A. Orea-Tejeda, Ó. Martínez-Reyna, D. González-Islas, R. Hernández-Zenteno, R. Sánchez-Santillán, A. Flores-Vargas, A. Ibarra-Fernández, Ilse Pérez-García, Justino Pineda-Regalado, J. Orozco-Gutíerrez
Introduction Lower respiratory tract infections remain the deadliest communicable disease worldwide. The relationship between cardiovascular diseases and viral infections is well known; for example, during the AH1N1 influenza pandemic, many patients developed acute cardiovascular disease. In the SARS-CoV2 pandemic, cardiovascular health has again become a challenge, with early reports showing cardiac damage in these patients. Objective The study aims to describe the clinical characteristics of COVID-19 patients with an emphasis on cardiovascular compromises, compared with past outbreaks of influenza AH1N1, to identify prognostic factors of severity. Methods A cross-sectional study of 72 subjects with a confirmed diagnosis of COVID-19 was conducted. Subjects were evaluated in two groups: 38 hospitalized patients and 34 patients in the Intensive Care Unit (ICU). Data from different outbreaks of influenza AH1N1 were then compared with this group. Results The 34 subjects in the ICU had higher levels of high sensible troponin, D dimer, creatinine, and leukocytes compared with the 38 hospitalized subjects. The lymphocytes count was diminished in 85.29% of ICU subjects. When compared with AH1N1 patients, it was found that SARS-CoV2 patients were 10 years older on average. The proportion of overweight and obese SARS-CoV2 patients was double that in the influenza outbreaks. In addition, it was observed that a high number of SARS-CoV2 subjects presented with diabetes mellitus. Conclusion There were various clinical and severity differences between each of these outbreaks. However, viral respiratory infection diseases such as SARS-CoV2 are a significant risk factor for acute ischemic, functional, and structural cardiovascular complications. The only way to combat this risk is a prevention approach, specifically through vaccines, but also through measures that force drastic changes in health policies to reduce perhaps the worst of pandemics, obesity, and its metabolic consequences.
{"title":"Clinical and cardiovascular characteristics from subjects with in COVID-19 and viral outbreaks","authors":"A. Orea-Tejeda, Ó. Martínez-Reyna, D. González-Islas, R. Hernández-Zenteno, R. Sánchez-Santillán, A. Flores-Vargas, A. Ibarra-Fernández, Ilse Pérez-García, Justino Pineda-Regalado, J. Orozco-Gutíerrez","doi":"10.29390/cjrt-2021-042","DOIUrl":"https://doi.org/10.29390/cjrt-2021-042","url":null,"abstract":"Introduction Lower respiratory tract infections remain the deadliest communicable disease worldwide. The relationship between cardiovascular diseases and viral infections is well known; for example, during the AH1N1 influenza pandemic, many patients developed acute cardiovascular disease. In the SARS-CoV2 pandemic, cardiovascular health has again become a challenge, with early reports showing cardiac damage in these patients. Objective The study aims to describe the clinical characteristics of COVID-19 patients with an emphasis on cardiovascular compromises, compared with past outbreaks of influenza AH1N1, to identify prognostic factors of severity. Methods A cross-sectional study of 72 subjects with a confirmed diagnosis of COVID-19 was conducted. Subjects were evaluated in two groups: 38 hospitalized patients and 34 patients in the Intensive Care Unit (ICU). Data from different outbreaks of influenza AH1N1 were then compared with this group. Results The 34 subjects in the ICU had higher levels of high sensible troponin, D dimer, creatinine, and leukocytes compared with the 38 hospitalized subjects. The lymphocytes count was diminished in 85.29% of ICU subjects. When compared with AH1N1 patients, it was found that SARS-CoV2 patients were 10 years older on average. The proportion of overweight and obese SARS-CoV2 patients was double that in the influenza outbreaks. In addition, it was observed that a high number of SARS-CoV2 subjects presented with diabetes mellitus. Conclusion There were various clinical and severity differences between each of these outbreaks. However, viral respiratory infection diseases such as SARS-CoV2 are a significant risk factor for acute ischemic, functional, and structural cardiovascular complications. The only way to combat this risk is a prevention approach, specifically through vaccines, but also through measures that force drastic changes in health policies to reduce perhaps the worst of pandemics, obesity, and its metabolic consequences.