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RESPIRATORY DISEASES (103 journals)                     

Showing 1 - 104 of 104 Journals sorted alphabetically
Advances in Respiratory Medicine     Open Access   (Followers: 7)
Advances in Thoracic Diseases     Open Access  
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)
Archives of Pulmonology and Respiratory Care     Open Access   (Followers: 1)
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: 2)
BMC Pulmonary Medicine     Open Access   (Followers: 5)
BMJ Open Respiratory Research     Open Access   (Followers: 7)
Breathe     Open Access   (Followers: 5)
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: 102)
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: 16)
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: 2)
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: 4)
European Respiratory Journal     Full-text available via subscription   (Followers: 39)
European Respiratory Review     Open Access   (Followers: 7)
Experimental Lung Research     Hybrid Journal   (Followers: 1)
Expert Review of Respiratory Medicine     Hybrid Journal   (Followers: 5)
Heart & Lung: The Journal of Acute and Critical Care     Hybrid Journal   (Followers: 14)
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: 5)
Journal of Asthma Allergy Educators     Hybrid Journal   (Followers: 5)
Journal of Bronchology & Interventional Pulmonology     Hybrid Journal   (Followers: 5)
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: 5)
Journal of Respiratory Research     Open Access   (Followers: 2)
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: 3)
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: 2)
Open Respiratory Medicine Journal     Open Access   (Followers: 2)
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: 3)
Pulmonary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 2)
Pulmonary Therapy     Open Access   (Followers: 2)
Pulmonology and Respiratory Research     Open Access   (Followers: 2)
Respiratory Care     Full-text available via subscription   (Followers: 11)
Respiratory Investigation     Full-text available via subscription   (Followers: 1)
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: 17)
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: 35)
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: 11  
 
  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: 2020-03-25T13:08:09-07:00
      Issue No: Vol. 65, No. 4 (2020)
       
  • Success of a Tobacco Cessation Program for Parents at a Children's
           Hospital
    • Authors: Leighann Sweeney; Laura Taylor, Jubrae Peurifoy, Kelly Kauffman, Natalie Napolitano
      Pages: 407 - 412
      Abstract: BACKGROUND:Children are most affected by passive smoke and least able to avoid it. The Tobacco Dependence Program was developed to help reduce first-, second-, and thirdhand smoke exposure to our patients while they are in the hospital.METHODS:The Tobacco Dependence Program consists of a director, 3 coordinators, and 15 team members certified as tobacco treatment specialists. The program is offered to any admitted patient or his or her caregiver(s). We support participants whether their goal is to quit smoking or to abstain during the hospitalization. We provide weekly counseling and free over-the-counter nicotine replacement therapy for the entire duration of the hospitalization. The inclusion criterion for caregivers is a 7-d minimum stay. In-patients are automatically eligible. Before discharge, we provide a referral to an out-patient program.RESULTS:As of March 2019, we enrolled 138 participants, 5% were in-patients. Fifty-five percent had children who were critically ill and in the ICU: pediatric ICU/progressive care unit (PCU) 28%, neonatal ICU 19%, cardiac ICU (CICU) 9%. The ethnicity of the participants was predominately white (56%), followed by African American (33%), Hispanic (12%), and Asian (
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.06810
      Issue No: Vol. 65, No. 4 (2020)
       
