Respiratory care最新文献

{"title":"Year in Review: Pulmonary Function Testing.","authors":"Jeffrey M Haynes","doi":"10.1089/respcare.13066","DOIUrl":"10.1089/respcare.13066","url":null,"abstract":"<p><p>Pulmonary function testing dates back to the 19th century, and the most commonly performed tests pre-date the use of computers. Despite its long and rich history, much is still unknown about how to best perform, interpret, and apply pulmonary function tests. This year-in-review article will discuss recently published papers covering important topics including the performance of lung volume testing, the definition and severity grading of air flow obstruction, the clinical utility of bronchodilator responsiveness, and the use of race-neutral reference equations.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1033-1044"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120654","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":"Evaluation of Venturi Adapters for CPAP.","authors":"Trey Blackwell, Joseph Orr, Derek Sakata, Kai Kuck","doi":"10.1089/respcare.12609","DOIUrl":"10.1089/respcare.12609","url":null,"abstract":"<p><p><b>Background:</b> CPAP therapy has been shown to effectively reduce the risk of obstructive apnea and oxygen desaturation in procedural sedation. An economical approach to administering CPAP is through a Venturi adapter, which amplifies oxygen flows to produce pressures suitable for CPAP. The objective of this study was to evaluate the performance of four Venturi adapters across clinically relevant metrics including pressure-generation efficiency, inspired oxygen concentration (F_IO₂), dilution of the end-tidal carbon dioxide (E_tCO₂) sample for capnometry, and noise levels produced. <b>Methods:</b> A benchtop simulator was used to evaluate Venturi adapters. The simulator was composed of a test lung, corrugated tubing to simulate a trachea, a silicone-molded face, an air-cushioned mask strapped to the face, a high-pressure oxygen source, and several Venturi adapters. The oxygen flows required to produce specific airway pressures were measured to evaluate pressure-generation efficiency, and the noise levels produced by the Venturi adapters at these pressures were recorded. CO₂ was infused into the test lung while the lung was ventilated, and the E_tCO₂ measured at the mask was compared with a reference measurement taken from the trachea. F_IO₂ was evaluated by ventilating the test lung and observing the steady-state oxygen concentration in the lung. <b>Results:</b> Each of the Venturi adapter designs provides their unique strengths and weaknesses. There appears to be a direct trade-off between high pressure-generation efficiency and high F_IO₂. There also appears to be a direct trade-off between high F_IO₂ and the extent of dilution in the E_tCO₂ sample. Some Venturi adapters produce high noise levels, which might result in patient discomfort and clinician unwillingness to use. <b>Conclusion:</b> Variations in Venturi adapter designs create different clinical benefits. Clinicians should choose the Venturi adapter to best suit their present clinical needs.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"995-1004"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031873","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":"Impact of Telemonitoring With Exacerbation Prediction Algorithm Versus Telemonitoring Alone on Hospitalizations and Health-Related Quality of Life in Patients With COPD.","authors":"Thomas Kronborg, Stine Hangaard, Sisse Heiden Laursen, Lisa Korsbakke Emtekær Hæsum, Julie Egmose, Clara Bender, Pernille Heyckendorff Secher, Ole Hejlesen, Flemming Witt Udsen","doi":"10.1089/respcare.12611","DOIUrl":"10.1089/respcare.12611","url":null,"abstract":"<p><p><b>Background:</b> Unreported and untreated exacerbations of COPD have significant negative impacts on health status, disease progression, rate of hospitalization, and readmission. The present study investigated whether a COPD exacerbation prediction algorithm embedded into a telemonitoring system can reduce the number of hospitalizations and improve health-related quality of life (HRQOL) compared with telemonitoring alone. <b>Methods:</b> A total of 137 participants were enrolled in this single-blinded randomized controlled trial. Patients were eligible for inclusion if they had a COPD diagnosis, were adults, had fixed residence in Aalborg Municipality in Denmark, and already used an existing telemonitoring system. The primary outcome was the between-group difference in the number of acute hospitalizations per subject after 6 months of follow-up. Secondary outcomes included the difference in all-cause hospitalization, HRQOL measured by 12-item Short Form Health Survey (version 2) and EuroQol-5 Dimension Questionnaire (EQ-5D-5L), and mortality after 6 months. Data were analyzed according to the intention-to-treat principle. <b>Results:</b> The adjusted incidence rate ratio (IRR) of acute hospitalizations per subject was 1.30 (95% CI 0.50-3.38). The odds ratio (OR) for the hospitalization proportion was 2.10 (95% CI: 0.72-6.09). The adjusted IRR for the number of all-cause hospitalizations were 1.25 (95% CI: 0.51-3.07), whereas the OR for an all-cause hospitalization proportion was 1.92 (95% CI: 0.70-5.26). The adjusted OR for mortality was 0.46 (95% CI: 0.11-1.94). The adjusted mean difference in the physical component score and mental component score was 0.77 (95% CI: -1.72 to 3.47) and 0.91 (95% CI: -2.63 to 4.72), respectively, and -0.05 (95% CI: -0.14 to 0.03) for the EQ-5D index score. All results were nonstatistically significant. <b>Conclusions:</b> No definitive conclusions could be drawn regarding the effect on hospitalizations and HRQOL when implementing a COPD prediction algorithm in addition to telemonitoring.