Canadian Journal of Respiratory Therapy最新文献

{"title":"Work of breathing during arm bracing in normal male subjects.","authors":"Tomoyuki Ogino,&nbsp;Kyoshi Mase,&nbsp;Shigefumi Murakami,&nbsp;Kazuhisa Domen","doi":"10.29390/cjrt-2020-012","DOIUrl":"https://doi.org/10.29390/cjrt-2020-012","url":null,"abstract":"<p><strong>Objective: </strong>Although chronic obstructive pulmonary disease patients get relief from their dyspnea by arm bracing, the mechanics of this effect are unknown. This study aimed to investigate the mechanisms by which arm bracing affects dyspnea by measuring the work of breathing (WOB) in the arm bracing posture.</p><p><strong>Methods: </strong>Six normal male subjects were studied in two standing postures: erect and with their arms braced. For the arm bracing posture, the subjects leaned forward with their arms stretched and rested their hands on a platform. Respiratory frequency was set at 20 tidal breaths/min with the use of a metronome, and tidal volume was set at 1 L by observing the lung volume on a monitor. All the subjects randomly adopted the two postures, and a preset respiratory pattern was measured for 30 s in each posture. Lung volume and flow rate were measured using a hot-wire flowmeter. Esophageal pressure was measured using a 12-cm balloon catheter. The WOB was estimated using modified Campbell diagrams.</p><p><strong>Results: </strong>Lung volume increased and inspiratory resistive WOB decreased, while inspiratory elastic WOB increased significantly with arm bracing compared with that of the erect posture (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Arm bracing posture increases the chest wall expansion thereby increasing the end-expiratory lung volume and decreasing the inspiratory resistive WOB among healthy individuals.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"56 ","pages":"65-69"},"PeriodicalIF":0.0,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2a/f6/cjrt-2020-012.PMC7690311.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38333813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cough peak flow to predict the extubation outcome: Comparison between three cough stimulation methods.","authors":"Christiane Melo Almeida,&nbsp;Agnaldo José Lopes,&nbsp;Fernando Silva Guimarães","doi":"10.29390/cjrt-2020-037","DOIUrl":"https://doi.org/10.29390/cjrt-2020-037","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to compare the predictive value of three cough peak flow (CPF) maneuvers in predicting the extubation outcome in a cohort of mechanically ventilated subjects.</p><p><strong>Methods: </strong>Eighty-one mechanically ventilated subjects who succeeded in the spontaneous breathing trial were included. In a randomized order, CPF was stimulated and measured using three methods: voluntary command (V_CPF), tracheal saline instillation (S_CPF), and mechanical stimulation with a catheter (C_CPF). Additionally, CPF was measured 20 min after the extubation (PE_CPF). The diagnostic accuracy of the CPF methods in relation to the extubation outcome was measured using the receiver operating characteristic (ROC) curve. ROC curve results were compared using the Hanley and McNeil method.</p><p><strong>Results: </strong>The three methods presented high accuracy in predicting the extubation outcome (V_CPF = 0.89, S_CPF = 0.93, and C_CPF = 0.90), without statistically significant differences between them (V_CPF vs. S_CPF, <i>p</i> = 0.14; V_CPF vs. C_CPF, <i>p</i> = 0.84; S_CPF vs. C_CPF, <i>p</i> = 0.13). The optimum cutoff values were V_CPF = 45 L/min, S_CPF = 60 L/min, and C_CPF = 55 L/min. PE_CPF also showed high accuracy in predicting the extubation outcome (AUC = 0.95; cutoff = 75 L/min).</p><p><strong>Conclusions: </strong>In mechanically ventilated and cooperative subjects, there is no difference in the accuracy of CPF measured voluntarily, with stimulation using saline or by catheter stimulation in predicting the reintubation. CPF recording after endotracheal tube removal has high accuracy to predict the extubation outcome.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"56 ","pages":"58-64"},"PeriodicalIF":0.0,"publicationDate":"2020-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cb/2c/cjrt-2020-037.PMC7678950.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38640447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Publication of study protocols in the CJRT.","authors":"Justin Sorge","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"56 ","pages":"v"},"PeriodicalIF":0.0,"publicationDate":"2020-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/f8/cjrt-2020-048.PMC7654439.