  • The Clinical Effect of an Early, Protocolized Approach to Mechanical
           Ventilation for Severe and Refractory Hypoxemia
    • Authors: Alice Gallo de Moraes; Steven R Holets, Ann N Tescher, Jennifer Elmer, Grace M Arteaga, Gregory Schears, Richard K Patch, John K Bohman, Richard A Oeckler
      Pages: 413 - 419
      Abstract: BACKGROUND:ARDS remains a source of significant morbidity and mortality in the critically ill patient. The mainstay of therapy entails invasive mechanical ventilation utilizing a lung-protective strategy designed to limit lung injury associated with excessive stress and strain while the underlying etiology of respiratory failure is identified and treated. Less is understood about what to do once conventional ventilation parameters have been optimized but the patient's respiratory status remains unchanged or worsens. In 2015, a protocolized, stepwise approach to mechanical ventilation with partially automated and clearly defined thresholds for management changes was implemented at our institution. We hypothesized that, by identifying appropriate patients earlier, time-to-escalation and rescue therapy implementation would be shortened.METHODS:Subjects with severe ARDS, treated with prone positioning based on our institution's protocolized approach from December 2013 to August 2016 were included. Their baseline characteristics, severity of illness scores, and mechanical ventilation parameters were collected and analyzed.RESULTS:Baseline characteristics, tidal volumes, PaO2/FIO2, duration of ventilation after proning, and mortality were similar in both groups. Median (interquartile range [IQR]) PEEP at the time of proning was higher after the protocol implementation (12.5 cm H2O [IQR 6.5–19.4] vs 18 cm H2O [IQR 10–22], P = .386), and mean (IQR) respiratory system driving pressure was lower (16 cm H2O [IQR 13–36.2] vs 12 cm H2O [IQR 9–19.6], P = .029). Median (IQR) time from refractory hypoxemia identification to proning was shorter after protocol implementation (42.2 h [IQR 6.83–347.2] vs 16.3 h [IQR 1–99.7], I = .02), and PaO2/FIO2 at 1 h after proning was higher. ICU and hospital LOS were shorter after the protocol implementation.CONCLUSIONS:Following the implementation of an early, evidence-based, protocolized approach to optimizing mechanical ventilation, subjects with true refractory hypoxemia were identified earlier and time to proning was significantly shorter. Despite improvement in the evaluation and management of refractory hypoxemia as well as time to initiation of prone positioning, mortality was unchanged and there was variation in the duration of the position.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07243
      Issue No: Vol. 65, No. 4 (2020)
       
  • Development of a Lung Rescue Team to Improve Care of Subjects With
           Refractory Acute Respiratory Failure
    • Authors: Stefano Spina; Martin Capriles, Roberta De Santis Santiago, Gaetano Florio, Maddalena Teggia-Droghi, Luigi Grassi, Jie Hu, Rosemary Kelley, Edward A Bittner, Robert M Kacmarek, Lorenzo Berra, for The Lung Rescue Team
      Pages: 420 - 426
      Abstract: BACKGROUND:A lung-protective mechanical ventilation strategy has become the hallmark of ventilation management for patients with acute respiratory failure. However, some patients progress to more severe forms of acute respiratory failure with refractory hypoxemia. In such circumstances, individualized titration of mechanical ventilation according to the patient's specific respiratory and cardiovascular pathophysiology is desirable. A lung rescue team (LRT) was recently established at our institution to improve the medical care of patients with acute respiratory failure when conventional treatment fails. The aim of this report is to describe the consultation processes, the cardiopulmonary assessment, and the procedures of the LRT.METHODS:This was a retrospective review of the LRT management of patients with acute respiratory failure and refractory hypoxemia at Massachusetts General Hospital in Boston, Massachusetts. The LRT is composed of a critical care physician, the ICU respiratory therapist on duty, the ICU nurse on duty, and 2 critical care fellows. In the LRT approach, respiratory mechanics are evaluated through lung recruitment maneuvers and decremental PEEP trials by means of 3 tools: esophageal manometry, echocardiography, and electrical impedance tomography lung imaging.RESULTS:The LRT was consulted 89 times from 2014 to 2019 for evaluation and management of severely critically ill patients with acute respiratory failure and refractory hypoxemia on mechanical ventilation. The LRT was requested a median of 2 (interquartile range 1–6) d after intubation to optimize mechanical ventilation and to titrate PEEP in 77 (86%) subjects, to manage ventilation in 8 (9%) subjects on extracorporeal membrane oxygenation (ECMO), and to manage weaning strategy from mechanical ventilation in 4 (5%) subjects. The LRT found consolidations with atelectasis responsive to recruitment maneuvers in 79% (n = 70) of consultations. The LRT findings translated into a change of care in 81% (n = 72) of subjects.CONCLUSIONS:The LRT individualized the management of severe acute respiratory failure. The LRT consultations were shown to be effective, safe, and efficient, with an impact on decision-making in the ICU.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07350
      Issue No: Vol. 65, No. 4 (2020)
       
