Respiratory care最新文献

{"title":"Rehabilitation Is Associated With Improvements in Post-COVID-19 Sequelae.","authors":"Andreas Asimakos, Stavroula Spetsioti, Spyros Mentzelopoulos, Ioannis Vogiatzis, Alice G Vassiliou, Pantelis Gounopoulos, Archontoula Antonoglou, Dimitrios Spaggoulakis, Sofia Pappa, Spyros Zakynthinos, Ioanna Dimopoulou, Paraskevi Katsaounou","doi":"10.4187/respcare.11863","DOIUrl":"10.4187/respcare.11863","url":null,"abstract":"<p><strong>Background: </strong>Post-COVID-19 syndrome has affected millions of people, with rehabilitation being at the center of non-pharmacologic care. However, numerous published studies show conflicting results due to, among other factors, considerable variation in subject characteristics. Currently, the effects of age, sex, time of implementation, and prior disease severity on the outcomes of a supervised rehabilitation program after COVID-19 remain unknown.</p><p><strong>Methods: </strong>This was a non-randomized case-control study. Subjects with post-COVID-19 sequelae were enrolled. Among study participants, those who could attend an 8-week, supervised rehabilitation program composed the intervention group, whereas those who couldn't the control group. Measurements were collected at baseline and 8 weeks thereafter.</p><p><strong>Results: </strong>Study groups (<i>N</i> = 119) had similar baseline measurements. Participation in rehabilitation (<i>n</i> = 47) was associated with clinically important improvements in the 6-min walk test (6MWT) distance, adjusted (for potential confounders) odds ratio (AOR) 4.56 (95% CI 1.95-10.66); 1-min sit-to-stand test, AOR 4.64 (1.88-11.48); Short Physical Performance Battery, AOR 7.93 (2.82-22.26); health-related quality of life (HRQOL) 5-level EuroQol-5D (Visual Analog Scale), AOR 3.12 (1.37-7.08); Montreal Cognitive Assessment, AOR 6.25 (2.16-18.04); International Physical Activity Questionnaire, AOR 3.63 (1.53-8.59); Fatigue Severity Scale, AOR 4.07 (1.51-10.98); Chalder Fatigue Scale (bimodal score), AOR 3.33 (1.45-7.67); Modified Medical Research Council dyspnea scale (mMRC), AOR 4.43 (1.83-10.74); Post-COVID-19 Functional Scale (PCFS), AOR 3.46 (1.51-7.95); and COPD Assessment Test, AOR 7.40 (2.92-18.75). Time from disease onset was marginally associated only with 6MWT distance, AOR 0.99 (0.99-1.00). Prior hospitalization was associated with clinically important improvements in the mMRC dyspnea scale, AOR 3.50 (1.06-11.51); and PCFS, AOR 3.42 (1.16-10.06). Age, sex, and ICU admission were not associated with the results of any of the aforementioned tests/grading scales.</p><p><strong>Conclusions: </strong>In this non-randomized, case-control study, post-COVID-19 rehabilitation was associated with improvements in physical function, activity, HRQOL, respiratory symptoms, fatigue, and cognitive impairment. These associations were observed independently of timing of rehabilitation, age, sex, prior hospitalization, and ICU admission.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1361-1370"},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752466","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":"Anesthetic Gas Scavenging System for Gas Evacuation in the ICU.","authors":"Lucie Collet, Mona Assefi, Jean-Michel Constantin","doi":"10.4187/respcare.11662","DOIUrl":"https://doi.org/10.4187/respcare.11662","url":null,"abstract":"<p><strong>Background: </strong>Inhaled sedation is increasing in ICUs, with active carbon filters (ACFs) commonly used for evacuating halogenated gases. However, the potential benefits of a waste anesthetic gas system (WAGS) similar to the ones used in operating rooms should be explored. To limit the suction over the flow sensor where the WAGS is connected on ICU ventilators, an anesthetic gas receiving system (AGRS) is required, constituting with the WAGS an active gas receiving and scavenging system (AGRSS). Ensuring that this whole device does not compromise the flow sensor reliability is crucial. The aim of this study was to compare various gas evacuation devices and assess the reliability of AGRSS on ICU ventilators.</p><p><strong>Methods: </strong>In this experimental study, pressures and flows were recorded during the ventilation of a test lung using various ventilator settings and gas evacuation methods: no device (reference condition), ACF, the WAGS alone, AGRSS (WAGS and AGRS together), and the expiratory valve connected to the medical vacuum system with the AGRS in between. Visual comparisons of the pressure and flow curves followed by a statistical analysis comparing median pressures and flows of each device to the reference were performed.</p><p><strong>Results: </strong>The test lung model demonstrated consistent comparability in pressures and flows among all devices, except for the WAGS alone, which exhibited discordance through significant overestimation or underestimation.