Respiratory care最新文献

{"title":"Estimating Patient Breathing Effort During Noninvasive Ventilation: Is It Possible?","authors":"Thomas Piraino, L Felipe Damiani","doi":"10.1089/respcare.12880","DOIUrl":"10.1089/respcare.12880","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions and Barriers to Degree Advancement of Respiratory Therapists.","authors":"Trevor Lee, Megan Koster, Donna Gardner, Carl Siebert","doi":"10.1089/respcare.12181","DOIUrl":"10.1089/respcare.12181","url":null,"abstract":"<p><p><b>Background:</b> The profession of respiratory care has not seen an increase in minimum education requirements in over 40 years; however, the roles and responsibilities of providers have dramatically increased. Although degree advancement (DA) opportunities have increased exponentially to support respiratory therapists (RTs) pursue higher levels of education, the number of RTs who pursue a baccalaureate-level degree remain a small percentage of practitioners, indicating that barriers to advancement exist. The purpose of this study was to identify the perceptions and barriers to DA among active RTs. <b>Method:</b> This cross-sectional study utilized a web-based survey to glean descriptive and qualitative information related to the study questions. The survey was conducted using Qualtrics software and released via a social media platform with a specific audience of over 60,000 practicing RTs. <b>Results:</b> Responses from 785 RTs were included in the final analysis. Relevant findings identified variables such as age, time in the field, likelihood and rate of tuition reimbursement, and compensation post completion of DA all represented perceived barriers to DA. Qualitative analysis of open-ended questions revealed four predominant themes in the perception of DA in respiratory care. These themes included the perception of irrelevance, insurmountable alterations to lifestyle, cost of DA, and age in the context of benefits to DA. <b>Conclusions:</b> Findings support the need for institutions to encourage RTs who are concerned about the cost to return for DA. Other factors such as age and years of experience also play large roles in an individual's choice to return for DA. However, individuals who found financial barriers were more likely to signify a positive indication to return for DA; therefore, it is vital to provide a level of tuition reimbursement to minimize this barrier.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450071","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":"Racial and Ethnic Disparities in the Use of Invasive Ventilation for Bacterial Pneumonia in the United States.","authors":"Mohamad El Labban, Roba El Zibaoui, Karine Eid, Perla Mansour, Mohamad Wehbe, Farah Wigdan, Yewande Odeyemi","doi":"10.1089/respcare.12213","DOIUrl":"10.1089/respcare.12213","url":null,"abstract":"<p><p><b>Background:</b> Previous reports have emphasized disparities in the utilization of invasive respiratory support for bacterial pneumonia among various racial and ethnic minority groups with bacterial pneumonia. However, there is a shortage of detailed epidemiological data on this, particularly after the onset of the COVID-19 pandemic. <b>Methods:</b> We used the National In-patient Sample to conduct a retrospective cohort analysis from 2017 to 2021. We included patients hospitalized across the United States with a primary diagnosis of bacterial pneumonia. Statistical methods used included Pearson chi-square and multivariable regression analyses. Examining racial and ethnic differences in hospitalized subjects' usage of invasive mechanical ventilation for bacterial pneumonia was the primary outcome of the study. Secondary outcomes included mortality, use of noninvasive ventilation, and hospital stay. <b>Results:</b> The study found significant differences among racial and ethnic groups in pneumonia-related outcomes and the need for advanced respiratory ventilator assistance. Black and Asian American and Pacific Islander (AAPI) subjects had the highest rates of invasive mechanical ventilation compared with other racial groups, with adjusted odds ratios (ORs) indicating a higher likelihood of requiring this intervention for Black (OR 1.15) and AAPI (OR 1.31) subjects. For secondary outcomes, Black and AAPI subjects experienced longer hospital stays than other racial and ethnic groups. Noninvasive ventilation rates were comparable across groups. Mortality rates were the highest among Black subjects, but were elevated for all racial and ethnic minority subjects compared with white subjects. The pandemic exacerbated these disparities, leading to increased rates of both invasive and noninvasive ventilation and higher mortality, with particularly pronounced effects seen in AAPI patients, thereby worsening existing health inequities. <b>Conclusions:</b> The study suggests potential racial-ethnic disparities in invasive mechanical ventilation use among Black and AAPI subjects, but further investigation is needed to confirm these findings and explore underlying causes.