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38621923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory therapists: the unnoticed warriors during COVID-19 pandemic in India.","authors":"Mrudula M Sawadkar,&nbsp;Varun R Nayak","doi":"10.29390/cjrt-2020-044","DOIUrl":"https://doi.org/10.29390/cjrt-2020-044","url":null,"abstract":"57 This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http:// creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact editor@csrt.com Published online at https://www.cjrt.ca on 30 October 2020 LETTER TO THE EDITOR","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"56 ","pages":"57"},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d5/4e/cjrt-2020-044.PMC7597862.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38569833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjunct low level laser therapy (LLLT) in a morbidly obese patient with severe COVID-19 pneumonia: A case report.","authors":"Scott A Sigman,&nbsp;Soheila Mokmeli,&nbsp;Mariana A Vetrici","doi":"10.29390/cjrt-2020-022","DOIUrl":"https://doi.org/10.29390/cjrt-2020-022","url":null,"abstract":"<p><strong>Introduction: </strong>COVID-19 poses a higher risk of complications in obese patients due to low respiratory system compliance, increased inflammatory cytokines, and an activated immune system secondary to excess adiposity. Low level laser therapy (LLLT) has significant anti-inflammatory effects and reduces inflammatory cytokines. It is noninvasive and approved for pain management and musculoskeletal injuries. Data from human and experimental animal models of respiratory tract disease suggests that LLLT reduces inflammation and promotes lung healing.</p><p><strong>Case and outcomes: </strong>A morbidly obese 32-year-old Asian female with severe COVID-19 received four consecutive once-daily LLLT sessions via a laser scanner. Pulsed 808 nm and 905 nm laser beams were delivered over the posterior chest for 28 min. The patient was evaluated before and after LLLT by radiological assessment of lung edema (RALE) on chest X-ray, oxygen requirements and saturation, pneumonia severity indices (SMART-COP and Brescia-COVID), blood inflammatory markers (interleukin-6, ferritin, and C-Reactive protein (CRP)). Prior to treatment, oxygen saturation (SpO₂) via pulse oximetry was 88%-93% on 5-6 L oxygen. Following LLLT, SpO₂ increased to 97%-99% on 1-3 L oxygen. Reductions in RALE score from 8 to 3, Brescia-COVID from 4 to 0, and SMART-COP from 5 to 0 were observed. Interleukin-6 decreased from 45.89 to 11.7 pg/mL, ferritin from 359 to 175 ng/mL, and CRP from 3.04 to 1.43 mg/dL. Post-treatment, the patient noted appreciable improvement in respiratory symptoms.</p><p><strong>Conclusion: </strong>Following LLLT our patient showed improvement over a few days in respiratory indices, radiological findings, inflammatory markers, and patient outcomes. This report suggests that adjunct LLLT can be safely combined with conventional treatment in patients with severe COVID-19 and morbid obesity.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"56 ","pages":"52-56"},"PeriodicalIF":0.0,"publicationDate":"2020-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/75/83/cjrt-2020-022.PMC7521601.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38480183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unintended consequences of COVID-19: Opportunities for respiratory therapists' involvement in developing respiratory-related technologies.","authors":"Patricia McClurg,&nbsp;Nikolay Moroz,&nbsp;Marco Zaccagnini","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"56 ","pages":"35-37"},"PeriodicalIF":0.0,"publicationDate":"2020-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/02/c1/cjrt-2020-032.PMC7485964.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38412109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of scholarly practice in health care professionals: A scoping review protocol.","authors":"Marco Zaccagnini,&nbsp;André Bussières,&nbsp;Andrew West,&nbsp;Jill Boruff,&nbsp;Aliki Thomas","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Health care professionals are expected to embrace and enact the scholarly practitioner role. Scholarly practitioners demonstrate a lifelong commitment to excellence in practice through continuous learning, engagement in evidence-informed decision-making, contributions to scholarship, and knowledge translation. However, the specific features and requirements associated with this role are not uniform. The absence of well-defined and delineated conceptualizations of scholarly practice and the scarcity of empirical research on how scholarly practice is operationalized contribute to a lack of a shared understanding of this complex role.