Respiratory care最新文献

{"title":"Nasopharyngeal Airspace Temperature During Rhinothermy.","authors":"Grace Bird, Sophie Sharpe, Irene Braithwaite, Mark Weatherall, Richard Beasley","doi":"10.1089/respcare.12405","DOIUrl":"10.1089/respcare.12405","url":null,"abstract":"<p><p><b>Background:</b> Respiratory viruses such as influenza and human rhinoviruses are temperature sensitive. Rhinothermy delivers heated, humidified air to the upper airways via the nares, and by possibly inhibiting viral replication, it is proposed as a potential therapy to attenuate the severity and duration of common cold or influenza symptoms. The effect of rhinothermy on nasopharyngeal air space temperature is uncertain. The objective of this study was to investigate the effect of rhinothermy delivering 100% humidified air at 41°C on nasopharyngeal air space temperature. The hypothesis was that the mean nasopharyngeal air space temperature while nose breathing would be within 1.5°C of the device's set dew point temperature of 41°C. <b>Methods:</b> In this single-center nonblind nonrandomized parallel arm interventional study, nasopharyngeal air space temperature was continuously measured during delivery of 100% humidified air via a nasal high-flow device at 41°C and 30-35 L/min (rhinothermy [rNHF]) (<i>n =</i> 6), and at 31°C and 10 L/min ('sham' rhinothermy) (<i>n =</i> 6). The primary outcome measure was mean nasopharyngeal air space temperature during delivery of rNHF while nose breathing. Change in nasopharyngeal air space temperature during nose breathing and mouth breathing was compared for both interventions. <b>Results:</b> Twelve participants age 18-75 years were recruited. The mean (SD) nasopharyngeal air space temperature during rNHF at 41°C while nose breathing was 37.9°C (1.22) and with sham rhinothermy at 31°C was 36.8°C (0.18). There was no significant difference in nasopharyngeal air space temperature between nose and mouth breathing for both interventions combined (difference [95% CI] -0.1°C [-0.59 to 0.36], <i>P</i> = .60). <b>Conclusions:</b> The mean nasopharyngeal air space temperature during rNHF while nose breathing was not within 1.5°C of the device's set dew point temperature of 41°C. rNHF temperatures may need to be set considerably higher than the target nasopharyngeal air space temperature when investigating the effect of rhinothermy on symptom severity or duration of respiratory infections caused by viruses with temperature-dependent replication.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"946-953"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516511","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":"Mechanical Power to Predict Ventilator Liberation in Patients With a Tracheostomy.","authors":"Toshiharu Nakama, Takehiro Umemura, Soukun Hoshino, Masahiro Tamashiro, Kenichi Satoh, Hiroshi Sekiguchi","doi":"10.1089/respcare.12237","DOIUrl":"10.1089/respcare.12237","url":null,"abstract":"<p><p><b>Background:</b> Mechanical power (MP) is useful for predicting the outcomes of attempts to liberate patients from mechanical ventilation. MP is computed based on measured variables derived to determine the power in joules required to breathe while receiving mechanical ventilation. The main objectives of this study were to calculate a cutoff value of MP that would predict successful liberation and to determine the prediction rate of liberation success based on this cutoff value. <b>Methods:</b> This was a single-center retrospective study. Data from 110 tracheostomized subjects receiving mechanical ventilation were analyzed. We divided subjects into two groups based on ventilator liberation outcome. Confounding factors in subject background were adjusted using propensity score matching (PSM). Statistically significant differences in MP at tracheostomy and liberation success between liberation success and failure groups were examined. We calculated the MP cutoff value for successful liberation using the area under the curve of the receiver operating characteristic (ROC) and its corresponding prediction rate of liberation success. <b>Results:</b> The number of subjects in the successful liberation group was 79 and that of the failed liberation group was 31. The MP cutoff value and corresponding prediction rate for liberation success were 256.5 J/min (area under the curve-ROC = 0.839) and 92.2%, respectively. After PSM, the low MP group (<i>n =</i> 36), divided based on the MP cutoff value, had a significantly higher liberation success rate than the high MP group (<i>n =</i> 36), with an odds ratio of 19.95 (CI 3.95, 91.23, <i>P</i> < .001). <b>Conclusions:</b> MP at tracheostomy was a strong predictor of successful ventilator liberation, and the prediction rate of liberation success based on the MP cutoff value was shown to be very high. We recommend that patients with low MP be actively considered for liberation. In contrast, those with high MP should continue weaning while simultaneously making early transfer arrangements if liberation is unsuccessful.