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Development of a guide for continuous positive airway pressure use - A good fit: Making continuous positive airway pressure work for you.
0 CRITICAL CARE MEDICINE Pub Date : 2025-01-23 eCollection Date: 2025-01-01 DOI: 10.29390/001c.127656
Adeel Meraj, Lauren Koep, Muhammad R Baig

Background: Obstructive sleep apnea (OSA) is highly prevalent in veterans with mental illnesses such as post-traumatic stress disorder (PTSD). Untreated OSA reduces the effectiveness of the treatment of PTSD. Treatment of OSA has been shown to reduce daytime sleepiness and symptoms of PTSD and depression. Continuous positive airway pressure (CPAP) therapy is the most effective treatment for OSA. A large number of veterans cannot tolerate CPAP therapy due to anxiety and PTSD symptoms. Positive airway pressure (PAP) NAP, a daytime sleep study for patients with anxiety about starting CPAP and exposure-based cognitive behavioural interventions are the mainstay for the management of CPAP intolerance. However, these options are not readily available to veterans in rural areas, who constitute about 40% of veterans registered in the South Texas Veterans Health Care System (STVHCS).

Methods: After getting local IRB exemption, we surveyed thirty (30) veterans in the outpatient clinic setting who could not tolerate CPAP therapy to evaluate the need for a tool to improve CPAP adherence. We reviewed the literature and conducted focused group meetings with local and national experts. We also convened consumer groups and stakeholder meetings, including primary care, sleep medicine, and mental health providers.

Results: After a comprehensive evaluation process, we compiled a concise self-help guide combining principles of cognitive behavioural therapy using a behavioural hierarchy approach towards CPAP desensitization. This guide can be used by veterans independently at their homes to improve CPAP use. A printer-friendly version is available for download on the South Central Mental Illness, Research, Education and Clinical Center (SC MIRECC) and the South Texas Veterans Healthcare System (STVHCS) website. The guide will be provided to veterans during the initial CPAP setup and available in clinic waiting rooms throughout the system.

Conclusion: Our guide will serve as an effective self-help tool to improve CPAP adherence. It may result in the improvement of various medical and psychiatric conditions.

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引用次数: 0
Is CT pulmonary angiography overutilized in the evaluation of patients with suspected pulmonary embolism? A retrospective study. CT肺血管造影在评估疑似肺栓塞患者时是否被过度使用?回顾性研究。
0 CRITICAL CARE MEDICINE Pub Date : 2025-01-13 eCollection Date: 2025-01-01 DOI: 10.29390/001c.127660
Rabbani Mahmoud Daoud, Ahmed Majeed Mohamed, Muath Salahuddin Almajthoob, Salim Fredericks, Israa ElSayed Daoud, Moath Mahmoud Daoud, Mahmood AlSaeed

Introduction: Despite the high mortality rate of acute untreated pulmonary embolism (PE) at 30%, diagnosing PE is challenging. While the prevalence of PE has decreased in recent years, the overuse of computed tomography pulmonary angiography (CTPA) remains a concern. The National Institute for Health and Care Excellence (NICE) provides guidelines using the Wells score for PE assessment. The Royal College of Radiologists (RCR) recommends a positive yield of 15.4% - 37% for CTPA tests. This study assesses the positive yield of CTPA for suspected PE patients and evaluates the potential reduction through Wells score/D-dimer assessment as recommended by NICE.

Methods: All patients who underwent CTPA between September 1, 2019, and January 31, 2020, at Salmaniya Medical Complex were included. Data on patient demographics and pre-CTPA workup were collected from electronic patient records (EPR) and stored in MS Excel 2019 for analysis.

Results: Of 188 suspected PE patients (mean age 50 ±12.3 years; 62.8% female), 12.2% were diagnosed with PE. None had documented Wells scores. A low-risk Wells score (≤4) was assigned to 68.6% of patients, with only 26.1% undergoing D-dimer testing. PE was confirmed in 4 patients with low-risk Wells scores and elevated D-dimers. All 10 patients with low-risk Wells scores and negative D-dimers were PE-negative.

