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Obesity Modifies the Effect of PEEP During Spontaneous Breathing in Acute Hypoxemic Respiratory Failure. 肥胖改变急性低氧性呼吸衰竭自发性呼吸时PEEP的作用。
IF 2.1 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-12-05 DOI: 10.1177/19433654251399184
Bryan Kozdas, Jose Dianti, Ewan C Goligher
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引用次数: 0
Obstructive Sleep Apnea in 0- to 12-Month-Old Infants. 0- 12个月婴儿的阻塞性睡眠呼吸暂停。
IF 2.1 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-12-04 DOI: 10.1177/19433654251395629
Egambaram Senthilvel, Charmi Shah, Theresa Kluthe, Quang L Nguyen, Kelly Betz, Kahir Jawad, Karim El-Kersh

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, SpO2 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.

背景:调查婴儿阻塞性睡眠呼吸暂停(OSA)的患病率、相关合并症、不同睡眠状态下呼吸事件的分布和体位。方法:这是一项单中心回顾性研究,包括接受多导睡眠图(PSG)检查的0至12个月的婴儿。根据阻塞性呼吸暂停低通气指数(OAHI)将OSA严重程度分为轻度(1-4.9事件/h)、中度(5-9.9事件/h)和重度(≥10事件/h)。结果:纳入118例婴儿,OSA组(73/118)中位年龄为5个月(四分位间距,[IQR] 2.0-9.0),非OSA组(45/118)中位年龄为7个月(IQR 6.0-9.0) (P = 0.01)。PSG最常见的指征是打鼾(57.5%),其次是呼吸暂停(41.1%)。OSA患病率为61.9%(轻度53.4%,中度17.8%,重度28.8%)。胃食管反流病(GERD; 32.9%)和21.9%的颅面异常是常见的合并症。多因素二项回归分析显示,有颅面异常史的婴儿(P = 0.038)患OSA的几率更高。在睡眠结构中位数,如总睡眠时间、睡眠效率、睡眠潜伏期、第1、2、3阶段和快速眼动(REM)睡眠持续时间等方面,OSA组与非OSA组之间没有显著差异,但唤醒指数中位数明显高于OSA组(15.7[11.9,24.1]对10.6 [9.4,16.3];P < .001)。呼吸参数包括呼吸暂停低通气指数(AHI)、OAHI、REM AHI、非REM AHI、SpO2最低点和平均值、二氧化碳平均值和峰值,差异均有统计学意义。在6-12个月大的OSA患儿中,32例REM AHI高于非REM (AHI: 17.0[10.9, 33.8]比2.3 [0.6,6.0];P < .001)。同样,当我们单独比较每个非仰卧位时,仰卧位AHI更高(P < 0.001)。结论:在我们的队列中,OSA在婴儿中非常普遍;胃食管反流病史和颅面异常是常见的合并症。梗阻性事件主要发生在快速眼动睡眠和仰卧位。
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引用次数: 0
Virtual Reality During Arterial Puncture and Its Impact on Patient-Reported Pain Scores, Anxiety Scores, and Patient Satisfaction. 在动脉穿刺中使用虚拟现实技术并评估其对患者报告的疼痛评分、焦虑评分和患者满意度的影响。
IF 2.1 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-12-01 Epub Date: 2025-06-30 DOI: 10.1089/respcare.12625
Pradeep Upadhyaya, James Mirocha, Kimberly Fuleihan, Benga Agbelemose

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.

