Samantha Mekhuri, S. Quach, Caroline Barakat, Winnie Sun, Mika L Nonoyama
Rationale Extremes of temperature and humidity are associated with adverse respiratory symptoms, reduced lung function, and increased exacerbations among individuals living with chronic obstructive pulmonary disease (COPD). Objectives To describe the reported effects of temperature and humidity extremes on the health outcomes, health status and physical activity (PA) in individuals living with COPD. Methods A cross-sectional self-reported survey collected the effects on health status (COPD Assessment Test [CAT]), PA, and health outcomes in 1) moderate/ideal (14 to 21°C, 30 to 50% relative humidity [RH]), 2) hot and humid (≥ 25°C, > 50% RH) and 3) cold and dry (≤ 5°C, < 30% RH) weather conditions. Participants were ≥ 40 years old with COPD or related chronic respiratory diseases (e.g., asthma, sleep apnea, interstitial lung disease, lung cancer) and residing in Canada for ≥ 1 year. Negative responders to weather extremes were a priori defined as having a change of ≥ 2 points in the CAT. Main Results Thirty-six participants responded; the mean age (SD) was 65 (11) years, and 23 (64%) were females. Compared to ideal conditions, 23 (66%) and 24 (69%) were negatively affected by cold/dry and hot/humid weather, respectively. Health status was significantly lower, and PA amount and difficulty level were reduced in hot/humid and cold/dry conditions compared with ideal conditions. The number of exacerbations in hot/humid was significantly higher compared to ideal conditions. Conclusions More participants were negatively affected by extremes of weather: health status worsened, PA decreased, and frequency of exacerbations was higher compared to ideal. Future prospective studies should directly and objectively investigate different combinations of extreme temperature and humidity levels on symptoms and PA to understand their long-term health outcomes.
{"title":"A cross-sectional survey on the effects of ambient temperature and humidity on health outcomes in individuals with chronic respiratory disease","authors":"Samantha Mekhuri, S. Quach, Caroline Barakat, Winnie Sun, Mika L Nonoyama","doi":"10.29390/001c.90653","DOIUrl":"https://doi.org/10.29390/001c.90653","url":null,"abstract":"Rationale Extremes of temperature and humidity are associated with adverse respiratory symptoms, reduced lung function, and increased exacerbations among individuals living with chronic obstructive pulmonary disease (COPD). Objectives To describe the reported effects of temperature and humidity extremes on the health outcomes, health status and physical activity (PA) in individuals living with COPD. Methods A cross-sectional self-reported survey collected the effects on health status (COPD Assessment Test [CAT]), PA, and health outcomes in 1) moderate/ideal (14 to 21°C, 30 to 50% relative humidity [RH]), 2) hot and humid (≥ 25°C, > 50% RH) and 3) cold and dry (≤ 5°C, < 30% RH) weather conditions. Participants were ≥ 40 years old with COPD or related chronic respiratory diseases (e.g., asthma, sleep apnea, interstitial lung disease, lung cancer) and residing in Canada for ≥ 1 year. Negative responders to weather extremes were a priori defined as having a change of ≥ 2 points in the CAT. Main Results Thirty-six participants responded; the mean age (SD) was 65 (11) years, and 23 (64%) were females. Compared to ideal conditions, 23 (66%) and 24 (69%) were negatively affected by cold/dry and hot/humid weather, respectively. Health status was significantly lower, and PA amount and difficulty level were reduced in hot/humid and cold/dry conditions compared with ideal conditions. The number of exacerbations in hot/humid was significantly higher compared to ideal conditions. Conclusions More participants were negatively affected by extremes of weather: health status worsened, PA decreased, and frequency of exacerbations was higher compared to ideal. Future prospective studies should directly and objectively investigate different combinations of extreme temperature and humidity levels on symptoms and PA to understand their long-term health outcomes.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138587401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stefanie Tonguino Rosero, Juan Carlos Ávila Valencia, Jhonatan Betancourt Peña
Background The educational component is a comprehensive part of Pulmonary Rehabilitation (PR), and telephone follow-up (TFU) is an alternative to reinforce face-to-face education. The objective was to determine the effect of telephone follow-up on educational needs, dyspnea, quality of life and functional capacity in Chronic Obstructive Pulmonary Disease (COPD) patients undergoing PR. Methods Double-blind randomized controlled clinical trial in patients with COPD in a PR program in Cali-Colombia, allocation by randomization tables. All patients received 24 sessions of PR, which included face-to-face education sessions. In addition, the experimental group received telephone calls twice a week to reinforce the face-to-face educational content. The Lung Information Needs Questionnaire (LINQ) was used to measure disease knowledge, the Saint George’s Respiratory Questionnaire to measure quality of life, the modified Medical Research Council (mMRC) scale to measure dyspnea, and the 6-minute walking test (6MWT) to measure functional capacity. Results Thirty-four patients were randomized and 31 were analyzed. PR group with conventional education (PRTE) n=15 and PR group with education plus telephone follow-up (PRTETFU) n=16. Significant improvement from baseline to endpoint in both groups: LINQ (PRTE 4±1.1, p=0.003, PRTETFU 5.8±10.6, p=0.000), mMRC (PRTE 1.6±0.3, p=0.000, PRTETFU 0.6±0.3, p=0.036) and functional capacity (PM6M: PRTE 45.9m±16.1, p=0.013, PRTETFU 62.8m±21.4, p=0.010). Analysis showed differences between groups for changes in LINQ knowledge domain after intervention, with greater improvement for PRTETFU (p=0.018). Discussion The TFU is an alternative to reinforce the education. This study demonstrated greater positive effects for the autonomous management of the pathology. Conclusion Adding educational reinforcement through phone calls to patients with COPD during PR leads to improved knowledge and skills for managing the disease.
