Canadian Journal of Respiratory Therapy最新文献

Background: Respiratory therapists (RTs) play an important role in delivering care across diverse clinical settings. However, the research questions guiding the profession remain underdeveloped and often shaped by external professions. To address this gap, we conducted a national Delphi study to identify research priorities directly informed by the RT profession in Canada.

Methods: We used a modified Delphi method, informed by a prior qualitative study, which aimed to identify and prioritize research needs across RT practice domains. We developed and distributed a list of 74 research items categorized into four domains to RTs across Canada through two rounds of online surveys. Consensus for items was defined as ≥70% agreement in Round 1 and ≥80% agreement in Round 2. Subgroup analyses were conducted by primary practice setting.

Results: In Round 1, 286 participants reviewed 74 items and identified 11 (14.8%) as priorities. After incorporating open-ended feedback, some statements were combined, resulting in 53 statements carried forward. In Round 2, 165 participants reviewed 53 items and identified an additional 11 items (20.7%) as important. These topics reflect the breadth of RT practice, including airway management, rapid response teams, personalized ventilation strategies, and system-level contributions. Workforce sustainability issues such as burnout, staffing ratios, and retention were also identified. Subgroup analyses revealed meaningful variation in research priorities across different practice areas in Round 1 and 2.

Conclusion: This study presents a profession-driven research agenda for respiratory therapy in Canada. These findings can inform future research, continuing professional development, and policy advocacy aligned with the profession's evolving roles and contexts.

Aim: Positive expiratory pressure devices are frequently used for airway clearance in children with cystic fibrosis and tracheobronchomalacia. This study aimed to establish if electrical impedance tomography is a feasible measure to titrate pressures in non-sedated children.

Method: Ten children with cystic fibrosis and tracheobronchomalacia performed airway clearance using positive pressure devices whilst monitored with electrical impedance tomography. Feasibility was measured as tolerability and completion of the intervention; ease of administration and interpretation of software data; ability to determine differences in regional lung ventilation; and compatibility for use in the clinic. A pre-determined score of ≥70% was deemed successful for each measure and reported as means and ranges.

Results: Criterion met success for tolerability (98%; 86-100) and intervention completion (95%; 90-100). Regions of interest display (96%; 80-100) and software data analysis (96%; 90-100) allowed regional lung ventilation changes to be observed with different pressures. Ease of administration and compatibility for the clinic highlighted difficulties with automated software functionality and clinician time (66%; 10-100% and 75%; 0-100).

Conclusion: Use of electrical impedance tomography is feasible in non-sedated children with cystic fibrosis. It has potential as a tool for guiding positive pressure titration for airway clearance. Results and application to clinical practice require further study.

Background: The prevalence of tobacco use is high among health science students in low- and middle-income countries. This population participates in tobacco and nicotine delivery systems prevention strategies. We sought to determine the status of tobacco and nicotine delivery systems used among health sciences students in low- and middle-income countries.

Methods: A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included original research articles published in the last 10 years in indexed journals, written in Spanish and English, that focused on populations of healthcare students in low- and middle-income countries and provided information on the use of tobacco or nicotine delivery systems. Eleven databases were searched, and data were extracted using inductive analysis and thematic synthesis.

Results: Thirty-four articles were reviewed. Asia was the continent that produced the most literature on the subject, and most studies had a quantitative cross-sectional methodological design. Information on social and cultural issues related to drug use, mental health, healthcare, smoking cessation, and policies and programs is presented in narrative form.

Conclusions: Little information exists about the social and cultural aspects associated with the use of nicotine delivery systems, and the needs of health science students in this regard. This issue requires research through participatory, qualitative, or mixed-method approaches, focusing on analyzing participants' needs and identifying ways to transform their reality.

Purpose: To evaluate whether the onset and duration of electromyography (EMG) activity of different inspiratory muscles vary during an incremental inspiratory threshold loading (ITL) in healthy adults and whether it is associated with dyspnea and inspiratory mouth pressure (Pm) at task failure.

Methods: Twelve healthy adults (30 ± 7 years, six females) performed incremental ITL starting at warm-up (7.6 ± 1.7 cmH₂O), followed by 50 g increments every two minutes until task failure in this cross-sectional study. EMG onset (relative to inspiratory flow) and activity duration of the costal diaphragm/7th intercostal and extra-diaphragmatic inspiratory muscles (scalene, parasternal intercostal, sternocleidomastoid) were quantified using a validated algorithm. Ventilatory parameters, including Pm, were evaluated.

