Canadian Journal of Respiratory Therapy最新文献

Background: Patient-ventilator asynchronies (PVAs) are common during mechanical ventilation and are associated with adverse outcomes. While most research has focused on ventilator modes, pulmonary mechanics, and sedation, the influence of routine clinical practices remains largely unexplored.

Objectives: To document ventilatory asynchronies induced by routine clinical practices through systematic observation and to contrast these findings with a structured scoping review of the literature.

Methods: Systematic observation of ventilator waveforms was performed during routine clinical interventions in critically ill patients receiving invasive mechanical ventilation. In parallel, a scoping review was conducted across five databases (Scopus, ScienceDirect, PubMed, LILACS, and Cochrane), guided by the PCC framework (Population, Concept, and Context) and PRISMA-ScR recommendations. Study selection was carried out independently by two reviewers using Rayyan software, with disagreements resolved by consensus.

Results: Thirteen studies were included in the scoping review; only three addressed the eight PVAs described in the literature, and none reported induced asynchronies as a cause or risk factor. Our observational analysis demonstrated that routine interventions such as respiratory care, repositioning, and intrahospital transfers may trigger transient episodes of PVA.

Conclusions: Routine clinical practices,including suctioning, repositioning, and intrahospital transport, can unintentionally induce PVAs. To the best of our knowledge, this phenomenon has not previously been reported in the literature, as confirmed by our scoping review. These findings highlight an overlooked source of asynchrony with potential clinical implications.

Introduction: Simulation-based training is increasingly used to teach respiratory interventions, but limited studies have evaluated its impact on both non-invasive positive pressure ventilation (NIPPV) and supplemental oxygen delivery systems. We assessed changes in internal medicine residents' knowledge and attitudes before and after a simulation-based training program.

Methods: This is a retrospective study of a simulation-based training program. There were 78 internal medicine residents from postgraduate first year (PGY1), postgraduate second year (PGY2), and postgraduate third year (PGY3) who participated in a one-hour training session, including lecture and three simulation stations covering oxygen delivery devices, high-flow nasal cannula, and bi-level positive airway pressure/continuous positive airway pressure (BIPAP/CPAP). Pre- and post-training questionnaires assessed attitudes and knowledge.

Results: Attitudes for comfort level or recognition increased after training (all p < 0.001), and attitudes for needing more training decreased after training (all p < 0.001). Specific knowledge increased after training with percentage-point differences ranging from 48.7% to 60.3% for all of the questions (all p < 0.001). Case scenario knowledge increased after training with percentage-point differences ranging from 29.4% to 48.7% (all p < 0.001). Knowledge differences between postgraduate years were mostly eliminated after training. All residents rated the training highly.

Conclusion: Simulation-based training improved attitudes and knowledge for both oxygen modalities and NIPPV. PGY1 and PGY2 residents achieved knowledge levels similar to PGY3 residents after the training. We recommend incorporating simulation-based respiratory training into residency programs to improve resident competency for both oxygen modalities and NIPPV.

Introduction: Point-of-care ultrasound (PoCUS) is a clinical tool that has been gaining popularity. Its purpose is to either guide procedures (for example, arterial or venous catheter insertions) or to supplement the physical exam to answer focused clinical questions. Despite the evidence supporting PoCUS and its generalized uptake, respiratory therapists lack formal PoCUS training prior to entry to practice. Therefore, our purpose was to create, deliver, and evaluate an evidence-based course aimed at teaching respiratory therapists the basics of lung PoCUS and PoCUS-guided vascular access.

Methods: Using a scoping review conducted by our group to inform the curriculum, we created a one-day PoCUS introductory course that is delivered annually at the Canadian Society of Respiratory Therapists Conference. We have administered the course for three years and evaluated each occurrence for course design, delivery, and outcomes.

Results: The course was delivered to 117 different participants. All participants felt that the difficulty of the content was at a "perfect level". There was a large improvement in self-reported confidence in transducer selection, image acquisition, and image interpretation for both lung PoCUS and PoCUS-guided intravascular cannulation. One hundred percent of participants enjoyed the workshop led by an interdisciplinary team and would recommend it to a colleague.

Conclusions: We have assembled a strong interdisciplinary team to introduce the basic concepts of PoCUS in a reliable, easy-to-deliver format that is well-received by respiratory therapists who practice in Canada.

Background: Healthcare systems are rapidly transforming in response to demographic pressures, changing funding models, technological advances, and new models of care. As a result, professions must adapt in parallel to remain relevant. In Canada, respiratory therapy stands at an inflection point. Respiratory Therapists (RTs) provide essential and complex care across diverse clinical settings, yet the profession remains anchored in traditional roles. Questions remain about whether RTs are evolving in step with broader system changes, and what may be lost if they do not.

