Respiratory care最新文献

{"title":"Neonatal ARDS treated with electrical impedance tomography-guided recruitment maneuvers and surfactant-vehicled budesonide.","authors":"Jan-Christoph Clausen, Daniele De Luca, Anastasia Schleiger, Michael Emeis, Oliver Miera","doi":"10.4187/respcare.12384","DOIUrl":"https://doi.org/10.4187/respcare.12384","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308534","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":"Ventilation and Oxygenation During and After Adult Cardiopulmonary Resuscitation: Changing Paradigms.","authors":"Ahmed I Algahtani,J Brady Scott,Jie Li","doi":"10.4187/respcare.12427","DOIUrl":"https://doi.org/10.4187/respcare.12427","url":null,"abstract":"Cardiac arrest (CA) remains a major cause of death despite advancements in cardiopulmonary resuscitation (CPR), post-resuscitation care, and international efforts to develop evidence-based guidelines. Effectively managing ventilation and oxygenation during and after CPR is vital for patient survival and neurological outcomes, yet it remains a challenging task. This review examines current strategies for ventilation and oxygenation during and after CPR, focusing on evidence-based guidelines, the balance between ventilation effectiveness and risks, and proposed methods for monitoring ventilation quality. It emphasizes the need to provide adequate ventilation and oxygenation during and after CPR while avoiding hyperventilation and hypoventilation, which can negatively impact resuscitation and post-CA outcomes. The review also explores mechanical ventilation as an alternative to manual methods and the use of feedback devices. The impact of post-CA ventilation and oxygenation on patient outcomes and recommended management strategies are discussed. Finally, the review highlights current gaps in the literature and the need for more well-designed large clinical studies, such as the impact of different ventilation variables (tidal volume and respiratory rate) on the return of spontaneous circulation (ROSC) and long-term outcomes.","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"16 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142267707","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":"Influence of Hospice Palliative Care on Medical Service Usage in Prolonged Mechanical Ventilation Cases: A Nationwide Cohort Study.","authors":"Chin-Jung Liu,Yeong-Ruey Chu,Chia-Chen Chu,Pei-Tseng Kung,Hsiu-Ling Huang,Wen-Chen Tsai","doi":"10.4187/respcare.11587","DOIUrl":"https://doi.org/10.4187/respcare.11587","url":null,"abstract":"BACKGROUNDNumerous studies have demonstrated that hospice palliative care interventions for cancer patients can reduce health care utilzation. In Taiwan, 20-25% of patients who require mechanical ventilation are using prolonged mechanical ventilation (PMV); however, only a limited number of studies have addressed the effectiveness of hospice palliative care for these patients. This study investigated the impact of hospice palliative care utilization on medical utilization among subjects using PMV.METHODSBy using the health insurance database of a nationwide population-based study, we identified subjects who had been on mechanical ventilation for > 21 d, were age ≥18 y between 2009 and 2017, and had received hospice palliative care. The control group was formed through 1:1 matching by using propensity scoring after excluding patients who had participated in palliative care for <15 d or for >181 d. Furthermore, we used a conditional logistic regression analysis to investigate the incidence of ICU admission, emergency department presentation, and cardiopulmonary resuscitation within 14 d before death.RESULTSA total of 186,533 new subjects receiving PMV age ≥ 18 y were admitted between 2009 and 2017. In addition, the number of subjects receiving palliative care increased annually, rising from 0.6% in 2009 to 41.33% in 2017. The emergency department visits (odds ratio [OR] 0.68, 95% CI 0.63-0.74), ICU admission (OR 0.59, 95% CI 0.53-0.66), cardiopulmonary resuscitation (OR 0.40, 95% CI 0.35-0.46), and total hospitalization cost ($1,319.91 ± $1,821.66 versus $1,544.37 ± $2,309.27 [$USD], P < .001) were significant lower in the palliative care group.CONCLUSIONSSubjects undergoing PMV while receiving hospice palliative care experienced significant reductions in total hospitalization costs, ICU admissions, cardiopulmonary resuscitation, and medical expenses within 14 d before death.","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"18 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200249","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":"Exploring the Impact of Varied Design Approaches and Materials in Respiratory Therapy