  • Curvilinearity of a Maximum Expiratory Flow-Volume Curve: A Useful
           Indicator for Assessing Airway Obstruction in Children With Asthma
    • Authors: Yanli Zhang; Xiaorong Xiong, Fuli Dai, Aifang Su, Xiufang Wang, Yan Zhang, Chunling Cai, Hongke Shi, Yuehong Zheng
      Pages: 427 - 436
      Abstract: BACKGROUND:Lung function parameters are used as signs in the diagnosis and evaluation of asthma; however, their sensitivity and specificity are not ideal. We calculated and combined angle β with lung function parameters to identify the ideal indicator.OBJECTIVE:We aimed to identify an ideal indicator for evaluating the severity of airway obstruction in children with asthma.METHODS:In total, 151 school-age children diagnosed with asthma were selected as the asthma group, and 106 healthy children were selected as the control group. The subjects were divided into the exacerbation group, chronic persistent group, and clinical remission group. Furthermore, the subjects were classified into mild and moderate groups or severe and critical groups. Angle β was calculated in each group. A receiver operating characteristic curve analysis was performed to determine the cutoff values of angle β and lung function parameters that together provided high sensitivity and specificity for airway obstruction evaluation in children with asthma.RESULTS:The mean value of angle β in the asthma group was significantly smaller than that in the control group (178.18° and 196.72°, respectively, P < .001). More exacerbations or greater severity corresponded to smaller angle β values (P < .001). The best cutoff value of angle β was 189.43°, and the area under the receiver operating characteristic curve of angle β was 0.877, which is greater than the area under the receiver operating characteristic curve of FEV1, forced expiratory flow (FEF) at 75% vital capacity (FEF25%), and FEF at 50% vital capacity (FEF50%), but smaller than the area under the receiver operating characteristic curve of FEF75% and FEV1/FVC%. Interestingly, combining these measures can enhance the sensitivity and specificity in assessing airway obstruction.CONCLUSIONS:Angle β was a useful indicator for assessing airway obstruction. Furthermore, angle β combined with FEV1, FEV1/FVC%, FEF25%, FEF50%, and FEF75% can enhance the sensitivity and specificity of airway obstruction evaluations.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07142
      Issue No: Vol. 65, No. 4 (2020)
       
  • The 1-Minute Sit-to-Stand Test in Lung Transplant Candidates: An
           Alternative to the 6-Minute Walk Test
    • Authors: Dario Kohlbrenner; Christian Benden, Thomas Radtke
      Pages: 437 - 443
      Abstract: BACKGROUND:The 6-min walk test (6MWT) is a well-established functional exercise capacity test in lung transplant candidates. This study aimed to investigate the construct validity of the 1-min sit-to-stand test (1-min STS) as a marker of exercise capacity and knee extensor strength in lung transplantation candidates.METHODS:We retrospectively analyzed data from consecutive subjects referred for lung transplantation evaluation to our institution between 2015 and 2018.RESULTS:38 subjects were included. We found strong correlations between the normalized 1-min STS and 6MWT (r = 0.79, P < .001) and moderate correlations between 1-min STS and knee extensor strength (r = 0.53, P = .001) and between 6MWT and knee extensor strength (r = 0.44, P = .008). The 1-min STS elicited greater dyspnea (P = .008) and lower oxygen desaturation compared to the 6MWT (P < .001).CONCLUSIONS:The 1-min STS is a valid functional exercise capacity test in lung transplantation candidates. Due to its ease of application, clinical practitioners may consider using the 1-min STS in situations when the 6MWT cannot be performed. Our pilot study may stimulate future research, including a head-to-head comparison between the 6MWT and 1-min STS in a large patient cohort including post-lung transplantation-monitoring.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07124
      Issue No: Vol. 65, No. 4 (2020)
       