Conclusion: In total, 5.3% - 47.9% of the CTPAs conducted could have been avoided by following NICE guidelines. We propose integrating an algorithm-based checklist with validated tools like the Wells and Geneva scores into the ePMA system to guide appropriate CTPA referrals, promote evidence-based decision-making, reduce unnecessary imaging, and optimize patient care and resource use.

尽管未经治疗的急性肺栓塞(PE)死亡率高达30%,但PE的诊断具有挑战性。虽然近年来PE的患病率有所下降,但过度使用计算机断层肺血管造影(CTPA)仍然是一个问题。国家健康和护理卓越研究所(NICE)提供了使用威尔斯分数进行体育评估的指导方针。皇家放射科医师学院(RCR)建议CTPA检测的阳性率为15.4% - 37%。本研究评估疑似PE患者CTPA的阳性产率,并通过NICE推荐的Wells评分/ d -二聚体评估评估潜在的减少。方法:纳入2019年9月1日至2020年1月31日在Salmaniya医疗中心接受CTPA治疗的所有患者。从电子病历(EPR)中收集患者人口统计数据和ctpa前检查数据,并存储在MS Excel 2019中进行分析。结果:188例疑似PE患者(平均年龄50±12.3岁;62.8%为女性),12.2%为PE。没有人记录威尔斯的分数。68.6%的患者获得了低风险的Wells评分(≤4),只有26.1%的患者接受了d -二聚体检测。4例低危Wells评分和d -二聚体升高的患者证实PE。10例低危Wells评分和d -二聚体阴性的患者均为pe阴性。结论:总的来说,5.3% - 47.9%的ctpa可以通过遵循NICE指南来避免。我们建议将基于算法的检查表与Wells和Geneva评分等经过验证的工具整合到ePMA系统中,以指导适当的CTPA转诊,促进循证决策,减少不必要的成像,并优化患者护理和资源利用。
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引用次数: 0
Highlighting the year's most transformative research as voted by the editorial board: Exploring knowledge gaps and research needs in respiratory therapy. 重点介绍由编委会投票选出的年度最具变革性的研究:探索呼吸治疗的知识差距和研究需求。
0 CRITICAL CARE MEDICINE Pub Date : 2024-12-10 eCollection Date: 2024-01-01 DOI: 10.29390/001c.126973
Elizabeth Rohrs
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引用次数: 0
Earning a Journal Impact Factor: Progress, recognition, and growth for the CJRT. 获得期刊影响因子:CJRT的进步、认可和发展。
0 CRITICAL CARE MEDICINE Pub Date : 2024-11-25 eCollection Date: 2024-01-01 DOI: 10.29390/001c.125457
Marco Zaccagnini, Carly Brockington, Elizabeth Rohrs
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引用次数: 0
CPAP vs HFNC in treatment of patients with COVID-19 ARDS: A retrospective propensity-matched study. 治疗 COVID-19 ARDS 患者的 CPAP 与 HFNC:一项回顾性倾向匹配研究。
0 CRITICAL CARE MEDICINE Pub Date : 2024-10-31 eCollection Date: 2024-01-01 DOI: 10.29390/001c.125145
Ivan Šitum, Lovro Hrvoić, Ante Erceg, Anja Mandarić, Dora Karmelić, Gloria Mamić, Nikolina Džaja, Anđela Babić, Slobodan Mihaljević, Mirabel Mažar, Daniel Lovrić

Background: Previous studies exploring the application of noninvasive ventilation or high-flow nasal cannula in patients with COVID-19-related acute respiratory distress syndrome (ARDS) have yielded conflicting results on whether any method of respiratory support is superior. Our aim is to compare the efficacy and safety of respiratory therapy with high-flow nasal cannula and noninvasive ventilation with continuous positive airway pressure in treatment of COVID-19-related ARDS.

