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RESPIRATORY DISEASES (102 journals)                     

Showing 1 - 102 of 102 Journals sorted alphabetically
Advances in Respiratory Medicine     Open Access   (Followers: 7)
American Journal of Respiratory and Critical Care Medicine     Full-text available via subscription   (Followers: 257)
American Journal of Respiratory Cell and Molecular Biology     Full-text available via subscription   (Followers: 20)
American Review of Respiratory Disease     Full-text available via subscription   (Followers: 4)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 17)
Annals of Thoracic Medicine     Open Access   (Followers: 6)
Archivos de Bronconeumología     Full-text available via subscription  
Archivos de Bronconeumología (English Edition)     Full-text available via subscription   (Followers: 1)
Asthma Research and Practice     Open Access   (Followers: 1)
BMC Pulmonary Medicine     Open Access   (Followers: 5)
BMJ Open Respiratory Research     Open Access   (Followers: 6)
Breathe     Open Access   (Followers: 4)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 1)
Canadian Respiratory Journal     Open Access   (Followers: 3)
Case Reports in Pulmonology     Open Access   (Followers: 3)
Chest     Full-text available via subscription   (Followers: 101)
Chest Disease Reports     Open Access   (Followers: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9)
Clinical Lung Cancer     Hybrid Journal   (Followers: 6)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3)
Clinical Pulmonary Medicine     Hybrid Journal   (Followers: 2)
COPD Research and Practice     Open Access   (Followers: 1)
COPD: Journal of Chronic Obstructive Pulmonary Disease     Hybrid Journal   (Followers: 15)
Current Opinion in Pulmonary Medicine     Hybrid Journal   (Followers: 10)
Current Pulmonology Reports     Hybrid Journal  
Current Research in Tuberculosis     Open Access   (Followers: 3)
Current Respiratory Care Reports     Hybrid Journal   (Followers: 1)
Current Respiratory Medicine Reviews     Hybrid Journal   (Followers: 5)
Der Pneumologe     Hybrid Journal   (Followers: 1)
Egyptian Journal of Chest Diseases and Tuberculosis     Open Access   (Followers: 3)
ERJ Open Research     Open Access   (Followers: 3)
Eurasian Journal of Pulmonology     Open Access  
European Clinical Respiratory Journal     Open Access   (Followers: 3)
European Respiratory Journal     Full-text available via subscription   (Followers: 39)
European Respiratory Review     Open Access   (Followers: 7)
Experimental Lung Research     Hybrid Journal  
Expert Review of Respiratory Medicine     Hybrid Journal   (Followers: 5)
Heart & Lung: The Journal of Acute and Critical Care     Hybrid Journal   (Followers: 13)
Heart, Lung and Circulation     Full-text available via subscription   (Followers: 9)
Indian Journal of Respiratory Care     Open Access   (Followers: 3)
Indian Journal of Tuberculosis     Full-text available via subscription  
Influenza and Other Respiratory Viruses     Open Access   (Followers: 3)
International Journal of Chronic Obstructive Pulmonary Disease     Open Access   (Followers: 3)
Journal of Association of Chest Physicians     Open Access   (Followers: 2)
Journal of Asthma     Hybrid Journal   (Followers: 4)
Journal of Asthma Allergy Educators     Hybrid Journal   (Followers: 4)
Journal of Bronchology & Interventional Pulmonology     Hybrid Journal   (Followers: 4)
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases     Open Access  
Journal of Heart and Lung Transplantation     Hybrid Journal   (Followers: 12)
Journal of Respiratory Medicine     Open Access   (Followers: 4)
Journal of Respiratory Research     Open Access   (Followers: 1)
Journal of Tuberculosis Research     Open Access   (Followers: 1)
Jurnal Respirasi     Open Access  
Karger Kompass Pneumologie     Full-text available via subscription   (Followers: 1)
Kindheit und Entwicklung     Hybrid Journal  
Lung     Hybrid Journal   (Followers: 2)
Lung Cancer     Hybrid Journal   (Followers: 16)
Lung Cancer International     Open Access   (Followers: 2)
Lung Cancer: Targets and Therapy     Open Access   (Followers: 3)
Lung India     Open Access   (Followers: 1)
Multidisciplinary Respiratory Medicine     Open Access   (Followers: 4)
npj Primary Care Respiratory Medicine     Open Access   (Followers: 2)
Open Journal of Respiratory Diseases     Open Access   (Followers: 1)
Open Respiratory Medicine Journal     Open Access   (Followers: 1)
Paediatric Respiratory Reviews     Hybrid Journal   (Followers: 11)
Pediatric Quality & Safety     Open Access  
Pediatric Respirology and Critical Care Medicine     Open Access   (Followers: 1)
Pulmonary Circulation     Open Access   (Followers: 4)
Pulmonary Medicine     Open Access   (Followers: 2)
Pulmonary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 2)