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"979-986"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812174","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":"Airway Opening Pressure: Positively Perplexing Parameters.","authors":"Robert L Chatburn","doi":"10.1089/respcare.13139","DOIUrl":"10.1089/respcare.13139","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1069-1071"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286354","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":"Editor's Commentary.","authors":"","doi":"10.1177/19433654251365112","DOIUrl":"10.1177/19433654251365112","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 8","pages":"i-ii"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785076","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":"Home Monitoring of High-Risk Individuals Receiving Opioids Post Orthopedic Surgery.","authors":"Robert L Mazzola, Kim J Bennion, Megan J Hepworth, Greg G Petersen, Gaylinn Breeze, Kelly C Jensen, Megan Jensen, Vanessa Henriksen, Lisa Bagley, Chance Keddington, Gregory L Snow, Tom Belnap, Carrie M Winberg, Shawna B Papenfuss, Tom V Cloward","doi":"10.1089/respcare.11783","DOIUrl":"10.1089/respcare.11783","url":null,"abstract":"<p><p><b>Background:</b> Postoperative patients receiving opioids are at risk for morbidity and mortality caused by opioid-induced respiratory depression (OIRD). Guidelines advocate electronic monitoring for OIRD during postoperative hospitalization, but the utility of home monitoring following ambulatory surgery has not been assessed. We describe the utilization of capnography and pulse oximetry in an ambulatory orthopedic cohort to determine subject/home caregiver acceptance and utility of continuous monitors at home. The specific aims of this initiative were to (1) determine the subject/home caregiver acceptance of home monitoring to detect OIRD in patients after hospital discharge following orthopedic surgery, (2) determine the rate of OIRD and associated morbidity after hospital discharge following orthopedic surgery, and (3) determine patient understanding of the risk of OIRD. <b>Methods:</b> This prospective, subject/home caregiver acceptance quality improvement initiative was conducted from September 28, 2019, to October 31, 2020. Ambulatory subjects undergoing orthopedic surgical procedures had cardiorespiratory data monitored with a commercially available device at home for 4 days while napping/sleeping. Recorded data were analyzed for reliability comparing end-tidal carbon dioxide pressure (P_ETCO₂), S_pO₂, breathing frequency (f), and heart rate (beats/min). <b>Results:</b> Three hundred fifty-nine subjects were enrolled and had complete data. Two hundred fifty-two (70%) were discharged with supplemental oxygen. When comparing audible alarms with/without delays, there were 4,770/22,409 low P_ETCO₂, 1,601/6,246 high P_ETCO₂, 460/4,211 low frequency, 1,572/6,547 low heart rate, and 462/5,520 low S_pO₂ alarms. Twenty-six (7.2%) subjects visited the emergency department in response to low S_pO₂ audible alarms. Of these, 14 (3.9%) were diagnosed with a clinically relevant opioid-induced event, 95% CI 2.1%-6.5%, and 1 subject was administered naloxone by home caregivers. <b>Conclusions:</b> This study demonstrates home monitoring of oxygenation (S_pO₂), but not respiration (P_ETCO₂), following ambulatory orthopedic procedures is feasible. Subjects at risk for clinically relevant opioid events may experience higher rates of postoperative complications, hospital readmissions, clinically relevant events, or death.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"968-978"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606276","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":"Training Intensity Needed for Volume Linearity and Syringe D_LCO Check Quality Control.","authors":"Ellen A Becker, Ellen M Moran, Jason B Blonshine, Vanessa I Rodriguez, Susan B Blonshine","doi":"10.1089/respcare.12565","DOIUrl":"10.1089/respcare.12565","url":null,"abstract":"<p><p><b>Background:</b> Technologists must assure the accuracy and precision of pulmonary function equipment prior to testing patients. This study aimed to identify the sources of failure and unacceptable submission rates for spirometry volume linearity and syringe diffusing capacity of the lung for carbon monoxide (D_LCO) check quality control (QC). In addition, we explored whether the time between training and first QC submission affected overall percentage of unacceptable submissions. <b>Methods:</b> Participants in a cross-sectional global study submitted QC for evaluation from October 