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450074","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 the Kigali Modifications on ARDS Diagnosis.","authors":"Tyler M Santos, Dawn A Maldonado","doi":"10.1089/respcare.12489","DOIUrl":"10.1089/respcare.12489","url":null,"abstract":"<p><p><b>Background:</b> The Berlin definition of ARDS has recently been expanded to include the Kigali criteria, which allows for the inclusion of more non-intubated patients. However, there is concern that the expanded criteria may be overly inclusive, potentially representing different pathologies. This study evaluates the characteristics of patients with sepsis who meet the Kigali criteria compared with those who meet the original Berlin criteria. <b>Methods:</b> This retrospective cohort study was conducted at a single institution and included subjects aged 18 and older who were admitted for sepsis. Berlin-ARDS was defined by a P_aO₂/F_IO₂ ratio of ≤300 mm Hg within the first 7 days of admission, the use of intubation or noninvasive ventilation with PEEP of at least 5 cm H₂O, bilateral opacities on chest imaging, and respiratory failure not attributed to heart failure. Kigali-ARDS was defined for subjects who did not meet the Berlin criteria owing to unavailable arterial blood gas values, a P_aO₂/F_IO₂ ratio >300 mm Hg, or who had a P_aO₂/F_IO₂ ratio ≤300 mm Hg but were not ventilated with a PEEP of 5 cm H₂O. <b>Results:</b> Of 427 subjects, 73 developed ARDS according to the Berlin criteria, and 94 met the ARDS criteria only by the Kigali definition, whereas 260 did not meet either definition. Smoking was significantly associated with meeting the Kigali criteria (<i>P</i> = .045) but not the Berlin criteria (<i>P</i> = .49). Higher lactate and white blood cell levels were linked to the Berlin criteria (<i>P</i> = .02 and <i>P</i> = .01, respectively) but not to the Kigali criteria. <b>Conclusions:</b> Smoking was a risk factor for meeting the Kigali criteria but not the Berlin criteria, suggesting that the Kigali criteria might include patients with chronic lung conditions rather than true acute lung injury. Additionally, higher lactate and white blood cell levels were associated with Berlin-ARDS, indicating more severe sepsis in these subjects compared with those meeting the Kigali criteria.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450032","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":"Aerosol Delivery Challenges and Strategies for Pediatric Asthma.","authors":"Ariel Berlinski","doi":"10.1089/respcare.12626","DOIUrl":"10.1089/respcare.12626","url":null,"abstract":"<p><p>Asthma is a chronic respiratory condition affecting 6.5% of the pediatric population in the United States. Inhaled medications are the mainstay of treatment of asthma. Delivering inhaled medications to children with asthma has several challenges. Personalized device selection and education are paramount for successful asthma treatment. The complexity of drug delivery in pediatric asthma is potentiated by the anatomical, physiological, and behavioral differences present in children. In addition, aerosols are given for preventive and for rescue reasons. The latter might also occur in children receiving respiratory support. This article reviews patient- and device-related factors affecting inhaled drug delivery and deposition. It also provides a framework to understand variations of drug delivery that occur during transition between different respiratory support devices. This review also discusses clinical trial data comparing different devices. Finally, guidance on how to choose the right delivery device for each patient is provided.