Pulmonary Therapy     Open Access   (Followers: 1)
Pulmonology and Respiratory Research     Open Access   (Followers: 1)
Respiratory Care     Full-text available via subscription   (Followers: 10)
Respiratory Investigation     Full-text available via subscription  
Respiratory Medicine     Hybrid Journal   (Followers: 18)
Respiratory Medicine : X     Open Access  
Respiratory Medicine Case Reports     Open Access  
Respiratory Medicine CME     Hybrid Journal  
Respiratory Medicine Extra     Full-text available via subscription   (Followers: 1)
Respiratory Physiology & Neurobiology     Hybrid Journal   (Followers: 4)
Respiratory Research     Open Access   (Followers: 1)
Respirology     Hybrid Journal   (Followers: 5)
Respirology Case Reports     Open Access  
Revista Americana de Medicina Respiratoria     Open Access  
Revista Chilena de Enfermedades Respiratorias     Open Access  
Revista Inspirar     Open Access  
Revista ORL     Open Access  
Revista Portuguesa de Pneumologia     Open Access  
Sarcoidosis Vasculitis and Diffuse Lung Disese     Full-text available via subscription   (Followers: 3)
Seminars in Respiratory and Critical Care Medicine     Hybrid Journal   (Followers: 14)
Sleep Medicine Reviews     Hybrid Journal   (Followers: 18)
The Clinical Respiratory Journal     Hybrid Journal   (Followers: 3)
The International Journal of Tuberculosis and Lung Disease     Full-text available via subscription   (Followers: 8)
The Lancet Respiratory Medicine     Full-text available via subscription   (Followers: 33)
Therapeutic Advances in Chronic Disease     Open Access   (Followers: 7)
Therapeutic Advances in Respiratory Disease     Open Access   (Followers: 1)
Thorax     Hybrid Journal   (Followers: 38)
Translational Respiratory Medicine     Open Access   (Followers: 1)
Tuberculosis     Hybrid Journal   (Followers: 12)
Tuberculosis Research and Treatment     Open Access   (Followers: 3)
Пульмонология     Full-text available via subscription  


Similar Journals
Journal Cover
Respiratory Care
Journal Prestige (SJR): 0.971
Citation Impact (citeScore): 2
Number of Followers: 10  
  Full-text available via subscription Subscription journal
ISSN (Print) 0020-1324 - ISSN (Online) 1943-3654
Published by American Association for Respiratory Care Homepage  [1 journal]
  • Editor's Commentary
    • PubDate: 2020-01-27T01:24:22-08:00
      Issue No: Vol. 65, No. 2 (2020)
  • Long-Term Mechanical Insufflation-Exsufflation Cough Assistance in
           Neuromuscular Disease: Patterns of Use and Lessons for Application
    • Authors: Michelle Chatwin; Anita K Simonds
      Pages: 135 - 143
      Abstract: BACKGROUND:Mechanical insufflation-exsufflation (MI-E) devices increase expiratory air flow and thereby promote increased cough peak flow (CPF) in conjunction with a cough. There is little research looking at long-term use of MI-E in subjects with neuromuscular disease (NMD), and no long-term study has reported CPF, MI-E device settings, and adherence.METHODS:We evaluated 181 patient records (130 adults, 51 children) of individuals who received a MI-E device from our center between February 2014 and February 2018. Median age (interquartile range [IQR]) was 27 (14–51) y. Duchenne muscular dystrophy (DMD), spinal muscular atrophy (SMA), and amyotrophic lateral sclerosis (ALS) were the 3 most common diagnoses.RESULTS:MI-E devices were provided to the weakest subjects with a CPF < 160 L/min. Median (IQR) settings were insufflation, 25 (23–30) cm H2O, exsufflation −35 (−30 to −40) cm H2O, insufflation time 1.5 (1.3–1.7) s, exsufflation time 1.8 (1.5–2.0) s, and pause 1.5 (1.3–2.0) s. The inspiratory flow profile was set to high in all subjects, and no subject used supplemental oxygen with the MI-E device. When comparing insufflation pressures to exsufflation pressures, a greater negative pressure was used relative to positive pressure (P < .001). When comparing insufflation to exsufflation time, there was a significantly longer exsufflation duration (P < .001). Median (IQR) CPF at the start of MI-E was 60 (10–100) L/min. There was no correlation between either insufflation or exsufflation pressures and CPF. Median (IQR) usage for the group was 60% (13.5–100%) of days for the total days. Subjects with tracheostomies or SMA type I had the greatest adherence to treatment. Median (IQR) duration of MI-E use was 17 (8.5–32) months. Ninety-six percent of subjects were receiving ventilatory support.CONCLUSIONS:Greater exsufflation pressures than insufflation pressures, together with a shorter insufflation time than exsufflation time, were used. Predicting good adherence among the subjects was difficult. Subjects who produced daily secretions were more likely to use MI-E every day.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.06882
      Issue No: Vol. 65, No. 2 (2020)
  • The Effect of Speaking Valves on ICU Mobility of Individuals With
