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, PaCO2, SpO2) 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, PaCO2, SpO2) 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.
背景:先天性心脏病(CHD)是全球儿童发病率和死亡率的主要原因。术后呼吸系统并发症,特别是再插管,仍然是儿童心脏手术后的一个关键问题。本研究评估早期鼻腔CPAP在降低冠心病患儿拔管后再插管率和呼吸并发症方面的有效性。方法:于2022年7月~ 2024年7月进行单中心随机对照试验。共264例(≤3岁)接受冠心病心脏手术的儿童随机分为干预组(n = 132)和对照组(n = 132),干预组在拔管后立即接受鼻腔CPAP (4cm H2O压力,5l /min氧流量),对照组接受标准鼻插管氧治疗。主要终点是48小时内重新插管。次要终点包括通气参数(PaO2、PaCO2、SpO2)和呼吸并发症(如支气管痉挛、低氧血症)。结果:CPAP组48 h内再插管率明显低于对照组(12% vs 28%,风险比0.41,95% CI 0.22 ~ 0.76, P < 0.05)。CPAP组在拔管后4、8、12小时通气参数(PaO2、PaCO2、SpO2)均有显著改善(P < 0.05)。干预组呼吸系统并发症发生率明显降低(P < 0.05)。结论:CHD患儿拔管后早期应用鼻腔CPAP可显著降低再插管率,改善呼吸预后。这种低复杂性的CPAP有望在资源有限的环境中采用,其潜在的成本优势值得进一步研究。
{"title":"CPAP Versus Conventional Oxygenation Postextubation in Children With Congenital Heart Disease.","authors":"Aiguo Shi, Mingxiong Li, Jing Zhou, Mingqi Peng, Lanzheng Bian","doi":"10.1177/19433654251403497","DOIUrl":"https://doi.org/10.1177/19433654251403497","url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Methods:</b> 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 (<i>n =</i> 132), receiving nasal CPAP (4 cm H<sub>2</sub>O pressure, 5 L/min oxygen flow) immediately postextubation, or a control group (<i>n =</i> 132), receiving standard nasal cannula oxygen therapy. The primary outcome was reintubation within 48 h. Secondary outcomes included ventilation parameters (PaO<sub>2</sub>, P<sub>aCO<sub>2</sub></sub>, S<sub>pO<sub>2</sub></sub>) and respiratory complications (eg, bronchospasm, hypoxemia). <b>Results:</b> 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, <i>P</i> < .05). The CPAP group demonstrated marked improvements in ventilation parameters (PaO<sub>2</sub>, P<sub>aCO<sub>2</sub></sub>, S<sub>pO<sub>2</sub></sub>) at 4, 8, and 12 h postextubation (<i>P</i> < .05 for all). Additionally, the incidence of respiratory complications was notably reduced in the intervention group (<i>P</i> < .05). <b>Conclusions:</b> 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.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145857522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Effects of Five Body Positions on the Regional Ventilation Distribution Assessed Using Electrical Impedance Tomography.","authors":"Natalia Morales Mestre, Guillaume Maerckx, Xavier Wittebole, Virginie Montiel, Gregory Reychler","doi":"10.1177/19433654251405269","DOIUrl":"https://doi.org/10.1177/19433654251405269","url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Methods:</b> 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). <b>Results:</b> 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 (<i>P</i> < .001). In the left lung, ventilation was 56.6 ± 11.6% in left lateral decubitus versus 34.4 ± 13.0% in right lateral decubitus (<i>P</i> < .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, <i>P</i> = .03) and decreased in the right dorsal quadrant (supine > prone, <i>P</i> = .03). These subtle variations likely reflect the physiological characteristics of healthy individuals. <b>Conclusions:</b> 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.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145857612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1177/19433654251399184
Bryan Kozdas, Jose Dianti, Ewan C Goligher
{"title":"Obesity Modifies the Effect of PEEP During Spontaneous Breathing in Acute Hypoxemic Respiratory Failure.","authors":"Bryan Kozdas, Jose Dianti, Ewan C Goligher","doi":"10.1177/19433654251399184","DOIUrl":"https://doi.org/10.1177/19433654251399184","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 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.