  • Impact of a Specialized Ambulatory Clinic on Refractory Breathlessness in
           Subjects With Advanced COPD
    • Authors: Amany F Elbehairy; Hannah McIsaac, Elizabeth Hill, Patrick A Norman, Andrew G Day, J Alberto Neder, Denis E O'Donnell, Ingrid A Harle
      Pages: 444 - 454
      Abstract: BACKGROUND:Severe exertional dyspnea is a commonly reported symptom in patients with COPD, especially in the advanced stages. Our objective was to assess the preliminary impact of comprehensive, individualized management provided by a specialized tertiary center clinic on exertional dyspnea and patient-centered outcomes in patients with advanced COPD.METHODS:This retrospective analysis included 45 subjects with COPD who were evaluated in a newly established dyspnea clinic over 3 years. Those with severe exertional dyspnea (Medical Research Council dyspnea score of ≥4/5), despite optimal disease-targeted therapy were eligible for referral. We used the revised Edmonton Symptom Assessment System (ESAS-r) to assess symptoms. Responders were defined as those whose change from baseline to 2-months met the minimum clinically important difference of ≤−1 in ESAS-r score for shortness of breath.RESULTS:Subjects (mean ± SD age 70 ± 7 years) had an average FEV1 of 36 ± 18% predicted and a Medical Research Council dyspnea score of 4.7 ± 0.4. Responses to the intervention were variable and mean change in the ESAS-r score for shortness of breath in the total group was −0.32 ± 3.39, P = .53. Forty-seven percent of the subjects were identified as responders, and 42, 40, 40, and 33% met the minimum clinically important difference for improvement in ESAS-r scores for tiredness, anxiety, well-being, and depression, respectively. Responders had fewer emergency department annual visits in the 2 years after their first clinic visit compared with nonresponders (mean ± SD, 1.38 ± 1.63 vs 4.45 ± 5.52, P = .034).CONCLUSIONS:Although the impact of our specialized advanced dyspnea clinic was variable, as evaluated by the ESAS-r, it provided measurable additional clinically important benefit to almost half of the subjects with advanced COPD and severe refractory dyspnea.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.06950
      Issue No: Vol. 65, No. 4 (2020)
       
  • Reduced Step Count and Clinical Frailty in Hospitalized Adults With
           Community-Acquired Pneumonia
    • Authors: Hayley Rice; Kylie Hill, Robin Fowler, Carol Watson, Grant Waterer, Megan Harrold
      Pages: 455 - 463
      Abstract: BACKGROUND:In adults hospitalized with community-acquired pneumonia (CAP), increasing ward-based walking may reduce length of stay (LOS). There are few data to describe ward-based walking in this population. In adults hospitalized with CAP, we aimed to report variables of walking and non-walking time, to determine whether demographic or clinical variables influenced daily step count, and to determine whether daily step count influenced LOS.METHODS:Following admission, daily step count and variables related to walking and non-walking time were quantified using the StepWatch Activity Monitor. Details regarding demographics, clinical characteristics, clinical care, and LOS were extracted from the medical records and hospital electronic data systems. Frailty was calculated via the 7-point Clinical Frailty Scale; disease severity was measured via the CURB-65 score. Health care utilization at 30 d following discharge was measured via telephone interview.RESULTS:Two hundred participants completed the study, of whom 121 contributed ≥ 24 h of data from the StepWatch Activity Monitor. The median (interquartile range (IQR)) number of daily steps was 926 (457–1706). These were accumulated over 66 (41–121) min/d, with a usual bout duration of 3 (2–4) min and 1-min peak cadence of 56 (43–74) steps/min. An average of 93% (89–96) of waking hours was spent in non-walking time. In the multivariable model, increased frailty was retained as a predictor of lower step count (incidence rate ratio [IRR] 0.59, 95% CI 0.41–0.85). For every increase in 500 steps/d, LOS reduced by 11% (IRR 0.89, 95% CI 0.80–0.99).CONCLUSIONS:Subjects hospitalized with CAP did very little walking, most of which was accumulated in short bouts at a low intensity. Compared with subjects with mild frailty, those with moderate to severe frailty took 59% fewer steps per day. Those with a higher daily step count had a shorter LOS.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.06992
      Issue No: Vol. 65, No. 4 (2020)
       