</p><p><strong>Aim: </strong>The purpose of this scoping review is to map the breadth and depth of the literature on what is known about scholarly practice in licensed health care professionals.</p><p><strong>Methods: </strong>Arksey and O'Malley's 6-stage scoping review framework will be used to examine the breadth and depth of the literature on the definitions and conceptualizations of the scholar role in health care professionals. We will conduct a comprehensive search from inception to present in MEDLINE (Ovid), EMBASE (Ovid), and CINAHL using scholarly practitioner terms and related synonyms, including a grey literature search. Following a calibration exercise, two independent reviewers will screen retrieved papers for inclusion and extract relevant data. Included papers will: (i) explore, describe, or define scholarly practice, scholar or scholarly practitioner, and/or related concepts in the licensed health care professionals; (ii) be conceptual and/or theoretical in nature; (iii) use quantitative, qualitative, or mixed methodologies; and (iv) be published in English or French. Numeric and thematic analysis will characterize the data and address the research objectives.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"56 ","pages":"38-41"},"PeriodicalIF":0.0,"publicationDate":"2020-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/35/e0/cjrt-2020-007.PMC7485963.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38412110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of humidified versus nonhumidified CPAP on inflammatory response and nasopharyngeal symptoms in healthy participants.","authors":"Hajed M Al-Otaibi,&nbsp;Mohammed D Alahmari,&nbsp;Thekra N Al-Maqati,&nbsp;Abdullah Ghazwani","doi":"10.29390/cjrt-2020-005","DOIUrl":"https://doi.org/10.29390/cjrt-2020-005","url":null,"abstract":"<p><strong>Introduction: </strong>Continuous positive airway pressure (CPAP) may induce nasal inflammation because of mucosal compression or dryness. This study examined the impact of humidified versus nonhumidified CPAP on nasal inflammation and upper airway symptoms.</p><p><strong>Methods: </strong>Seventeen healthy male subjects with no previous or current history of nasal symptoms were recruited. All subjects underwent 3 hours of nonhumidified CPAP at 12.5 cmH₂O via nasal mask. Among the 17 studied subjects, seven returned to receive a humidified CPAP at 12.5 cmH₂O via nasal mask. The nasal wash leukocyte count was assessed at baseline and after each CPAP setting. The white blood cell (WBC) count and levels of WBCs that are mononuclear cells (including lymphocytes and monocytes) were monitored. A six-point nasal score was also assessed before and after the CPAP intervention.</p><p><strong>Results: </strong>The nasal wash WBC count (10³/µL) and mononuclear cell level (10³/µL) at baseline, on 12.5 cmH₂O humidified CPAP, and on 12.5 cmH₂O nonhumidified CPAP were significantly different (<i>p</i> = 0.016; <i>p</i> = 0.003). Changes in nasopharyngeal symptoms occurred in 12 of 17 subjects (70.5%) in the nonhumidified group. Participants experienced at least one nasal symptom after application of nonhumidified CPAP at 12.5 cmH₂O.</p><p><strong>Conclusion: </strong>The present investigation suggests that humidified CPAP was not associated with early nasal inflammation and there were fewer nasopharyngeal symptoms. Further study is required to confirm the results and evaluate the impact of adding heat to the humidified CPAP system.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"56 ","pages":"21-24"},"PeriodicalIF":0.0,"publicationDate":"2020-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e9/05/cjrt-2020-005.PMC7428007.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38308181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Helmet CPAP revisited in COVID-19 pneumonia: A case series.","authors":"Aniket S Rali,&nbsp;Christopher Howard,&nbsp;Rachel Miller,&nbsp;Christopher K Morgan,&nbsp;Dennis Mejia,&nbsp;John Sabo,&nbsp;James P Herlihy,&nbsp;Sunjay R Devarajan","doi":"10.29390/cjrt-2020-019","DOIUrl":"https://doi.org/10.29390/cjrt-2020-019","url":null,"abstract":"<p><strong>Introduction: </strong>Noninvasive positive pressure ventilation (NIPPV) plays an important role in the management of respiratory failure. However, since the emergence of the COVID-19 pandemic, utilization of traditional face mask NIPPV has been curtailed in part due to risk of aerosolization of respiratory particles and subsequent health care worker exposure. A randomized clinical trial in 2016 reported that an alternative interface, helmet NIPPV, may be more effective than traditional NIPPV at preventing intubation and improving mortality. The helmet NIPPV interface provides positive airway pressure, while also theoretically minimizing aerosolization, making it a feasible modality in management of respiratory failure in COVID-19 patients.