</p><p><strong>Conclusions: </strong>These findings indicate that using a WAGS with the AGRS system appeared to be reliable for managing gas evacuation in ICUs without compromising pressure or flow delivery. The data from this experimental trial should be confirmed with clinical studies involving human subjects. Given the increasing use of inhaled sedation in ICUs, these results support the daily application of the WAGS with the AGRS for gas evacuation, similar to its established use in anesthesiology.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506909","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":"Respiratory Residency: Establishing Excellence for the Newly Licensed Respiratory Therapist.","authors":"Jessica L Patel, Carly A Grzehowiak, Laura O Douglas, Anna D Dunahoe, Jody Y Collins, Angela R Cushman, Heidi E Gilroy","doi":"10.4187/respcare.12108","DOIUrl":"https://doi.org/10.4187/respcare.12108","url":null,"abstract":"<p><strong>Background: </strong>Workforce issues have highlighted the fact that newly graduated respiratory therapists (RTs) need more support during their transition to practice; however, there are few data on best practices for RT residency programs.</p><p><strong>Methods: </strong>The aim of this project was to evaluate the feasibility and effectiveness of a residency program for licensed RTs with < 1 y of experience post graduation. The approach to improve new graduate transition to practice included a streamlined clinical-based orientation, didactic learning, evidence-based practice plan, and incorporated simulation. Data were collected in a secure electronic database at a multi-campus health care system utilizing anonymous questionnaires. The participants responded to questions about demographic information, overall confidence, clinical skills, and knowledge base topic confidence.</p><p><strong>Results: </strong>Participant responses reported an increase in their overall factor score measures for role confidence, clinical skills, and knowledge-based topics.</p><p><strong>Conclusions: </strong>The collected responses showed an increase in a wide range of clinical skills and other soft skills. These results indicate that a respiratory care residency program adds value to the training, overall well-being, and retention of the newly graduated RT.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506914","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 Strategies Used to Reduce UEs in the Neonatal Intensive Care Unit.","authors":"Samira Ansari, Michael Finelli, Efrosini A Papaconstantinou, Carolyn McGregor, Mika L Nonoyama","doi":"10.4187/respcare.11912","DOIUrl":"https://doi.org/10.4187/respcare.11912","url":null,"abstract":"<p><strong>Background: </strong>Unplanned extubation (UE) is the premature or unintended removal of an artificial airway and can cause worse patient outcomes. Study objectives were to describe implementation strategies used to reduce UE in the Hospital for Sick Children neonatal ICU (NICU) and their influence on UE rates, and contributing factors and patient characteristics of infants who had an UE, and compare them between the biological sexes. We hypothesized that the boys would experience more UEs and worse outcomes compared to the girls.</p><p><strong>Methods: </strong>The single-center retrospective cohort study included all infants who experienced UE (2007-2019). Outcomes consisted of implementation reduction strategies developed by using the plan-do-study-act quality-improvement methodology and UE characteristics, including patient (eg, sex, length of stay) and unplanned extubation situation characteristics (eg, events and/or procedures, repeats). Five plan-do-study-act cycles were implemented. Analyses included text summaries of all strategies, and quantitative descriptive and comparative statistics.</p><p><strong>Results: </strong>UE per 100 ventilator days decreased from 3.46 to 0.14. Key success factors included setting achievable goals; ensuring that strategies were evaluated and amended; maintaining consistency over the long-term; incorporating strategies in the NICU; having institutional support and validation; and having good communication. There were 302 UE in 257 infants, 141 boys (55%), average ± SD gestational age of 31 ± 6 weeks, and 31 (12%) had 45 repeated UEs. The only significant difference between the biological sexes was that more boys (129 [92%]) versus girls (94 [83%]) received the Hospital for Sick Children NICU endotracheal tube taping protocol (<i>P</i> = .030). The incidence of UE occurred in a 2-peaked pattern, highest for those < 32 weeks and ≥ 32 weeks of gestational age. Infants < 32 weeks of gestational age and with repeated UE had longer durations of invasive mechanical ventilation and length of stay. For infants <32 versus => 32 weeks gestational age, the median (interquartile range) duration of mechanical ventilation was 38 (16-77) d versus 6 (3-13) d and hospital length of stay 61 (30-100) d versus 16 (10-41) d. For infants with repeated versus no repeated unplanned extubations, duration of mechanical ventilation was 69 (26-125) d versus 13 (4-52) d and hospital length of stay 90 (39-137) d versus 32 (12-75) d.