{"title":"Impact of telephone follow-up on COPD outcomes in pulmonary rehabilitation patients: A randomized clinical trial","authors":"Stefanie Tonguino Rosero, Juan Carlos Ávila Valencia, Jhonatan Betancourt Peña","doi":"10.29390/001c.90520","DOIUrl":"https://doi.org/10.29390/001c.90520","url":null,"abstract":"Background The educational component is a comprehensive part of Pulmonary Rehabilitation (PR), and telephone follow-up (TFU) is an alternative to reinforce face-to-face education. The objective was to determine the effect of telephone follow-up on educational needs, dyspnea, quality of life and functional capacity in Chronic Obstructive Pulmonary Disease (COPD) patients undergoing PR. Methods Double-blind randomized controlled clinical trial in patients with COPD in a PR program in Cali-Colombia, allocation by randomization tables. All patients received 24 sessions of PR, which included face-to-face education sessions. In addition, the experimental group received telephone calls twice a week to reinforce the face-to-face educational content. The Lung Information Needs Questionnaire (LINQ) was used to measure disease knowledge, the Saint George’s Respiratory Questionnaire to measure quality of life, the modified Medical Research Council (mMRC) scale to measure dyspnea, and the 6-minute walking test (6MWT) to measure functional capacity. Results Thirty-four patients were randomized and 31 were analyzed. PR group with conventional education (PRTE) n=15 and PR group with education plus telephone follow-up (PRTETFU) n=16. Significant improvement from baseline to endpoint in both groups: LINQ (PRTE 4±1.1, p=0.003, PRTETFU 5.8±10.6, p=0.000), mMRC (PRTE 1.6±0.3, p=0.000, PRTETFU 0.6±0.3, p=0.036) and functional capacity (PM6M: PRTE 45.9m±16.1, p=0.013, PRTETFU 62.8m±21.4, p=0.010). Analysis showed differences between groups for changes in LINQ knowledge domain after intervention, with greater improvement for PRTETFU (p=0.018). Discussion The TFU is an alternative to reinforce the education. This study demonstrated greater positive effects for the autonomous management of the pathology. Conclusion Adding educational reinforcement through phone calls to patients with COPD during PR leads to improved knowledge and skills for managing the disease.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138594404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Busico, M. M. Laiz, J. Urrutia, Maria Emilia Amado, D. Villalba, S. Saavedra, Adrián Gallardo, A. Thille
Introduction The use of high-flow nasal oxygen (HFNO) is a simple method that can reduce intubation in patients with hypoxemic acute respiratory failure (ARF). Early and prolonged prone position has demonstrated benefits on mortality in mechanically ventilated patients and on intubation in awake patients with ARF. However, strategies to achieve adherence to awake prone positioning (APP) have not been previously described. Case and outcomes We present six patients with ARF due to COVID-19 treated with HFNO and APP. The median (p25–75) of PaFiO2 upon admission was 121 (112–175). The average duration of APP on the first day was 16 h (SD 5 h). Duration (median p25–75) in APP for the following 20 days was 13 (10–18) h/day. Several strategies such as the presence of a health care team, recreational activities, adaptation of the circadian rhythm, oral nutritional support, and analgesics were used to improve prone tolerance. None of the patients suffered from delirium, all were ambulating on discharge from the ICU and none require intubation. Conclusion The case series presented show the feasibility of prolonged use of HFNO and APP in patients with COVID-19 and severe persistent hypoxemia and described strategies to enhance adherence.