{"title":"Obstructive Sleep Apnea in 0- to 12-Month-Old Infants.","authors":"Egambaram Senthilvel, Charmi Shah, Theresa Kluthe, Quang L Nguyen, Kelly Betz, Kahir Jawad, Karim El-Kersh","doi":"10.1177/19433654251395629","DOIUrl":"https://doi.org/10.1177/19433654251395629","url":null,"abstract":"<p><p><b>Background:</b> To investigate obstructive sleep apnea (OSA) prevalence, associated comorbidities, distribution of respiratory events in different sleep states, and body positions in infants. <b>Methods:</b> 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). <b>Results:</b> 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) (<i>P</i> = .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 (<i>P</i> = .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]; <i>P</i> < .001). Differences in respiratory parameters including apnea hypopnea index (AHI), OAHI, REM AHI, non-REM AHI, S<sub>pO<sub>2</sub></sub> 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]; <i>P</i> < .001). Similarly, supine AHI was higher (<i>P</i> < .001) when we compared it with each non-supine positions individually. <b>Conclusions:</b> 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.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-06-30DOI: 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.
{"title":"Virtual Reality During Arterial Puncture and Its Impact on Patient-Reported Pain Scores, Anxiety Scores, and Patient Satisfaction.","authors":"Pradeep Upadhyaya, James Mirocha, Kimberly Fuleihan, Benga Agbelemose","doi":"10.1089/respcare.12625","DOIUrl":"10.1089/respcare.12625","url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> Quantitative analysis revealed a statistically significant (<i>P</i> < .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 (<i>P</i> < .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 (<i>P</i> = .004), though no difference was observed in overall satisfaction (<i>P</i> = .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. <b>Conclusions:</b> 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.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1516-1522"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-14DOI: 10.1177/19433654251396857
Christopher Janowak, Lauren Janowak
{"title":"Bridging the Gap Between Patient Voices and Evidence: Challenges in Evaluation of Patient-Centered Outcomes.","authors":"Christopher Janowak, Lauren Janowak","doi":"10.1177/19433654251396857","DOIUrl":"https://doi.org/10.1177/19433654251396857","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 12","pages":"1591-1592"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-06-30DOI: 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。
{"title":"Best Respiratory Compliance Following a Recruitment Maneuver Allows Hemodynamic Stability During Laparoscopic Surgery.","authors":"Xiaojing Ma, Libin Ma, Xiangmei Piao, Yunke Fu, Roberta Ribeiro De Santis Santiago, Lorenzo Berra, Zhenggang Guo, Weidong Mi, Changsheng Zhang","doi":"10.1089/respcare.12862","DOIUrl":"10.1089/respcare.12862","url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> Sixty-four subjects were enrolled in this study. Our findings revealed that the hemodynamic effects, including reduction in cardiac index (<i>P</i> < .001), mean arterial pressure (MAP) (<i>P</i> < .001), and increase in stroke volume variation (SVV) (<i>P</i> < .001), were transient, without requiring vasopressor support. Receiver operating characteristic (ROC) analysis showed that PEEP levels >17 cm H<sub>2</sub>O reduced cardiac index (area under the ROC curve = 0.594). Post hoc analysis indicated minimal cardiac index impact at PEEP levels ≤16 cm H<sub>2</sub>O (<i>P</i> < .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, <i>P</i> = .01). <b>Conclusions:</b> In subjects undergoing laparoscopic surgery, individualized PEEP levels ≤16 cm H<sub>2</sub>O 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.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1508-1515"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-06-30DOI: 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.
{"title":"A Review of Medical Oxygen Concentrators for Respiratory Applications.","authors":"Dogan Erdemir, Ibrahim Dincer","doi":"10.1089/respcare.13046","DOIUrl":"10.1089/respcare.13046","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1573-1587"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1177/19433654251396855
Lynda Goodfellow
{"title":"Mapping the Impact of Respiratory Therapists: Lessons From a Scoping Review.","authors":"Lynda Goodfellow","doi":"10.1177/19433654251396855","DOIUrl":"https://doi.org/10.1177/19433654251396855","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 12","pages":"1593-1594"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-14DOI: 10.1177/19433654251396858
Santje A S Slot, Pieter R Tuinman, Micah L A Heldeweg
{"title":"Calibrating the Lung Ultrasound Aeration Score: Moving from Terminology to Clinical Relevance.","authors":"Santje A S Slot, Pieter R Tuinman, Micah L A Heldeweg","doi":"10.1177/19433654251396858","DOIUrl":"https://doi.org/10.1177/19433654251396858","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 12","pages":"1598-1600"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}