    • Authors: Camila Ceron; Danielle Otto, Alana Verza Signorini, Marco Colome Beck, Marcio Camilis, Daniel Sganzerla, Regis Goulart Rosa, Cassiano Teixeira
      Pages: 144 - 149
      Abstract: BACKGROUND:Early mobilization is part of the rehabilitation process for critically ill patients and is currently considered a means of preventing ICU-acquired muscle deterioration and worsening of physical function. We sought to determine whether the use of speaking valves in tracheostomized patients would improve their mobility. We evaluated the changes in mobility performance with the use of speaking valves in tracheostomized subjects.METHODS:We performed a cohort study of a series of subjects who were tracheostomized and were being weaned from mechanical ventilation between April 2016 and May 2018. The subjects were those able to tolerate a speaking valve for a minimum of 30 min. Demographic data, comorbidities, cause of ICU admission, days in the ICU, duration of mechanical ventilation before tracheostomy, and days free from mechanical ventilation before tracheostomy were collected. Mobility status was evaluated using daily measurements of the Perme Intensive Care Unit Mobility Score.RESULTS:During the study period, 63 patients were tracheostomized. Patients with deficiencies in language (n = 2) or cognitive deficits (n = 36) and patients in exclusive palliative care (n = 7) were excluded. Eighteen subjects were enrolled in the study. The mean age of the subjects was 64.6 ± 14.2 y (55.5% were male), and the most common reason for ICU admission was pneumonia (n = 7; 38.8%). Perme scores increased from 11.3 (interquartile range 10.1–12.0) on the day before initiation of the speaking valve to 18.2 (IQR 16.2–20.1) immediately after the initiation of a speaking valve (P < .01). These changes were maintained during all periods of speaking valve use.CONCLUSIONS:The use of speaking valves in tracheostomized subjects improved mobility.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.06768
      Issue No: Vol. 65, No. 2 (2020)
  • Physical Exercise Combined With CPAP in Subjects Who Underwent Surgical
           Myocardial Revascularization: A Randomized Clinical Trial
    • Authors: Pollyana Windmoller; Emely Teixeira Bodnar, Julia Casagrande, Fernanda Dallazen, Juliana Schneider, Silvana Agnolleto Berwanger, Audrey Borghi–Silva, Eliane Roseli Winkelmann
      Pages: 150 - 157
      Abstract: BACKGROUND:Aerobic exercise and CPAP benefit patients in the postoperative period of cardiac surgery. To our knowledge, the association of aerobic exercise on an exercise bicycle with CPAP has not yet been demonstrated. Therefore, we aimed to evaluate the effectiveness of physical exercise on a cycle ergometer combined with CPAP in the postoperative period after coronary artery bypass graft surgery.METHODS:This was a randomized clinical trial, with recruitment from May 2017 to December 2017 (registered in the Brazilian Clinical Trials Registry: RBR-69CDYF). The step group (n = 16 subjects) started rehabilitation in the immediate postoperative period with breathing exercises and passive mobilization in the sitting position, progressing to active exercises, ambulation, and stair training. For the intervention group (n = 15 subjects), dynamic exercises on a cycle ergometer combined with CPAP were added to the step program from the second to the fourth postoperative day in a single daily session.RESULTS:Functional capacity decreased in both groups, but this reduction was not significant in the intervention group (P = .11). The length of stay in ICU was lower in the intervention group (P = .050). In both groups there was a decrease in maximum inspiratory and expiratory pressure, as well as in the 1-min sit-to-stand test on the fourth postoperative day compared to the preoperative period.CONCLUSIONS:Physical exercise combined with CPAP promoted the maintenance of functional capacity and reduced the length of stay in the ICU.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.06919
      Issue No: Vol. 65, No. 2 (2020)
  • Subjects With COPD Walk With Less Consistent Organization of Movement
           Patterns of the Lower Extremity
    • Authors: Wai-Yan Liu; Kendra K Schmid, Kenneth Meijer, Martijn A Spruit, Jennifer M Yentes
      Pages: 158 - 168