</p><p><strong>Conclusions: </strong>Detailed well-planned UE reduction strategies significantly reduced the rate of UEs with key factors of success identified. UE characteristics and infant morbidity did not differ between the biological sexes. Infants < 32 weeks of gestational age and with repeated UE had a longer duration of mechanical ventilation and length of stay.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506911","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":"Features Associated With the Presence of Specific Bacterial Strains in Pediatric Tracheostomy.","authors":"Caseng Zhang, Dalia Elawad, Matthew S Hicks, Cathy Schellenberg, Carina Majaesic, Gregory Tyrrell, E Anne Hicks","doi":"10.4187/respcare.11733","DOIUrl":"https://doi.org/10.4187/respcare.11733","url":null,"abstract":"<p><strong>Background: </strong>Tracheostomy bypasses physical barriers that decrease microbial access to the lower airway, which can lead to changes to the lung microbiota. Patients often become chronically colonized with potential pathogens. This study described the incidence and prevalence of specific organisms in a 5-y cohort of children with tracheostomy.</p><p><strong>Methods: </strong>This retrospective cohort of children aged 0-18 y with tracheostomy identified associations between microbial species and subject characteristics including reason for tracheostomy, gastrostomy tube (G-tube), fundoplication, and ventilator use using chi-square test or Fisher exact test.</p><p><strong>Results: </strong>Of 113 eligible patients, 79 (57% male) met study inclusion criteria. Reasons for tracheostomy included airway obstruction secondary to craniofacial anomalies in 16 children (20%), upper-airway obstruction in 14 subjects (17.3%), neuromuscular disorder in 19 subjects (24%), bronchopulmonary dysplasia with or without pulmonary hypertension in 17 subjects (21%), and congenital heart disease in 13 subjects (16%). Most (69%) used a ventilator for at least 6 h/d; 63% had a G-tube; 41% also had a Nissen fundoplication. Of the 20% with upper-airway obstruction, one third were ventilator dependent, unlike other diagnoses where 57% used a ventilator. <i>Staphylococcus aureus</i> (52/113), <i>Pseudomonas aeruginosa</i> (43/113), and <i>Stenotrophomonas</i> species (39/113) were the most frequently identified bacterial species. Most microbes identified were not associated with subjects underlying diagnoses, ventilator use, or feeding type. However, there was a significant association between upper-airway obstruction and group B Streptococcus species and G-tube with <i>P. aeruginosa</i>.</p><p><strong>Conclusions: </strong>This retrospective single-site descriptive cohort analysis of pediatric subjects with long-term tracheostomy identified trends in microbial prevalence. The presence of specific bacterial strains was more likely to follow individual subject trajectories than sequential appearance of species. <i>P. aeruginosa</i> was associated with G-tube and <i>Streptococcus</i> species with upper-airway obstruction. Ventilator dependence was not associated with specific microbial profiles.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506910","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":"Transpulmonary Pressure as a Predictor of Successful Lung Recruitment: Reanalysis of a Multicenter International Randomized Clinical Trial.","authors":"Abeer Santarisi, Aiman Suleiman, Simone Redaelli, Dario von Wedel, Jeremy R Beitler, Daniel Talmor, Valerie Goodspeed, Boris Jung, Maximilian S Schaefer, Elias Baedorf Kassis","doi":"10.4187/respcare.11736","DOIUrl":"https://doi.org/10.4187/respcare.11736","url":null,"abstract":"<p><strong>Background: </strong>Recruitment maneuvers are used in patients with ARDS to enhance oxygenation and lung mechanics. Heterogeneous lung and chest-wall mechanics lead to unpredictable transpulmonary pressures and could impact recruitment maneuver success. Tailoring care based on individualized transpulmonary pressure might optimize recruitment, preventing overdistention. This study aimed to identify the optimal transpulmonary pressure for effective recruitment and to explore its association with baseline characteristics.</p><p><strong>Methods: </strong>We performed post hoc analysis on the Esophageal Pressure Guided Ventilation (EpVent2) trial. We estimated the dose-response relationship between end-recruitment end-inspiratory transpulmonary pressure and the change in lung elastance after a recruitment maneuver by using logistic regression weighted by a generalized propensity score. A positive change in lung elastance was indicative of overdistention. We examined how patient characteristics, disease severity markers, and respiratory parameters predict transpulmonary pressure by using multivariate linear regression models and dominance analyses.