Respiratory care最新文献

Background: Congenital heart disease (CHD) is a leading contributor to pediatric morbidity and mortality worldwide. Postoperative respiratory complications, particularly reintubation, remain a critical concern following cardiac surgery in children. This study evaluates the effectiveness of early nasal CPAP in reducing reintubation rates and respiratory complications in children with CHD after extubation. Methods: A single-center randomized controlled trial was conducted from July 2022 to July 2024. A total of 264 children (≤3 years) undergoing cardiac surgery for CHD were randomized to either an intervention group (n = 132), receiving nasal CPAP (4 cm H₂O pressure, 5 L/min oxygen flow) immediately postextubation, or a control group (n = 132), receiving standard nasal cannula oxygen therapy. The primary outcome was reintubation within 48 h. Secondary outcomes included ventilation parameters (PaO₂, P_aCO2, S_pO2) and respiratory complications (eg, bronchospasm, hypoxemia). Results: The reintubation rate within 48 h was significantly lower in the CPAP group compared with the control group (12% vs 28%, risk ratio 0.41, 95% CI 0.22-0.76, P < .05). The CPAP group demonstrated marked improvements in ventilation parameters (PaO₂, P_aCO2, S_pO2) at 4, 8, and 12 h postextubation (P < .05 for all). Additionally, the incidence of respiratory complications was notably reduced in the intervention group (P < .05). Conclusions: Early application of nasal CPAP postextubation significantly reduces reintubation rates and enhances respiratory outcomes in children with CHD. This low-complexity CPAP shows promise for adoption in resource-limited settings, with potential cost advantages meriting further investigation.

Background: Electrical impedance tomography (EIT) is a noninvasive method for visualization and quantification of regional ventilation. The objective of this study was to assess regional variations in ventilation across different positions in healthy subjects. Methods: Regional differences in ventilation were compared between the right and left lateral decubitus positions, as well as between the supine, semi-sitting, and prone positions. EIT was performed using a PulmoVista 500 (Dräger Medical, Lübeck, Germany). Results: During lateral decubitus, ventilation significantly increased in the dependent lung. In the right lung, ventilation was 42.5 ± 11.4% in the left lateral decubitus compared with 65.2 ± 12.8% in the right lateral decubitus (P < .001). In the left lung, ventilation was 56.6 ± 11.6% in left lateral decubitus versus 34.4 ± 13.0% in right lateral decubitus (P < .001). These changes were mainly observed in the ventral dependent quadrants. In the supine, semi-sitting, and prone positions, no global differences in ventilation distribution were observed. However, ventilation slightly increased in the left ventral quadrant (supine < prone, P = .03) and decreased in the right dorsal quadrant (supine > prone, P = .03). These subtle variations likely reflect the physiological characteristics of healthy individuals. Conclusions: EIT demonstrated a clear redistribution of ventilation toward the dependent lung in lateral decubitus positions. In contrast, only minimal regional ventilation changes were observed among supine, semi-sitting, and prone positions in healthy subjects. These findings support the utility of EIT in assessing position-related ventilation shifts and underscore the need for further research in patients with impaired pulmonary function.

Molecular hydrogen (H₂) has emerged as a promising therapeutic agent with potential applications across a wide range of conditions, including neurological, cardiovascular, oncologic, and respiratory diseases. Substantial preclinical studies attribute its benefits to selective antioxidant, anti-inflammatory, and cytoprotective properties. Published clinical findings are encouraging, although data are limited by small sample sizes, methodological variability, and the absence of standardized and validated commercially available delivery systems. This narrative review summarizes the current clinical experience with inhaled H₂ therapy, discusses key challenges and limitations in the existing literature, and identifies areas of interest for future research, including the development of a validated delivery system to enable broader clinical investigation and application of H₂ therapy.

