Respiratory care最新文献

{"title":"Consequences of Pausing Heated Humidification During Invasive Ventilation.","authors":"François Lellouche, Pierre-Alexandre Bouchard","doi":"10.4187/respcare.12084","DOIUrl":"10.4187/respcare.12084","url":null,"abstract":"<p><strong>Background: </strong>During invasive mechanical ventilation, where medical gases are very dry and the upper airway is bypassed, appropriate gas conditioning and humidification are mandatory at all times. Results of in vitro studies suggest that dry gases may improve lung deposition during nebulization, but this has not been confirmed through in vivo studies. The objective of this study was to measure gas humidity under multiple conditions to better describe gas hygrometry when heated humidifiers are turned off.</p><p><strong>Methods: </strong>We measured, on a bench, the hygrometry of different gases at steady state: medical gases, at the Y-piece without humidifier, with the humidifier switched off, and with humidifier switched on. We measured gas humidity every 10-60 s during dynamic conditions after switching off the heated humidifier and after switching on the heated humidifier. Hygrometry was measured by using the psychrometric method with at least 3 measurements for each tested condition.</p><p><strong>Results: </strong>We performed 287 psychrometric measurements in different situations. The mean ± SD gas absolute humidity at steady state during different conditions were the following: 1.6 ± 0.2 mg H₂O/L for the medical gases, 4.5 ± 0.9 mg H₂O/L at the Y-piece without humidifier, 9.1 ± 0.3 mg H₂O/L at the Y-piece with heated humidifier turned off, and 34.2 ± 2.2 mg H₂O/L at the Y-piece with the heated humidifier turned on. During the dynamic evaluation, after turning off the humidifier, humidity was < 30 mg H₂O/L after a few minutes, attained 15 mg H₂O/L after 15 min, and was below 10 mg H₂O/L after 1 h but never reached the level of dry medical gases. After turning on the heated humidifier, the gas hygrometry reached 30 mg H₂O/L after 5 min.</p><p><strong>Conclusions: </strong>When heated humidifiers are turned off, gas humidity levels are very low but not as low as medical gases. The clinical impact of repeated shutdowns is unknown. As recommended, heated humidifiers should never be turned off during nebulization.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1239-1244"},"PeriodicalIF":2.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856267","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":"Extended Prone Position and 90-Day Mortality in Mechanically Ventilated Patients With COVID-19.","authors":"Alfonso Estrella-Alonso, J Alberto Silva-Obregón, Rodrigo Fernández-Tobar, Carlos Marián-Crespo, Valentín Ruiz de Santaquiteria-Torres, Gema Jiménez-Puente, Ramón Arroyo-Espliguero, María C Viana-Llamas, Karen Lizzette Ramírez-Cervantes, Manuel Quintana-Díaz","doi":"10.4187/respcare.11622","DOIUrl":"10.4187/respcare.11622","url":null,"abstract":"<p><strong>Background: </strong>Prone positioning (PP) has demonstrated its potential for improving outcomes in patients with ARDS who require invasive mechanical ventilation. However, the ability of prolonged proning to reduce mortality in patients with COVID-19 specifically, sessions lasting > 24 h remains uncertain.</p><p><strong>Methods: </strong>In this retrospective cohort study, we examined 158 subjects with COVID-19 pneumonia who required mechanical ventilation due to moderate-to-severe ARDS. Seventy-six subjects were placed in standard PP and 82 in extended PP, defined as prone sessions lasting at least 32 h. Our primary aim was to evaluate the effect of EPP on 90-d survival in subjects with COVID-19 with acute severe respiratory failure. To ensure the reliability of our findings and to minimize bias, we applied 3 adjustment approaches: cardinality matching (CM), matching weighting (MW), and inverse probability of treatment weighting with stabilized and trimmed weights (SW). We used Kaplan-Meier curves and Cox proportional hazard models to analyze the effects of EPP on 90-d mortality and sensitivity analysis by calculating E-values.</p><p><strong>Results: </strong>The overall crude 90-d mortality rate was 31.7%. The unadjusted 90-d mortality rates were 19.5% in the EPP group and 44.7% in the SPP group (hazard ratio [HR] 0.35 [95% CI 0.19- 0.63], <i>P</i> < .001). After adjustment for confounding factors using CM, MW, and SW, baseline covariates were balanced between the 2 groups. Subjects in the EPP group exhibited lower 90-d mortality rates after adjustment using CM (HR 0.42 [95% CI 0.23-0.79], <i>P</i> = .007), MW (HR 0.45 [95% CI 0.21-0.95], <i>P</i> = .036), or SW (HR 0.29 [95% CI 0.15-0.56], <i>P</i> < .001).