Canadian Journal of Respiratory Therapy最新文献

Purpose: To determine whether inhaled furosemide can be effectively used in patients with chronic obstructive pulmonary disease (COPD) to improve feelings of dyspnea and improve pulmonary function values.

Methods: This literature review was conducted using randomized control trials and a literature review in which the participants consisted of or included patients with COPD receiving inhaled furosemide as a potential treatment option for their dyspnea and low pulmonary function values.

Results: Searches in four databases and secondary sources using five key terms yielded 83 unduplicated articles. Ultimately, four studies, one of which was a literature review, were included which studied the short-term result of inhaled furosemide on dyspnea and pulmonary function values. All studies measured dyspnea as an outcome and three found a statistically significant improvement in patient reported symptoms. Pulmonary function values were measured in all studies which all found improvements.

Conclusion: The effect of inhaled furosemide on the dyspnea and pulmonary function values in people with COPD remains uncertain, and questions have emerged regarding the long-term impact on these patients. While this therapy is promising for dyspnea relief and improvement of pulmonary function values in people with COPD, further consideration and additional data still need to be gathered.

Background: Respiratory therapy is an emerging profession that has existed in India since 1995. Respiratory therapy students will play a significant role in strengthening various aspects of healthcare in the future. There are no validated instruments to evaluate students' perceptions of their careers and satisfaction with the learning resources. The primary objective of the current study is to develop and validate a structured questionnaire (SQ) for respiratory therapy students in India, encompassing all the components of their career development and satisfaction.

Methods: Based on the literature review and content validity from respiratory therapy experts through multiple focused group discussions, a reliable SQ was generated with 40 items based on the Likert scale. After getting institutional ethics clearance and informed consent, the SQ was administered to 904 respiratory therapy students across the country. We performed principal component analysis (PCA), structural equation modeling, and confirmatory factor analysis (CFA) for the global fit. Cronbach's alpha was performed to estimate the internal consistency.

Results: The PCA generated a 4-factor model, and internal consistency for the total scale exceeded the standard criterion of >0.70. Satisfactory goodness of fit data were yielded from CFA. Average variances extracted were higher than the correlation coefficients of the factors, which show sufficient discriminant validity.

Conclusion: This study shows a clinically acceptable model, it fits and suggests the possibility of applying a SQ to a respiratory therapy student with relatively good construct validity and internal consistency, based on the results of CFA.

Background: We report the characteristics, timing, and factors related to the decision to perform a tracheostomy in patients with confirmed COVID-19 infection admitted to eight Italian intensive care units (ICUs).

Materials and methods: Prospective observational cohort study of patients with COVID-19 disease on mechanical ventilation. Long-term functional impairment (up to 180 days' post-hospital discharge) was assessed using the Karnofsky scale. Kaplan-Meier analysis assessed differences in survival and freedom from tracheostomy in relation to ICU stay. Cox regression model was used to assess which variables impacted on tracheostomy as a categorical outcome.

Results: A total of 248 patients were recruited in the eight participating ICUs. Patients undergoing tracheostomy (n = 128) had longer ICU (25 (18-36) vs. 10 (7-16), P = 0.001) and hospital (37 (26.5-50) vs. 19 (8.5-34.5) P = 0.02) stays. ICU and hospital mortality of patients tracheostomized was 34% and 37%, respectively. Cumulative survival Kaplan-Meier analysis documented improved survival rates in patients undergoing tracheostomy (Log-Rank, Mantel-Cox = 4.8, P = 0.028). Median Karnofsky scale values improved over time but were similar between survivors receiving or not receiving tracheostomy. No healthcare worker involved in the tracheostomy procedure developed COVID-19 infection during the study period.

Conclusions: Patients with COVID-19 infection who underwent tracheostomy had a better cumulative survival but similar long-term functional outcomes at 30, 60, and 180 days after hospital discharge.

Background: Students reported positive learning outcomes during a simulation study addressing compliance and speaking up.

Purpose: Investigate if the impacts of the simulation had a lasting effect on participants after moving into practice.

Method: Semi-structured interviews focusing on memory of the study, psychological impacts, educational impacts, professional impacts, and experiences in practice were conducted with Advanced Care Paramedics (3) and Respiratory Therapists (7) between 19 and 24 months after the original study.

Discussion: Participants indicated the simulation helped them develop the skill and confidence to speak up, preparing them to speak up in practice. Primary findings included: (i) the importance of experience for speaking up, (ii) the benefit of high-impact simulation, and (iii) the importance of simulation training.

Conclusions: Simulation for speaking up should occur early. Conducting high-impact simulations for speaking up is a practical and actionable intervention that appears to enhance confidence, ability, and likelihood of speaking up in practice.