高流量鼻吸氧(HFNO)是低氧性急性呼吸衰竭(ARF)患者减少插管的一种简便方法。早期和延长俯卧位已被证明对机械通气患者的死亡率和ARF清醒患者的插管有好处。然而，以前没有描述过坚持清醒俯卧位(APP)的策略。病例和结果我们报告了6例经HFNO和APP治疗的COVID-19所致ARF患者。入院时PaFiO2的中位数(p25-75)为121(112-175)。第一天APP的平均持续时间为16 h (SD 5 h)，随后20天APP的持续时间(p25-75)为13 (10-18)h/d。一些策略，如卫生保健团队的存在，娱乐活动，适应昼夜节律，口服营养支持和止痛药被用来改善俯卧耐受性。所有患者均无谵妄，出院时均可走动，均无需插管。结论本病例系列显示了COVID-19合并严重持续性低氧血症患者长期使用HFNO和APP的可行性，并描述了增强依从性的策略。
{"title":"Strategies to achieve adherence to prone positioning in awake COVID-19 patients with high-flow nasal oxygen. A case series","authors":"M. Busico, M. M. Laiz, J. Urrutia, Maria Emilia Amado, D. Villalba, S. Saavedra, Adrián Gallardo, A. Thille","doi":"10.29390/cjrt-2022-035","DOIUrl":"https://doi.org/10.29390/cjrt-2022-035","url":null,"abstract":"Introduction The use of high-flow nasal oxygen (HFNO) is a simple method that can reduce intubation in patients with hypoxemic acute respiratory failure (ARF). Early and prolonged prone position has demonstrated benefits on mortality in mechanically ventilated patients and on intubation in awake patients with ARF. However, strategies to achieve adherence to awake prone positioning (APP) have not been previously described. Case and outcomes We present six patients with ARF due to COVID-19 treated with HFNO and APP. The median (p25–75) of PaFiO2 upon admission was 121 (112–175). The average duration of APP on the first day was 16 h (SD 5 h). Duration (median p25–75) in APP for the following 20 days was 13 (10–18) h/day. Several strategies such as the presence of a health care team, recreational activities, adaptation of the circadian rhythm, oral nutritional support, and analgesics were used to improve prone tolerance. None of the patients suffered from delirium, all were ambulating on discharge from the ICU and none require intubation. Conclusion The case series presented show the feasibility of prolonged use of HFNO and APP in patients with COVID-19 and severe persistent hypoxemia and described strategies to enhance adherence.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83326121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction While challenges facing community and acute care practitioners have been studied elsewhere, this is not the case for respiratory therapists (RTs). This study aimed to examine attitudinal differences amongst RTs in British Columbia regarding challenges faced by acute and community settings. Methods A 40-item anonymous online survey was sent to members of the British Columbia Society or Respiratory Therapists. Of the 40 questions, 11 were relevant to the study’s aim. Results Of 1024 invitations, 197 (19.2%) responded. One-hundred and seventeen (59.4%) self-identified as working in acute care settings, 53 (26.9%) in community settings, and 27 (13.7%) as “other”. Stress- and interpersonal-related challenges showed statistically significant differences (P ≤ 0.05) based on work setting. Acute care had the highest percentage of responses for challenges related to technology, stress, inter-professional collaboration, and training. Community settings had the highest percentage in challenges related to independence and education. Both being equal received the highest percentage in challenges related to problem-solving, interpersonal, communication, and resource management. Discussion While attitudinal differences exist, they are not extreme. It did not appear that respondents’ primary motivation was to vote along “party lines”. Conclusions The setting an RT works in can influence attitudes related to stress and interpersonal challenges. Despite this, one setting is not universally more challenging. Acute care settings can have greater technological, inter-professional, and training-related challenges. Community settings can have greater independence and education-related challenges. Both settings can provide similar challenges with problem-solving, communication, and resource management.
{"title":"A survey on the attitudinal differences between acute and community settings","authors":"Cael Field","doi":"10.29390/cjrt-2022-031","DOIUrl":"https://doi.org/10.29390/cjrt-2022-031","url":null,"abstract":"Introduction While challenges facing community and acute care practitioners have been studied elsewhere, this is not the case for respiratory therapists (RTs). This study aimed to examine attitudinal differences amongst RTs in British Columbia regarding challenges faced by acute and community settings. Methods A 40-item anonymous online survey was sent to members of the British Columbia Society or Respiratory Therapists. Of the 40 questions, 11 were relevant to the study’s aim. Results Of 1024 invitations, 197 (19.2%) responded. One-hundred and seventeen (59.4%) self-identified as working in acute care settings, 53 (26.9%) in community settings, and 27 (13.7%) as “other”. Stress- and interpersonal-related challenges showed statistically significant differences (P ≤ 0.05) based on work setting. Acute care had the highest percentage of responses for challenges related to technology, stress, inter-professional collaboration, and training. Community settings had the highest percentage in challenges related to independence and education. Both being equal received the highest percentage in challenges related to problem-solving, interpersonal, communication, and resource management. Discussion While attitudinal differences exist, they are not extreme. It did not appear that respondents’ primary motivation was to vote along “party lines”. Conclusions The setting an RT works in can influence attitudes related to stress and interpersonal challenges. Despite this, one setting is not universally more challenging. Acute care settings can have greater technological, inter-professional, and training-related challenges. Community settings can have greater independence and education-related challenges. Both settings can provide similar challenges with problem-solving, communication, and resource management.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82341030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Brown, R. Floro, A. Lam, T. Nguyen, M. Patel, J. Paul, T. Peacock
Canadian Respiratory Therapist COVID-19 vaccination uptake rates and responses were investigated with a look at the reasons behind any delays or non-vaccinations as well as other demographics, attitudes, or factors that may be shown to play a role. An anonymous survey using SurveyMonkey® on vaccination uptake rates, responses, and attitudes was available to Student, Graduate, and Registered Respiratory Therapists in Canada from July to October of 2021. A total of 1066 surveys (8.4% of target population) were started, 983 in English and 83 in French with 1013 completed fully and included in the data analysis. Canadian RT Vaccination uptake rates were compared to those of all Canadian healthcare workers which showed that 90.42% of the surveyed RT population in Canada received their vaccination right away compared to the posted rate at the time of 86.27% for all Canadian Healthcare Workers. Pearson Chi-Square Tests were performed to evaluate association between vaccination status and other categorical parameters evaluated in the survey. There was a significant (P = 0.013) association between early vaccination and age, a significant (P = 0.036) association between vaccination status and participants’ response on whether or not they have a family member or know someone who has had COVID-19, a significant (P < 0.001) association between vaccination status and attitudes towards trusting science to develop safe, effective, new vaccines, and a significant (P < 0.001) association between vaccination status and attitudes towards trusting the Ministry of Health to ensure that vaccines are safe. There was no significant association between vaccination status and gender, province/territory of residency/work, level of education, level of involvement with COVID-19 patients. The results suggest that the RT groups across Canada had higher early vaccination uptake rates than the general Healthcare worker groups and that age, relationship to people with COVID-19 and trust in science played a significant role in their vaccination uptake rates.