</p><p><strong>Conclusions: </strong>Extended PP was associated with improved 90-d survival in subjects with COVID-19 undergoing mechanical ventilation for severe ARDS. These findings suggest the potential benefit of EPP in the management of COVID-19-related respiratory failure. Further research and prospective studies are warranted to confirm and elucidate the underlying mechanisms of this association.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1255-1265"},"PeriodicalIF":2.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976527","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":"Physiological Effects of High-Flow Tracheal Oxygen in Tracheostomized Patients Weaning From Mechanical Ventilation.","authors":"Matthijs L Janssen, Dolf Weller, Henrik Endeman, Leo Ma Heunks, Evert-Jan Wils","doi":"10.4187/respcare.11755","DOIUrl":"10.4187/respcare.11755","url":null,"abstract":"<p><strong>Background: </strong>High-flow tracheal oxygen (HFTO) is being used as supportive therapy during weaning in tracheostomized patients difficult to wean from invasive mechanical ventilation. There is, however, no clinical evidence for such a strategy. Therefore, we conducted a systematic review to summarize studies evaluating the physiologic effects of HFTO during tracheostomy-facilitated weaning and to identify potential areas for future research in this field.</p><p><strong>Methods: </strong>Observational and interventional studies on critically ill subjects weaning from mechanical ventilation via tracheostomy published until December 22, 2022, were eligible. Studies on high-flow oxygen, only in children, non-human models or animals, on clinical outcome only, abstracts without full-text availability, case reports, and reviews were excluded. Main outcomes were end-expiratory lung volume (EELV) and tidal volume using electrical impedance tomography, respiratory effort assessed by esophageal manometry, work of breathing and neuroventilatory drive as assessed by electrical activity of the diaphragm (EA_di) signal, airway pressure (P_aw), oxygenation (P_aO₂ /F_IO₂ or S_pO₂ /F_IO₂ ), breathing frequency, tidal volume, and P_aCO₂ .</p><p><strong>Results: </strong>In total, 1,327 references were identified, of which 5 were included. In all studies, HFTO was administered with flow 50 L/min and compared to conventional O₂ therapy in a crossover design. The total average duration of invasive ventilation at time of measurements ranged from 11-27 d. In two studies, P_aO₂ /F_IO₂ and mean P_aw were higher with HFTO. EELV, tidal volumes, esophageal pressure swings, and EA_di were similar during high-flow tracheal oxygen and conventional O₂ therapy.</p><p><strong>Conclusions: </strong>The main physiological effect of HFTO as compared to conventional O₂ therapy in tracheostomized subjects weaning from mechanical ventilation was improved oxygenation that is probably flow-dependent. Respiratory effort, lung aeration, neuroventilatory drive, and ventilation were similar for HFTO and conventional O₂ therapy. Future studies on HFTO should be performed early in the weaning process and should evaluate its effect on sputum clearance and patient-centered outcomes like dyspnea.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1336-1344"},"PeriodicalIF":2.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076634","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":"Pre-Admission Predictors of Walking Independence in Critically Ill Patients.","authors":"Ryuji Yoshinaga, Narumi Yamada, Masatoshi Hanada, Yuji Ishimatsu, Ryo Kozu","doi":"10.4187/respcare.11777","DOIUrl":"10.4187/respcare.11777","url":null,"abstract":"<p><strong>Background: </strong>Recovery of walking independence in critically ill patients is required for safe discharge home. However, the pre-admission predictors affecting this outcome in this patient group are unknown. This study aimed to identify these predictors.</p><p><strong>Methods: </strong>We included subjects who required mechanical ventilation for at least 48 h and could walk before admission. We investigated frailty, cognitive impairment, and malnutrition risk according to the pre-admission health status. Walking independence was defined as the ability to walk for at least 45 m on level ground. The primary outcome was the association between the time to event from an ICU discharge to walking independence, and pre-admission predictors were analyzed using a Fine-Gray proportional hazards regression.</p><p><strong>Results: </strong>The rate of walking independence was 38.0 (100 cases/person-month; sample <i>N =</i> 144). In the proportional hazards regression model, adjusted for covariates, frailty (hazard ratio [HR] 0.08 [95% CI 0.01-0.67]), pre-frailty (HR 0.37 [95% CI 0.14-0.99]), cognitive impairment (HR 0.21 [95% CI 0.05-0.90]), and malnutrition risk (HR 0.20 [95% CI 0.07-0.58]) were associated with walking independence.