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":"400 1","pages":"39 - 43"},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84846358","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 Management of Long COVID (LC) is hugely challenging for clinicians. This pilot study evaluated a breathing retraining and singing programme (SingStrong for LC) to address common LC symptoms. The study hypothesized that this intervention would improve symptoms impacting disordered breathing and participant wellbeing. Methods The 10-week, bi-weekly online programme was comprised of a 45-min class of mindfulness, breathing retraining, vocal exercises, and singing. Sessions were recorded for non-attenders and conducted by a trained vocal coach experienced in respiratory cohorts. Persons with a confirmed COVID-19 diagnosis and persisting symptoms were invited to participate. Demographic and COVID-19 data were collected, and the DePaul Symptom Questionnaire Short Form (DSQ- SF) and COVID-19 Yorkshire Rehab Screen questionnaires were administered. Post-intervention focus groups were also conducted. Results Of 27 (F = 23(85%)) participants recruited, data from 21 who completed at least 10 (50%) classes were analysed. Participants showed significant pre–post-intervention improvements in all breathlessness symptoms (at rest: P < 0.001; dressing: P = 0.01; stairs: P < 0.001), fatigue (P = 0.03), usual activities (P = 0.04), pain/disability (P = 0.03), voice quality (P = 0.01), and communication/cognition (P = 0.04). Pre–post number of instances meeting DSQ-SF criteria for myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) decreased by a net of nine cases (14.3%). No association between COVID-19 hospitalisation status and diagnosis of ME/CFS was identified. Qualitative feedback from eight participants was overwhelmingly positive with all reporting improvements in breathing and general well-being. Conclusion The SingStrong programme shows promise as a viable treatment option for LC sufferers. Future studies are required to further investigate the efficacy of this intervention.
{"title":"SingStrong—A singing and breathing retraining intervention for respiratory and other common symptoms of long COVID: A pilot study","authors":"R. Cahalan, Ciara Meade, Sarah Mockler","doi":"10.29390/cjrt-2021-074","DOIUrl":"https://doi.org/10.29390/cjrt-2021-074","url":null,"abstract":"Background Management of Long COVID (LC) is hugely challenging for clinicians. This pilot study evaluated a breathing retraining and singing programme (SingStrong for LC) to address common LC symptoms. The study hypothesized that this intervention would improve symptoms impacting disordered breathing and participant wellbeing. Methods The 10-week, bi-weekly online programme was comprised of a 45-min class of mindfulness, breathing retraining, vocal exercises, and singing. Sessions were recorded for non-attenders and conducted by a trained vocal coach experienced in respiratory cohorts. Persons with a confirmed COVID-19 diagnosis and persisting symptoms were invited to participate. Demographic and COVID-19 data were collected, and the DePaul Symptom Questionnaire Short Form (DSQ- SF) and COVID-19 Yorkshire Rehab Screen questionnaires were administered. Post-intervention focus groups were also conducted. Results Of 27 (F = 23(85%)) participants recruited, data from 21 who completed at least 10 (50%) classes were analysed. Participants showed significant pre–post-intervention improvements in all breathlessness symptoms (at rest: P < 0.001; dressing: P = 0.01; stairs: P < 0.001), fatigue (P = 0.03), usual activities (P = 0.04), pain/disability (P = 0.03), voice quality (P = 0.01), and communication/cognition (P = 0.04). Pre–post number of instances meeting DSQ-SF criteria for myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) decreased by a net of nine cases (14.3%). No association between COVID-19 hospitalisation status and diagnosis of ME/CFS was identified. Qualitative feedback from eight participants was overwhelmingly positive with all reporting improvements in breathing and general well-being. Conclusion The SingStrong programme shows promise as a viable treatment option for LC sufferers. Future studies are required to further investigate the efficacy of this intervention.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":"78 1","pages":"20 - 27"},"PeriodicalIF":0.0,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88233183","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}