  • Effect of the Integrated Prospective Payment Program on Family Members'
           Knowledge and Acceptance of Hospice Care of Patients on Prolonged
           Mechanical Ventilation
    • Authors: Chin-Jung Liu; Pei-Tseng Kung, Chia-Chen Chu, Wen-Yu Chou, Chuen-Ming Shih, Wen-Chen Tsai
      Pages: 464 - 474
      Abstract: BACKGROUND:We sought to evaluate the effect of an integrated prospective payment program (IPP) on knowledge of hospice care and willingness to participate in hospice care among family members of patients on prolonged mechanical ventilation (PMV).METHODS:Between November 2013 and April 2014, we used paper-based survey questionnaires from 64 institutions to evaluate knowledge, willingness, and related factors among the main caregivers of patients on PMV regarding hospice care and to determine whether their decisions for the patients were affected by the IPP.RESULTS:The average ages of the respondents and patients on PMV were 51.9 y and 70.8 y respectively; 70.6% of the respondents knew about the Hospice Palliative Care Act (HPCA), and 42.3% of the medical staff had introduced hospice care-related information to patients and caregivers in Taiwan. Among the caregiver respondents, 67.6% agreed to write a letter of intent regarding the choice of hospice care or limited life-sustaining treatment. In total, 66.2% (16.1 + 50.1%) of the respondents agreed to hospice care for their family members (ie, the patients on PMV) when the condition was terminal. The factors of greater HPCA knowledge among the patients on PMV were IPP participation, female sex, and coma status. Factors leading to higher levels of HPCA knowledge included age ≥ 65 y being married, higher income, awareness of the law, and being introduced to hospice care by medical staff.CONCLUSIONS:High levels of hospice care knowledge were unrelated to willingness to participate. HPCA knowledge was greater in the IPP group than in the non-IPP group; however, there was no significant difference in the willingness to agree to hospice care. It is recommended that individuals be encouraged to express their medical decisions.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.06934
      Issue No: Vol. 65, No. 4 (2020)
       
  • Predictors of Extubation Failure Related to Aspiration and/or Excessive
           Upper Airway Secretions
    • Authors: Marie–Helene Houze; Nicolas Deye, Joaquim Mateo, Bruno Megarbane, Francoise Bizouard, Frederic J Baud, Didier Payen de la Garanderie, Eric Vicaut, Alain P Yelnik, for the EVAKIN Study Group
      Pages: 475 - 481
      Abstract: BACKGROUND:Extubation failure may have several causes, including swallowing dysfunction, aspiration, and excessive upper airway secretions. We hypothesized that a bedside global swallowing pattern assessment including 9 criteria (volume of pharyngeal secretions, 5 swallowing motor items, swallowing reflex, and 2 gag reflexes) performed prior to extubation could identify patients at risk of extubation failure.METHODS:In a multicenter prospective observational study, all consecutive patients intubated and mechanically ventilated for ≥6 d were included. Before a planned extubation, a physiotherapist evaluated the 9 criteria of the swallowing assessment. The final extubation decision was left to the physician's discretion, blinded to the swallowing assessment. Extubation failure was defined as the need for re-intubation related to aspiration or excessive upper airway secretions within the first 72 h after extubation. Results are expressed as median (interquartile range [IQR]).RESULTS:The study included 159 subjects (age 61 y [IQR 48–75]; male/female ratio 1.5; Simplified Acute Physiologic score II 54 [IQR 42–66]; duration of mechanical ventilation 11 d [IQR 8–17]). A total of 23 subjects (14.5%) required re-intubation, with 16 occurring within the first 72 h after extubation and 7 related to aspiration or excessive secretions. Swallowing assessment was significantly lower in subjects with re-intubation related to aspiration or excessive secretions within the first 72 h after extubation versus those not re-intubated for aspiration or excessive secretions (6 [IQR 5–7] vs 8 [IQR 7–8], P = .008, respectively). Among the 9 swallowing assessment criteria, normal right pharyngeal gag reflex was associated with a lower incidence of re-intubation related to aspiration or excessive secretions (odds ratio 0.12, 95% CI 0.03–0.59, P = .01), as well as normal left pharyngeal gag reflex (odds ratio 0.13, 95% CI 0.03–0.63, P = .01), with a negative predictive value of 0.98 for each reflex.CONCLUSIONS:In subjects with prolonged ventilation, the presence of one or both gag reflexes could predict a reduction in extubation failure related to aspiration or excessive upper airway secretions. (Clinical trials.gov registration NCT00780078.)
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07025
      Issue No: Vol. 65, No. 4 (2020)
       
