Respiratory care最新文献

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.

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.