C. Kappel, D. Chaudhuri, K. Hassall, Shannon Theune, Sameer Sharif, W. Alhazzani, Kimberley A. Lewis
Introduction Point-of-care ultrasound (POCUS), although commonly used in clinical practice, is not currently included in training programs for respiratory therapists (RTs). In fact, given its ubiquity and clinical utility, RTs in Ontario, Canada, are changing their mandate to incorporate POCUS into their daily patient assessment. Therefore, we conducted a scoping review of the literature, aiming to describe the current evidence of POCUS training and methods of curriculum delivery for RTs to inform an evidence-based program design. Method We systematically searched MEDLINE, EMBASE, CINAHL, and Web of Science from inception to 8 July 2020. We included all studies reporting on RT training in POCUS. Documents included English language, full-text reports of all study designs. Title and abstract screening, full-text review, and data abstraction were done independently and in duplicate. Results Seven studies met our inclusion criteria, including four full texts and three abstracts; all were prospective and single-center studies, except one multicenter study. Reports were from nine different countries. Studies described cardiac, lung, and procedural ultrasonography use. The majority used a combination of educational methods; didactic talks, hands-on sessions, and practical assessments being the most common methods. There was a median of 11 participants enrolled in a training session. The instructors were physicians from various specialties such as critical care, pulmonology, and radiology. Conclusions This scoping review identified seven papers that explored different methods of a POCUS curriculum delivery for RTs. From the interventions outlined, teaching POCUS skills to RTs seems feasible. However, further work needs to be done to solidify a POCUS curriculum specific to RTs and examine the impact on patient-related outcomes.
即时超声(POCUS)虽然在临床实践中被广泛使用，但目前还没有被纳入呼吸治疗师(RTs)的培训计划。事实上，考虑到POCUS的普遍性和临床实用性，加拿大安大略省的RTs正在改变他们的任务，将POCUS纳入他们的日常患者评估中。因此，我们对文献进行了范围综述，旨在描述POCUS培训的当前证据和RTs课程交付方法，以为循证课程设计提供信息。方法系统检索MEDLINE、EMBASE、CINAHL、Web of Science自建站至2020年7月8日。我们纳入了所有报道POCUS中RT训练的研究。文献包括所有研究设计的英文、全文报告。题目和摘要筛选、全文审查和数据提取独立完成，一式两份。结果7项研究符合我们的纳入标准，包括4篇全文和3篇摘要;除一项多中心研究外，所有研究均为前瞻性单中心研究。报告来自九个不同的国家。研究描述了心脏、肺和程序超声检查的使用。大多数人采用综合的教育方法;说教式讲座、动手环节和实际评估是最常见的方法。参加培训课程的平均人数为11人。指导员是来自不同专业的医生，如重症监护、肺科和放射科。本综述确定了7篇论文，探讨了针对RTs的POCUS课程交付的不同方法。从上述干预措施来看，向RTs教授POCUS技能似乎是可行的。然而，需要进一步的工作来巩固针对RTs的POCUS课程，并检查其对患者相关结果的影响。
{"title":"Point-of-care ultrasound training for respiratory therapists: A scoping review","authors":"C. Kappel, D. Chaudhuri, K. Hassall, Shannon Theune, Sameer Sharif, W. Alhazzani, Kimberley A. Lewis","doi":"10.29390/cjrt-2021-065","DOIUrl":"https://doi.org/10.29390/cjrt-2021-065","url":null,"abstract":"Introduction Point-of-care ultrasound (POCUS), although commonly used in clinical practice, is not currently included in training programs for respiratory therapists (RTs). In fact, given its ubiquity and clinical utility, RTs in Ontario, Canada, are changing their mandate to incorporate POCUS into their daily patient assessment. Therefore, we conducted a scoping review of the literature, aiming to describe the current evidence of POCUS training and methods of curriculum delivery for RTs to inform an evidence-based program design. Method We systematically searched MEDLINE, EMBASE, CINAHL, and Web of Science from inception to 8 July 2020. We included all studies reporting on RT training in POCUS. Documents included English language, full-text reports of all study designs. Title and abstract screening, full-text review, and data abstraction were done independently and in duplicate. Results