      Abstract: BACKGROUND:The inherent stride-to-stride fluctuations during walking are altered in the aging population and could provide insight into gait impairments and falls in patients with COPD. Stride-to-stride fluctuations are quantified two ways: variability of the fluctuations (eg, standard deviation), and movement patterns within the fluctuations. Our objective was to investigate stride-to-stride fluctuations by evaluating the variability and movement patterns of lower limb joints in subjects with COPD compared to subjects without COPD as control subjects.METHODS:In this cross-sectional study, 22 subjects with COPD (age 63 ± 9 y; FEV1 54 ± 19% predicted) and 22 control subjects (age 62 ± 9 y; FEV1 95 ± 18% predicted) walked for 3 min on a treadmill while their gait was recorded. The amount of variability (ie, standard deviation and coefficient of variation) and movement patterns (ie, predictability and consistency in organization) were quantified for the range of motion and joint angle of the hip, knee, and ankle, at 3 walking speeds (ie, self-selected, fast, and slow). General linear mixed models were used for analysis.RESULTS:Control subjects had more consistent organization of the hip and knee joint movement patterns compared to subjects with COPD (P = .02 and P = .02, respectively). Further, control subjects adapted to speed changes by demonstrating more consistent organization of movement patterns with faster speeds, whereas subjects with COPD did not. At the fast walking speed, subjects with COPD demonstrated less consistent organization of knee and hip joint movement patterns as compared to control subjects without COPD (P = .03 and P = .005, respectively). The amount of variability did not differ between groups.CONCLUSIONS:Although subjects with COPD did not demonstrate decreased amount of variability, their hip and knee joint movement patterns were less consistent in organization during walking. Reduced consistency in organization of movement patterns may be a contributing factor to falls and mobility problems experienced by patients with COPD.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.06743
      Issue No: Vol. 65, No. 2 (2020)
  • Cough Strength Is an Indicator of Aspiration Risk When Restarting Food
           Intake in Elderly Subjects With Community-Acquired Pneumonia
    • Authors: Yasunari Sakai; Masayoshi Ohira, Yoshiharu Yokokawa
      Pages: 169 - 176
      Abstract: BACKGROUND:The incidence of community-acquired pneumonia (CAP) is relatively high in elderly subjects. Cough peak flow (CPF) is an objective indicator of cough strength, and CPF evaluation might be useful to assess whether food intake can be restarted. We aimed to examine whether cough strength assessed with CPF can be used as an indicator of the aspiration risk when restarting food intake in elderly subjects with CAP.METHODS:This cross-sectional study included 82 elderly subjects with CAP between August 2016 and March 2018. CPF was measured using a peak flow meter, and we performed the repetitive saliva-swallowing test (RSST), which is a videoendoscopic evaluation of swallowing and is used to assess dysphagia and aspiration. Receiver operating characteristic (ROC) curve analysis was performed. The cutoff value was determined, and the area under the ROC was calculated.RESULTS:The areas under the RSST and CPF curves were 0.87 and 0.83, respectively. The RSST value for identifying the aspiration risk was 2.5 swallows. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 70.0%, 71.7%, 2.5, and 0.42, respectively. The CPF for identifying the aspiration risk was 190 L/min. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 82.6%, 69.4%, 2.7, and 0.25, respectively.CONCLUSIONS:Our findings suggest that cough strength assessed with CPF can be used as an indicator of the aspiration risk when restarting food intake in elderly subjects with CAP and that CPF evaluation is not inferior to the RSST. However, CPF evaluation should be performed together with swallowing screening tests to determine the aspiration risk.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.07067
      Issue No: Vol. 65, No. 2 (2020)
  • Concordance in Discriminating Recordings of Different Lung Sounds Between
    • Authors: Jaime Andres Munoz Barraza; Camilo Nicolas Saavedra Benardis, Rodrigo Sebastian Adasme Jeria, Daniel Humberto Arellano Sepulveda, Igancio Sanchez Diaz, Pablo Jose Bertrand Navarrete
      Pages: 177 - 182
      Abstract: BACKGROUND:Auscultation is a fundamental part of the physical examination, but its utility has been questioned due to the low inter-rater concordance. We therefore sought to evaluate the concordance of the discrimination of lung sound recordings between experienced physiotherapists.METHODS:Lung sound recordings were selected and validated by an expert panel when Fleiss κ concordance was> 0.75. Eleven recordings were played for subject recognition using a portable computer in their workplace. Results were analyzed using Fleiss κ when looking for concordance between physiotherapists. Univariate regression was performed to determine if there was an association with clinical training, years of experience, academic accomplishment, or university affiliation.RESULTS:Sixty-nine physiotherapists with a median of 4 years of working experience (interquartile range 2–6 y) completed the study. There was moderate concordance (κ = 0.562; 95% CI 0.462–0.605) for overall lung sound recording discrimination. For continuous and noncontinuous lung sound recordings, discrimination concordance was substantial (κ = 0.63 and κ = 0.76, respectively). A bivariate analysis revealed that years of experience presented an inverse association with stridor recognition.CONCLUSIONS:Concordance between physiotherapists in discriminating recorded lung sounds was moderate. The ability to recognize stridor was inversely associated with years of work experience.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.06624