{"title":"Winning Posters from the Canadian Society of Respiratory Therapists 2022 Annual Conference","authors":"J. Brown, R. Floro, A. Lam, T. Nguyen, M. Patel, J. Paul, T. Peacock","doi":"10.29390/cjrt-2022-043","DOIUrl":"https://doi.org/10.29390/cjrt-2022-043","url":null,"abstract":"Canadian Respiratory Therapist COVID-19 vaccination uptake rates and responses were investigated with a look at the reasons behind any delays or non-vaccinations as well as other demographics, attitudes, or factors that may be shown to play a role. An anonymous survey using SurveyMonkey® on vaccination uptake rates, responses, and attitudes was available to Student, Graduate, and Registered Respiratory Therapists in Canada from July to October of 2021. A total of 1066 surveys (8.4% of target population) were started, 983 in English and 83 in French with 1013 completed fully and included in the data analysis. Canadian RT Vaccination uptake rates were compared to those of all Canadian healthcare workers which showed that 90.42% of the surveyed RT population in Canada received their vaccination right away compared to the posted rate at the time of 86.27% for all Canadian Healthcare Workers. Pearson Chi-Square Tests were performed to evaluate association between vaccination status and other categorical parameters evaluated in the survey. There was a significant (P = 0.013) association between early vaccination and age, a significant (P = 0.036) association between vaccination status and participants’ response on whether or not they have a family member or know someone who has had COVID-19, a significant (P < 0.001) association between vaccination status and attitudes towards trusting science to develop safe, effective, new vaccines, and a significant (P < 0.001) association between vaccination status and attitudes towards trusting the Ministry of Health to ensure that vaccines are safe. There was no significant association between vaccination status and gender, province/territory of residency/work, level of education, level of involvement with COVID-19 patients. The results suggest that the RT groups across Canada had higher early vaccination uptake rates than the general Healthcare worker groups and that age, relationship to people with COVID-19 and trust in science played a significant role in their vaccination uptake rates.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77923010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The long-term impact of COVID-19 is still unknown. Objective: This study aimed to explore post COVID-19 effect on patients’ chest computed tomography (CT), lung function, respiratory symptoms, fatigue, functional capacity, health-related quality of life (HRQoL) and the ability to return to work beyond 3 months post-infection. Methods: A systematic search was performed on PubMed, Web of Science and Ovid MEDLINE on May 22, 2021, to identify studies that reported persistent effects of COVID-19 beyond 3 months follow-up. Data on the proportion of patients who had the outcome were collected and analyzed using a one-group meta-analysis. Results: Data were extracted from 24 articles that presented information on a total of 5323 post COVID-19 adults between 3 and 6 months after symptoms onset or hospital discharge. The pooled prevalence of CT abnormalities was 59% (95% CI 4473, I2 = 96%), abnormal lung function 39% (95% CI 24–55, I2 = 94%), fatigue 38% (95% CI 27–49, I2 = 98%), dyspnea 32% (95% CI 24–40, I2 = 98%), chest paint/tight-ness 16% (95% CI 12–21, I2 = 94%), and cough 13%, (95% CI 9–17, I2 = 94%). Decreased functional capacity and HRQoL were found in 36% (95% CI 22–49, I2 = 97%) and 52% (95% CI 33–71, they may be vaccine hesitant despite acknowledging that vaccination is necessary. This presentation will present an ethics methodology approach to encourage collaboration between opposing groups. Reasons for both vaccine hesitancy and vaccine support will be presented. The goal is to provide respiratory students and professionals with additional tools to approach vaccine-hesitant patients so that future confrontations are col-laborative and proactive. Recommended methods on how to approach and challenging patients on their values can help guide difficult discus-sions around vaccinations and mistrust in healthcare. The findings from this case series reveal that the pres-ence of ventilator-associated pneumonia in SARS-CoV-2 patients is a source of significant mortality. This study strengthens the importance of non-invasive mechanical ventilation strategies and also high-lights the need for careful infection control surveillance in invasive mechanical ventilation. Due to the high rates of VAP and associated increased mortality, uprating antibiotic/antifungal therapy selec-tion is also paramount in caring for SARS-CoV-2 cases admitted to the ICU. steps therapeutic algorithm for VV-ECMO ARDS 1. an optimization of mechanical ventilation before VV-ECMO consideration; 2. VV-ECMO indications; 3. start, maintenance and weaning phases of VV-ECMO; 4. post decannulation. The complex interaction between a patient, a VV-ECMO machine, and a mechanical ventilator as well as challenges of respiratory monitoring be