Methods: This paper originates from a panel at the 2025 Canadian Society of Respiratory Therapists annual conference. We used narrative methodology and composite narrative techniques to synthesize the reflections of four clinician-researcher panelists into a unified account. Drawing on clinical, professional, policy, and research perspectives, we co-constructed a narrative that highlights shared insights, tensions, and opportunities in the profession.

Results: We identified multiple sources of tension. RTs engage with evidence daily, yet most of this evidence comes from other health professions. This reliance constrains the development of RT-specific frameworks, guidelines, and research agendas. Additionally, scholarship in respiratory therapy often remains undervalued and narrowly defined, treated as an optional activity rather than a core part of professional identity. Finally, structural, cultural, and organizational barriers, further restrict the integration of evidence and scholarship into routine work.

Discussion: Moving forward requires deliberate action to embed scholarship and evidence generation within the respiratory therapy profession. We suggest that strengthening research literacy at entry-to-practice, creating formal roles for clinical scholars, recognizing scholarly work within career structures and innovation incubators and interprofessional collaborations can position RTs as co-creators of solutions to health system challenges. By embracing these suggestions, the profession can evolve in step with health system change, enhance its influence, and secure its relevance in the future of healthcare.

Background: Clinical trials comparing liberal versus conservative oxygen therapy strategies in patients requiring mechanical ventilation have shown contradictory results regarding the best strategy for improving mortality outcomes, length of stay, and ventilator-free days. To summarize the evidence regarding the effects of conservative oxygen therapy compared with liberal oxygen therapy in adult patients admitted to an intensive care unit (ICU).

Methods: This systematic review with meta-analysis included controlled and randomized clinical trials obtained from the MEDLINE/PubMed, Embase, the Cochrane Library, Lilacs/bvs, PEDro and ScienceDirect. The effect estimate for mortality was expressed as the relative risk (RR), whereas the other variables were expressed as the mean difference (MD). A meta-analysis of the data was conducted via Review Manager software version 5.3 (Cochrane Collaboration).

Results: Nineteen randomized clinical trials involving more than 10,000 patients were included. Liberal oxygen therapy did not significantly differ from conventional oxygen therapy in terms of mortality (RR 1.00; 95% CI: 0.93-1.07, GRADE moderate), length of stay (MD 0.18; 95% CI: - 2.69-3.05, GRADE very low) or ventilator-free days (MD 0.25; 95% CI: -1.78-2.27, GRADE very low).

Conclusion: The findings of this review show no significant differences in clinical outcomes between liberal and conventional oxygen therapy in adult ICU patients. As the burden of proof rests on the intervention, the absence of evidence for the superiority of liberal oxygen therapy means its benefit cannot be assumed.

Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by respiratory muscle weakness, hyperinflation, and systemic inflammation, leading to impaired pulmonary function and quality of life. Respiratory muscle training (RMT) may strengthen the inspiratory and expiratory muscles, improve pulmonary function, reduce dyspnea, and enhance functional outcomes. This study assessed the impact of concurrent RMT on respiratory muscle strength, spirometry, dyspnea, and quality of life in patients with COPD.

Materials and methods: This was a single-cohort pre/post-intervention study initially recruiting 43 patients with COPD to participate in an 8-week RMT program using a threshold pressure device. Both inspiratory and expiratory training were performed using a PowerLung device with adjustable resistance. Training consisted of three sets of ten breaths twice daily for each mode, and participants were instructed to increase resistance incrementally when the load became easy. Assessments included spirometry, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), COPD Assessment Test (CAT), Medical Research Council (MRC) Breathlessness Scale, and Airways Questionnaire 20 (AQ20). Data were collected at baseline and post-intervention and analyzed using paired t-tests and Wilcoxon signed-rank tests, stratified by GOLD category.

Results: Twenty-seven participants completed the study. Statistically significant improvements were observed in MIP (mean increase 14.1 cm H₂O, p < .001), MEP (mean increase 20.1 cm H₂O, p < .001), CAT (mean decrease 2.92, p = .020), and AQ20 (mean decrease 1.67, p = .005). FEV₁ improved modestly but did not reach statistical significance (mean increase 0.0367 L, p = .064). The GOLD distribution included eight participants in GOLD 2, 12 in GOLD 3, and seven in GOLD 4. Improvements in MIP and MEP were statistically significant within all GOLD categories. A clinically meaningful increase in FEV₁ (≥ 60 mL) was observed in participants in GOLD 3 and 4 stages, though not statistically significant. Correlations between muscle strength improvements and symptom scores were moderate to strong.

Discussion: Concurrent RMT improves respiratory muscle strength and quality of life in patients with COPD, with the greatest benefits observed in advanced disease stages. Enhanced respiratory muscle efficiency may reduce dyspnea and promote exercise tolerance.

Conclusion: RMT is a promising intervention for COPD management that offers improved respiratory muscle strength and quality of life. Future studies should explore the long-term effects and optimize protocols for broader implementation.