      Issue No: Vol. 65, No. 2 (2020)
  • High-Flow Nasal Cannula Therapy With Early Extubation for Subjects
           Undergoing Off-Pump Coronary Artery Bypass Graft Surgery
    • Authors: Wataru Tatsuishi; Toshiro Sato, Go Kataoka, Atsuhiko Sato, Ryota Asano, Kiyoharu Nakano
      Pages: 183 - 190
      Abstract: BACKGROUND:The effects of high-flow nasal cannula (HFNC) therapy on postoperative atelectasis and duration of oxygen therapy after off-pump coronary artery bypass graft are unknown. The purpose of this study was to compare the effects of HFNC therapy for subjects who underwent off-pump coronary artery bypass graft with the effects of standard oxygen therapy in terms of oxygen requirement and atelectasis.METHODS:This prospective single-blinded randomized, controlled trial included 148 subjects who underwent off-pump coronary artery bypass graft between 2010 and 2015 with HFNC (n = 72) or without HFNC (standard O2, n = 76). The primary end point was the percentage difference in loss of lung volume between subjects with or without HFNC therapy. Secondary end points included the total amount of oxygen administered and duration of oxygen therapy with and without HFNC therapy.RESULTS:There were significant between-group differences in the percentage loss of lung volume (P < .001), total amount of oxygen administered (P < .001), duration of oxygen therapy (P < .001), and the need for postoperative diuretic therapy (P = .037). The amount (ρ = 0.569, P < .001) and duration (ρ = 0.678, P < .001) of oxygen administered were correlated with atelectasis volume.CONCLUSIONS:Using HFNC therapy after off-pump coronary artery bypass graft shortened the duration of oxygen therapy and reduced the percentage loss of lung volume and total amount of oxygen administered when compared with standard oxygen therapy.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.06382
      Issue No: Vol. 65, No. 2 (2020)
  • Respiratory Therapy Administrators' Perceptions of Effective Teaching
           Characteristics of Clinical Preceptors
    • Authors: Abdulelah M Aldhahir; Abdallah Y Naser, Douglas S Gardenhire
      Pages: 191 - 197
      Abstract: BACKGROUND:Clinical preceptors in respiratory therapy (RT) are expected to possess effective teaching skills and qualities that signify their knowledge, expertise, and professionalism. Thus, it is important to determine which teaching characteristics are effective among RT clinical preceptors from the administrators' perspective as well as the predictors for the administrators' decisions.METHODS:A cross-sectional survey study of RT administrators was conducted in hospitals in a major southeastern metropolitan area in the United States. We used the modified version of the Effective Clinical Instructor Characteristics Inventory, which consists of 35 questions that cover 3 main domains: professional competence (15 questions), relationship with the students (8 questions), and personal attributes (12 questions); questions were answered according to a 5-point Likert scale (ranging from 1 to 5). Multiple linear regression analysis was used to identify predictors of clinical preceptors' selection, reflected in their final scores.RESULTS:A total of 34 RT administrators participated in this study, representing 18 health care institutions. The response rate was 54.8%. Participants showed the most interest in the professional competence of clinical preceptors, with a total mean score of 68.6 ± 4.4. This characteristic was followed by personal attributes and relationship with students, with mean scores of 53.8 ±4.8 and 35.8 ± 3.4, respectively. The perception of managers from different managerial positions toward preceptors' professional competence showed a statistically significant difference (P = .042). The variable defined as years in clinical practice as a respiratory therapist was negatively associated with participants' final scores.CONCLUSIONS:This study indicates that the professional competence of clinical preceptors is believed by RT administrators to be the most important behavioral characteristic. The results also indicate that role modeling and showing genuine interest in patients and their care are the most effective teaching characteristics of clinical preceptors.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.06947