2014 to May 2018 from 114 laboratories. Descriptive statistics summarized the percentage of unacceptable submissions and sources of failure for volume linearity and syringe D_LCO check maneuvers. Spearman's rho described the correlation between site-specific unacceptable submission rates, and both days between training and the first unacceptable submission and the days between training and first submission. <b>Results:</b> The unacceptable submission rate from 5,083 volume linearity assessments was 10% compared with a 6.2% rate from 4,992 syringe D_LCO check maneuvers. Aggregate volume linearity rates of procedural errors (5.8%) and equipment errors (6.2%) were similar, whereas there were more syringe D_LCO check equipment errors (5.9%) than procedural errors (0.78%). The time between training and submitting a QC test was not related to overall unacceptable submission rates for volume linearity and syringe D_LCO check, <i>r_sp</i> = 0.11, <i>P</i> = .27 and <i>r_sp</i> = 0.19, <i>P</i> = .052, respectively. Higher unacceptable rates occurred when the first QC failure occurred close to the completion of training for volume linearity and syringe D_LCO check, <i>r_sp</i> = -0.41, <i>P</i> < .001 and <i>r_sp</i> = -0.38, <i>P</i> < .001, respectively. <b>Conclusions:</b> A single QC training session does not adequately prepare technologists to conduct QC. Technologists need clear and consistent guidelines for conducting QC procedures and regular follow-up from experts to properly interpret QC findings, resolve equipment problems, and assure their testing systems are in-control.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1005-1012"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586505","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":"Mechanical Power: Using Ideal Body Weight to Identify Injurious Mechanical Ventilation Thresholds.","authors":"William M LeTourneau, Alice Gallo De Moraes","doi":"10.1089/respcare.11815","DOIUrl":"10.1089/respcare.11815","url":null,"abstract":"<p><p>Identifying the mechanisms of ventilator/ventilation-induced lung injury requires an understanding of the pulmonary physiology involved in the mechanical properties of the lung along with the involvement of the inflammatory cascade. Accurately measuring parameters that represent physiologic lung stress and lung strain at the bedside can be clinically challenging. Although surrogates for lung stress and strain have been proposed, such as plateau pressure and driving pressure, these values only represent a static variable in the ventilator breath. It has been proposed that a single variable could be used as a unifying parameter to identify a threshold for the safe application of mechanical ventilation. The concept of \"mechanical power\" applies an energy load transfer designation to the ventilator settings and output of tidal volume, airway pressures, and flow. However, there is a potential disconnect between the use of \"absolute\" mechanical power and the variability of body weight throughout a mixed medical population. Using ideal body weight as an influential factor to express mechanical power can potentially allow for a more accurate depiction of energy applied to the lungs and a potentially reliable injurious mechanical ventilation threshold indicator.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1053-1061"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586490","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":"2024 Year in Review: Ventilator-Associated Pneumonia.","authors":"Brian J Ring","doi":"10.1089/respcare.13102","DOIUrl":"10.1089/respcare.13102","url":null,"abstract":"<p><p>Mechanical ventilation is essential for supporting critically ill patients but increases the risk of bacterial colonization resulting from instrumental, biological, and practice-related factors. Ventilator-associated pneumonia (VAP), a common complication, is linked to prolonged mechanical ventilation and poor outcomes. Although decades of research have emphasized prevention through care bundles and best practices, VAP remains a significant concern. This review highlights current evidence and emerging strategies for VAP prevention and management in 2024, with practical relevance for respiratory therapists caring for mechanically ventilated adult patients.