Education.","authors":"Shih-Hsing Yang,Wei-Lun Liu,Chao-Yu Chen,Hsia-Wei Liu,Ke-Yun Chao","doi":"10.4187/respcare.12133","DOIUrl":"https://doi.org/10.4187/respcare.12133","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"26 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200248","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":"An Electronic Health Record-Based Strategy to Enhance Detection of Alpha-1 Antitrypsin Deficiency.","authors":"Avantika Nathani,James K Stoller","doi":"10.4187/respcare.12200","DOIUrl":"https://doi.org/10.4187/respcare.12200","url":null,"abstract":"BACKGROUNDBecause alpha-1 antitrypsin deficiency is severely underrecognized and delayed diagnosis is associated with harm, strategies to enhance early detection of alpha-1 antitrypsin deficiency are needed.METHODSThe study intervention was placing a reminder to test for alpha-1 antitrypsin deficiency within an electronic medical record health maintenance dashboard that houses prompts to providers to implement guideline-based recommendations. This recommendation was for all patients assigned a diagnosis of COPD based on relevant International Classification of Diseases, Tenth Revision codes. The rate of testing for and detecting individuals with alpha-1 antitrypsin deficiency was assessed in 12 one-month intervals before and after implementing the dashboard.RESULTSAfter the prompt, whereas testing was still performed in only a small percentage of guideline-concordant instances, the rate of testing for alpha-1 antitrypsin deficiency increased 3.8-fold (ie, from 1.2% to 4.6%, P < .05). This did not result in detection of new patients with alpha-1 antitrypsin deficiency. The rate of testing increased both for alpha-1 antitrypsin serum levels and genotypes in each month after the intervention, though the rate of genotype testing was 2-5-fold lower than the rate of testing for serum level.CONCLUSIONSThe results of this preliminary study of a detection strategy for alpha-1 antitrypsin deficiency show that placing a reminder to test for alpha-1 antitrypsin deficiency when indicated in an electronic medical record health maintenance dashboard significantly increased the frequency of testing. Still, that only 4.6% of those in whom testing for alpha-1 antitrypsin deficiency was indicated were tested in the post-intervention period shows that, as for all other alpha-1 antitrypsin deficiency-targeted detection interventions to date, the impact of the intervention was marginal and that other strategies remain needed to mitigate underrecognition. A focus on combining targeted detection strategies (eg, coupling enhanced awareness with free testing) and population-based screening for alpha-1 antitrypsin deficiency is suggested.","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"44 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200268","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":"Effect of Hospital-to-Home Transitional Care for COPD on Patient-Centered Outcomes.","authors":"Yukyung Park,Woo Jin Kim,Seon Sook Han,Yeon Jeong Heo,Da Hye Moon,Ohbeom Kwon,Myung Goo Lee,Ji Young Hong,Chang Youl Lee,Yu Seong Hwang,Su Kyoung Kim,Heui Sug Jo","doi":"10.4187/respcare.11924","DOIUrl":"https://doi.org/10.4187/respcare.11924","url":null,"abstract":"BACKGROUNDAppropriate hospital-to-home transitional care has been recognized for its positive impact on health care usage and health outcomes in patients with COPD. However, there is limited research assessing its effects on patient-centered outcomes, focusing on patient symptoms and experiences.METHODSThis single-blind randomized controlled trial included subjects diagnosed with COPD at one of 2 university hospitals in South Korea. The study included 179 subjects (transitional care group [transitional care], 87; usual care group [usual care], 92). The transitional care received transitional care comprising post-discharge care planning, personalized education, breathing exercises, telephone counseling, home visits, and referral to social services. We analyzed the effects of these interventions by comparing breathing symptoms and various patient-centered outcomes between the 2 groups.RESULTSThe Modified Medical Research Council scores (mean [SD], transitional care 1.3 [1.06], usual care 1.82 [1.1], P = .002) and COPD Assessment Test scores (transitional care 6.32 [5.5], usual care 9.43 [7.16], P = .001) in the intervention group demonstrated more significant improvement than did those in the usual care. Following intervention, the subjects exhibited enhanced awareness of their disease, an increased frequency of inhaler use (transitional care 49.69 [1.67], usual care 46.86 [7.92], P = .002), and lower depression and anxiety scores. Additionally, the transitional