Background: To investigate obstructive sleep apnea (OSA) prevalence, associated comorbidities, distribution of respiratory events in different sleep states, and body positions in infants. Methods: This was a single-center retrospective study that included infants aged 0 to 12 months who underwent polysomnogram (PSG). OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as mild (1-4.9 events/h), moderate (5-9.9 events/h), and severe (≥10 events/h). Results: One hundred eighteen infants were included with a median age of 5 months (interquartile range, [IQR] 2.0-9.0) for the OSA group (73/118) and 7 months (IQR 6.0-9.0) for the non-OSA group (45/118) (P = .01). The most common indication for PSG was snoring (57.5%), followed by apneas (41.1%). OSA prevalence was 61.9% (53.4% mild, 17.8% moderate, and 28.8% severe). Gastroesophageal reflux disease (GERD; 32.9%) and 21.9% of craniofacial abnormalities were commonly associated comorbidities. Multivariate binominal regression analysis indicated that infants with a history of craniofacial abnormalities (P = .038) had higher odds of having OSA. There were no significant differences noted in sleep architecture medians, such as total sleep time, sleep efficiency, sleep latency, stage 1, 2, 3, and rapid eye movement (REM) sleep durations, between the OSA and the non-OSA group, except for the median arousal index, which was significantly higher in the OSA group (15.7 [11.9, 24.1] versus 10.6 [9.4, 16.3]; P < .001). Differences in respiratory parameters including apnea hypopnea index (AHI), OAHI, REM AHI, non-REM AHI, S_pO2 nadir and mean, and carbon dioxide mean and peak were significant. In 6-12-month-olds, 32 infants with OSA had REM AHI that was higher than non-REM (AHI: 17.0 [10.9, 33.8] versus 2.3 [0.6, 6.0]; P < .001). Similarly, supine AHI was higher (P < .001) when we compared it with each non-supine positions individually. Conclusions: In infants, OSA was highly prevalent in our cohort; a history of GERD and craniofacial abnormalities were commonly associated comorbidities. Obstructive events occurred predominantly in REM sleep and the supine position.

Background: The factors that determine variability in impulse oscillometry (IOS) are not well defined. Methods: We used IOS data from a well-screened population of active-duty service members (ADSMs) cleared for deployment (STAMPEDE II cohort) to identify variables independently associated with IOS measurements. We constructed our own predictive models and compared them with existing reference equations when applied to postdeployment STAMPEDE II subjects and two additional ADSM IOS datasets. Results: There were 775 STAMPEDE II subjects without a history of respiratory symptoms, tobacco exposure, or lung disease (32.0 ± 9.0 years old, BMI = 26.8 ± 3.5, 16.4% female, 57.3% white) predeployment. Age, height, weight, sex, self-reported race/ethnicity, and military rank (a surrogate for socioeconomic status) in various combinations were significantly associated with the individual measures (R₅, R₂₀, X₅, fres, and AX) comprising impedance. Existing equations universally predicted lower impedance when applied to the 775 subjects from STAMPEDE II. External validation with postdeployment STAMPEDE II subjects and non-STAMPEDE II ADSM datasets showed our derived equations over-estimated while existing equations under-estimated IOS measurements. The degree of respective over and under-estimation was similar in magnitude but varied across IOS variables and between external datasets. Conclusions: In a well-screened ADSM population, we found OS measurements were higher than predicted by existing equations. Our models suggest differences in predicted values were driven, at least in part, by the demographic characteristics (race and military rank) of the underlying derivation populations.

Background: Arterial puncture for blood gas sampling is a painful procedure, often requiring multiple attempts. At this institution, the current standard of care does not include regular use of analgesics, which may lead to high anxiety and low patient satisfaction. Virtual reality (VR) technology has shown promise in reducing pain and anxiety in various medical procedures, though its use in arterial puncture remains unexplored. This study investigates the effectiveness of VR in reducing pain and anxiety during arterial puncture and its impact on patient satisfaction. Methods: A mixed-method study was conducted at Cedars-Sinai Medical Center's pulmonary function testing lab. Forty-one subjects scheduled for arterial blood sampling were assigned to either VR (21 subjects) or standard care (20 subjects) during the procedure. Remarkable differences in pain, anxiety, and patient satisfaction were evaluated. Additionally, qualitative insights were gathered from interviews with eleven subjects. Results: Quantitative analysis revealed a statistically significant (P < .001) and clinically important reduction in pain within the VR group with a 63% decrease that exceeded the minimum clinically important difference. Anxiety levels also showed a statistically significant (P < .001) and clinically meaningful reduction, with a 16.4-point decrease, surpassing the minimum clinically important difference. Patient satisfaction during the procedure was substantially higher in the VR group (P = .004), though no difference was observed in overall satisfaction (P = .21). Qualitative data indicated that subjects valued VR as a distraction from pain and felt more cared for, contributing positively to the overall patient experience. Conclusions: VR reduced pain and anxiety and enhanced patient satisfaction during arterial puncture. However, limitations such as small sample size and inclusion of only English language-speaking subjects restrict the ability to generalize results. Despite this, VR may show potential as a tool to improve patient experience and care quality.