背景:动脉穿刺血气取样是一个痛苦的过程,往往需要多次尝试。在该机构,目前的护理标准不包括常规使用镇痛药,这可能导致高度焦虑和低患者满意度。虚拟现实(VR)技术在减轻各种医疗过程中的疼痛和焦虑方面显示出了希望,尽管它在动脉穿刺方面的应用仍未得到探索。本研究探讨了VR在动脉穿刺中减轻疼痛和焦虑的有效性及其对患者满意度的影响。方法:在雪松-西奈医学中心肺功能检测实验室进行了一项混合方法研究。在手术过程中,41名计划进行动脉采血的受试者被分配到VR(21名受试者)或标准护理(20名受试者)。评估了疼痛、焦虑和患者满意度的显著差异。此外,从11个对象的访谈中收集了定性见解。结果:定量分析显示,VR组疼痛减轻有统计学意义(P < 0.001),具有临床重要意义(63%),超过了最小临床重要差异。焦虑水平也有统计学意义(P < 0.001)和临床意义的降低,降低16.4分,超过了最低临床重要差异。在手术过程中,VR组的患者满意度明显更高(P = 0.004),尽管总体满意度没有差异(P = 0.21)。定性数据表明,受试者认为虚拟现实可以分散疼痛的注意力,感受到更多的照顾,对患者的整体体验有积极的贡献。结论:VR可显著减轻动脉穿刺过程中的疼痛和焦虑,提高患者满意度。然而,样本量小和只纳入说英语的受试者等限制限制了推广结果的能力。尽管如此,虚拟现实可能会显示出改善患者体验和护理质量的潜力。
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引用次数: 0
Bridging the Gap Between Patient Voices and Evidence: Challenges in Evaluation of Patient-Centered Outcomes. 弥合患者声音和证据之间的差距:以患者为中心的结果评估的挑战。
IF 2.1 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-12-01 Epub Date: 2025-11-14 DOI: 10.1177/19433654251396857
Christopher Janowak, Lauren Janowak
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引用次数: 0
Best Respiratory Compliance Following a Recruitment Maneuver Allows Hemodynamic Stability During Laparoscopic Surgery. 在腹腔镜手术中,最佳的呼吸顺应性使血液动力学稳定。
IF 2.1 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-12-01 Epub Date: 2025-06-30 DOI: 10.1089/respcare.12862
Xiaojing Ma, Libin Ma, Xiangmei Piao, Yunke Fu, Roberta Ribeiro De Santis Santiago, Lorenzo Berra, Zhenggang Guo, Weidong Mi, Changsheng Zhang

Background: PEEP and alveolar recruitment maneuvers are commonly used during laparoscopic surgery to improve respiratory mechanics and prevent atelectasis but may adversely affect cardiovascular function. We hypothesized that individualized PEEP titrated to best lung compliance would be hemodynamically well tolerated. Methods: We analyzed cardiovascular effects of individualized PEEP in subjects undergoing laparoscopic surgery. Cardiac index, mean arterial pressure (MAP), heart rate, stroke volume variation (SVV) changes were recorded during recruitment maneuvers and decremental PEEP trials. Results: Sixty-four subjects were enrolled in this study. Our findings revealed that the hemodynamic effects, including reduction in cardiac index (P < .001), mean arterial pressure (MAP) (P < .001), and increase in stroke volume variation (SVV) (P < .001), were transient, without requiring vasopressor support. Receiver operating characteristic (ROC) analysis showed that PEEP levels >17 cm H2O reduced cardiac index (area under the ROC curve = 0.594). Post hoc analysis indicated minimal cardiac index impact at PEEP levels ≤16 cm H2O (P < .001). Notably, individualized PEEP caused a reduction in cardiac index in 10 (16%) subjects and decreased MAP in 11 (17%) subjects. Mixed-effects modeling identified age as an independent predictor of MAP reduction (estimate = -0.21, P = .01). Conclusions: In subjects undergoing laparoscopic surgery, individualized PEEP levels ≤16 cm H2O generally maintain hemodynamic stability. Recruitment maneuvers and decremental PEEP trials transiently affect cardiac index, MAP, and SVV, and increasing age is associated with greater MAP sensitivity. However, individualized PEEP titration does not ensure hemodynamic neutrality in all patients, underscoring the need for multi-parameter approaches integrating both respiratory and cardiovascular monitoring.