      Issue No: Vol. 65, No. 2 (2020)
  • Acute Effects of the 6-Minute Pegboard and Ring Test in COPD
    • Authors: Ivanize Mariana Masselli dos Reis; Renata Pedrolongo Basso–Vanelli, Thomas Beltrame, Maria Cecilia Moraes Frade, Raphael Martins de Abreu, Marina Machado Cid, Aparecida Maria Catai, Ana Beatriz Oliveira, Mauricio Jamami
      Pages: 198 - 209
      Abstract: BACKGROUND:There are few reports in the literature supporting the understanding of the physiological mechanisms of intolerance in patients with COPD to perform unsupported upper limb activities. The aims of this study were to quantify the electrical activity and oxygenation of inspiratory and upper limb muscles, and to investigate whether electromyographic manifestations of muscle fatigue are related to upper limb function as assessed by the 6-min pegboard and ring test (6PBRT) in subjects with COPD and in healthy subjects.METHODS:Thirty subjects with COPD (FEV1 42.1 ± 16.4% predicted; 68.0 ± 7.6 y old) comprised the COPD group, and 34 healthy subjects (66.8 ± 8.0 y old) comprised the control group. Both groups were assessed for body composition with dual-energy radiograph absorptiometry and spirometry. The 6PBRT was performed with simultaneous assessment of electromyography, near-infrared spectroscopy, and gas analyses (expiratory minute volume).RESULTS:Differences were observed between groups for performance (number of rings) in the 6PBRT, with the COPD group achieving lower values than the control group (P < .001). The ventilatory demand (expiratory minute volume/maximum voluntary ventilation) and root mean square amplitude of the sternocleidomastoid muscle were higher in the COPD group than in the control group (P < .04). Lower values for oxyhemoglobin and total hemoglobin were found in intercostal muscles of the COPD group compared to the control group. The root mean square amplitude of the intercostal muscles was lower in the COPD group, while it was similar between groups for anterior deltoid and trapezius muscles. Median frequency of anterior deltoid muscles presented a decreased in both groups.CONCLUSIONS:Our results indicate that the 6PBRT was performed at a higher electrical activity in the accessory inspiratory muscles, such as the sternocleidomastoid muscle, and a lower oxygenation profile in the intercostal muscles in subjects with COPD compared with healthy controls, but without muscle fatigue signs. These findings suggest that the higher ventilatory demand presented in subjects with COPD could have contributed to the worse performance in this group without signals of peripheral muscle limitation.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.06948
      Issue No: Vol. 65, No. 2 (2020)
  • Prevalence of and Risk Factors for Mechanical Ventilation Reinstitution in
           Patients Weaned From Prolonged Mechanical Ventilation
    • Authors: Dario Villalba; Gregorio Gil Rossetti, Mariana Scrigna, Jessica Collins, Ana Rocco, Amelia Matesa, Laura Areas, Nicolas Golfarini, Paula Pini, Marcos Hannun, Sabrina Boni, Sabrina Grimaldi, Paula Pedace, Ladislao Diaz–Ballve, Mauro Andreu, Pablo Bunirigo, Diego Noval, Fernando Planells
      Pages: 210 - 216
      Abstract: BACKGROUND:Prolonged mechanical ventilation is increasingly common in ICUs. Although a consensus conference defined weaning success in this patient population, few studies have used this definition. A clear definition of successful weaning is useful to assess clinical and epidemiological outcomes, facilitate clinical decision making, and set goals of care. The aims of our study were to describe the prevalence of reinstitution of mechanical ventilation within 28 d in patients successfully weaned according to our institution criterion (ie, weaning success as per consensus guidelines), to describe reasons to reestablish mechanical ventilation, and to identify associated factors.METHODS:An observational, analytical, cross-sectional study was conducted at a weaning and rehabilitation center. All patients liberated from mechanical ventilation (ie, no ventilatory support for 7 d) were included as subjects. Requirement of and reasons for reinstitution of mechanical ventilation within 28 d of weaning were recorded.RESULTS:A total of 639 tracheostomized subjects were analyzed. Of these, 219 (34%) were weaned, and 15 were eliminated due to lack of data. Of the remaining 204 subjects, 42 (21%) were reconnected to mechanical ventilation within 28 d. Sepsis accounted for 64% of reconnections. In the multivariate analysis, neurological comorbidity (adjusted odds ratio 5.1 [95% CI 2.3–11.1]) and delayed weaning (> 7 d after admission) (adjusted odds ratio 2.37 [95% CI 1.1–5.3]) were independently associated with reinstitution of mechanical ventilation within 28 d of weaning. The synergistic effect of both variables showed an adjusted odds ratio of 5.35 (95% CI 2.4–11.4).CONCLUSIONS:Reinstitution of mechanical ventilation within 28 d is a common event in patients considered to be weaned: 1 in 5 of such patients requires reconnection to mechanical ventilation, with sepsis being the most prevalent cause. Neurological comorbidity and delayed weaning are risk factors associated with reestablishment of mechanical ventilation. The presence of more than one risk factor increases the association with reinstitution of mechanical ventilation within 28 d of weaning.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.06807
