Respiratory care最新文献

Background: There is limited evidence comparing center and home-based sit-to-stand (STS) tests in individuals with chronic respiratory disease (CRD). This study aimed to estimate the level of agreement and performance differences among center-based, remotely supervised, and self-administered STS tests in individuals with CRD.

Methods: A repeated-measures design was used to compare the 30-s and 1-min STS across 3 test conditions. The sample size was one of convenience and included subjects with CRD from an out-patient pulmonary rehabilitation program in Toronto, Canada. Bland-Altman analysis was used to estimate STS agreement across conditions, reporting mean difference and 95% limits of agreement (LoA). Analysis of variance was used to estimate differences in STS performance across conditions, controlling for testing order. Secondary measures included indicators of safety and acceptability of the remotely supervised and self-administered conditions. All analyses were completed using Stata/BE 17.0 with a significance level of P ≤ .05.

Results: Twenty-seven participants (mean age 69.4 ± 11.8 years, 52% female) completed STS testing in all 3 conditions. Bland-Altman plots revealed limited bias across all comparisons (mean difference < 1 repetition). LoA illustrated individual variation across comparisons for the 30-s STS (LoA -3.4 to 4.1) and 1-min STS (LoA: -7.4 to 8.6). Analysis of variance models indicated no effect of test condition on either 30-s STS (P = .12) or 1-min STS (P = .33). There was an observed order effect for the 30-s STS (P = .005) and 1-min STS (P = .005). There were no serious adverse events for remotely supervised and self-administered tests. The majority (≥ 80%) of participants found the instructions clear, and felt safe and confident while performing the remotely supervised and self-administered STS.

Conclusions: Performance on the 30-s and 1-min STS did not differ across test conditions. Remotely supervised and self-administered tests may be safe and acceptable.

Background: This study aimed to evaluate the efficacy and reliability of maintaining a constant tidal volume (V_T) using a square-wave flow pattern in currently available turbine-based ventilators (TBVs) compared with a bellows-based ventilator (BBV), under conditions of abrupt changes in ventilator load. Such changes frequently occur in ventilator-dependent patients during mouthpiece ventilation and sleep with a mask, including events such as air stacking (AS), leakage, disconnection for speaking or eating/drinking, and complete obstruction.

Methods: Five TBVs and one BBV were assessed in a bench test simulating 4 distinct transient events (AS, leakage, disconnection, and complete obstruction) across 3 consecutive cycles.

Results: During AS, only one TBV maintained V_T as effectively as the BBV, whereas the others showed a significant decrease in V_T when the elastic load increased because of the preceding stacked breath(s). During leakage, the same TBV again maintained V_T as effectively as the BBV, both during and after the leak. In contrast, the other TBVs exhibited a transient increase in delivered V_T at the onset of leakage, followed by a decrease once it ended. Except for the BBV, disconnection resulted in continuous air flow, with flow peaks occurring at the moments when V_T was expected to be delivered. Following the termination of obstructive apnea, all devices maintained the targeted V_T, except for one BBV, which delivered a V_T above baseline during the 2 subsequent cycles.

Conclusions: At least one BBV consistently maintained a stable V_T under various conditions, including AS, leakage, postapnea recovery, and postdisconnection. However, disconnection was associated with continuous air flow in the TBVs, which could be disruptive during mouthpiece ventilation disconnection for speaking, eating, or drinking. This unintended effect warrants further investigation.