背景:在腹腔镜手术中,正压和肺泡扩张术常用于改善呼吸力学和预防肺不张,但可能对心血管功能产生不利影响。我们假设个体化PEEP滴定至最佳肺顺应性将在血流动力学上耐受良好。方法:我们分析个体化PEEP对腹腔镜手术患者心血管的影响。在招募演习和递减PEEP试验期间记录心脏指数、平均动脉压(MAP)、心率、卒中容积变化(SVV)的变化。结果:本研究共纳入64名受试者。我们的研究结果显示,血流动力学的影响,包括心脏指数(P < 0.001)、平均动脉压(MAP) (P < 0.001)和卒中容积变化(SVV)增加(P < 0.001),是短暂的,不需要血管加压药物支持。受试者工作特征(ROC)分析显示,PEEP水平> - 17 cm H2O降低心脏指数(ROC曲线下面积= 0.594)。事后分析显示,PEEP水平≤16 cm H2O时心脏指数影响最小(P < 0.001)。值得注意的是,个体化PEEP导致10名(16%)受试者心脏指数下降,11名(17%)受试者MAP下降。混合效应模型确定年龄是MAP减少的独立预测因子(估计= -0.21,P = 0.01)。结论:在接受腹腔镜手术的患者中,个体化PEEP水平≤16 cm H2O一般能维持血流动力学稳定性。招募操作和递减PEEP试验会短暂影响心脏指数、MAP和SVV,年龄的增加与MAP的敏感性增加有关。然而,个体化PEEP滴定并不能确保所有患者的血流动力学中性,因此需要多参数方法整合呼吸和心血管监测。
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引用次数: 0
A Review of Medical Oxygen Concentrators for Respiratory Applications. 医用氧气呼吸器的研究进展。
IF 2.1 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-12-01 Epub Date: 2025-06-30 DOI: 10.1089/respcare.13046
Dogan Erdemir, Ibrahim Dincer

Medical oxygen concentrators are vital devices that deliver supplemental oxygen to persons with hypoxemia. This narrative review provides a review of oxygen concentrators, outlining their operational mechanisms, classification, evaluation criteria, market accessibility, advantages, disadvantages, and prospective developments. Critical insights encompass the dominance of pressure swing adsorption technology in oxygen separation, the increasing demand for portable and energy-efficient models, and the promise of smart technologies and new materials to improve oxygen therapy. The analysis underscores the necessity of tackling issues of accessibility and cost, especially in resource-constrained environments. This review highlights the essential function of oxygen concentrators in potentially fulfilling the United Nations Sustainable Development Goals 3, 8, 12, 13, and 17 by improving health care accessibility, fostering economic growth, advancing environmental sustainability, and facilitating global partnerships. The incorporation of automated controls and artificial intelligence-driven modifications may become important for customizing oxygen administration to meet patient requirements and fluctuating conditions, hence ensuring optimal therapy and reducing the workload of health care providers. Finally, it is emphasized that the necessity of addressing issues with accessibility and cost, especially in resource-constrained environments.

医用吸氧器是为低氧血症患者提供补充氧气的重要设备。这篇叙述性的综述提供了氧气浓缩器的综述,概述了它们的运作机制,分类,评价标准,市场可及性,优势,劣势和未来的发展。关键见解包括变压吸附技术在氧气分离中的主导地位,对便携式和节能模型的需求日益增长,以及智能技术和新材料改善氧气治疗的前景。分析强调了解决可及性和成本问题的必要性,特别是在资源有限的环境中。本综述强调了氧气浓缩器在实现联合国可持续发展目标3、8、12、13和17方面的基本功能,包括改善卫生保健可及性、促进经济增长、促进环境可持续性和促进全球伙伴关系。结合自动化控制和人工智能驱动的修改对于定制氧气管理以满足患者需求和波动的条件可能变得重要,从而确保最佳治疗并减少医疗保健提供者的工作量。最后,强调必须解决可及性和成本问题,特别是在资源有限的环境中。
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引用次数: 0
Mapping the Impact of Respiratory Therapists: Lessons From a Scoping Review. 绘制呼吸治疗师的影响:从范围审查的教训。
IF 2.1 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-12-01 DOI: 10.1177/19433654251396855
Lynda Goodfellow
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引用次数: 0
Calibrating the Lung Ultrasound Aeration Score: Moving from Terminology to Clinical Relevance. 校准肺超声通气评分:从术语到临床相关性。
IF 2.1 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-12-01 Epub Date: 2025-11-14 DOI: 10.1177/19433654251396858
Santje A S Slot, Pieter R Tuinman, Micah L A Heldeweg
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引用次数: 0
Hierarchy of Preferred Patient Outcomes Among Survivors of Acute Respiratory Failure. 急性呼吸衰竭幸存者的首选患者结局等级。
IF 2.1 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-12-01 Epub Date: 2025-07-11 DOI: 10.1089/respcare.13083
Somnath Bose, Lena Novack, Samantha Harrison, Valerie Goodspeed, Krystal Capers, Margaret M Hayes, Victor D Dinglas, Dale M Needham, Samuel M Brown