Methods: This is a retrospective cohort study based on data from patients who received respiratory support as part of their treatment in the COVID intensive care unit at the University Hospital Centre Zagreb between February 2021 and February 2023. Using propensity score analysis, 42 patients treated with high-flow nasal cannula (HFNC group) were compared to 42 patients treated with noninvasive ventilation with continuous positive airway pressure (CPAP group). Primary outcome was intubation rate.

Results: Intubation rate was 71.4% (30/42) in the HFNC group and 40.5% (17/42) in the CPAP group (p = 0.004). Hazard ratio for intubation was 3.676 (95% confidence interval [CI] 1.480 to 9.232) with the HFNC versus CPAP group. Marginally significant difference in survival between the two groups was observed at 30 days (p = 0.050) but was statistically significant at 60 days (p = 0.043).

Conclusions: Respiratory support with high-flow nasal cannula and noninvasive ventilation with continuous positive airway pressure yielded significantly different intubation rates in favour of continuous positive airway pressure. The same patients also had better 30-day and 60-day survival post-admission.

背景:以往的研究探讨了无创通气或高流量鼻插管在 COVID-19 相关急性呼吸窘迫综合征(ARDS)患者中的应用,但对于任何一种呼吸支持方法是否更优,研究结果不尽相同。我们的目的是比较高流量鼻插管呼吸疗法和持续气道正压无创通气治疗 COVID-19 相关 ARDS 的有效性和安全性:这是一项回顾性队列研究,基于 2021 年 2 月至 2023 年 2 月期间在萨格勒布大学医院中心 COVID 重症监护病房接受呼吸支持治疗的患者数据。通过倾向评分分析,42 名接受高流量鼻插管治疗的患者(HFNC 组)与 42 名接受无创通气和持续气道正压治疗的患者(CPAP 组)进行了比较。主要结果是插管率:结果:HFNC 组的插管率为 71.4%(30/42),CPAP 组为 40.5%(17/42)(p = 0.004)。HFNC 组与 CPAP 组的插管危险比为 3.676(95% 置信区间 [CI] 1.480 至 9.232)。两组患者的存活率在 30 天时略有差异(p = 0.050),但在 60 天时具有统计学意义(p = 0.043):结论:使用高流量鼻插管进行呼吸支持和使用持续气道正压进行无创通气的插管率明显不同,持续气道正压的插管率更高。同样的患者入院后的 30 天和 60 天存活率也更高。
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引用次数: 0
A multi-institution longitudinal randomised control trial of speaking up: Implications for theory and practice. 一项关于 "大声说出来 "的多机构纵向随机对照试验:对理论和实践的启示。
0 CRITICAL CARE MEDICINE Pub Date : 2024-10-23 eCollection Date: 2024-01-01 DOI: 10.29390/001c.124914
Efrem Violato, Jennifer Stefura, Meredith Patey, Brian Witschen

Background: Speaking up is an important yet challenging aspect of health professional communication. To overcome social-cognitive influences and improve speaking up, an intervention based on Kolb's experiential learning cycle was developed, which integrated Virtual Simulation, curriculum, and practice speaking up. The present study investigated if integrating Virtual Simulation influenced Respiratory Therapy students' ability to challenge a physician compared to a control condition at multiple time points during training.

Methods: A multi-institutional longitudinal randomized control trial was conducted. Students from two schools completed a Virtual Simulation or No Virtual Simulation before classroom instruction on speaking up and an in-person simulation requiring speaking up. After three-to-six months and post-clinical placement, students completed a second simulation requiring speaking up. The student's ability to speak up and use CUS (Concerned, Uncomfortable, Safety Issue) was measured.

Results: No significant effects for the intervention were observed across time points, p>.05, with a small effect for using CUS, ϕ=.28. During the study, two unexpected findings emerged with theoretical and practical implications. The multi-institutional design created a natural experiment that allowed for the identification of instructor effects on speaking up and Bloom's Two-Sigma problem. Observations were also made related to perceptual limitations that diminish the ability to speak up.