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"954-961"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796228","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":"Prevalence of Interventions After Difficult Airway Response Team Activation: A Systematic Review and Meta-Analysis.","authors":"Quincy K Tran, Chih-Hsuan Chen, Jamie Palmer, Madison Moran, Vera Bzhilyanskaya, David Yamane, Ali Pourmand","doi":"10.1089/respcare.12498","DOIUrl":"10.1089/respcare.12498","url":null,"abstract":"<p><p><b>Background:</b> We sought to define the prevalence of interventions by the Difficult Airway Response Team (DART) following its activation and investigate variables associated with increased risk of surgical airway and successful first intubation attempt. <b>Methods:</b> We conducted a systematic review and included 14 studies in our meta-analysis. DART activations in ICUs, general wards, and emergency departments (EDs) were inspected. Variables collected included age, body mass index, and the percentage of subjects with a known difficult airway. Additional data included the DART activation location and time, the method of airway securement, and the number of first successful intubation attempts. The primary outcome was the prevalence of interventions by DART, defined as the number of subjects who underwent intubation by any method or received a surgical airway following consultation and evaluation by the DART. We used random-effects models. Moderator analyses and meta-regressions were performed to identify sources of heterogeneity and clinical variables associated with the prevalence of interventions by DART after its activation, respectively. <b>Results:</b> We included 4,092 subjects with a mean age of 57 (±3) years. Eleven studies reported 36% (1,030) female subjects. There were 3,441 DART activations among subjects in the ED, ICU, and ward. The pooled prevalence of the interventions by the DART, after activation was 76% (95% CI 0.41-0.93). The pooled prevalences of surgical airway placement and first successful intubation attempt was 6% (95% CI 0.03-0.10), and 72% (95% CI 0.61-0.81), respectively. Higher percentage of subjects undergoing video laryngoscopy (VL) was negatively correlated with higher percentage of surgical airway (coefficient -2.7, 95% CI -3.9 to -1.5) and positively correlated with first successful intubation attempts (coefficient 1.6, 95% CI 1.1-2.2). <b>Conclusions:</b> The prevalence of interventions by DART after its activation was high, combined with lower prevalence of surgical airway demonstrate the benefits and efficacy of this emergent difficult airway program. Higher prevalence of successful first attempt was correlated with the usage of VL. Further research endeavors should investigate the efficiency of DART pathways in different institutions.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1013-1022"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029391","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 Contributions of Respiratory Therapists in the United States of America: A Scoping Review.","authors":"Marco Zaccagnini, Fred Liang, Clement Tse, Ashley Bucknall, Mika L Nonoyama, Lee Wisdom, Natalie Napolitano, Brian K Walsh, Shirley Quach","doi":"10.1089/respcare.13044","DOIUrl":"https://doi.org/10.1089/respcare.13044","url":null,"abstract":"<p><p>Respiratory therapists (RTs) provide essential care across the United States of America (USA) in various health care settings, with a prominent role in critical care. RTs specialize in managing mechanical ventilation, maintaining patent airways, and assisting with specialized procedures. While RTs in the USA have a broad scope of practice, it varies based on multiple factors; as a result, limited evidence exists detailing their specific roles and responsibilities. This review aims to map the breadth and depth of the available literature on RT practice in critical care within the USA. This review included three aims: (1) describe the practices and roles of RTs in adult critical care settings (including value-efficiency scores), (2) summarize the different RT models of care in critical care teams in the USA, and (3) investigate regional variations in RT practices in critical care across the USA. This scoping review was guided by the Joanna Briggs Institute methodology for scoping reviews. Studies that described the RT role in adult critical care within the USA were included. Data extraction was informed by the Respiratory Therapy Practice-Based Outcome Initiative (RT-PBOI) model and value-efficiency metrics. Eighty peer-reviewed articles and 45 pieces of grey literature met the inclusion criteria (total 125). RTs' roles and responsibilities were categorized per the RT-PBOI model as follows: Technical Skills (131), Approach to Practice (90), Leveraging Capacity (45), Strategic Expertise (73), and Growing Value for the Future (16). The grey literature (45) provided brief descriptions of the RT scope from various state regulatory/licensing bodies or state respiratory societies, guidelines, reports, and/or position statements. While RTs are crucial to critical care, gaps remain in quantifying their impact and clearly defining their evolving scope of practice. Further research is essential to optimize their integration into care teams, quantify impact, and improve patient outcomes.