Seven studies met our inclusion criteria, including four full texts and three abstracts; all were prospective and single-center studies, except one multicenter study. Reports were from nine different countries. Studies described cardiac, lung, and procedural ultrasonography use. The majority used a combination of educational methods; didactic talks, hands-on sessions, and practical assessments being the most common methods. There was a median of 11 participants enrolled in a training session. The instructors were physicians from various specialties such as critical care, pulmonology, and radiology. Conclusions This scoping review identified seven papers that explored different methods of a POCUS curriculum delivery for RTs. From the interventions outlined, teaching POCUS skills to RTs seems feasible. However, further work needs to be done to solidify a POCUS curriculum specific to RTs and examine the impact on patient-related outcomes.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":"37 1","pages":"28 - 33"},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83219182","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}
Purpose To develop, internally validate, and assess the utility of implementing a regression model for determining endotracheal tube (ETT) insertion depth. Research methods We recorded height, weight, age, sex, ETT internal diameter (ID), lip marking, and tracheal position from the electronic record from a random subset of 2,000 intubated subjects obtained from 1 January 2009 to 5 May 2012. A multivariable linear regression model was constructed and validated by a nonparametric bootstrapping technique using unrestricted random sampling methods. A prospective pilot of subjects admitted to the pediatric intensive care unit requiring invasive mechanical ventilatory support was conducted from 7 January 2019 to 31 May 2019. Those with spinal and/or skeletal malformations, without a post-intubation chest-x-ray (CXR) order, or whose CXR quality impaired visualizing the carina and ETT tip, were excluded. The validated regression equation determined insertion depth. CXR following intubation determined ETT position. Demographic data were summarized. Two-tailed, one-sample binomial test of proportions assessed differences in the proportion of correct position by the equation. Main findings Four hundred and seventy-seven subjects included in model construction yielded 10,000 independent samples for internal validation; 55% were female, and the mean age (SD) was 47 (63) months. Bias between bootstrap coefficients and refined model estimates were negligible (P < 0.01). Eleven subjects in the pilot were female (64%), mean age (SD) of 36.7 (38) months. Four protocol violations (36.4%) resulted in malposition. Subsequent repositioning per protocol resulted in 100% correct positioning (P = 0.01). Conclusion The regression equation [0.8636 * (Ht. 0.6223)] facilitated correct ETT placement. A larger, diverse sample is required for external model validation.
{"title":"Development and internal validation of an equation using anthropometric measures to predict correct endotracheal tube insertion depth","authors":"T. Volsko, N. McNinch, Christopher K. Page-Goertz","doi":"10.29390/cjrt-2021-068","DOIUrl":"https://doi.org/10.29390/cjrt-2021-068","url":null,"abstract":"Purpose To develop, internally validate, and assess the utility of implementing a regression model for determining endotracheal tube (ETT) insertion depth. Research methods We recorded height, weight, age, sex, ETT internal diameter (ID), lip marking, and tracheal position from the electronic record from a random subset of 2,000 intubated subjects obtained from 1 January 2009 to 5 May 2012. A multivariable linear regression model was constructed and validated by a nonparametric bootstrapping technique using unrestricted random sampling methods. A prospective pilot of subjects admitted to the pediatric intensive care unit requiring invasive mechanical ventilatory support was conducted from 7 January 2019 to 31 May 2019. Those with spinal and/or skeletal malformations, without a post-intubation chest-x-ray (CXR) order, or whose CXR quality impaired visualizing the carina and ETT tip, were excluded. The validated regression equation determined insertion