Conclusions: Single speaking-up interventions continue to appear to be ineffective. To substantially influence behaviour, consistent mentorship through a "champion" is likely necessary to train for and create a culture of speaking up. Training in situational awareness is also likely needed to counter human perceptual limitations in complex situations.

背景:直言不讳是医护人员沟通的一个重要方面,但也是一个具有挑战性的方面。为了克服社会认知影响并提高开口说话的能力,我们开发了一种基于科尔布体验式学习循环的干预方法,将虚拟仿真、课程和开口说话练习融为一体。本研究调查了在培训期间的多个时间点,与对照组相比,虚拟仿真是否会影响呼吸治疗专业学生挑战医生的能力:方法:进行了一项多机构纵向随机对照试验。来自两所学校的学生在课堂教学之前完成了虚拟仿真或未完成虚拟仿真,然后接受了关于如何开口说话的课堂教学和需要开口说话的现场仿真。三到六个月后,学生在临床实习后完成了第二次需要开口说话的模拟。结果显示,干预效果并不显著:结果:各时间点的干预效果均不明显(P>.05),使用 CUS 的效果较小(j=.28)。在研究过程中,有两个意想不到的发现具有理论和实践意义。多机构设计创造了一个自然实验,可以确定教师对发言和布卢姆的 "双西格玛 "问题的影响。此外,还观察到了与削弱畅所欲言能力的感知限制有关的问题:结论:单一的畅所欲言干预似乎仍然无效。要想对行为产生实质性影响,可能需要通过 "倡导者 "进行持续的指导,以培训和创建一种畅所欲言的文化。此外,还可能需要进行情境意识培训,以应对人类在复杂情况下的感知局限。
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引用次数: 0
Cut-off values of one-minute sit-to-stand test for determining physical performance in mild-post-COVID-19 individuals. 用于确定轻度 COVID-19 后人群体能表现的一分钟坐立测试临界值。
0 CRITICAL CARE MEDICINE Pub Date : 2024-10-10 eCollection Date: 2024-01-01 DOI: 10.29390/001c.124110
Arunrat Srithawong, Puttipong Poncumhak, Tichanon Promsrisuk, Patchareeya Amput

Background: This study aims to establish cutoff values for the one-minute sit-to-stand test (1STST) to predict physical performance in mild-post- coronavirus disease 2019 (COVID-19) individuals and to compare the 1STST with the 6-minute walk test (6MWT) in assessing hemodynamic response and to explore the correlation between 1STST, 6MWT, and muscle strength, including leg and respiratory muscle strength.

Methods: A cross-sectional study of 93 participants with mild post-COVID-19 symptoms was conducted. Sociodemographic and anthropometric data were collected, and pulmonary function, as well as respiratory and quadriceps muscle strength, were evaluated. Functional capacity was assessed using the 6MWT and 1STST. Additionally, hemodynamic responses, fatigue, and dyspnea were measured before and after each test.

Results: The cutoff for the 1STST in mild post-COVID-19 individuals was ≥29 repetitions, with an AUC of 0.84, sensitivity of 80.52%, and specificity of 75.00%. The 1STST resulted in higher heart rate, systolic blood pressure, and dyspnea compared to the 6MWT, and showed a significant moderate correlation with the 6MWT (r = 0.532, p < 0.0001) and weak correlations with leg strength and respiratory muscle strength.

Conclusion: A cutoff of less than 29 repetitions on the 1STST indicates functional impairment in mild post-COVID-19 cases, as it induces greater physiological stress than the 6MWT and correlates with muscle strength, making it crucial for rehabilitation assessment.