      Issue No: Vol. 65, No. 2 (2020)
  • FEV1 as a Standalone Spirometric Predictor and the Attributable Fraction
           for Death in Older Persons
    • Authors: Carlos A Vaz Fragoso; Peter H Van Ness, Gail J McAvay
      Pages: 217 - 226
      Abstract: BACKGROUND:Commonly used thresholds for staging FEV1 have not been evaluated as standalone spirometric predictors of death in older persons. Specifically, the proportion of deaths attributed to a reduced FEV1, when staged by commonly used thresholds in L, percent of predicted (% pred), and Z scores, has not been previously reported.METHODS:In 4,232 white persons ≥ 65 y old, sampled from the Cardiovascular Health Study, FEV1 was stratified as stage 1 (FEV1 ≥ 2.00 L, ≥80% pred, and Z score ≥−1.64), stage 2 (FEV1 1.50–1.99 L, 50–79%pred, and Z score −2.55 to −1.63), and stage 3 (FEV1 < 1.50 L, < 50% pred, and Z score < −2.55). Notably, a Z score threshold of −1.64 defines normal-for-age lung function as the lower limit of normal (ie, 5th percentile of distribution), and accounts for differences in age, sex, height, and ethnicity. Next, adjusted odds ratios and average attributable fractions for 10-y all-cause mortality were calculated, comparing FEV1 stages 2 and 3 against stage 1, expressed in L, % pred, and Z scores. The average attributable fraction estimates the proportion of deaths attributed to a predictor by combining the prevalence of the predictor with the relative risk of death conferred by that predictor.RESULTS:FEV1 stage 2 and 3 in L, % pred, and Z scores yielded similar adjusted odds ratios of death: 1.40–1.51 for stage 2 and 2.35–2.66 for stage 3. Conversely, FEV1 stages 2 and 3 in L, % pred, and Z scores differed in prevalence: 12.8–28.6% for stage 2 and 6.4–17.5% for stage 3, and also differed in the adjusted average attributable fraction for death: 3.2–6.4% for stage 2 and 4.5–9.1% for stage 3.CONCLUSIONS:In older persons, the proportion of deaths attributed to a reduced FEV1 is best stratified by Z score staging thresholds because these yield a similar relative risk of death but a more age- and sex-appropriate prevalence of FEV1 stage.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.07012
      Issue No: Vol. 65, No. 2 (2020)
  • Aerosol Delivery During Continuous High Frequency Oscillation for
           Simulated Adults During Quiet and Distressed Spontaneous Breathing
    • Authors: Jie Li; Ahmad A Elshafei, Lingyue Gong, James B Fink
      Pages: 227 - 232
      Abstract: BACKGROUND:Continuous high-frequency oscillation (CHFO) is a therapeutic mode for the mobilization of secretions. The Metaneb CHFO device also incorporates aerosol administration using an integrated jet nebulizer. However, the effectiveness of aerosol delivery and influential factors remain largely unreported.METHODS:A collecting filter was placed between an adult manikin with a representative upper airway and a breath simulator, set to simulate quiet and distressed patterns of spontaneous adult breathing. The Metaneb CHFO device was attached to the manikin via a mask. Two jet nebulizers were tested in 2 different positions: placement in the manifold and placement between manifold and mask. A vibrating mesh nebulizer was placed between the manifold and mask with and without extension tubing. Aerosol administration was compared during CHFO and during nebulization mode alone. Albuterol (2.5 mg in 3 mL) was nebulized for each condition. The drug was eluted from the filter and assayed with ultraviolet spectrophotometry (276 nm).RESULTS:During CHFO, inhaled doses with jet nebulizers were low (∼ 2%), regardless of nebulizer placement. Inhaled dose was improved with the vibrating mesh nebulizer placed between the manifold and mask (12.48 ± 2.24% vs 2.58 ± 0.48%, P = .004). Inhaled doses with the jet nebulizer in the manifold with nebulization mode alone was lower than with the jet nebulizer with an aerosol mask (4.03 ± 1.82% vs 10.39 ± 2.79%, P = .004). Inhaled dose was greater with distressed breathing than quiet breathing. The use of a vibrating mesh nebulizer (P < .001) and distressed breathing (P = .001) were identified as predictors of increased inhaled dose.CONCLUSIONS:Inhaled dose with a jet nebulizer via the Metaneb CHFO device was lower than with a jet nebulizer alone. Placement of a vibrating mesh nebulizer at the airway and distressed breathing increased inhaled dose.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.07050