背景:COVID-19的长期影响尚不清楚。目的:本研究旨在探讨COVID-19感染后3个月对患者胸部CT、肺功能、呼吸系统症状、疲劳、功能能力、健康相关生活质量(HRQoL)和重返工作能力的影响。方法:于2021年5月22日在PubMed、Web of Science和Ovid MEDLINE上进行系统检索，以确定报告COVID-19在3个月随访后持续影响的研究。采用单组荟萃分析收集并分析了达到上述结果的患者比例的数据。结果:数据从24篇文章中提取，这些文章提供了5323名COVID-19后成人在症状出现或出院后3至6个月的信息。CT异常的总患病率为59% (95% CI 4473, I2 = 96%)，肺功能异常39% (95% CI 24-55, I2 = 94%)，疲劳38% (95% CI 27-49, I2 = 98%)，呼吸困难32% (95% CI 24-40, I2 = 98%)，胸漆/胸闷16% (95% CI 12-21, I2 = 94%)，咳嗽13% (95% CI 9-17, I2 = 94%)。36% (95% CI 22-49, I2 = 97%)和52% (95% CI 33-71)的患者功能能力和HRQoL下降，尽管承认有必要接种疫苗，但他们可能对疫苗犹豫不决。本报告将介绍一种伦理方法论方法，以鼓励对立团体之间的合作。将介绍对疫苗犹豫和支持疫苗的原因。目标是为呼吸学学生和专业人员提供额外的工具来接近疫苗犹豫的患者，以便未来的对抗是合作和积极主动的。关于如何接近和挑战患者价值观的推荐方法可以帮助指导围绕疫苗接种和医疗保健不信任的困难讨论。该病例系列的研究结果表明，SARS-CoV-2患者出现呼吸机相关肺炎是导致严重死亡率的一个原因。本研究强调了无创机械通气策略的重要性，也强调了在有创机械通气中进行仔细的感染控制监测的必要性。由于VAP的高发生率和相关的死亡率增加，在护理ICU收治的SARS-CoV-2病例时，提高抗生素/抗真菌治疗的选择也至关重要。VV-ECMO ARDS的治疗算法考虑VV-ECMO前机械通气的优化;2. VV-ECMO迹象;3.VV-ECMO的启动、维持和脱机阶段;4. 后拔管。患者、VV-ECMO机和机械呼吸机之间复杂的相互作用以及呼吸监测的挑战
{"title":"Proceedings from the Canadian Society of Respiratory Therapists Annual Conference May 13–14, 2022","authors":"T. Tessier","doi":"10.29390/cjrt-2022-024","DOIUrl":"https://doi.org/10.29390/cjrt-2022-024","url":null,"abstract":"Background: The long-term impact of COVID-19 is still unknown. Objective: This study aimed to explore post COVID-19 effect on patients’ chest computed tomography (CT), lung function, respiratory symptoms, fatigue, functional capacity, health-related quality of life (HRQoL) and the ability to return to work beyond 3 months post-infection. Methods: A systematic search was performed on PubMed, Web of Science and Ovid MEDLINE on May 22, 2021, to identify studies that reported persistent effects of COVID-19 beyond 3 months follow-up. Data on the proportion of patients who had the outcome were collected and analyzed using a one-group meta-analysis. Results: Data were extracted from 24 articles that presented information on a total of 5323 post COVID-19 adults between 3 and 6 months after symptoms onset or hospital discharge. The pooled prevalence of CT abnormalities was 59% (95% CI 4473, I2 = 96%), abnormal lung function 39% (95% CI 24–55, I2 = 94%), fatigue 38% (95% CI 27–49, I2 = 98%), dyspnea 32% (95% CI 24–40, I2 = 98%), chest paint/tight-ness 16% (95% CI 12–21, I2 = 94%), and cough 13%, (95% CI 9–17, I2 = 94%). Decreased functional capacity and HRQoL were found in 36% (95% CI 22–49, I2 = 97%) and 52% (95% CI 33–71, they may be vaccine hesitant despite acknowledging that vaccination is necessary. This presentation will present an ethics methodology approach to encourage collaboration between opposing groups. Reasons for both vaccine hesitancy and vaccine support will be presented. The goal is to provide respiratory students and professionals with additional tools to approach vaccine-hesitant patients so that future confrontations are col-laborative and proactive. Recommended methods on how to approach and challenging patients on their values can help guide difficult discus-sions around vaccinations and mistrust in healthcare. The findings from this case series reveal that the pres-ence of ventilator-associated pneumonia in SARS-CoV-2 patients is a source of significant mortality. This study strengthens the importance of non-invasive mechanical ventilation strategies and also high-lights the need for careful infection control surveillance in invasive mechanical ventilation. Due to the high rates of VAP and associated increased mortality, uprating antibiotic/antifungal therapy selec-tion is also paramount in caring for SARS-CoV-2 cases admitted to the ICU. steps therapeutic algorithm for VV-ECMO ARDS 1. an optimization of mechanical ventilation before VV-ECMO consideration; 2. VV-ECMO indications; 3. start, maintenance and weaning phases of VV-ECMO; 4. post decannulation. The complex interaction between a patient, a VV-ECMO machine, and a mechanical ventilator as well as challenges of respiratory monitoring be","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84839994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Late diagnosis of COVID-19 in young patients in a hypercoagulable state can cause a high mortality rate. Clinical manifestations of COVID-19 include respiratory and extrapulmonary symptoms such as a hypercoagulable state, increased transaminase enzymes, and multiple-organ failure. Case and outcomes A 34-year-old male presented to the emergency room after 3 days of high fever, weakness, and flatulence. The patient had thrombocytopenia and elevated liver transaminase enzymes and was initially diagnosed with dengue