研究背景:本研究旨在确定一分钟坐立测试(1STST)的临界值,以预测2019年冠状病毒病(COVID-19)后轻度患者的体能表现,并比较1STST与6分钟步行测试(6MWT)在评估血液动力学反应方面的差异,探讨1STST、6MWT与肌肉力量(包括腿部和呼吸肌力量)之间的相关性:方法:对 93 名有轻度后 COVID-19 症状的参与者进行了横断面研究。收集了社会人口学和人体测量数据,并评估了肺功能、呼吸肌和股四头肌肌力。使用 6MWT 和 1STST 评估功能能力。此外,还在每次测试前后测量了血液动力学反应、疲劳和呼吸困难:1STST 在轻度后 COVID-19 患者中的临界值为重复次数≥29 次,AUC 为 0.84,灵敏度为 80.52%,特异性为 75.00%。与 6MWT 相比,1STST 会导致更高的心率、收缩压和呼吸困难,与 6MWT 呈显著的中度相关性(r = 0.532,p < 0.0001),与腿部力量和呼吸肌力量呈弱相关性:结论:1STST重复次数少于29次的临界值表明轻度COVID-19后病例存在功能障碍,因为它比6MWT引起更大的生理压力,并与肌力相关,因此对康复评估至关重要。
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引用次数: 0
Enhancing scholarly practice in respiratory therapy: A call for professional evolution. 加强呼吸治疗的学术实践:呼吁专业发展。
N/A CRITICAL CARE MEDICINE Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.29390/001c.122734
Elizabeth Rohrs
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引用次数: 0
The scholarly and practice profile of respiratory therapists in Canada: A cross-sectional survey. 加拿大呼吸治疗师的学术和实践概况:横向调查。
N/A CRITICAL CARE MEDICINE Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.29390/001c.122345
Marco Zaccagnini, André Bussières, Peter Nugus, Andrew West, Aliki Thomas

Introduction: Respiratory therapists (RTs) are expected to provide high-quality care for patients with chronic and acute cardiopulmonary conditions across the lifespan by staying abreast of emerging scientific evidence and effectively integrating it into clinical practice. This integration of evidence is encompassed within the competency of scholarly practice. However, there is currently a limited understanding of RTs' scholarly practice. Furthermore, despite RTs' widespread presence in the Canadian healthcare system, comprehensive studies describing the profiles of RTs are lacking. This study aimed to describe the demographic characteristics, scholarly and practice profiles of the respiratory therapy profession in Canada.

Methods: A cross-sectional survey was distributed via the national professional association and regulatory bodies. The survey contained seven sections with 52 items. We calculated means and standard deviations, or medians and interquartile ranges for continuous variables and frequencies and proportions for categorical variables. Open-ended questions were analyzed using summative content analysis.

Results: We analyzed data from 832 participants (6.8% response rate) from Ontario (17.8%), Québec (15.7%), and Alberta (13.3%), and across other provinces. Nearly 40% had completed an undergraduate degree beyond their respiratory therapy diploma. Few participants had authored or co-authored peer-reviewed publications. RTs reported reading approximately 2.2 peer-reviewed publications monthly. Most participants agreed on the importance of critical reflection in practice (93.1%) and that having a supportive work environment was vital. Almost three-quarters of participants (73.4%) reported that they believe that RTs are valued members of interprofessional teams, and 78% agreed that understanding research enables them to engage in patient advocacy.

Conclusion: This survey provides a portrait of the practice and scholarly profile of the respiratory therapy profession in Canada. While the profession shows potential for growth, concerns persist regarding limited engagement in activities related to scholarly practice. Addressing these challenges and nurturing a culture of scholarly practice are likely necessary to support the development of scholarly practice in the profession. Creating supportive environments, providing access to resources, and encouraging professional development activities may advance the scholarly practice of RTs. Future national surveys could employ random sampling strategies to achieve a more representative sample of the profession.

