Canadian Journal of Respiratory Therapy最新文献

Introduction: Adequate respiratory support with mechanical lung ventilation (MLV) is crucial for maintaining gas exchange and pulmonary circulation hemodynamics in patients with severe lung diseases in the perioperative period. However, the selection of optimal parameters for ventilation is often a serious problem, which can lead to the development of complications and worsening of treatment outcomes.

Purpose: This study aimed to evaluate the effectiveness of the developed method of individual calculation of ventilator parameters to optimize respiratory support in patients with various lung diseases undergoing surgical intervention.

Methods: This study used a prospective clinical approach to optimize mechanical lung ventilation by calculating individualized ventilatory parameters based on each patient's lung function during surgery.

Results: The results showed that in patients with unilateral lesions, the application of the developed method achieved PaO2 94.1±6.7 mmHg and PaCO2 36.2±4.5 mmHg, mean pulmonary artery pressure 25.8±3.6 mmHg, as well as cardiac output 4.8±0.8 l/min and oxygen transport 489±77 ml/min at the final post-operative stage. Even in bilateral diffuse lesions, individualized ventilatory parameters provided PaO2 79.6±11.3 mmHg and reduced bronchial resistance to 11.4±3.6 cmH2O/l/sec after surgery. Despite gross respiratory dysfunction, the personalized approach maintained PaO2 79.2±9.7 mmHg and PaCO2 46.1±6.3 mmHg postoperatively in patients with congenital pulmonary malformations such as cystic hypoplasia.

Conclusion: This study demonstrates the high efficacy of personalized approaches to respiratory support management to improve patient outcomes and reduce the risk of complications in patients with lung disease in the perioperative period.

We are pleased to present a select number of abstracts from the proceedings of the CSRT Annual Conference. Held in Ottawa, Ontario, from May 8 to 10, 2025, this conference included topics delivered by individuals with expertise in various areas of respiratory therapy practice.  As evidenced by the following abstracts, the work of our colleagues in 2025 highlighted current research and practice innovations led by RTs. We have made every effort to include all abstracts accepted by the Program Committee before the publication deadline; however, please note that this collection does not represent the entire program (available at www.csrt.com).  The editorial board looks forward to receiving manuscripts from this conference for consideration for publication in the Canadian Journal of Respiratory Therapy in order to continue building the body of knowledge specific to our profession.  Please note these abstracts have not been peer-reviewed.

Introduction: Anesthesia assistants (AAs) are respiratory therapists or nurses who have additional sub-specialty training in the provision and maintenance of anesthesia. Their skill set includes advanced airway management, vascular access, and knowledge of vasoactive medications and resuscitative protocols. AAs function as non-physician members of the anesthesia team and can act as physician extenders to help offset the current shortage of anesthesiologists.

Methods: This study was a retrospective analysis of AA roles at code blue events at an adult academic teaching centre. Data was extracted from administrative data collection forms completed by AAs at adult code blue events between 2017 and 2022. The data elements that each form captured included time and location of event, presumed cause of the code, airway management details, vascular access provision, medication preparation or administration, human factors and cognitive supports provided to the team by the AAs.

Results: Administrative data collection forms from 320 code blue events were analyzed in this study. The most common primary causes of the code blue events were "arrest" (39%) and "respiratory failure" (26%). Regular floor beds (47%) and the intermediate care units (18%) were the most common locations of code blue events. Airway support was required in 77% of the codes, and in 50% of the cases requiring intubation, it was performed by the AAs. The first pass success rate for AA intubations was 83%, and overall success rate was 96%. In addition to airway management at codes, the AAs also reported providing numerous other valuable contributions to the team. The most reported supports provided to the team included cognitive support regarding resuscitation (49% of cases), intravenous access (19% of cases), and medication preparation or administration (9% of cases). Other roles included placement of arterial lines and drawing blood gases, obtaining interosseous vascular access, and assisting with patient transport to critical care units after resuscitation.

Conclusions: Our study characterizes the supporting roles that AAs can provide as members of the code blue team and demonstrates their contributions to management of critically ill patients. The AAs' airway management, vascular access skillsets, and knowledge of vasoactive and resuscitative medications and protocols make them well-suited to the code blue team. In addition to assisting within the operating room team, AAs can also provide valuable support in non-operating room environments such as cardiopulmonary arrests.

Background: Aerosol drug delivery is widely used in treating respiratory conditions, but the patient's breathing pattern can significantly influence its effectiveness. This study investigates the impact of normal, obstructive, and restrictive breathing patterns on aerosol drug delivery with jet and mesh nebulizers in a simulated model of spontaneously breathing adults.

Methods: A spontaneously breathing adult was simulated using a teaching manikin (Nasco Healthcare) connected to a breathing simulator (QuickLung Breather; IngMar Medical Inc). A collecting filter (CareFusion) was placed distal to the bifurcation of the mainstem bronchi and connected to the breathing simulator. Albuterol sulfate (2.5 mg/3 mL) was delivered with jet (MistyMax 10) and mesh nebulizers (Aerogen Ultra). Each experiment was conducted in triplicate (n = 3), comparing drug delivery across six breathing patterns: (1) normal, (2) moderate obstruction, (3) severe obstruction, (4) moderate restriction, (5) severe restriction, and (6) combined obstruction and restriction. Data analysis included the Friedman ANOVA, uncorrected Dunn's test, and paired t-tests with Holm-Sidak's multiple comparison test (GraphPad Prism 10.3), with statistical significance set at p < 0.05.