  • Respiratory Volume Monitoring in the Perioperative Setting Across Multiple
           Centers
    • Authors: Chunyuan Qiu; Eugene Cheng, Shawn R Winnick, Vu T Nguyen, Fang-Chen Hou, Sally Shou Yen, Gonzalo D Custodio, Jennifer H Dang, Diana LaPlace, Atef Morkos, Elena P Chung, Vimal N Desai
      Pages: 482 - 491
      Abstract: BACKGROUND:The prevalence of nuisance (technical) alarms is the leading cause of alarm fatigue resulting in decreased awareness and a reduction in effective care. The Joint Commission identified in their National Patient Safety goals alarm fatigue as a major safety issue. The introduction of noninvasive respiratory volume monitoring (RVM) has implications for effective perioperative respiratory status management. We evaluated this within the Kaiser Permanente health system.METHODS:This observational study was conducted at 4 hospitals in the Kaiser Permanente system. Standard data from RVM, pulse oximetry, and capnography were collected postoperatively in the post-anesthesia care unit (PACU) and/or on the general hospital floor. Device-specific alarm types, rates, and respective actions were recorded and analyzed by non-study staff.RESULTS:RVM was applied to 247 subjects (143 females, body mass index 32.3 ± 8.7 kg/m2, age 60.9 ± 13.9 y) providing 2,321 h. RVM alarms occurred 605 times (0.25 alarms/h); 64% were actionable and addressed, 17% were not addressed, 13% were self-resolved, and only 6% were nuisance. In a subgroup, RVM completed all 127 h of monitoring, whereas oximetry with capnography only completed 51 h with 12.9 alarms/h (73% nuisance). The overall RVM alarm rate was significantly lower than with either pulse oximeters or capnography monitors. We saw a nearly 1,000-fold reduction in nuisance alarms compared to capnography and a 20–50-fold reduction in nuisance alarms compared to pulse oximetry.CONCLUSIONS:Our study indicates that alarm fatigue due to nuisance alarms continues to be a clinical challenge in perioperative settings. Among the 3 common technologies for respiratory function monitoring, RVM had the lowest rate of overall technical alarms and the highest rate of compliance. Furthermore, with early interventions, none of the subjects monitored with RVM suffered any negative outcomes.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07187
      Issue No: Vol. 65, No. 4 (2020)
       
