be delivered. Following the termination of obstructive apnea, all devices maintained the targeted V_T, except for one BBV, which delivered a V_T above baseline during the 2 subsequent cycles. <b>Conclusions:</b> At least one BBV consistently maintained a stable V_T under various conditions, including AS, leakage, postapnea recovery, and postdisconnection. However, disconnection was associated with continuous air flow in the TBVs, which could be disruptive during mouthpiece ventilation disconnection for speaking, eating, or drinking. This unintended effect warrants further investigation.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Dead Space to Tidal Volume Ratio and Duration of Respiratory Support After Extubation in Children With Congenital Heart Disease.","authors":"Leonid Bederman, Monica Alvarez, Andrew G Miller, Elizabeth J Thompson, Rachel M Watts, Alexandre T Rotta, Karan R Kumar","doi":"10.1177/19433654251362706","DOIUrl":"https://doi.org/10.1177/19433654251362706","url":null,"abstract":"<p><p><b>Background:</b> Children with cardiac disease liberated from mechanical ventilation often receive noninvasive respiratory support (NRS) postextubation via high-flow nasal cannula, CPAP, or noninvasive ventilation. Predicting the type and duration of postextubation NRS can be challenging due to a lack of objective tools to guide decision-making. The dead space to tidal volume ratio (V_D/V_T) is a potential tool to guide this decision. We hypothesized that an elevated V_D/V_T would be associated with longer duration and higher level of NRS following extubation in children with cardiac disease. <b>Methods:</b> We conducted a retrospective cohort study of mechanically ventilated patients admitted to our pediatric cardiac intensive care unit between March 2019 and July 2021 with at least one V_D/V_T recorded before extubation. Subjects were dichotomized a priori into two groups V_D/V_T < 0.30 and V_D/V_T ≥ 0.30. We recorded the type of NRS at 24 hours, 48 hours, 72 hours, 7 days, and 14 days after extubation. <b>Results:</b> We included 226 subjects. Median (IQR) weight was 4.1 (3.3-6.6) kg, 47% were female, 47% had cyanotic heart disease, and 90% were mechanically ventilated for respiratory failure or cardiac surgery. Subjects with V_D/V_T ≥ 0.30 experienced longer postextubation NRS (4 [1.9-9.1] vs 3 [1.2-5.3] days, <i>P</i> = .001) and were more likely to receive high-flow nasal cannula (67% vs 45%, <i>P</i> = .02) 24 hours following extubation. NRS modality immediately postextubation and reintubtion rates were similar between groups. Subjects with V_D/V_T ≥ 0.30 were younger (1.2 [0.1-3.6] vs 4.8 [1.2-30] months, <i>P</i> < .001) and more likely to have cyanotic congenital heart disease (59% vs 26%, <i>P</i> < .001). After adjusting for demographic and clinical characteristics, V_D/V_T was not associated with NRS use. <b>Conclusion:</b> V_D/V_T was not associated with the length of NRS after extubation or re-intubation after controlling for demographic and clinical differences.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966800","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":"To Breathe or Not to Breathe.","authors":"Jonathon D Truwit, R Duncan Hite","doi":"10.1177/19433654251373024","DOIUrl":"https://doi.org/10.1177/19433654251373024","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966786","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":"Ventilator Hyperinflation Versus Manual Chest Compression and Airway Clearance in Mechanically Ventilated Patients.","authors":"Jéssica Magnante, Daniel Lago Borges, Antuani Rafael Baptistella","doi":"10.1177/19433654251366897","DOIUrl":"https://doi.org/10.1177/19433654251366897","url":null,"abstract":"<p><p><b>Background:</b> Secretion accumulation in patients undergoing mechanical ventilation impairs ventilatory mechanics and gas exchange, which may prolong hospital stay and increase the risk of respiratory infections. Manual chest compression (MCC) and ventilator hyperinflation (VHI) are techniques used for airway clearance, but there are no studies comparing the effect of these two techniques. The aim of this study was to compare the effects of VHI and MCC on secretion clearance in mechanically ventilated patients. <b>Method:</b> This randomized crossover clinical trial enrolled 44 adult ICU subjects on mechanical ventilation. Each participant received both interventions in random order, separated by a 4-hour washout period. The primary outcome was the amount of sputum removed. Secondary outcomes included peak expiratory flow (PEF), flow bias, dynamic lung compliance, and hemodynamic parameters. <b>Results:</b> The results showed that although VHI significantly