Canadian Journal of Respiratory Therapy最新文献

Background: The shortage of mechanical ventilators during the COVID-19 pandemic led doctors to use alternative noninvasive ventilation systems, including a modified snorkel mask. Data on the use of the modified snorkel mask is limited.

Purpose: The study aims to describe the effect and clinical characteristics of patients with COVID-19 treated with a snorkel mask and to investigate the factors associated with the failure to use noninvasive ventilation with a snorkel mask.

Methods: In this retrospective observational study, adult patients with COVID-19 who were treated with a snorkel mask at Daniel Alcides Carrion Hospital of Huancayo-Perú were selected.

Results: Of the 390 patients included, 158 (20.5%) received noninvasive ventilation with a snorkel, 84 (53.2%) patients were discharged alive without intubation, and the mortality rate was 22%. In the control group that received standard treatment, 129 patients (55.6%) failed (i.e., deceased or admitted to a mechanical ventilator). The mortality rate was 33.2%. ROX index < 4.8, consolidation-type tomographic pattern, and the presence of complications, such as bacterial pneumonia or thromboembolism, were independently associated with a higher risk of noninvasive ventilation failure with snorkels.

Conclusions: Using the snorkel system resulted in an absolute mortality reduction of 11%, and recovery increased by 15% compared to the standard treatment system. Therefore, this device can be used as an acceptable alternative in the absence of mechanical ventilators.

Background: Minimally invasive surfactant therapy (MIST), a method of surfactant delivery via a thin catheter during spontaneous breathing, is an increasingly popular alternative to intubation and surfactant administration. Recently, purpose-built catheters for MIST received regulatory approval in Canada and became available for use. However, procedural success and user experience with such catheters have not been described.

Methods: This retrospective cohort study included neonates who received MIST using purpose-built catheters between January 1, 2021, and March 31, 2022. Two types of purpose-built catheters were used in this period - SurfCath™ and BLEScath™. Procedural success, number of attempts, and adverse events in neonates receiving MIST via the two catheters were compared using chi-square or Fisher's tests. User experience was described using an ease-of-use scale.

Results: Thirty-seven neonates met eligibility criteria; 22 received MIST via SurfCath™, whereas 15 received MIST via BLEScath™. Success rates were 91% in SurfCath™ and 93% in BLEScath™ (P> 0.994). Failed attempts were lower in SurfCath™ (23%) in comparison to BLEScath™ (33%), but the difference was not statistically significant (P=0.708). Among operators, 90% found SurfCath™ very easy/relatively easy to use compared to 43% of users reflecting the same degree of use with BLEScath™ (P=.021). There was no difference in adverse events.

Conclusion: This is the first study in Canada to report MIST with purpose-built catheters. Overall, the success rate was equally high with both catheters. Users subjectively reported higher ease of use with SurfCath™. Commercially available purpose-built catheters should facilitate universal adaptation of the MIST method.

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.