Background: Surviving acute respiratory failure (ARF) in the ICU is often a life-changing event. Most survivors face endure impairments across several domains, termed as post-intensive care syndrome (PICS). There is limited investigation on how survivors and their caregivers perceive recovery from their own lived experiences. The objective of this study was to characterize which domains of recovery matter most to ARF survivors and their caregivers. Methods: A single-center, prospective observational study nested within 2 contiguous cohort studies: Addressing Post-Intensive Care Syndrome (APICS)-01 and APICS-COVID that enrolled ARF survivors who were admitted to ICU and discharged home. Survivors and caregivers were asked to prioritize following 9 domains of recovery using a custom-made survey: cognition, pain, physical function, pulmonary function, muscle/nerve function, mental health, fatigue, return to work or prior activities, and survival. These domains were chosen based on prior literature and modified based on input from a patient and family advisory council at the study site. The order of prioritization of domains of recovery was assessed at hospital discharge and at 3- and 6-month follow-up. Results: Forty eligible study subjects and 10 caregivers were recruited between 2019 and 2022. Mean age was 51.0 (SD 13.8) years, more than two thirds were male, and approximately one-third were non-white. Of the 9 domains surveyed, survival was consistently ranked the highest at each of the 3 time points. Cognitive recovery and physical function were ranked as the next 2 most important domains of recovery. Conclusions: ARF survivors who were discharged to home prioritized survival and then physical and cognitive recovery over 6 other domains. Understanding what matters most to survivors is a key step toward identifying priority areas for care in ICUs and rehabilitation after critical illness. Future studies should include survivors and caregivers from diverse backgrounds to obtain a comprehensive assessment of their perspective of recovery.

背景:急性呼吸衰竭(ARF)在ICU存活往往是一个改变生活的事件。大多数幸存者面临着跨越几个领域的损伤,称为重症监护后综合征(PICS)。关于幸存者及其照顾者如何看待从自己的生活经历中恢复的调查有限。本研究的目的是表征哪些领域的恢复最重要的ARF幸存者和他们的照顾者。方法:一项单中心、前瞻性观察性研究,纳入两项连续队列研究:解决重症监护后综合征(APICS)-01和APICS- covid,纳入入院ICU并出院的ARF幸存者。通过一项定制的调查,要求幸存者和照顾者优先考虑以下9个康复领域:认知、疼痛、身体功能、肺功能、肌肉/神经功能、心理健康、疲劳、重返工作或之前的活动以及生存。这些领域是根据先前的文献选择的,并根据研究现场患者和家属咨询委员会的输入进行修改。在出院时以及3个月和6个月随访时评估康复领域的优先顺序。结果:在2019年至2022年期间招募了40名符合条件的研究受试者和10名护理人员。平均年龄为51.0岁(SD 13.8),超过三分之二为男性,约三分之一为非白人。在调查的9个领域中,生存率在3个时间点中的每一个都始终排名最高。认知恢复和身体功能被列为接下来两个最重要的恢复领域。结论:出院回家的ARF幸存者优先考虑生存,其次是身体和认知恢复,而不是其他6个领域。了解对幸存者最重要的是什么,这是确定重症监护室护理和危重疾病后康复优先领域的关键一步。未来的研究应该包括来自不同背景的幸存者和照顾者,以获得对他们康复观点的全面评估。
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引用次数: 0
Can We Really Expect to Predict Patient Outcomes Using the Lung Ultrasound Aeration Score Pattern? 我们真的可以期望使用肺超声通气评分模式来预测患者的预后吗?
IF 2.1 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2025-12-01 DOI: 10.1177/19433654251384243
Diana Adrião, Javiera Aguilera, Pablo Mercado, Francesco Mojoli, Silvia Mongodi
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引用次数: 0
期刊
Respiratory care
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