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718260","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":"Should Mechanical Power Be Normalized to Compliance?","authors":"Roberto Santa Cruz, Juan Nadur, Matias Jara, Marcelo Navarrete, Juan Gagliardi, Antonio Esquinas, John J Marini","doi":"10.1177/19433654251360618","DOIUrl":"https://doi.org/10.1177/19433654251360618","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715188","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":"Feasibility of Oxygraphy for the Noninvasive Measurement of P_AO₂ in Anesthetized Patients.","authors":"Gerardo Tusman, Florencia Ferrazzano, Tomás Tajan, Adriana Scandurra, Stephan H Böhm, Fernando Suarez-Sipmann","doi":"10.1089/respcare.13059","DOIUrl":"https://doi.org/10.1089/respcare.13059","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626983","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":"Hierarchy of Preferred Patient Outcomes Among Survivors of Acute Respiratory Failure.","authors":"Somnath Bose, Lena Novack, Samantha Harrison, Valerie Goodspeed, Krystal Capers, Margaret M Hayes, Victor D Dinglas, Dale M Needham, Samuel M Brown","doi":"10.1089/respcare.13083","DOIUrl":"https://doi.org/10.1089/respcare.13083","url":null,"abstract":"<p><p><b>Background:</b> Surviving acute respiratory failure (ARF) in the ICU is often a life-changing event. Most survivors face endure impairments across several domains, termed as post-intensive care syndrome (PICS). There is limited investigation on how survivors and their caregivers perceive recovery from their own lived experiences. The objective of this study was to characterize which domains of recovery matter most to ARF survivors and their caregivers. <b>Methods:</b> A single-center, prospective observational study nested within 2 contiguous cohort studies: Addressing Post-Intensive Care Syndrome (APICS)-01 and APICS-COVID that enrolled ARF survivors who were admitted to ICU and discharged home. Survivors and caregivers were asked to prioritize following 9 domains of recovery using a custom-made survey: cognition, pain, physical function, pulmonary function, muscle/nerve function, mental health, fatigue, return to work or prior activities, and survival. These domains were chosen based on prior literature and modified based on input from a patient and family advisory council at the study site. The order of prioritization of domains of recovery was assessed at hospital discharge and at 3- and 6-month follow-up. <b>Results:</b> Forty eligible study subjects and 10 caregivers were recruited between 2019 and 2022. Mean age was 51.0 (SD 13.8) years, more than two thirds were male, and approximately one-third were non-white. Of the 9 domains surveyed, survival was consistently ranked the highest at each of the 3 time points. Cognitive recovery and physical function were ranked as the next 2 most important domains of recovery. <b>Conclusions:</b> ARF survivors who were discharged to home prioritized survival and then physical and cognitive recovery over 6 other domains. Understanding what matters most to survivors is a key step toward identifying priority areas for care in ICUs and rehabilitation after critical illness. Future studies should include survivors and caregivers from diverse backgrounds to obtain a comprehensive assessment of their perspective of recovery.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609206","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":"Factors Influencing Aerosol Delivery During Invasive Ventilation.","authors":"Fai A Albuainain, Xiaoyan Man, Omar Alamoudi, Jie Li","doi":"10.1089/respcare.12942","DOIUrl":"https://doi.org/10.1089/respcare.12942","url":null,"abstract":"<p><p><b>Background:</b> Several factors influence aerosol delivery during mechanical ventilation, such as patient characteristics, device configuration, and ventilator settings. This study aimed to evaluate how ventilator settings, humidification, nebulizer positions, bias flows, and circuit adapters affected aerosol delivery during invasive ventilation. <b>Methods:</b> Using an in vitro model, aerosol delivery of albuterol (2.5 mg/3 mL) via a vibrating mesh nebulizer was tested under 28 conditions during invasive ventilation. A systematic stepwise ruling-out approach was taken over 3 phases: (1) dry circuit, (2) dry circuit with exhaled humidity, and (3) heated and humidified circuit with exhaled humidity. Variables included ventilator settings (high vs low), nebulizer positions (proximal to the endotracheal tube vs distal), bias flows (2 vs 5 L/min), and circuit adapters (Y- vs V-shaped). The variables deemed unimportant were progressively excluded in later phases. Each condition was tested 5 times. Drug deposition was collected on filters, eluted, and quantified using ultraviolet spectrophotometry at 276 nm. <b>Results:</b> High ventilator settings significantly increased inhaled doses compared with lower settings across most conditions (all <i>P</i> < .05), with the greatest absolute increase of inhaled dose was observed in dry circuits without exhaled humidity (11-22%). This effect was reduced to 4-7% with the use of exhaled humidity in both dry and heated humidified circuits. Proximal nebulizer placement yielded higher doses than distal placement under high settings in dry circuits without exhaled humidity, but this difference was diminished or absent when exhaled humidity or heated humidification were introduced. Bias flow and adapter type had minimal impact on inhaled dose, except in specific conditions under dry circuit without exhaled humidity. <b>Conclusions:</b> In dry circuits without exhaled humidity, aerosol delivery was substantially affected by ventilator settings and nebulizer placement, whereas bias flow and circuit adapter types had no notable impact. However, the effects of ventilator settings and nebulizer placement diminished in circuits with exhaled humidity or heated humidification.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554340","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":"It Takes a Village-Evolving Role for Dedicated Teams for COPD Management.","authors":"Neil R MacIntyre","doi":"10.1089/respcare.13160","DOIUrl":"10.1089/respcare.13160","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"928-929"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111830","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}