Results: With increasing ITL, Pm increased (p ≤ 0.033), accompanied by increased EMG activity of extra-diaphragmatic muscles (p ≤ 0.016). Critically, the EMG onset of the sternocleidomastoid (p < 0.001), parasternal intercostal (p = 0.002), and scalene (p = 0.002) occurred earlier relative to inspiratory flow at task failure compared to lower loads. Earlier EMG onsets of these muscles were correlated with higher Pm at task failure (sternocleidomastoid: r = -0.65; parasternal intercostal: r = -0.45; scalene: r = -0.29; p ≤ 0.034). Notably, earlier EMG onsets of scalene at low loads were associated with higher Pm at task failure (r ≤ -0.75; p ≤ 0.026). Furthermore, an earlier EMG onset of the parasternal intercostal (r = -0.67; p = 0.023) and sternocleidomastoid (r = -0.65; p = 0.023) at task failure was associated with greater dyspnea intensity.

Conclusion: Appreciation of timing of inspiratory muscle EMG may provide further insight into understanding the contributors to ventilatory task failure and dyspnea.

Background: Coinfections and superinfections significantly impair prognosis in severely ill COVID-19 patients who may develop ventilator-associated pneumonia. However, the role of bacterial and fungal infections and/or lung colonization in patients with moderate COVID-19 who are not on mechanical ventilation remains controversial. Additionally, there is limited data on the impact of coinfections on pneumonia development in vaccinated subjects. To clarify this question, we summarize the data for patients treated in the single infectious department for a moderate form of COVID-19-associated pneumonia.

Methods: We evaluated the association of the medical condition on hospital admission and disease duration with anti-Chlamydophila pneumoniae and anti-Mycoplasma pneumoniae quantitative IgM and sputum culture results in COVID-19 in patients (n=271).

Results: Non-pneumococcal Streptococci were the most frequent bacteria isolated from sputum (70% of the population; only one case of St. pneumoniae), followed by Candida albicans (15.6% of the population) and Neisseria spp. (13% of the population). Airway colonization with C. albicans and anti-M. pneumoniae IgM seropositivity was significantly associated with a higher CT score, especially in vaccinated patients; meanwhile, fungal pathogen C. albicans colonization was associated with prolonged hospital duration. Airway colonization with C. albicans was associated with slightly longer disease duration.

Conclusion: The results demonstrate that respiratory pathogens, at least M. pneumoniae, can contribute to the risk of COVID-19 onset and/or severity in the vaccinated population. Meanwhile, neither bacterial agents of atypical pneumonia nor lung colonization with opportunistic pathogens are essential for recovery in patients with moderate COVID-19 infection when appropriate treatment is provided.

Introduction: It is unknown whether bucket hydrotherapy is beneficial to premature newborns with bronchopulmonary dysplasia (BPD).

Objective: To evaluate the effects of bucket hydrotherapy on physiological and behavioural parameters and the oxygen need in preterm infants with BPD during hospitalization.

Methods: Twenty infants with BPD were randomized into a control (conventional physiotherapy - PG) or an intervention group (conventional physiotherapy plus bucket hydrotherapy - BHG). All infants underwent twelve days of intervention, and data from the first (D1), sixth (D6) and twelfth (D12) days were analyzed. Respiratory rate (RR), heart rate (HR), peripheral oxygen saturation (SpO₂), inspired oxygen fraction (FiO₂), pain, respiratory effort, sleep, and wakefulness status were measured before, immediately after, and at 15, 30, and 60 minutes after the intervention.

Results: In the BHG, intragroup analysis showed lower values for FiO₂ on D1 (30': p = 0.03, 60': p = 0.02), HR on D6 (p = 0.004) and RR on D12 (p < 0.03), and higher values for SpO₂ on D12 (p = 0.0003). Intergroup comparisons favored BHG for SpO₂ (p = 0.03; effect size [ES] =0.99) and FiO₂ (p < 0.02; ES > 0.47) on D1, HR changes on D6 (p < 0.04; ES > 0.9) and D12 (p = 0.009; ES = 0.61). No significant intra- or intergroup differences were found in pain, respiratory effort, sleep, or wakefulness (p > 0.05 for all).

Discussion: Given the persistent gas exchange abnormalities in BPD, bucket hydrotherapy appears to be a feasible and beneficial non-pharmacological method for reducing oxygen requirements.

Conclusion: The present pilot study demonstrates that bucket hydrotherapy is a therapeutic intervention that reduces HR, RR and oxygen requirements in premature infants with BPD without inducing changes in behavioural parameters.