      Issue No: Vol. 65, No. 2 (2020)
  • Cystic Fibrosis Lung Disease: An Overview
    • Authors: Nelson L Turcios
      Pages: 233 - 251
      Abstract: Although better insights into the natural course of cystic fibrosis (CF) have led to treatment approaches that have improved pulmonary health and increased the life expectancy of individuals with this disorder, lung disease remains the main cause of morbidity and mortality in patients with CF. Evidence suggests that airway epithelial defects in ions-water transport lead to dehydrated mucus, impaired mucus clearance, and mucus adhesion to airway surfaces. An increase in mucin secretion is also suggested by the formation of endobronchial mucus plaques and plugs, which become the main sites of air flow obstruction, infection, and inflammation conducing to early small airways disease followed by the development of bronchiectasis. The lung involvement is usually progressive with intermittent exacerbations. Aggressive management and advances in treatment delay, but, do not prevent progression of lung disease. Respiratory failure ensues and is the major cause of death. The lung parenchyma is virtually untouched for much of the course of the disease. This review focuses on the lung involvement in cystic fibrosis and summarizes new developments on the diagnostic approach of CF and pathogenesis of related lung disease. Current therapeutic modalities, novel therapies targeting the basic genetic defect, and lung transplantation are also reviewed.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.06697
      Issue No: Vol. 65, No. 2 (2020)
  • Frequency of Signs and Symptoms in Persons With Asthma
    • Authors: Zhengguang He; Juntao Feng, Junbo Xia, Qingguo Wu, Hong Yang, Qianli Ma
      Pages: 252 - 264
      Abstract: BACKGROUND:Signs and symptoms of asthma are well established; however, no study has been performed to rank them. Therefore, we performed this systematic review and meta-analysis to determine the pooled frequencies of different signs and symptoms of asthma in subjects age ≥ 14 y to develop a patient-specific questionnaire.METHODS:Specific search queries were developed to include records published in Embase, PubMed, Cochrane Library, and Google Scholar, until November 2016. We planned to include randomized controlled trials (RCTs) and observational studies for determining the pooled proportions of signs and symptoms and association between combination of symptoms and asthma severity in subjects age ≥ 14 y. The quality assessment was performed using 3 parameters: reported number or percentage of subjects with asthma symptoms, respiratory disorder history, and method for data collection.RESULTS:Of the 4,939 records retrieved, 67 observational studies (N = 57,033 subjects; age ≥ 14 y) were considered eligible for inclusion in the analysis. A total of 10 symptoms were reported across the studies, with pooled proportions of nasal congestion, sleep disturbances, breathlessness, chest tightness, and wheezing being 61.57%, 56.56%, 50.31%, 50.41%, and 46.97%, respectively. In records of medical history, the pooled proportion of rhinitis was 76.37%, followed by allergy/atopy at 63.53%. The pooled proportion of asthma medication use was 83.27%. In terms of the symptom combinations, the combination of wheezing, breathlessness, chest tightness, and cough was reported in 71.26% of subjects from 4 studies (n = 12,014 subjects). Nasal congestion, sleep disturbance, and chest tightness were the most common symptoms of asthma, followed by wheezing and breathlessness with a combination of symptoms (ie, wheezing, breathlessness, chest tightness, and cough) affecting the highest proportion of subjects.CONCLUSIONS:Asthma severity was dependent on variety of symptoms, consisting mostly of wheezing, breathlessness, chest tightness, and cough. On the basis of our analysis, we recommend a combination of symptoms be included in diagnostic-based questionnaires to aid early diagnosis.
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.06714
      Issue No: Vol. 65, No. 2 (2020)
  • Optimizing Mechanical Insufflation-Exsufflation - Much More than Cough
           Peak Flow
    • Authors: Richard D Branson; Joshua O Benditt
      Pages: 265 - 268
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.07682
      Issue No: Vol. 65, No. 2 (2020)
  • Enhancing Early Mobility With a Speaking Valve
    • Authors: Karsten J Roberts
      Pages: 269 - 270
      PubDate: 2020-01-27T01:24:22-08:00
      DOI: 10.4187/respcare.07671
      Issue No: Vol. 65, No. 2 (2020)
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Heriot-Watt University
Edinburgh, EH14 4AS, UK
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