Problem: Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death worldwide, yet frontline workers lack the capacity and education required to provide evidence-based management and support for COPD patients.

Purpose: The aim of this review was to: (i) identify the respiratory education gaps within frontline health workers such as nurses, physicians, respiratory therapists, and other allied health professionals, in the initiation of integrated care coordination, and (ii) outline organizational strategies to initiate integrated care coordination towards comprehensive evidence-based management and treatment for COPD patients.

Methods: A literature review representing articles published between 2011 and 2021 was conducted. The focus was examining the factors that are involved in educating frontline health workers to support evidence-based COPD management and identifying organizational strategies to provide this comprehensive care. The initial searches yielded 353 articles; 18 were retained for review.

Results: Thematic analysis revealed two prominent themes as contributing factors to the challenges and strategic solutions: (i) the perceived challenges of frontline health worker respiratory education and (ii) the current deficits within organizational strategies, collaboration, resources, and educational interventions.

Conclusions: Providing respiratory education to frontline health workers is imperative to optimize evidence-based care, patient support, and improve outcomes. The solutions include recognizing and focusing on identified contextual barriers, implementing/disseminating strategic solutions, and engaging specialty trained COPD certified respiratory educators as facilitators of COPD primary care.

Introduction: Minimally invasive surfactant therapy (MIST) can be used to treat neonatal respiratory distress syndrome in neonatal intensive care units (NICUs). Clinical and institutional variances in MIST utilization persist globally with little published research regarding MIST utilization in Canada. Therefore, the objective of this study was to survey MIST utilization in NICUs in Canada.

Methods: An online survey was emailed to the 33 participating centres of Canadian Neonatal Network^TM (CNN) Evidence-based Practice for Improving Quality (EPIQ) Lung Health Group (LHG). Site demographics and surfactant therapy procedural details were categorically collected. Free text and multiple-choice questions were utilized to capture perceived barriers and individual preferences for MIST use.

Results: Twenty-eight of 33 participating members of the CNN EPIQ-LHG completed the survey between April 2021 and October 2021 (85%); 17/28 (61%) respondents reported ongoing MIST utilization at their center. Most centers that used MIST techniques administered bovine lipid extract surfactant (68%), commonly using angiocatheters (47%) and purpose-built catheters (41%). MIST was widely used for patients at 26-33 weeks gestational age (88%). Nine centres had never used MIST (32%), and 3 indicated a plan to implement MIST within the next 2 years. Common barriers to MIST use included lack of consensus amongst clinicians (78%), lack of training (56%), and lack of experience with MIST (56%).

Conclusion: While MIST is being increasingly used in Canadian NICUs, universal use is yet to be seen. Clinician inexperience and lack of consensus, formal training, and local guidelines contribute to underutilization of MIST. Training workshops, country-wide data collection, and uniform operating protocols are needed to standardize practice.

Background: Critical care ventilators are frequently used to provide noninvasive ventilation (NIV) support to critically ill patients. Questions remain regarding carbon dioxide (CO₂) clearance while using a critical care ventilator and dual limb circuit with various patient interfaces. The purpose of this study is to determine the positive end expiratory pressure (PEEP) level required to effectively washout CO₂ for full-face and oronasal masks when using a dual limb circuit.

Method: This randomized crossover trial was conducted at an academic medical center in the Midwest United States. After obtaining informed consent, eight healthy volunteers were placed on a 980 Puritan Bennett (Medtronic, Minneapolis, MN) ventilator operating in the NIV mode. All subjects performed 20 min of breathing on four levels of PEEP (0, 2, 4, and 5 cm H₂O) and pressure support of 5 cm H₂O. NIV settings were applied to four masks (two oronasal and two full-face masks) that were randomly selected with a 5-min washout period between each mask. The fraction of inspired carbon dioxide (F _ICO2) was sampled/monitored with a nasal cannula using a Capnostream 20p monitor (Medtronic, Minneapolis, MN) and reported as percentages. A Kruskal-Wallis test was used to reveal significant differences across PEEP levels. Pairwise comparisons of the groups were made using Mann-Whitney tests with a family-wise error correction.

Results: Median (IQR) F _ICO2 was significantly lower 0.0% (0%-0.92%) at PEEP of 5 compared to 1.83% (0.66%-4.0%; p < 0.001) at PEEP of 0 or 1.0% (0.33%-2.66%; p = 0.002) at PEEP of 2. F _ICO2 was significantly lower 0.5% (0%-1.92%) at PEEP of 4 compared to PEEP of 0 (p = 0.001).

Conclusion: A PEEP level of at least 5 cm H₂O associated with the reported leak was required to minimize the likelihood of CO₂ rebreathing while using a critical care ventilator to provide NIV with a double limb circuit and full-face or oronasal masks.