Results: Our findings indicate that obstructive, restrictive, and combined breathing patterns significantly reduce aerosol deposition with jet and mesh nebulizers compared to normal breathing (p < 0.05). Aerosol delivery with the mesh nebulizer was up to 3-fold more than the jet nebulizer regardless of the breathing pattern tested in this study (p < 0.05).

Conclusions: This study highlights the necessity for tailored aerosol therapy strategies to optimize drug delivery in patients with different respiratory conditions..

Introduction: Asthma is a chronic respiratory condition frequently observed in childhood, which can have detrimental effects on breathing and thoracic mobility.

Objective: To describe the thoracic mobility of 6- to 11-year-old children diagnosed with asthma and compare it with that of non-asthmatic children in schools in Cali, Colombia.

Materials and methods: This cross-sectional analytical study used a non-probabilistic convenience sampling technique to assess thoracic mobility. Data were analyzed using STATA 14® statistical software. Measurement of thoracic mobility was performed using cirtometry at the axillary (CAx) and xiphoid (CX) levels according to the protocol established by Bockenhauer et al. Asthma prevalence, history, symptoms, and associated risk factors were assessed using the self-administered International Asthma and Allergies in Childhood (ISAAC) questionnaire. In addition, anthropometric measurements were collected to account for potential confounding variables.

Results: Of the 282 children enrolled, 193 met the inclusion criteria, and 11.9% were diagnosed with asthma. The asthmatic group exhibited several identified risk factors, including exposure to dust (47.8%), environmental fumes (30.4%), tobacco smoke (13%), and colds (47.8%). There were no statistically significant differences in anthropometric variables between the two groups. However, the asthmatic group showed significantly reduced thoracic mobility compared to the non-asthmatic group, especially in the CAx measurement (5.82 cm ± 2 for the non-asthmatic group vs. 5.18 cm ± 1.2 for the asthmatic group; p = 0.047).

Conclusions: Individuals diagnosed with asthma have reduced thoracic mobility compared to those without the condition.

Background: Increases in respiratory work and, consequently, the development of respiratory muscle fatigue can result in activation of the inspiratory muscle metaboreflex (IMM). This central nervous system response includes redirection of blood flow from skeletal muscles to respiratory muscles, which can limit exercise capacity. Therefore, developing approaches that may minimize the need for IMM is important. Recent studies have suggested that inspiratory muscle training (IMT) may reduce the IMM response. This review aims to synthesize studies that examine the efficacy of IMT in reducing IMM.

Methods: Databases were systematically searched for randomized controlled clinical trials (RCTs) and non-randomized controlled trials evaluating the effect of IMT on the IMM. Searches were performed in MEDLINE/PubMed, SCOPUS, Web of Science and LILACS from inception to December 2023. Assessment of the methodological quality of the included studies was guided by the PEDro scale.

Results: Four studies met the inclusion criteria, two RCTs and two non-randomized controlled trials, collectively including 76 subjects. Three studies included healthy subjects, and one included patients with heart failure. In all studies, IMT demonstrated a significant attenuating effect on the IMM, increasing inspiratory muscle strength and time of exercise tolerance (Tlim).

Conclusion: Current evidence suggests that IMT may provide an effective approach for attenuating the IMM and increasing inspiratory muscle strength and Tlim. However, the small collective sample size and heterogeneity across studies limit current recommendations.

Introduction: It is essential that diagnostic tests for evaluating respiratory muscles have proven reliability and validity. This study aims to synthesize studies that evaluated the psychometric properties of volitional tests used to measure respiratory muscle strength and endurance.

Methods: A systematic literature search was conducted in MEDLINE/PubMed, LILACS, Cochrane Central Register of Controlled Trials, Scopus and SciELO. Primary studies that evaluated the reliability and validity of volitional tests to measure respiratory muscle strength and endurance were included. The quality of the included studies was assessed using the Critical Appraisal Tool (CAT).

Results: Twenty-eight studies were included in this review, describing the psychometric properties of eight different approaches to measuring respiratory muscle strength and endurance. Respiratory muscle strength and endurance were assessed using static maximal inspiratory pressure, static maximal expiratory pressure, dynamic maximal inspiratory pressure, sustained maximal inspiratory pressure, nasal inspiratory pressure, manual respiratory muscle measurements, and maximal incremental inspiratory muscle performance. Overall, the studies included were of good methodological quality. Data related to validity and reliability showed excellent results for the maximum inspiratory pressure and maximum expiratory pressure, with maximum ICC values of 0.979 (CI 0.947-0.991) and 0.989 (CI 0.022-0.001), respectively. Other tests evaluated did not present high reliability and validity.

Conclusion: This review concluded that volitional tests vary in reliability for measures of respiratory muscle strength and endurance. The more traditional ones, such as maximum inspiratory pressure and maximum expiratory pressure, presented higher validity and reliability values compared to the other tests.