depth. CXR following intubation determined ETT position. Demographic data were summarized. Two-tailed, one-sample binomial test of proportions assessed differences in the proportion of correct position by the equation. Main findings Four hundred and seventy-seven subjects included in model construction yielded 10,000 independent samples for internal validation; 55% were female, and the mean age (SD) was 47 (63) months. Bias between bootstrap coefficients and refined model estimates were negligible (P < 0.01). Eleven subjects in the pilot were female (64%), mean age (SD) of 36.7 (38) months. Four protocol violations (36.4%) resulted in malposition. Subsequent repositioning per protocol resulted in 100% correct positioning (P = 0.01). Conclusion The regression equation [0.8636 * (Ht. 0.6223)] facilitated correct ETT placement. A larger, diverse sample is required for external model validation.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":"IA-20 1","pages":"9 - 14"},"PeriodicalIF":0.0,"publicationDate":"2022-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84601541","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}
E. Lam, S. Paz, Dominique Goddard-Harte, Yosif N. Pak, Joshua Fogel, S. Rubinstein
Introduction/Background Patients with Coronavirus Disease 2019 (COVID-19) present with a spectrum of respiratory symptoms. There are no studies describing respiratory system involvement adjusted for other organ systems, oxygen saturation nadir, hospitalization days until respiratory involvement, proportion of days of respiratory system involvement, and persistent respiratory involvement at discharge in COVID-19 patients. We studied these parameters in COVID-19 patients that received respiratory therapy interventions and their association with mortality and length of stay (LOS). Methods A single-center cross-sectional retrospective study of 738 COVID-19 patients with respiratory involvement at a hospital in the New York metropolitan area. Results COVID-19 patients with respiratory involvement had increased mortality with oxygen requirement of FiO2 >55% (OR:39.02, 95% CI:1.59–960.51, P < 0.05) and mechanical ventilation (OR:236.64, 95% CI:8.24–6798.93, P < 0.01). Respiratory system involvement adjusted for other organ system involvement was associated with increased mortality (OR:1.60, 95% CI:1.20, 2.14, P < 0.01) and LOS (B = 0.02, SE = 0.01, P < 0.01). Oxygen saturation nadir of 70%–89% was significantly associated with increased LOS (B = 0.07, SE = 0.03, P < 0.05), whereas oxygen saturation nadir of <70% was associated with increased mortality (OR:12.95, 95% CI:2.72–61.61, P < 0.01). An increased proportion of days in hospital with respiratory system involvement was associated with decreased mortality (OR:0.004, 95% CI:<0.001–0.06, P < 0.001) and increased LOS (B = 0.90, SE = 0.07, P < 0.001). Respiratory involvement on days 4–7 was associated with decreased mortality (OR:0.02, 95% CI:<0.003–0.17, P < 0.001), and respiratory involvement on day >1 was associated with increased LOS. Respiratory involvement persistent at discharge was associated with increased mortality (OR:56.82, 95%CI:18.51–174.43, P < 0.001). Conclusions Among all respiratory parameters, high oxygen requirements and low oxygen saturation nadir are the most predictive of COVID-19 prognosis.
2019冠状病毒病(COVID-19)患者表现出一系列呼吸道症状。没有研究描述COVID-19患者经其他器官系统调整后的呼吸系统受累、血氧饱和度最低点、住院至呼吸受累天数、呼吸系统受累天数比例和出院时持续呼吸受累。我们研究了接受呼吸治疗干预的COVID-19患者的这些参数及其与死亡率和住院时间(LOS)的关系。方法对纽约市区某医院738例新冠肺炎累及呼吸系统患者进行单中心横断面回顾性研究。结果新冠肺炎累及呼吸系统患者FiO2耗氧量为55% (OR:39.02, 95% CI:1.59 ~ 960.51, P < 0.05)和机械通气(OR:236.64, 95% CI:8.24 ~ 6798.93, P < 0.01)时死亡率增加。经其他器官系统受累调整后的呼吸系统受累与死亡率(OR:1.60, 95% CI:1.20, 2.14, P < 0.01)和LOS (B = 0.02, SE = 0.01, P < 0.01)增加相关。血氧饱和度最低为70% ~ 89%与LOS升高有显著相关性(B = 0.07, SE = 0.03, P < 0.05)，血氧饱和度最低为1与LOS升高有显著相关性。出院时持续呼吸受累与死亡率增加相关(OR:56.82, 95%CI: 18.51-174.43, P < 0.001)。结论在所有呼吸参数中，高需氧量和低血氧饱和度最能预测COVID-19的预后。