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1045-1052"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086233","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":"Rebound Hypoxemia in Mechanically Ventilated Patients With COVID-19 Completing a Standard 10-Day Course of Corticosteroid Therapy.","authors":"Rahul Costa-Pinto, Hannah Rotherham, Zachary O'Brien, Padeepa Perera, Vicky Chen, Christopher Massarany, Brett Xu, Rinaldo Bellomo","doi":"10.1089/respcare.12494","DOIUrl":"10.1089/respcare.12494","url":null,"abstract":"<p><p><b>Background:</b> Rebound hypoxemia may occur after cessation of corticosteroid therapy for COVID-19 pneumonitis. We aimed to determine the incidence of this phenomenon in mechanically ventilated patients with COVID-19 completing corticosteroid therapy. <b>Methods:</b> We conducted a retrospective observational cohort study across 2 tertiary ICUs from September to December 2021. We included all adult patients receiving invasive mechanical ventilation on completion of a 10-day course of dexamethasone for COVID pneumonitis. Our primary outcome was change in P_aO₂/F_IO₂ ratio in the 7 days following cessation of dexamethasone. Secondary outcomes included duration of ventilation, frequency of corticosteroid recommencement, and mortality. <b>Results:</b> We studied 88 subjects. Median age was 61 years (interquartile range [IQR] 51-67), and median duration of mechanical ventilation was 14 days (IQR 11-26). On completion of dexamethasone, 62 subjects (70%) remained off corticosteroid therapy for the subsequent 7 days. Of these, 63% (<i>n =</i> 20) had a stable P_aO₂/F_IO₂ ratio on day 7 (mean change 197 ± 42 mm Hg to 258 ± 83 mm Hg). Subjects who had a reduction in P_aO₂/F_IO₂ ratio >20 mm Hg by day 7 (mean change 214 ± 68 mm Hg to 152 ± 78 mm Hg) were more likely to die in hospital (<i>P</i> < .001). These subjects had a higher C-reactive protein level at time of steroid cessation (204 ± 87 mg/L, <i>P</i> = .17), which remained persistently elevated (206 ± 89 mg/L, <i>P</i> = .01) on day 7. The 30% of subjects who recommenced steroids required a longer duration of ventilation (13.5 vs 24.5 d, <i>P</i> = .002) but showed no differences in ICU mortality (19% vs 27%, <i>P</i> = .43). <b>Conclusions:</b> Rebound hypoxemia and steroid recommencement were common occurrences in mechanically ventilated subjects with COVID-19. Rebound hypoxemia was associated with higher mortality. Steroid recommencement was associated with longer duration of mechanical ventilation but no significant difference in mortality.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"987-994"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780900","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":"Empowering Respiratory Therapists to Restrict Nebulized 3% Saline and N-Acetylcysteine During Mechanical Ventilation.","authors":"Jonathon D Truwit, Kellianne Fleming, Rahul S Nanchal","doi":"10.1089/respcare.12586","DOIUrl":"10.1089/respcare.12586","url":null,"abstract":"<p><p><b>Background:</b> We previously implemented a policy that enabled respiratory therapists to reject orders for nebulized 3% hypertonic saline and/or N-acetylcysteine (HTS/NAC) that did not conform to the American Association for Respiratory Care (AARC) Clinical Practice Guideline. Outcomes of adhering to this more conservative approach are not well studied. We sought to determine if an approach conforming to guidelines is noninferior to a previously practiced more liberal approach. <b>Methods:</b> We performed a retrospective analysis of 2,272 subjects receiving mechanical ventilation ≥48 h within 5 adult ICUs between June 2020 and August 2023. The primary outcome was ventilator-free days at day 28 (VFD28). Secondary outcomes included ventilator days, ICU days, hospital stay, re-intubation rates, and mortality. Analysis was stratified by before and after policy implementation (see intervention) and by receiving HTS/NAC or not (ϕHTS/NAC). The latter was examined before and after propensity matching. The Δ for noninferiority was -0.5 days for VFD28 and +0.5 days for other continuous variables. As outcomes were not normally distributed, we analyzed them using Mann-Whitney U statistics. <b>Results:</b> Two thousand two hundred seventy-two subjects were evaluated. The mean age was 58.70 <u>+</u> 16.13 years and 929 (40.9%) subjects were women. HTS/NAC administration was reduced after policy implementation (40.2% before policy and 8.9% after policy; a reduction of 77.9%). The post-policy group and ϕHTS/NAC before and after propensity matching groups were all noninferior to the comparators. Subjects had significantly more VFD28 in the post-policy group, median (IQR), post 21 (0-25), pre: 20 (0-24), <i>P</i> = .02; and in the ϕHTS/NAC group, before matching ϕHTS/NAC: 21 (0-25), HTS/NAC: 18 (0-23), <i>P</i> < .001 and after propensity matching ϕHTS/NAC: 21 (0-25), HTS/NAC; 18 (0-23), <i>P</i> < .001. <b>Conclusions:</b> Restricting practice to conform to the AARC Clinical Practice Guideline was noninferior to more liberal use. The use of HTS/NAC in mechanically ventilated subjects does not appear efficacious and is both costly and time-consuming.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"937-945"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543272","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}