简介:呼吸治疗师(RTs)应通过掌握新出现的科学证据并将其有效地融入临床实践,为患有慢性和急性心肺疾病的患者提供高质量的护理。这种证据整合包含在学术实践能力中。然而,目前人们对 RTs 的学术实践了解有限。此外,尽管 RTs 在加拿大医疗保健系统中广泛存在,但缺乏描述 RTs 基本情况的全面研究。本研究旨在描述加拿大呼吸治疗专业的人口特征、学术和实践概况:通过国家专业协会和监管机构分发了一份横向调查问卷。调查包括七个部分,共 52 个项目。我们计算了连续变量的平均值和标准偏差或中位数和四分位数间距,以及分类变量的频率和比例。开放式问题采用总结性内容分析法进行分析:我们分析了来自安大略省(17.8%)、魁北克省(15.7%)和阿尔伯塔省(13.3%)以及其他省份的 832 名参与者(回复率为 6.8%)的数据。近 40% 的参与者在呼吸治疗文凭之外还完成了本科学位。很少有参与者撰写或合作撰写过同行评议出版物。据报告,呼吸治疗师每月阅读约 2.2 篇同行评审出版物。大多数参与者(93.1%)同意在实践中进行批判性反思的重要性,并认为拥有一个支持性的工作环境至关重要。近四分之三的参与者(73.4%)表示,他们认为 RT 是跨专业团队中的重要成员,78% 的参与者认为了解研究有助于他们参与患者权益维护:这项调查提供了加拿大呼吸治疗专业的实践和学术概况。虽然该专业显示出发展潜力,但人们对学术实践相关活动参与度有限的担忧依然存在。应对这些挑战和培养学术实践文化可能是支持该专业学术实践发展的必要条件。创造支持性环境、提供资源获取途径、鼓励专业发展活动,这些都可能推动 RTs 的学术实践。未来的全国性调查可以采用随机抽样策略,以获得更具代表性的行业样本。
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引用次数: 0
Survival analysis of COVID-19 versus non-COVID-19 patients requiring intensive care for acute respiratory distress syndrome: An observational retrospective study. 因急性呼吸窘迫综合征需要接受重症监护的 COVID-19 与非 COVID-19 患者的生存分析:一项观察性回顾研究。
0 CRITICAL CARE MEDICINE Pub Date : 2024-08-21 eCollection Date: 2024-01-01 DOI: 10.29390/001c.122402
Paulo Navas Boada, Kevin Chamorro, Santiago Ballaz

Background/aim: This study analyzed clinical factors impacting the survival of COVID-19 patients with acute respiratory distress síndrome, or ARDS (CARDS) to ICU compared to non-COVID-19 ARDS patients.

Methods: Clinical variables from 1,008 CARDS cases and 332 ARDS cases were computed using learning algorithms. The multivariable Cox proportional hazards regression models with the enter method evaluated risk factors and ICU mortality relationships. The survival analysis was completed with Kaplan-Meier and the log-rank tests.

Results: A Random Forest model revealed that mechanical ventilation-related factors, oxygenation, blood pH, superinfection, shock, and ICU length of stay have the greatest effects on ICU survival. According to a multivariate Cox model, reintubation and a high-flow nasal cannula were essential for survival in CARDS patients during the ICU stay. The length of stay in the ICU diminishes in patients older than 45 years, regardless of the source of ARDS.

Conclusion: This study gives recommendations for the respiratory care of ARDS in COVID-19 patients.

背景/目的:与非COVID-19型ARDS患者相比,本研究分析了影响COVID-19型急性呼吸窘迫综合征或ARDS(CARDS)患者入住ICU存活率的临床因素:使用学习算法计算了 1008 例 CARDS 和 332 例 ARDS 的临床变量。采用 enter 方法建立的多变量 Cox 比例危险回归模型评估了风险因素与 ICU 死亡率之间的关系。生存分析采用卡普兰-梅耶尔检验和对数秩检验完成:随机森林模型显示,机械通气相关因素、氧饱和度、血液pH值、超级感染、休克和ICU住院时间对ICU生存率的影响最大。根据多变量 Cox 模型,重新插管和高流量鼻插管对 CARDS 患者在重症监护室的存活率至关重要。无论 ARDS 的来源如何,45 岁以上的患者在重症监护室的住院时间都会缩短:本研究为COVID-19患者的ARDS呼吸护理提供了建议。
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引用次数: 0
期刊
Canadian Journal of Respiratory Therapy
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