</p><p><strong>Results: </strong>Of 121 subjects, 43.8% had a positive change in lung elastance. Subjects with a positive change in lung elastance had a mean ± SD transpulmonary pressure of 15.1 ± 4.9 cm H₂O, compared with 13.9 ± 3.9 cm H₂O in those with a negative change in lung elastance. Higher transpulmonary pressure was associated with increased probability of a positive change in lung elastance (adjusted odds ratio 1.35 per 1 cm H₂O of transpulmonary pressure, 95% CI 1.13-1.61; <i>P</i> = .001), which indicated an S-shaped dose-response curve, with overdistention probability > 50% at transpulmonary pressure values > 18.3 cm H₂O. The volume of recruitment was transpulmonary pressure-dependent (<i>P</i> < .001; R² = 0.49) and inversely related to a change in lung elastance after adjusting for baseline lung elastance (<i>P</i> < .001; R²= 0.43). Negative correlations were observed between transpulmonary pressure and body mass index, PEEP, Sequential Organ Failure Assessment score, and P_aO₂ /F_IO₂ , whereas baseline lung elastance showed a positive correlation. The body mass index emerged as the dominant negative predictor of transpulmonary pressure (ranking 1; contribution to R² = 0.08), whereas pre-recruitment elastance was the sole positive predictor (contribution to R² = 0.06).</p><p><strong>Conclusions: </strong>Higher end-recruitment transpulmonary pressure increases the volume of recruitment but raises the risk of overdistention, providing the rationale for transpulmonary pressure to be used as a clinical target. Predictors, for example, body mass index, could guide recruitment maneuver individualization to balance adequate volume gain with overdistention.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392832","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":"Neonatal Noninvasive Ventilation Nasal Mask Interface Pressure and the Inter-Individual Variation of Mask Placement.","authors":"Anne D Zakrajsek, Lissy Kesterson, Marty O Visscher, Vivek Narendran, Orlando S Hoilett, Eric A Nauman","doi":"10.4187/respcare.12217","DOIUrl":"https://doi.org/10.4187/respcare.12217","url":null,"abstract":"<p><strong>Background: </strong>The 2014 American Academy of Pediatrics recommendation for CPAP as an alternative to mechanical ventilation for treatment of neonatal respiratory distress prompted a rapid shift to noninvasive ventilation (NIV). Since most patients receive nasal bubble CPAP (a form of NIV), a concomitant increase in nasal pressure injuries followed. This prospective observational study aims to develop strategies to reduce nasal mask pressure injury in neonates by 1.) quantifying CPAP mask-interface pressure and 2.) assessing placement variability.</p><p><strong>Methods: </strong>A 1F MEMS Connect pressure sensor (Millar®) was modified for contact pressure measurements with silicone embedding and calibrated. The CPAP generator and interface components were sized for a 24-week neonatal simulator. Thirteen neonatal ICU staff placed the simulator on CPAP at 6 cmH₂O and 8 L/min of flow with no humidification. Pressure was measured at three locations (the forehead, nasal bridge, and philtrum) in triplicate (three measurements per site). Descriptive statistics, a location-specific, one-way analysis of variance (ANOVA) with a Tukey post hoc test, and a two-sample paired <i>t</i>-test of the means of the first and last triplicate were performed (Minitab, LLC).</p><p><strong>Results: </strong>Pressure ranged from 12.3 to 377.3 mmHg. The mean (SD) interface pressure at the philtrum was significantly higher than both the nasal bridge and the forehead (philtrum: 173.9 (101.3), nasal bridge: 67.79 (28.9), and forehead 79.02 (36.87), <i>p</i> ˂ 0.001). CPAP fixation varied, including bonnet placement, trunk angle, mask compression, use of hook and loop extenders, and level of vigorous bubble feedback achieved.</p><p><strong>Conclusions: </strong>This study developed a modified pressure sensor for quantifying the pressure exerted by a nasal mask on facial skin. Maximum pressures were higher than those previously reported. Inter-individual differences were present in both quantitative and qualitative measures of pressure. Reduction of NIV-associated pressure injuries may be achieved through NIV fixation technique training and improved nasal mask stability and size increments.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392830","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":"Family-Led Coaching of Patients During Weaning From Sedation and Mechanical Ventilation in the ICU.","authors":"Anmol Shahid, Corson Johnstone, Bonnie G Sept, Shelly Kupsch, Jon Pryznyk, Charissa Elton-LaCasse, Joanna Everson, Andrea Soo, Natalia Jaworska, Kirsten M Fiest, Henry T Stelfox","doi":"10.4187/respcare.11780","DOIUrl":"https://doi.org/10.4187/respcare.11780","url":null,"abstract":"<p><strong>Background: </strong>ICU patients are weaned from sedation and mechanical ventilation through spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs). Weaning can be distressing for patients and their families. Family-led coaching could reassure patients and reduce stress for families by engaging them in patient care. This study developed and piloted a family-led coaching tool to support patients undergoing SATs/SBTs.