{"title":"Respiratory involvement parameters in hospitalized COVID-19 patients and their association with mortality and length of stay","authors":"E. Lam, S. Paz, Dominique Goddard-Harte, Yosif N. Pak, Joshua Fogel, S. Rubinstein","doi":"10.29390/cjrt-2021-057","DOIUrl":"https://doi.org/10.29390/cjrt-2021-057","url":null,"abstract":"Introduction/Background Patients with Coronavirus Disease 2019 (COVID-19) present with a spectrum of respiratory symptoms. There are no studies describing respiratory system involvement adjusted for other organ systems, oxygen saturation nadir, hospitalization days until respiratory involvement, proportion of days of respiratory system involvement, and persistent respiratory involvement at discharge in COVID-19 patients. We studied these parameters in COVID-19 patients that received respiratory therapy interventions and their association with mortality and length of stay (LOS). Methods A single-center cross-sectional retrospective study of 738 COVID-19 patients with respiratory involvement at a hospital in the New York metropolitan area. Results COVID-19 patients with respiratory involvement had increased mortality with oxygen requirement of FiO2 >55% (OR:39.02, 95% CI:1.59–960.51, P < 0.05) and mechanical ventilation (OR:236.64, 95% CI:8.24–6798.93, P < 0.01). Respiratory system involvement adjusted for other organ system involvement was associated with increased mortality (OR:1.60, 95% CI:1.20, 2.14, P < 0.01) and LOS (B = 0.02, SE = 0.01, P < 0.01). Oxygen saturation nadir of 70%–89% was significantly associated with increased LOS (B = 0.07, SE = 0.03, P < 0.05), whereas oxygen saturation nadir of <70% was associated with increased mortality (OR:12.95, 95% CI:2.72–61.61, P < 0.01). An increased proportion of days in hospital with respiratory system involvement was associated with decreased mortality (OR:0.004, 95% CI:<0.001–0.06, P < 0.001) and increased LOS (B = 0.90, SE = 0.07, P < 0.001). Respiratory involvement on days 4–7 was associated with decreased mortality (OR:0.02, 95% CI:<0.003–0.17, P < 0.001), and respiratory involvement on day >1 was associated with increased LOS. Respiratory involvement persistent at discharge was associated with increased mortality (OR:56.82, 95%CI:18.51–174.43, P < 0.001). Conclusions Among all respiratory parameters, high oxygen requirements and low oxygen saturation nadir are the most predictive of COVID-19 prognosis.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":"50 1","pages":"1 - 8"},"PeriodicalIF":0.0,"publicationDate":"2022-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87404294","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}
{"title":"MESSAGE FROM THE EDITOR-IN-CHIEF","authors":"Elizabeth Rohrs","doi":"10.29390/cjrt-2021-080","DOIUrl":"https://doi.org/10.29390/cjrt-2021-080","url":null,"abstract":"","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":"33 1","pages":"167 - 167"},"PeriodicalIF":0.0,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76352896","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 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia may necessitate intubation and prolonged mechanical ventilation. Early in the course of mechanical ventilation neuromuscular blocking agents may be used to allow synchronous lung protective ventilation. However, patients with SARS-CoV-2 pneumonia tend to have an intense respiratory drive resulting in patient–ventilator asynchrony when neuromuscular blocking agents are discontinued. Case and Outcomes A 75-year-old male was admitted to the hospital with SARS-CoV-2 pneumonia requiring invasive mechanical ventilation. By ventilator day 5 the neuromuscular blocking agent had been discontinued, and the patient was markedly asynchronous in the volume control mode despite receiving continuous intravenous sedatives. The ventilator mode was changed to the neurally adjusted ventilatory assist (NAVA) mode. Initially NAVA resulted in improved synchrony and reduced work of breathing. However, a few days later the patient’s tidal volume had fallen to <300 mL on NAVA despite increases in the NAVA level. It appeared that the inspiratory phase was prematurely terminating, and the expiratory threshold in NAVA is not adjustable. The ventilator mode was changed to pressure support resulting in an increased tidal volume and reduced respiratory frequency. Conclusion In patients with SARS-CoV-2 pneumonia and intense respiratory drive, the performance of NAVA may be variable. NAVA may result in hypopnea and tachypnea when compared with pressure support. An assessment of the impact of an adjustable expiratory threshold in NAVA is warranted.