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449923","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":"Decades Under the Influence in ARDS: Shifting to PEEP or Shifting to Early Spontaneous Breathing?","authors":"Fabrice Petitjeans, Dan Longrois, Jean-Michel Constantin, Marco Ghignone, Luc Quintin","doi":"10.4187/respcare.12642","DOIUrl":"10.4187/respcare.12642","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449990","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":"Role of the Respiratory Therapist in Asthma Education.","authors":"L Denise Willis","doi":"10.1089/respcare.12546","DOIUrl":"10.1089/respcare.12546","url":null,"abstract":"<p><p>The primary goal of asthma management is attainment of the best possible outcomes for symptom control and reduction of exacerbations. This can be accomplished through partnering with patients and families and providing education. Asthma self-management education empowers patients with the knowledge, confidence, and skills necessary to successfully manage their condition. Components of asthma education include basic facts about asthma, inhaled medications, self-monitoring, environmental control, and a written asthma action plan. Repetition, reinforcement, and good clinician communication skills are vital for successful self-management education. Teach back, teach-to-goal, and motivational interviewing are effective strategies that have demonstrated improved outcomes for adults and children with asthma. Respiratory therapists have positively impacted outcomes for patients with asthma through educational interventions. This paper reviews the published literature regarding asthma education and provides guidance for clinicians for effective asthma self-management education.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450076","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":"Aerosol Generation During Spirometry and Simulated Bronchodilator Challenge Testing in the Pulmonary Function Laboratory.","authors":"Cameron G Gmehlin, Pavol Sajgalik, Matthew E Hainy, Chul-Ho Kim, Bruce D Johnson, Thomas G Allison, Kaiser Lim, Alexander S Niven","doi":"10.1089/respcare.12506","DOIUrl":"10.1089/respcare.12506","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449927","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":"ARDS Weaning: The Impact of Abnormal Breathing Patterns Detected by Electric Tomography Impedance and Respiratory Mechanics Monitoring.","authors":"Iuri Christmann Wawrzeniak, Josué Almeida Victorino, Eder Chaves Pacheco, Glasiele Cristina Alcala, Marcelo Britto Passos Amato, Silvia Regina Rios Vieira","doi":"10.1089/respcare.12304","DOIUrl":"10.1089/respcare.12304","url":null,"abstract":"<p><p><b>Background:</b> After the improvement of the initial phase of ARDS, when the patients begin spontaneous breathing and weaning from mechanical ventilation, some patients may present abnormal breathing patterns, whose evaluation of the repercussions were poorly studied. This study proposed to evaluate abnormal breathing patterns through the use of electrical impedance tomography (EIT), and clinical, respiratory mechanics, and ventilatory parameters according to the types of weaning from mechanical ventilation. <b>Methods:</b> This was a prospective cohort study of subjects with ARDS who were considered able to be weaned from mechanical ventilation in the clinical-surgical ICU. Weaning types were defined as simple, difficult, and prolonged weaning. EIT, ventilatory, lung mechanics, and clinical data were collected. Data were collected at baseline in a controlled ventilatory mode and, after neuromuscular blocker withdrawal, data were collected after 30 min, 2 h, and 24 h. EIT parameter analysis was performed for ventilation distribution in the lung regions, pendelluft, breath-stacking, reverse-trigger, double-trigger, and asynchrony index. <b>Results:</b> The study included 25 subjects who were divided into 3 groups (9/25 simple, 8/25 difficult, and 8/25 prolonged weaning). The prolonged weaning group showed more delirium, ICU-acquired weakness, stay in ICU, and hospital and ICU mortality. During the change from controlled to spontaneous mode, we observed increased tidal volumes and driving pressures, which were mainly found in the prolonged weaning group when compared with the simple weaning group. The prolonged weaning group showed a higher flow index, more asynchronies during volume-assisted ventilation, a higher incidence of pendelluft, and redistribution of ventilation to posterior regions visualized by EIT. <b>Conclusions:</b> The present study showed abnormal breathing patterns in the prolonged weaning group. The clinical occult findings of abnormal breathing patterns could be monitored, mainly through EIT and with better assessment of pulmonary mechanics.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delivering Specialty Gases for Potential Therapeutic Effect-Ventilator Validation of Safety Is Paramount.","authors":"John Davies, Mark Sollars","doi":"10.1089/respcare.12839","DOIUrl":"10.1089/respcare.12839","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}