</p><p><strong>Conclusions: </strong>Pre-admission frailty or pre-frailty, cognitive impairment, and malnutrition risk can help predict walking independence in critically ill patients who require mechanical ventilation.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1314-1322"},"PeriodicalIF":2.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311539","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":"Effect of Helmet CPAP on Tidal Volume Assessed by Bioelectrical Impedance.","authors":"Marco Giani, Emanuele Rezoagli, Davide Raimondi Cominesi, Lorenza Moretto, Benedetta Fumagalli, Francesco Cipulli, Alberto Lucchini, Matteo Pozzi, Giuseppe Foti","doi":"10.4187/respcare.11959","DOIUrl":"10.4187/respcare.11959","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1332-1335"},"PeriodicalIF":2.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752464","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":"Reassessing the Role of Heated Humidification During Nebulization: Implications for Clinical Practice.","authors":"Jie Li","doi":"10.4187/respcare.12438","DOIUrl":"10.4187/respcare.12438","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"69 10","pages":"1351-1352"},"PeriodicalIF":2.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352908","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":"Decades Under the Influence: Shifting the PEEP Paradigm in ARDS.","authors":"Brian J Ring","doi":"10.4187/respcare.12435","DOIUrl":"10.4187/respcare.12435","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"69 10","pages":"1347-1350"},"PeriodicalIF":2.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352906","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":"A Summed Score From Cardiopulmonary Exercise Test Parameters Predicts 1-Year Mortality in Newly Diagnosed Interstitial Lung Disease.","authors":"Yuan-Yang Cheng, Yu-Chun Lee, Yu-Wan Liao, Ming-Cheng Liu, Yu-Cheng Wu, Chiann-Yi Hsu, Yi-Hsuan Yu, Pin-Kuei Fu","doi":"10.4187/respcare.11754","DOIUrl":"10.4187/respcare.11754","url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary exercise testing (CPET) is a unique diagnostic tool that assesses the functional capacity of the heart, lungs, and peripheral oxidative system in an integrated manner. However, the clinical utility of CPET for evaluating interstitial lung disease (ILD) remains uncertain. The objective of this study was to determine the predictive value of CPET for mortality in subjects with ILD.</p><p><strong>Methods: </strong>We prospectively enrolled subjects with ILD who underwent CPET at a tertiary medical center in Taiwan and followed up their survival status for 12 months. Mortality prediction was based on comparing CPET parameters between subjects who survived and those who died. We further analyzed CPET parameters that showed significant differences using receiver operating characteristic curves to identify their optimal cutoff values.</p><p><strong>Results: </strong>A total of 106 newly diagnosed subjects with ILD underwent CPET, and the 1-y mortality rate was 7.5%. Six CPET variables were found to be significant predictors of mortality: peak oxygen consumption, oxygen pulse, end-tidal partial pressure of carbon dioxide, heart rate recovery 1 min after CPET, minute ventilation to carbon dioxide output slope, and functional aerobic impairment. We calculated a summed score by adding the number of CPET variables that exceeded their cutoff values. Subjects with a summed score of 6 had a 1-y survival rate of only 25%, whereas subjects with scores of 0-5 had a survival rate of 98%.</p><p><strong>Conclusions: </strong>In conclusion, the summed score represents a useful tool for screening patients with ILD who can undergo a CPET to determine their prognosis.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1305-1313"},"PeriodicalIF":2.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420656","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":"A Master Protocol Template for Pediatric ARDS Studies.","authors":"Andrew G Miller, Martha Aq Curley, Claire Destrampe, Heidi Flori, Robinder Khemani, Amy Ohmer, Neal J Thomas, Nadir Yehya, Shan Ward, Leanne West, Kanecia O Zimmerman, Saranya Venkatachalam, Sonya Sutton, Christoph P Hornik","doi":"10.4187/respcare.11839","DOIUrl":"10.4187/respcare.11839","url":null,"abstract":"<p><strong>Background: </strong>Pediatric ARDS is associated with significant morbidity and mortality. High-quality data from clinical trials in children are limited due to numerous barriers to their design and execution. Here we describe the collaborative development of a master protocol as a tool to address some of these barriers and support the conduct of pediatric ARDS studies.