hemorrhagic fever. He was given hydration intravenous fluids, oxygen, antipyretic, and hepatoprotector. On day 4, the patient was diagnosed with COVID-19 and received therapy to decrease the Alanine transaminase and Aspartate transaminase levels. While waiting for outsourced D dimer and prothrombin time results, the patient was given low molecular weight heparin (LMWH) on day 5. On day 13, his condition deteriorated with cephalgia and shortness of breath, but the patient’s family refused intubation. The chest CT scan revealed large ground-glass opacities in both lungs. The patient was given additional medications, such as Meropenem, Dexamethasone, and Remdesivir. On day 15, the patient passed away. Discussion Intermediate LMWH dosage seems to be associated with a lower mortality incidence than standard Deep Vein Thrombosis (DVT) prophylaxis in hospitalized COVID-19 patients. However, due to the late COVID-19 diagnosis, the patient was not given LMWH at the beginning of treatment. Conclusion A hypercoagulable state is partly responsible for the high mortality rate of COVID-19 patients. Early detection and management of the hypercoagulable state, including the use of LMWH, can decrease the severity of COVID-19 symptoms.
{"title":"Late diagnosis of COVID-19 in a 34-year-old man in a hypercoagulable state: A case report","authors":"D. Desdiani","doi":"10.29390/cjrt-2021-028","DOIUrl":"https://doi.org/10.29390/cjrt-2021-028","url":null,"abstract":"Background Late diagnosis of COVID-19 in young patients in a hypercoagulable state can cause a high mortality rate. Clinical manifestations of COVID-19 include respiratory and extrapulmonary symptoms such as a hypercoagulable state, increased transaminase enzymes, and multiple-organ failure. Case and outcomes A 34-year-old male presented to the emergency room after 3 days of high fever, weakness, and flatulence. The patient had thrombocytopenia and elevated liver transaminase enzymes and was initially diagnosed with dengue hemorrhagic fever. He was given hydration intravenous fluids, oxygen, antipyretic, and hepatoprotector. On day 4, the patient was diagnosed with COVID-19 and received therapy to decrease the Alanine transaminase and Aspartate transaminase levels. While waiting for outsourced D dimer and prothrombin time results, the patient was given low molecular weight heparin (LMWH) on day 5. On day 13, his condition deteriorated with cephalgia and shortness of breath, but the patient’s family refused intubation. The chest CT scan revealed large ground-glass opacities in both lungs. The patient was given additional medications, such as Meropenem, Dexamethasone, and Remdesivir. On day 15, the patient passed away. Discussion Intermediate LMWH dosage seems to be associated with a lower mortality incidence than standard Deep Vein Thrombosis (DVT) prophylaxis in hospitalized COVID-19 patients. However, due to the late COVID-19 diagnosis, the patient was not given LMWH at the beginning of treatment. Conclusion A hypercoagulable state is partly responsible for the high mortality rate of COVID-19 patients. Early detection and management of the hypercoagulable state, including the use of LMWH, can decrease the severity of COVID-19 symptoms.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89788012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahdokht Parsirad, B. Rahimi, S. Peiman, J. Zebardast, Elham Zangene
Introduction The aim of this study was to survey the attitudes of internists, cardiologists, and pulmonologists regarding treatment or no treatment of isolated subsegmental pulmonary embolism (ISSPE) with anticoagulant drugs. Methods Qualified physicians were asked to select their management options from a questionnaire that included a patient scenario with subsegmental pulmonary embolism (SSPE) and negative past medical history of thromboembolism. Results A total of 113 physicians responded to the survey. Of these, 8.8% preferred not to treat patients without further evaluation; 15% decided not to treat, but follow-up the patient with a serial lower-limb colour Doppler ultrasonography; 1.7% preferred anticoagulant treatment only during hospitalization and follow-up without medication; 5% preferred anticoagulant treatment for less than 3 months; and 34.5% chose a 3–6-month treatment with anticoagulation. Furthermore, 24% of physicians opted for anticoagulant treatment for more than 6 months, and 9.7% left the decision up to the patient. Opting not to treat was an option selected by more board-certified faculty members specialized in cardiology, internal medicine, and pulmonology compared with residents (p = 0.038). Willingness to provide anticoagulant therapy in the internal medicine, cardiology and pulmonology groups was 56.6%, 37.3% and 6%, respectively (p = 0.007). Conclusion The majority of physicians surveyed prefer anticoagulant therapy in patients with SSPE.