Background: Approximately 3,500 infants die of a sleep-related incident a year in the United States. Although safe sleep guidelines have been implemented, infants are still at risk from many commercial products. Breathing-related injuries or suffocation are of serious concern for younger infants exposed to soft product materials, yet respiration-related measures of these common materials are unknown.

Methods: Nine healthy young adults' respiratory patterns were evaluated while breathing into materials commonly used in infant products. Breathing rate, end-tidal carbon dioxide (EtCO2), heart rate, and oxygen saturation (SpO2) were collected using a Capnostream 35. Participants lay prone with their faces in contact with each material for ten-minute trials. Three baseline trials, where participants could breathe freely with no obstruction, were collected for comparison (ANOVA (p < 0.05), Tukey post-hoc comparisons).

Results: The 100% cotton and 50/50 (cotton/polyester) materials both resulted in significant changes in EtCO2 and SpO2, while the 10/90 (spandex/polyester) resulted in only a significant change in SpO2, and no significant changes were detected for the 100% polyester material. Mean respiratory rate decreased and mean heart rate increased significantly for all materials.

Discussion: EtCO2 and SpO2 are important considerations for suffocation risk when breathing into the selected materials. Even during this short time period, infants with more vulnerable respiratory systems and less robust arousal responses than the adults in this study will be at higher risk.

Conclusion: Conscious efforts should be made to prevent infants from interacting with soft goods microenvironments that inhibit normal breathing while using infant products.

Objective: To evaluate the effects of conventional and non-conventional respiratory physiotherapy on pulmonary mechanics, vital parameters, and pain in newborns admitted to a neonatal intensive care unit.

Methods and analyses: Databases including PubMed, LILACS, SciELO, Science Direct, Cochrane Library, and Web of Science were searched. Randomized clinical trials comparing conventional and non-conventional respiratory physiotherapy in newborns (1 hour to 28 days) in neonatal intensive care units were included. Two reviewers independently screened titles and abstracts and assessed bias using the PEDro scale. Data were presented as mean, standard deviation, median, and quartiles. Meta-analysis was not feasible due to incomplete post-intervention data.

Results: Out of 5,653 articles found, four were included. Two studies reported major increases in peripheral oxygen saturation after both respiratory physiotherapy techniques, a third showed decreased respiratory rate, and a fourth showed increased heart rate. Neither conventional nor non-conventional respiratory physiotherapy was suggested to cause pain in participants. No study evaluated lung mechanics parameters. The methodological quality of the included studies was predominantly moderate. Only one study exhibited low methodological quality.

Conclusion: Both conventional and non-conventional respiratory physiotherapy techniques showed no adverse effects on vital signs or pain in NICU newborns. Further clinical trials are encouraged to assess lung function more comprehensively. Future studies should include short- and long-term evaluations of lung mechanics, respiratory distress, and pain.

Background: Conical-positive expiratory pressure (conical-PEP) has been applied during exercise to improve exercise capacity, dynamic hyperinflation (DH), and dyspnea in COPD. However, evidence remains limited regarding the individualized selection of its resistor (orifice size) and its effects on exercise duration, DH development, and dyspnea.

Method: A randomized crossover trial was conducted to evaluate the effects of conical-PEP. Participants performed spot marching exercise while breathing through a conical-PEP device with a mask, compared to a sham-PEP condition in which a similar mask was worn without the conical-PEP component. The conical-PEP resistor was selected to achieve the minimum required PEP level, calculated by the proposed formula, while ensuring that pressure did not exceed 35 cmH₂O. Exercise endurance time, end-exercise inspiratory capacity (IC) to assess DH, and dyspnea using the modified Borg scale were recorded.

Results: Twenty moderate to severe COPD subjects (19 male, 1 female, age 67.40 ± 8.22 years, FEV1% predicted 56.05 ± 16.90) participated. Conical-PEP resulted in longer exercise time (4.98 ± 2.97 minutes) than sham-PEP (3.99 ± 2.19 minutes, p = 0.004). End-exercise IC was significantly better in conical-PEP (1.51 [1.24, 1.85] L) than sham-PEP (1.42 [1.16, 1.84] L, p = 0.020). Dyspnea was significantly lower in conical-PEP at iso-time (4 [4, 5]) compared to sham-PEP (5 [5, 6], p = 0.005), though no significant difference was found at end exercise.

Conclusion: Conical-PEP with minimum required PEP level improves exercise capacity, delays DH development, and delays dyspnea onset in COPD patients.