{"title":"Use of neurally adjusted ventilatory assist (NAVA) in a patient with severe SARS-CoV-2 pneumonia: A case report","authors":"J. Haynes","doi":"10.29390/cjrt-2021-017","DOIUrl":"https://doi.org/10.29390/cjrt-2021-017","url":null,"abstract":"Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia may necessitate intubation and prolonged mechanical ventilation. Early in the course of mechanical ventilation neuromuscular blocking agents may be used to allow synchronous lung protective ventilation. However, patients with SARS-CoV-2 pneumonia tend to have an intense respiratory drive resulting in patient–ventilator asynchrony when neuromuscular blocking agents are discontinued. Case and Outcomes A 75-year-old male was admitted to the hospital with SARS-CoV-2 pneumonia requiring invasive mechanical ventilation. By ventilator day 5 the neuromuscular blocking agent had been discontinued, and the patient was markedly asynchronous in the volume control mode despite receiving continuous intravenous sedatives. The ventilator mode was changed to the neurally adjusted ventilatory assist (NAVA) mode. Initially NAVA resulted in improved synchrony and reduced work of breathing. However, a few days later the patient’s tidal volume had fallen to <300 mL on NAVA despite increases in the NAVA level. It appeared that the inspiratory phase was prematurely terminating, and the expiratory threshold in NAVA is not adjustable. The ventilator mode was changed to pressure support resulting in an increased tidal volume and reduced respiratory frequency. Conclusion In patients with SARS-CoV-2 pneumonia and intense respiratory drive, the performance of NAVA may be variable. NAVA may result in hypopnea and tachypnea when compared with pressure support. An assessment of the impact of an adjustable expiratory threshold in NAVA is warranted.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":"13 1","pages":"90 - 92"},"PeriodicalIF":0.0,"publicationDate":"2021-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81985246","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}
Goel Vibha, V. Saluja, Mitra Lalita Gouri, K. Guresh, Aggarwal Prashant, M. Rakhi
Background Mechanical ventilation in cirrhosis with acute respiratory distress syndrome (ARDS) is not widely studied. We aimed to study the effect of the staircase recruitment manoeuvre followed by two different modes of ventilation. Methods Thirty patients with cirrhosis with moderate ARDS underwent the staircase recruitment manoeuvre followed by randomisation to volume control or pressure control group. Results The PaO2/FiO2 ratio showed a significant improvement in both the groups after recruitment. The improvement was significantly higher in the pressure control ventilation (PCV) group at the end of the first hour as compared to the volume control ventilation (VCV) group. However, this difference was not significant at the end of 6 and 12 h. In the PCV group it improved from 118.47 ± 10.21 at baseline to 189.87 ± 55.18 12 h post-recruitment. In the VCV group it improved from 113.79 ± 13.22 at baseline to 180.93 ± 81.971. Static lung compliance also improved in both the groups significantly (P < 0.001). The PCV group showed an improvement from 25.42 ± 11.94 mL/cm H2O at baseline to 29.51 ± 14.58 mL/cm H2O. In the VCV group the lung compliance improved from 24.78 ± 4.87 mL/cm H2O to 31.31 ± 10.88 mL/cm H2O. Conclusion This study shows that stepwise recruitment manoeuvre is an effective rescue therapy to improve oxygenation in cirrhosis with moderate ARDS. PCV may have an advantage over VCV in terms of better oxygenation.
{"title":"Efficacy and safety of an open lung ventilation strategy with staircase recruitment followed by comparison on two different modes of ventilation, in moderate ARDS in cirrhosis: A pilot randomized trial","authors":"Goel Vibha, V. Saluja, Mitra Lalita Gouri, K. Guresh, Aggarwal Prashant, M. Rakhi","doi":"10.29390/cjrt-2021-011","DOIUrl":"https://doi.org/10.29390/cjrt-2021-011","url":null,"abstract":"Background Mechanical ventilation in cirrhosis with acute respiratory distress syndrome (ARDS) is not widely studied. We aimed to study the effect of the staircase recruitment manoeuvre followed by two different modes of ventilation. Methods Thirty patients with cirrhosis with moderate ARDS underwent the staircase recruitment manoeuvre followed by randomisation to volume control or pressure control group. Results The PaO2/FiO2 ratio showed a significant improvement in both the groups after recruitment. The improvement was significantly higher in the pressure control ventilation (PCV) group at the end of the first hour as compared to the volume control ventilation (VCV) group. However, this difference was not significant at the end of 6 and 12 h. In the PCV group it improved from 118.47 ± 10.21 at baseline to 189.87 ± 55.18 12 h post-recruitment. In the VCV group it improved from 113.79 ± 13.22 at baseline to 180.93 ± 81.971. Static lung compliance also improved in both the groups significantly (P < 0.001). The PCV group showed an improvement from 25.42 ± 11.94 mL/cm H2O at baseline to 29.51 ± 14.58 mL/cm H2O. In the VCV group the lung compliance improved from 24.78 ± 4.87 mL/cm H2O to 31.31 ± 10.88 mL/cm H2O. Conclusion This study shows that stepwise recruitment manoeuvre is an effective rescue therapy to improve oxygenation in cirrhosis with moderate ARDS. PCV may have an advantage over VCV in terms of better oxygenation.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":"7 1","pages":"105 - 112"},"PeriodicalIF":0.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84692368","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. Doucet, T. Fournier, C. Bishop, Derek J. Gaudet, Daniel A Nagel