{"title":"A survey of physicians’ opinions about the treatment of subsegmental pulmonary embolism","authors":"Mahdokht Parsirad, B. Rahimi, S. Peiman, J. Zebardast, Elham Zangene","doi":"10.29390/cjrt-2021-053","DOIUrl":"https://doi.org/10.29390/cjrt-2021-053","url":null,"abstract":"Introduction The aim of this study was to survey the attitudes of internists, cardiologists, and pulmonologists regarding treatment or no treatment of isolated subsegmental pulmonary embolism (ISSPE) with anticoagulant drugs. Methods Qualified physicians were asked to select their management options from a questionnaire that included a patient scenario with subsegmental pulmonary embolism (SSPE) and negative past medical history of thromboembolism. Results A total of 113 physicians responded to the survey. Of these, 8.8% preferred not to treat patients without further evaluation; 15% decided not to treat, but follow-up the patient with a serial lower-limb colour Doppler ultrasonography; 1.7% preferred anticoagulant treatment only during hospitalization and follow-up without medication; 5% preferred anticoagulant treatment for less than 3 months; and 34.5% chose a 3–6-month treatment with anticoagulation. Furthermore, 24% of physicians opted for anticoagulant treatment for more than 6 months, and 9.7% left the decision up to the patient. Opting not to treat was an option selected by more board-certified faculty members specialized in cardiology, internal medicine, and pulmonology compared with residents (p = 0.038). Willingness to provide anticoagulant therapy in the internal medicine, cardiology and pulmonology groups was 56.6%, 37.3% and 6%, respectively (p = 0.007). Conclusion The majority of physicians surveyed prefer anticoagulant therapy in patients with SSPE.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82355090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Mashaal, Joshua Fogel, N. Sayedy, Ruchi Jalota Sahota, J. Akella
Introduction Trelegy is a combination inhaler that is often reported to offer benefits over multiple inhalers. We compared Trelegy use with multiple inhalers for adherence, symptoms, medication beliefs, and medication attitudes. Methods This cross-sectional survey of 58 patients compared the patient’s experience with Trelegy (n = 18) versus any other inhaler (n = 40). Outcome variables consisted of Test of the Adherence to Inhalers scale, the Chronic obstructive pulmonary disease Assessment Test (CAT) scale, attitude items from the St. George’s Respiratory Questionnaire, the Beliefs about Medicines Questionnaire (BMQ)-necessity subscale, and the BMQ-concerns subscale. Results We found that patients using Trelegy had greater CAT symptoms (M = 19.8, SD = 7.75) in comparison with the any other inhaler group (M = 15.7, SD = 11.10; P = 0.04). We did not find any difference between the groups for adherence or any of the medication attitudes or beliefs. CAT score was positively correlated with the number of months patients were on their current inhaler (rs = 0.29, P < 0.05) and their use of a rescue inhaler (rs = 0.42, P < 0.01). Patients with more concern about their medications were negatively correlated with the use of a rescue inhaler (rs = −0.31, P < 0.05). Discussion We found that patients using Trelegy had greater symptoms in comparison with the any other inhaler group, but did not differ for adherence, medication attitudes, or medication beliefs. Conclusion We recommend that clinicians should regularly re-evaluate their Trelegy recommendations, as Trelegy use may not be the best therapy for certain patients. Also, a study with a larger sample size can be beneficial to confirm these findings.