</p><p><strong>Methods: </strong>Patient and family member dyads were recruited from 2 medical-surgical ICUs in Calgary, Canada (February 3-August 1, 2023). Surveys were administered to collect family (1) demographics, (2) anxiety and satisfaction with ICU care, (3) feedback on the tool, and (4) attitudes about family presence during SATs/SBTs (also collected from clinicians). Tool feasibility was determined by calculating the proportions of (1) eligible patients who were recommended for participation in the study by clinicians and (2) families approached who consented to participate in the study.</p><p><strong>Results: </strong>One thousand one hundred fifty patients were admitted to the study ICUs during the study period of which 819 received mechanical ventilation, and 42 were recommended by bedside clinicians for participation in the study. Twenty-five dyads were approached, 21 dyads consented to participate, and one withdrew consent before data collection. Of the enrolled families, 12 (60%) reported the coaching tool to be useful, and 5 (25%) recommended minor suggestions such as \"shortening\" the tool. Fourteen (70%) families reported positive experiences (through open-ended feedback) with being present for the SAT/SBT. State-Trait Anxiety Inventory (Y1) scores (scale range 20-80 points) significantly decreased in families from the first (pre coaching) to the second (post coaching) measures (mean decrease 8.2 points, SD 10.3, <i>P</i> = .001). All clinicians indicated they were comfortable with family presence and/or coaching during SATs/SBTs.</p><p><strong>Conclusion: </strong>Family-led coaching of patients during SATs/SBTs appears to be feasible, favorably perceived by families and clinicians, and potentially associated with lower family anxiety.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392828","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":"Noninvasive Respiratory Support for Pediatric Critical Asthma.","authors":"Andrew G Miller, Alexandre T Rotta","doi":"10.4187/respcare.12487","DOIUrl":"https://doi.org/10.4187/respcare.12487","url":null,"abstract":"<p><p>Pediatric asthma is a significant cause of emergency department visits and hospital admissions. While most patients respond well to standard pharmacologic treatments, those with more severe disease frequently require noninvasive respiratory support (NRS) and adjunct therapies, or admission to an intensive care unit-a condition termed critical asthma. NRS modalities include high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and noninvasive ventilation (NIV) to deliver standard air-oxygen mixtures or helium-oxygen (heliox). Each NRS modality offers distinct physiological benefits, primarily aimed at reducing work of breathing, enhancing gas exchange, and optimizing aerosol delivery. Despite the growing use of NRS, robust evidence supporting its efficacy in pediatric critical asthma is limited, with few published clinical trials and a heavy reliance on observational studies to inform clinical practice. This narrative review explores the current evidence, physiological rationale, practical considerations, and future research directions for the use of NRS in pediatric critical asthma. The goal is to provide clinicians with a comprehensive overview of the benefits and limitations of NRS modalities to better inform therapeutic decisions and improve patient outcomes.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372740","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":"Pharmacological Management of Pediatric Critical Asthma.","authors":"Colin M Rogerson, Benjamin R White, Samer Abu-Sultaneh","doi":"10.4187/respcare.12458","DOIUrl":"https://doi.org/10.4187/respcare.12458","url":null,"abstract":"<p><p>Pediatric critical asthma, or formerly known as status asthmaticus, is a common pediatric condition encountered in emergency departments, hospital wards, and pediatric intensive care units. Systemic corticosteroids and inhaled bronchodilators are evidence-based, initial treatments for patients with pediatric critical asthma. If clinical symptoms do not improve, pediatric practitioners often prescribe adjunctive medications including inhaled anticholinergics, intravenous ketamine, intravenous magnesium, intravenous short acting beta 2 agonists, and intravenous methylxanthines (such as aminophylline). In this narrative review, we will summarize the current evidence and present the research gaps related to these therapies in the pediatric population.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352894","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}