care outperformed the usual care in the domain of subject experience during hospitalization (transitional care 39.34 [6.14], usual care 37.5 [5.61], P = .036), preparedness before discharge (transitional care 34.54 [4.96], usual care 32.3 [5.09], P = .003), and post-discharge management (transitional care 34.72 [4.36], usual care 30.29 [4.26], P = .003).CONCLUSIONSEvidence-based transitional care services can exert positive effects on patient-centered indices. Our findings can be used as evidence of the need to establish patient-centered transitional care as a form of universal care for patients with COPD.","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"165 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200326","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":"Classification of Patients Based on Dyspnea and Desaturation During Exercise in Interstitial Lung Disease.","authors":"Kohei Otake,Shogo Misu,Akio Yamamoto,Takumi Yamaguchi,Chisato Nagatani,Hideki Sakai,Masahiro Kaneko,Akira Ishikawa,Hiromi Tomioka","doi":"10.4187/respcare.11712","DOIUrl":"https://doi.org/10.4187/respcare.11712","url":null,"abstract":"BACKGROUNDDyspnea and desaturation during exercise are essential assessment items for pulmonary rehabilitation. Characterizing patients using these 2 factors may be important for providing more effective pulmonary rehabilitation. This study aimed to categorize subjects with interstitial lung disease (ILD) using dyspnea and desaturation at the end of the 6-min walk test (6MWT).METHODSThis was a retrospective study including 230 stable subjects with ILD who underwent 6MWT in our out-patient department at a general hospital in Japan. The modified Borg scale and oxygen saturation determined by SpO2 at the end of the 6MWT were used for cluster analysis using the k-means method with k = 4.RESULTSSubjects were classified into 4 characteristic clusters. SpO2 at the end of the 6MWT was lower in cluster 4 (80.5 ± 3.0%) than in clusters 1 (94.3 ± 2.0%), 2 (94.3 ± 1.9%), and 3 (87.9 ± 1.8%) and was lower in cluster 3 than in clusters 1 and 2. The modified Borg scale score at the end of the 6MWT was higher in clusters 2 (4 [3-8]), 3 (3 [0-9]), and 4 (4 [0-7]) than in cluster 1 (0.5 [0-2.0]) and was higher in cluster 2 than in cluster 3.CONCLUSIONSSubjects with ILD were classified into 4 characteristic clusters using dyspnea and SpO2 at the end of the 6MWT. The 4 clusters are characterized as follows: Cluster 1 had mild desaturation and mild dyspnea; cluster 2 had mild desaturation and severe dyspnea; cluster 3 had both moderate desaturation and dyspnea, and cluster 4 had both severe desaturation and dyspnea. These classification data offer insight for individualized pulmonary rehabilitation for patients with ILD.","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"63 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142225755","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":"Pressure Control Surrogate Formula for Estimating Mechanical Power in ARDS is Associated with Mortality.","authors":"Richard H Kallet, Michael S Lipnick","doi":"10.4187/respcare.12269","DOIUrl":"https://doi.org/10.4187/respcare.12269","url":null,"abstract":"<p><p><b>BACKGROUND:</b> Mechanical power applied to the respiratory system (MP_RS) is associated with ventilator-induced lung injury (VILI) and ARDS mortality. Absent automated ventilator MP_RS measurements, the alternative is clinically unwieldy equations. However, simplified surrogate formulas are now available and accurately reflect values produced by airway pressure-volume curves. This retrospective, observational study examined whether the surrogate pressure-control equation alone could accurately assess mortality risk in ARDS subjects managed almost exclusively with volume-control ventilation.<b>METHODS:</b> 948 subjects were studied in whom invasive mechanical ventilation and implementation of ARDSNet ventilator protocols commenced ≤ 24hr after ARDS onset, and who survived > 24hr. MP_RS was calculated as 0.098 x respiratory frequency x VT x (PEEP + driving pressure [P_DR]). MP_RS was assessed as a risk factor for hospital mortality, and compared between non-survivors and survivors across Berlin Definition classifications. In addition, mortality was compared across 4 MP_RS thresholds associated with VILI or mortality (ie. 15, 20, 25 and 30 J/m).<b>RESULTS:</b> MP_RS was associated with increased mortality risk: Odds Ratio (95% CI) of 1.06 (1.04-1.07) per J/m, P<0.001). Median MP_RS differentiated non-survivors from survivors in Mild (24.7 vs. 18.5 J/m, respectively, P==0.034); Moderate (25.7 vs. 21.3 J/m, P<0.001); and Severe ARDS (28.7 vs. 23.5 J/m, P<0.001). Across 4 MP_RS thresholds mortality increased from 23-29% when MP_RS was < threshold vs. 38-51% when MP_RS was > threshold (P<0.001). In the > cohort the Odds Ratio (95%CI) increased from 2.03 (1.34-3.12) to 2.51 (1.87-3.33).