Respiratory care最新文献

Background: Aerosol therapy is commonly used during treatment with high-flow nasal cannula (HFNC) in the ICU. Heated humidification inside the HFNC tubing circuit leads to unwanted condensation, which may greatly limit the efficiency of drug delivery. In this study, we aimed to investigate whether a novel humidification system, which decouples temperature and humidity control, can improve the delivered dose. Methods: In a bench study setup, fluorescein sodium solution was nebulized using a vibrating mesh nebulizer in an infant HFNC circuit to measure the delivered dose, with a conventional versus a decoupled humidifier. The deposition of fluorescein inside each breathing circuit component and a final collection filter at the end of the nasal cannula was collected and quantified with a UV-vis spectrometer. Droplet sizes at different sections of the breathing circuit were measured by laser diffraction. Three air flows, 5, 10, and 15 L/min; and 2 nebulizer positions, (1) at the humidifier and (2) after the inspiratory tube, were tested. Results: The delivered dose decreased with increasing flow for the conventional setup and was higher when the nebulizer was placed after the inspiratory tube. Turning off the conventional humidifier 10 min before and during nebulization did not improve the delivered dose. The decoupled humidifier achieved a significantly higher (P = .002) delivered dose than the conventional setup. The highest delivered dose obtained by the decoupled humidifier was 62.4% when the nebulizer was placed after the humidifier, while the highest dose obtained for the conventional humidifier was 36.3% by placing the nebulizer after the inspiratory tube. Conclusions: In this bench study, we found that the delivered dose for an infant HFNC nebulization setup could be improved significantly by decoupling temperature and humidity control inside the HFNC circuit, as it reduced drug deposition inside the breathing circuit.

The primary goal of asthma management is attainment of the best possible outcomes for symptom control and reduction of exacerbations. This can be accomplished through partnering with patients and families and providing education. Asthma self-management education empowers patients with the knowledge, confidence, and skills necessary to successfully manage their condition. Components of asthma education include basic facts about asthma, inhaled medications, self-monitoring, environmental control, and a written asthma action plan. Repetition, reinforcement, and good clinician communication skills are vital for successful self-management education. Teach back, teach-to-goal, and motivational interviewing are effective strategies that have demonstrated improved outcomes for adults and children with asthma. Respiratory therapists have positively impacted outcomes for patients with asthma through educational interventions. This paper reviews the published literature regarding asthma education and provides guidance for clinicians for effective asthma self-management education.

Background: After the improvement of the initial phase of ARDS, when the patients begin spontaneous breathing and weaning from mechanical ventilation, some patients may present abnormal breathing patterns, whose evaluation of the repercussions were poorly studied. This study proposed to evaluate abnormal breathing patterns through the use of electrical impedance tomography (EIT), and clinical, respiratory mechanics, and ventilatory parameters according to the types of weaning from mechanical ventilation. Methods: This was a prospective cohort study of subjects with ARDS who were considered able to be weaned from mechanical ventilation in the clinical-surgical ICU. Weaning types were defined as simple, difficult, and prolonged weaning. EIT, ventilatory, lung mechanics, and clinical data were collected. Data were collected at baseline in a controlled ventilatory mode and, after neuromuscular blocker withdrawal, data were collected after 30 min, 2 h, and 24 h. EIT parameter analysis was performed for ventilation distribution in the lung regions, pendelluft, breath-stacking, reverse-trigger, double-trigger, and asynchrony index. Results: The study included 25 subjects who were divided into 3 groups (9/25 simple, 8/25 difficult, and 8/25 prolonged weaning). The prolonged weaning group showed more delirium, ICU-acquired weakness, stay in ICU, and hospital and ICU mortality. During the change from controlled to spontaneous mode, we observed increased tidal volumes and driving pressures, which were mainly found in the prolonged weaning group when compared with the simple weaning group. The prolonged weaning group showed a higher flow index, more asynchronies during volume-assisted ventilation, a higher incidence of pendelluft, and redistribution of ventilation to posterior regions visualized by EIT. Conclusions: The present study showed abnormal breathing patterns in the prolonged weaning group. The clinical occult findings of abnormal breathing patterns could be monitored, mainly through EIT and with better assessment of pulmonary mechanics.

Background: Chronic Obstructive Pulmonary Disease (COPD) remains a significant public health challenge and a leading cause of mortality in the United States. Whereas the detrimental impact of smoking on COPD progression is well documented, the specific effects of smoking status on mortality risk among adults with COPD require further elucidation. Thus, this study investigates the relationship between smoking status (current smoker, former smoker, non-smoker) and mortality risk among patients diagnosed with COPD. Methods: We analyzed data from the National Health Interview Survey (NHIS), which was linked to mortality data from the National Death Index (NDI). Survival probabilities were estimated by using the Kaplan-Meier method, and the associations between smoking status and mortality risk were quantified by using hazard ratios (HR) and 95% CIs derived from univariate and multivariate Cox proportional hazards regression models. In the multivariate models, we adjusted for sex, age, marital status, heart condition, drinking status, body mass index, and health status. Results: The multivariate model revealed a significantly higher mortality risk for former smokers (HR 1.619, 95% CI 1.198-2.188) and current smokers (HR 1.894, 95% CI 1.386-2.590) compared with non-smokers. Marital status significantly modified the smoking status-mortality relationship in adults with COPD (P = .01), with single/never married former smokers exhibiting the highest mortality risk (HR 3.711, 95% CI 1.130-12.187). Conclusions: Both current and former smoking statuses are associated with an increased mortality risk in adults with COPD. These findings underscore the critical impact of smoking on mortality risk among adults with COPD and highlight the significant modifying effect of marital status.

Background: Alpha-1 antitrypsin is encoded by the polymorphic SERPINA1 gene, with pathogenic variants causing alpha-1 antitrypsin deficiency. While being underrecognized, alpha-1 antitrypsin deficiency can be screened through serum protein electrophoresis (SPE) to detect mutations. This study aimed to evaluate the effectiveness of an SPE-based screening protocol for identifying SERPINA1 mutations and diagnosing alpha-1 antitrypsin deficiency. Methods: This study involved analyzing all SPE tests over one year at the Hospital Clínico Universitario "Lozano Blesa" (Zaragoza, Spain). Alpha-1 antitrypsin concentration was measured in samples with <3% alpha-1 globulin band, selecting those with <100 mg/dL as potential study participants. Participants provided blood samples for the genetic analysis of the SERPINA1 gene. Results: Out of 12,460 SPE tests analyzed, 175 had alpha-1 globulin bands <3%, and 70 cases had alpha-1 antitrypsin concentrations <100 mg/dL. Of these cases, 39 subjects participated in the study. The mean alpha-1 antitrypsin concentration was 78.8 mg/dL. Genetic analysis showed 87.2% had SERPINA1 mutations, with common genotypes being PI*MS, PI*MZ, and PI*SZ. Conclusions: This study confirms the efficacy of SPE as a potential screening strategy for detecting mutations in the SERPINA1 gene. It can facilitate opportunistic diagnosis of alpha-1 antitrypsin deficiency, promoting early detection and treatment.