{"title":"Chronic obstructive pulmonary disease patients’ experience using Trelegy as compared with other inhalers","authors":"H. Mashaal, Joshua Fogel, N. Sayedy, Ruchi Jalota Sahota, J. Akella","doi":"10.29390/cjrt-2021-041","DOIUrl":"https://doi.org/10.29390/cjrt-2021-041","url":null,"abstract":"Introduction Trelegy is a combination inhaler that is often reported to offer benefits over multiple inhalers. We compared Trelegy use with multiple inhalers for adherence, symptoms, medication beliefs, and medication attitudes. Methods This cross-sectional survey of 58 patients compared the patient’s experience with Trelegy (n = 18) versus any other inhaler (n = 40). Outcome variables consisted of Test of the Adherence to Inhalers scale, the Chronic obstructive pulmonary disease Assessment Test (CAT) scale, attitude items from the St. George’s Respiratory Questionnaire, the Beliefs about Medicines Questionnaire (BMQ)-necessity subscale, and the BMQ-concerns subscale. Results We found that patients using Trelegy had greater CAT symptoms (M = 19.8, SD = 7.75) in comparison with the any other inhaler group (M = 15.7, SD = 11.10; P = 0.04). We did not find any difference between the groups for adherence or any of the medication attitudes or beliefs. CAT score was positively correlated with the number of months patients were on their current inhaler (rs = 0.29, P < 0.05) and their use of a rescue inhaler (rs = 0.42, P < 0.01). Patients with more concern about their medications were negatively correlated with the use of a rescue inhaler (rs = −0.31, P < 0.05). Discussion We found that patients using Trelegy had greater symptoms in comparison with the any other inhaler group, but did not differ for adherence, medication attitudes, or medication beliefs. Conclusion We recommend that clinicians should regularly re-evaluate their Trelegy recommendations, as Trelegy use may not be the best therapy for certain patients. Also, a study with a larger sample size can be beneficial to confirm these findings.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87949660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The diaphragm is the primary muscle responsible for breathing. Weakness in the diaphragm will result in breathing difficulties. The micro-RPM (respiratory pressure meter) is a non-invasive testing device to measure respiratory muscle strength, which is not always feasible, while thoracic expansion measurements are easy to do. Aim This study constructs a prediction formula for a maximal inspiratory pressure (MIP) value from thoracic expansion measurements. Methods This study was quantitative with a cross-sectional design. Participants were healthy adults aged 20–40 years, with normal Mini-Mental State Examinations, body mass index, spirometry, and moderate activity levels. The tests performed were MIP and thoracic expansion measurements at three levels: axilla (L1), the fourth intercostal space (L2), and at processus xiphoideus (L3). The data were analyzed using an unpaired t-test and multivariate. Results The mean MIP for males (81.51 ± 13.90 cmH2O) was significantly greater than females (63.17 ± 15.89 cmH2O) (P = 0.0001). These findings were not different with the Chinese, Indian, Mangalorean, and Malaysian populations because they are all of Asian ethnicity. Thoracic expansion L2 (r = 0.463, P = 0.0001) and L3 (r = 0.502, P = 0.0001) were moderately correlated with MIP, whereas thoracic expansion L2, L3 combined with gender had a weak effect on MIP. The prediction formula was: MIP = 56.802 + 2.387 + L2 + 13.904 + Gender * and MIP = 53.289+ 3.561 + L3 + 9.504 + Gender *, * 0 = female; 1 = male. Conclusions A prediction formula for MIP can be made using the thoracic expansion variable with gender as a determinant factor. A quick and easy measurement of thoracic expansion can be used as a mean of screening respiratory muscle strength in patient care.
{"title":"Prediction for the maximum inspiratory pressure value from the thoracic expansion measurement in Indonesian healthy young adults","authors":"M. Moeliono, D. M. Sari, Taufiq Nashrulloh","doi":"10.29390/cjrt-2021-064","DOIUrl":"https://doi.org/10.29390/cjrt-2021-064","url":null,"abstract":"Background The diaphragm is the primary muscle responsible for breathing. Weakness in the diaphragm will result in breathing difficulties. The micro-RPM (respiratory pressure meter) is a non-invasive testing device to measure respiratory muscle strength, which is not always feasible, while thoracic expansion measurements are easy to do. Aim This study constructs a prediction formula for a maximal inspiratory pressure (MIP) value from thoracic expansion measurements. Methods This study was quantitative with a cross-sectional design. Participants were healthy adults aged 20–40 years, with normal Mini-Mental State Examinations, body mass index, spirometry, and moderate activity levels. The tests performed were MIP and thoracic expansion measurements at three levels: axilla (L1), the fourth intercostal space (L2), and at processus xiphoideus (L3). The data were analyzed using an unpaired t-test and multivariate. Results The mean MIP for males (81.51 ± 13.90 cmH2O) was significantly greater than females (63.17 ± 15.89 cmH2O) (P = 0.0001). These findings were not different with the Chinese, Indian, Mangalorean, and Malaysian populations because they are all of Asian ethnicity. Thoracic expansion L2 (r = 0.463, P = 0.0001) and L3 (r = 0.502, P = 0.0001) were moderately correlated with MIP, whereas thoracic expansion L2, L3 combined with gender had a weak effect on MIP. The prediction formula was: MIP = 56.802 + 2.387 + L2 + 13.904 + Gender * and MIP = 53.289+ 3.561 + L3 + 9.504 + Gender *, * 0 = female; 1 = male. Conclusions A prediction formula for MIP can be made using the thoracic expansion variable with gender as a determinant factor. A quick and easy measurement of thoracic expansion can be used as a mean of screening respiratory muscle strength in patient care.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89195745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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