<b>CONCLUSION:</b> The pressure control surrogate formula is sufficiently accurate to assess mortality in ARDS, even when using volume control ventilation. In our subjects when MP_RS exceeds established cut-off values for VILI or mortality risk, we found mortality risk consistently increased by a factor of > 2.0.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146147","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":"Mobility Levels of Critically Ill Adult Patients and Extubation Success: A Cohort Study.","authors":"Camila Pal, Carolina Fu, Carlos Roberto Ribeiro de Carvalho, José Otávio Costa Auler Júnior, Liria Yuri Yamauchi","doi":"10.4187/respcare.12250","DOIUrl":"https://doi.org/10.4187/respcare.12250","url":null,"abstract":"<p><p><b>Background:</b> The reduced mobility in critically ill patients is still a reality in many intensive care units. This study aims to investigate if mobility level is associated with extubation outcome in adult patients.<b>Methods:</b> Prospective cohort study which comprised adults who had undergone initial invasive mechanical ventilation for more than 24 hours and were independently mobile before hospitalization. Patient progress was monitored from ICU admission to discharge. Data were collected daily from medical records and multidisciplinary teams, considering variables such as age, sex, BMI, SAPS III score, type of ICU admission, comorbidities, sedation, usage of vasoactive drugs, neuromuscular blockers, duration of mechanical ventilation, and ICU mobility scale (IMS). The primary outcome was the success of extubation.<b>Results:</b> IMS values did not directly associate with extubation outcome. Older patients demonstrated a reduced tendency for high IMS values, as did those on prolonged usage of vasoactive drugs or mechanical ventilation. Patients with higher IMS values achieved successful extubation earlier, suggesting a link between mobility and faster extubation success.<b>Conclusion:</b> The level of mobility assessed 24 hours after extubation was not associated with extubation success. The following characteristics were associated with a lower propensity to present high IMS: older age, greater number of days of use of vasoactive drugs and mechanical ventilation. Patients with higher levels of mobility had a successful extubation event earlier in the ICU. Studies that assess mobility on a continuous basis would be more precise in identifying this association.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081327","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":"Low Pressure Heliox-based Rebreather System to Reduce Work of Breathing and Conserve Gas.","authors":"Sairam Parthasarathy, Christopher J Morton","doi":"10.4187/respcare.12184","DOIUrl":"10.4187/respcare.12184","url":null,"abstract":"<p><p><b>Background:</b> To test the ability of a low-pressure, low-flow, Heliox-based rebreathing system to reduce work of breathing and conserve gas while preserving CO₂ concentration, temperature, and humidity at physiological levels in a bench study.<b>Methods:</b> We performed a bench study of a novel low-pressure, low-flow, noninvasive Heliox rebreathing system with CO₂ scrubber that was connected to an artificial lung simulator with careful monitoring of flow, pressure, work of breathing, oxygen (O₂), carbon-dioxide (CO₂), temperature, and humidity levels. Multiple runs of breathing were performed while manipulating levels of resistance (5 - 30 cm H₂O/L/sec), gas mixtures (room air, 79% Helium 21% O₂, and 70% Helium and 30% O₂), and leak levels (ultra-low, low, and high).<b>Results:</b> We found significant reductions in work of breathing (up to 64%) while conserving gas with estimates of up to 54-fold reduction in medical gas wastage (P<0.001). Specifically, at resistances of 5, 10, 20, and 30 cm H2O/L/sec we demonstrated 64%, 57%, 36%, and 7% reduction in work of breathing (P<0.0001). Gas wastage was reduced by 10- to 54-fold while the end-tidal CO₂ concentration, humidity, and temperature were maintained by the device at physiological levels.<b>Conclusions:</b> In a bench-test, a low-pressure, low-flow, noninvasive Heliox rebreathing system with CO₂ scrubber reduced work of breathing and conserved gas while preserving CO₂ concentration, temperature, and humidity at physiological levels. Future studies in human subjects need to be performed to determine whether reduction of work of breathing and gas conservation can be achieved.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081326","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}