increased PEF (<i>P</i> = .007) and expiratory flow bias (<i>P</i> < .001) compared with MCC, there was no statistically significant difference in the amount of sputum removed between the two methods (<i>P</i> = .51). Furthermore, there was no difference in the effects on blood pressure, heart rate, peripheral O₂ saturation, and compliance between the two maneuvers. <b>Conclusions:</b> VHI was noninferior to MCC in promoting airway clearance and offers additional advantages, including enhanced flow dynamics and reduced physical strain on physiotherapists. These findings suggest that VHI may be a practical, safe, and efficient alternative for airway clearance therapy in critically ill, mechanically ventilated patients.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of the Driving Pressure With Delayed Extubation After Pediatric Liver Transplantation.","authors":"Thomas Semenoff, Christophe Chardot, Stefania Querciagrossa, Florence Lacaille, Mehdi Oualha, Sylvain Renolleau, Meryl Vedrenne-Cloquet","doi":"10.1177/19433654251364826","DOIUrl":"https://doi.org/10.1177/19433654251364826","url":null,"abstract":"<p><p><b>Background:</b> Mechanical ventilation following pediatric liver transplant remains common and extends weaning duration. The aim of this study was to identify the risk factors for delayed extubation in children following liver transplantation, focusing on respiratory mechanics. We also compared respiratory morbidity and mortality according to the extubation status. <b>Methods:</b> In this retrospective, monocentric cohort study, children under 18 years were included if they underwent primary liver transplant. The primary end point was delayed extubation, defined as any extubation 48 hours after transplantation. Preoperative graft and subject characteristics, as well as intra- and postoperative ventilatory and hemodynamic parameters, were tested to assess their association with delayed extubation in univariate then multivariate analyses, using 2 logistic regression models (\"intra-operative model\" and \"pediatric intensive care unit [PICU] model\"). <b>Results</b>: Ninety-six subjects were included, among whom 46 (47%) had delayed extubation. In the operating room, independent risk factors for delayed extubation were the amount of transfusions (odds ratio [OR] 2.77, 95% CI, 1.19-9.04, <i>P</i> = .045) and maximal blood lactatemia (OR 1.62, 95% CI, 1.15-2.53, <i>P</i> = .01). In the PICU, driving pressure (ΔP) 12 hours after the surgery and the presence of a postoperative complication (any graft vessel thrombosis, severe bleeding, and/or surgical revision) were independently associated with delayed extubation (OR 1.31, 95% CI, 1.05-1.70, <i>P</i> = .03 for ΔP, and OR 14.55, 95% CI, 2.83-181.29, <i>P</i> = .004 for any complication). When excluding 28 children with surgical revision, ΔP remained associated with delayed extubation, whereas complications were not. <b>Conclusions:</b> A higher ΔP in the early hours following pediatric liver transplantation was associated with prolonged mechanical ventilation, along with hyperlactatemia and transfusions during surgery, and postoperative complications.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966804","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":"Management of Body Temperature via the Respiratory Tract.","authors":"Brian J Ring, François Lellouche, Robert Chatburn, Michael Goodman, Richard D Branson","doi":"10.1177/19433654251360619","DOIUrl":"https://doi.org/10.1177/19433654251360619","url":null,"abstract":"<p><p>Hypothermia, defined as a core body temperature ≤35°C, significantly increases morbidity and mortality in mechanically ventilated patients across numerous care settings. Physiologically, the upper airway conditions inspired gases to body temperature and humidity, minimizing heat energy loss and preventing mucosal damage. Instrumentation, such as endotracheal intubation, bypasses this natural mechanism, leading to considerable heat and moisture loss, potentially exacerbating hypothermia risks in critically ill patients. Active humidifiers and heat and moisture exchangers represent common strategies to mitigate airway heat loss, yet their effectiveness as a method to assist in whole-body rewarming is controversial. Emerging technologies indicate renewed interest in airway-based warming devices, especially for prehospital and military trauma scenarios, but robust clinical validation remains necessary. This narrative review evaluates the feasibility and effectiveness of airway-based thermoregulation through inhalation of heated, humidified gases.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966815","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}