</p><p><strong>Case and outcomes: </strong>This report describes a single-center experience of a series of three COVID-19 patients with hypoxemic respiratory failure managed with helmet NIPPV. One patient was able to avoid intubation while a second patient was successfully extubated to NIPPV. Ultimately, the third patient was unable to avoid intubation with helmet NIPPV, although the application of the device was late in the progression of the disease.</p><p><strong>Discussion: </strong>NIPPV is an important modality in the management of respiratory failure and has been shown to reduce the need for immediate endotracheal intubation in select populations. For patients unable to tolerate facemask NIPPV, the helmet provides an alternate interface. In COVID-19 patients, the helmet interface may reduce the risk of virus exposure to health care workers from aerosolization. Based on this experience, we recommend that helmet NIPPV can be considered as a feasible option for the management of patients with COVID-19, whether the goal is to prevent immediate intubation or avoid post-extubation respiratory failure. Randomized studies are needed to definitively validate the use of helmet NIPPV in this population.</p><p><strong>Conclusion: </strong>Helmet NIPPV is a feasible therapy to manage COVID-19 patients.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"56 ","pages":"32-34"},"PeriodicalIF":0.0,"publicationDate":"2020-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e0/20/cjrt-2020-019.PMC7427972.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38308185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Go with the flow-clinical importance of flow curves during mechanical ventilation: A narrative review.","authors":"Natsumi T Hamahata,&nbsp;Ryota Sato,&nbsp;Ehab G Daoud","doi":"10.29390/cjrt-2020-002","DOIUrl":"https://doi.org/10.29390/cjrt-2020-002","url":null,"abstract":"<p><p>Most clinicians pay attention to tidal volume and airway pressures and their curves during mechanical ventilation. On the other hand, inspiratory-expiratory flow curves also provide a plethora of information, but much less attention is paid to them. Flow curves chronologically show the velocity and direction of inspiration and expiration and are influenced by the respiratory mechanics, the patient's effort, and the mode of ventilation and its settings. When the ventilator setting does not synchronize with the patient's respiratory pattern, the patient can easily have worsening breathing effort, patient-ventilator asynchrony, which can lead to prolonged ventilator support or lung injury. The information provided by the flow curves during mechanical ventilation, such as respiratory mechanics, the patient's effort, and patient-ventilator interactions, are very helpful when adjusting the ventilator setting. If clinicians can monitor and assess the flow curves information appropriately, it can be a useful diagnostic and therapeutic tool at the bedside. There may be association between inspiratory effort and flow, and this may further guide us, especially in the weaning process and when patients are not synchronizing with the ventilator. In this review, we try to gather information about \"flow\" that is scattered around in the literature and textbooks in one place. We will summarize the different flow waveforms utilized in commonly used ventilator modes with their advantages and disadvantages, information gained by the flow curves (i.e., flow-time, flow-volume, and flow-pressure), how to detect and manage asynchronies, and some ideas for future uses. Flow waveforms shapes and patterns are very beneficial for the management of patients undergoing mechanical ventilatory support. Attention to those waveforms can potentially improve patient outcomes. Clinicians should be familiar with this information and how to act upon them.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"56 ","pages":"11-20"},"PeriodicalIF":0.0,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/60/b0/cjrt-2020-002.PMC7427988.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38308180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}