</p><p><strong>Methods: </strong>Using PubMed, we performed a literature search of randomized controlled trials (RCTs) in pediatric ARDS to characterize the current state and evaluate potential benefit of harmonized master protocols. We used a multi-stakeholder, collaborative, and team science-oriented process to develop a master protocol template with links to common data elements (CDEs) for pediatric ARDS trials.</p><p><strong>Results: </strong>We identified 11 RCTs that enrolled between 14-200 total subjects per trial. Interventions included mechanical ventilation, prone positioning, corticosteroids, and surfactant. Studies displayed significant heterogeneity in ARDS definition, design, inclusion and exclusion criteria, and reported outcomes. Mortality was reported in 91% of trials and ventilator-free days in 73%. The trial heterogeneity made pooled analysis unfeasible. These findings underscore the need for a method to facilitate combined analysis of future trials through standardization of trial elements. As a potential solution, we developed a master protocol, iteratively revised with input from a multidisciplinary panel of experts and organized into 3 categories: instructions and general information, templated language, and a series of text options of common pediatric ARDS trial scenarios. Finally, we linked master protocol sections to relevant CDEs previously defined for pediatric ARDS and captured in a series of electronic case report forms.</p><p><strong>Conclusions: </strong>The majority of pediatric ARDS trials identified were small and heterogeneous in study design and outcome reporting. Using a master protocol template for pediatric ARDS trials with CDEs would support combining and comparing pediatric ARDS trial findings and increase the knowledge base.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1284-1293"},"PeriodicalIF":2.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857951","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 Relationship of Diaphragmatic Ultrasound-Based and Manometric Indices With Difficult Weaning in Tracheostomized Patients.","authors":"Apostolos-Alkiviadis Menis, Vasiliki Tsolaki, Maria-Eirini Papadonta, Vasileios Vazgiourakis, Kostantinos Mantzarlis, Epaminondas Zakynthinos, Demosthenes Makris","doi":"10.4187/respcare.11782","DOIUrl":"10.4187/respcare.11782","url":null,"abstract":"<p><strong>Background: </strong>Patients with a tracheostomy and difficult weaning from invasive mechanical ventilation constitute a challenging problem in critical care. An increased duration of ventilation may lead to diaphragmatic dysfunction and a noninvasive assessment of the diaphragm, such as ultrasound, attracts interest in the clinical practice. We evaluated the relationship of ultrasound-derived indices with weaning outcome and with established indices of respiratory strength and load in subjects who are tracheostomized and undergoing weaning.</p><p><strong>Methods: </strong>This prospective study was conducted at an academic ICU in Greece. Twenty subjects with tracheostomy and difficult weaning, during a spontaneous breathing trial, underwent time synchronous diaphragmatic sonography and esophageal manometry, to assess diaphragmatic excursion and thickening fraction, esophageal and transdiaphragmatic pressures, pressure-time product of the esophageal pressure, and maximum inspiratory pressure. The primary outcome was liberation from mechanical ventilation at 48 h. The relationship of diaphragmatic ultrasound with esophageal pressure-derived indices was also evaluated.</p><p><strong>Results: </strong>Weaning from invasive ventilation failed in 10 subjects. Diaphragmatic excursion exhibited a significant difference between weaning success and failure (1.34 ± 0.56 versus 0.79 ± 0.44; <i>P</i> = .044), a strong correlation with transdiaphragmatic pressure (r = 0.7, <i>P</i> = .02), and a moderate correlation with the pressure-time product of the esophageal pressure (r = 0.65, <i>P</i> = .02) and the maximum inspiratory pressure (r = 0.66, <i>P</i> = .02). Transdiaphragmatic pressure presented the highest area under the curve (0.97). However, when transdiaphragmatic pressure was compared with diaphragmatic excursion (area under the curve, 0.84) for predictive accuracy, no significant difference was found.</p><p><strong>Conclusions: </strong>Diaphragmatic excursion is a valuable tool for the assessment of diaphragmatic strength, respiratory load, and weaning prediction.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1323-1331"},"PeriodicalIF":2.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311540","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}