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.

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: 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.

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.

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.