Background With the increasing prevalence of chronic pulmonary conditions in New Brunswick and Canada it is necessary to consider innovative interventions to improve access to rehabilitation and supportive care for affected clients. In Fall 2018 we piloted a pulmonary rehabilitation (PR) program for persons with moderate to severe chronic obstructive pulmonary disease (COPD) to demonstrate a novel approach of bridging interprofessional education of students in health care fields with provision of care in a community setting. Methods An 8-week PR program was implemented and evaluated using a quasi-experimental design with pre- and post-testing to measure the effects of the program’s exercise and educational interventions on persons with COPD. Participants were assessed using the 6-Minute Walk Test (6MWT), the St. George’s Respiratory Questionnaire (SGRQ), and a custom questionnaire that rated the participants’ activities of daily living and the PR program. Results Seven participants completed our PR program. Following the intervention, participants’ self-reported health demonstrated a statistically significant improvement. Even though changes on the 6MWT and SGRQ were not shown to be statistically significant, there was evidence of clinically meaningful improvements in those measures. On average, participants walked 25 m further postintervention and showed clinically meaningful improvements on the SGRQ. Conclusions This pilot project demonstrated that a community-based PR program with active involvement of students from multiple health care programs can have positive outcomes for clients with COPD. It also illustrated how educational programs can provide an innovative means for increasing access to rehabilitation and supportive care for clients in the community.
{"title":"Pilot of a community-based interprofessional “student-infused” pulmonary rehabilitation program in Saint John, New Brunswick","authors":"J. Doucet, T. Fournier, C. Bishop, Derek J. Gaudet, Daniel A Nagel","doi":"10.29390/cjrt-2020-053","DOIUrl":"https://doi.org/10.29390/cjrt-2020-053","url":null,"abstract":"Background With the increasing prevalence of chronic pulmonary conditions in New Brunswick and Canada it is necessary to consider innovative interventions to improve access to rehabilitation and supportive care for affected clients. In Fall 2018 we piloted a pulmonary rehabilitation (PR) program for persons with moderate to severe chronic obstructive pulmonary disease (COPD) to demonstrate a novel approach of bridging interprofessional education of students in health care fields with provision of care in a community setting. Methods An 8-week PR program was implemented and evaluated using a quasi-experimental design with pre- and post-testing to measure the effects of the program’s exercise and educational interventions on persons with COPD. Participants were assessed using the 6-Minute Walk Test (6MWT), the St. George’s Respiratory Questionnaire (SGRQ), and a custom questionnaire that rated the participants’ activities of daily living and the PR program. Results Seven participants completed our PR program. Following the intervention, participants’ self-reported health demonstrated a statistically significant improvement. Even though changes on the 6MWT and SGRQ were not shown to be statistically significant, there was evidence of clinically meaningful improvements in those measures. On average, participants walked 25 m further postintervention and showed clinically meaningful improvements on the SGRQ. Conclusions This pilot project demonstrated that a community-based PR program with active involvement of students from multiple health care programs can have positive outcomes for clients with COPD. It also illustrated how educational programs can provide an innovative means for increasing access to rehabilitation and supportive care for clients in the community.","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":"52 1","pages":"26 - 31"},"PeriodicalIF":0.0,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89541418","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}
{"title":"Publication of study protocols in the CJRT","authors":"J. Sorge","doi":"10.29390/cjrt-2020-048","DOIUrl":"https://doi.org/10.29390/cjrt-2020-048","url":null,"abstract":"","PeriodicalId":9533,"journal":{"name":"Canadian Journal of Respiratory Therapy: CJRT = Revue Canadienne de la Thérapie Respiratoire : RCTR","volume":"68 1","pages":"v - v"},"PeriodicalIF":0.0,"publicationDate":"2020-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73850352","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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