  • Comparison of 6 Oscillatory Positive Expiratory Pressure Devices During
           Active Expiratory Flow
    • Authors: William Poncin; Gregory Reychler, Massimo Liistro, Giuseppe Liistro
      Pages: 492 - 499
      Abstract: BACKGROUND:Air-flow oscillations generated by exhaling through oscillatory positive expiratory pressure (OPEP) devices favor airway clearance. Variations in mechanical properties between different devices may influence therapeutic efficacy. The objective of this study was to assess mechanical properties in vitro and to compare the performance of 6 OPEP devices at different resistance levels under active expiratory flow patterns.METHODS:4 gravity-dependent OPEP devices (ie, Flutter, Gelomuc, Pari O-PEP, Shaker Medic Plus) and 2 gravity-independent OPEP devices (ie, Acapella Choice and Aerobika) were each tested at low, medium, and high resistance settings. All devices were independently connected to a pulmonary waveform generator that reproduced active exhalation flows. Expiratory flow-volume curves were retrieved from 4 subjects with different stages of obstruction severity and were scaled according to either peak expiratory flow (4, 6, and 8 L/s) or volumes (2, 3 and 4 L), thus amounting to 24 active exhalations. Resulting waveforms were divided into 4 parts and the 2 middle parts were used to extract the following mechanical data: positive expiratory pressure (PEP), maximum expiratory pressure (Ppeak), oscillation frequency, and flow oscillation amplitude. The percentage of tests achieving oscillation frequencies ≥ 12 Hz and PEP ≥ 10 cm H2O was calculated for each device.RESULTS:Mechanistic effects of the Acapella, Aerobika, and Shaker devices were not comparable. The Flutter, Gelomuc, and Pari devices behaved similarly and achieved more tests with optimum oscillation frequency and PEP values than the other devices. These 3 devices also produced the highest oscillation amplitudes at the low-resistance level, whereas the Aerobika elicited higher and consistent oscillation amplitudes at medium and high resistance settings.CONCLUSIONS:Operational parameters differed between and within devices, yet the Flutter, Gelomuc, and Pari devices were similar in many aspects. Therapeutic efficacy may depend on the selected OPEP device and set resistance.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07271
      Issue No: Vol. 65, No. 4 (2020)
       
  • Physical Activity Level and Perception of Exercise in Cystic Fibrosis
    • Authors: David M Burnett; Ashley N Barry, Joel D Mermis
      Pages: 500 - 506
      Abstract: BACKGROUND:More patients with cystic fibrosis (CF) are living longer, and lifestyle-related behavior is becoming increasingly important for improving morbidity and mortality. Declining levels of exercise leads to low cardiorespiratory fitness, which is a strong, independent predictor of mortality in patients with CF. As a result, exercise training has become a commonly accepted form of treatment for patients with CF. The purpose of this study was to determine physical activity levels and perception of exercise in adult patients with CF.METHODS:Adult patients from an in-patient CF unit were recruited to participate. A structured interview and self-report questionnaires were used to collect information on levels of physical activity and exercise perception including preferences, readiness, and barriers.RESULTS:Forty-six adult patients with CF consented to participate in the interview and completed self-report questionnaires. Subjects self-reported that the majority (84%) of their time was spent performing physical activity at a moderate level, with mean ± SD of 11.8 ± 12.2 h per week of moderate physical activity. Vigorous physical activity was described as hard and very hard physical activity, with a mean ± SD of 1.8 ± 4.6 h (13%) and 0.4 ± 1.6 h (3%), respectively. Most of the adult subjects with CF preferred walking, and 65% of them felt that exercise was very important. Lack of energy, lack of good health, lack of self-discipline, and lack of time were noted as the most frequent barriers to exercise.CONCLUSIONS:In this study, adult subjects with CF self-reported performing an adequate amount of moderate physical activity, although only a small proportion of time was spent at a vigorous level of physical activity. Clinicians providing rehabilitation have an opportunity to improve adherence to prescribed exercise by understanding the impact that physiological and psychological factors have on patients with CF. Further, motivating patients with CF to engage in more vigorous physical activity may provide a stimulus that improves clinical outcomes and potentially survival.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07193
      Issue No: Vol. 65, No. 4 (2020)
       
  • Risk Factors for Inspiratory Muscle Weakness in Chronic Heart Failure
    • Authors: Naomi Kondo Nakagawa; Mariana Abreu Diz, Tatiana Satie Kawauchi, Geisa Nascimento de Andrade, Iracema Ioco Kikuchi Umeda, Fernanda Murata Murakami, Janaina Proenca Oliveira–Maul, Juliana Arauȷo Nascimento, Newton Nunes, Julio Yoshio Takada, Antonio de Padua Mansur, Lawrence Patrick Cahalin
      Pages: 507 - 516
      Abstract: BACKGROUND:Chronic heart failure is commonly associated with inspiratory muscle weakness. However, few studies have investigated the risk factors for inspiratory muscle weakness in individuals with chronic heart failure and systolic dysfunction (left-ventricular ejection fraction [LVEF]
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.06766
      Issue No: Vol. 65, No. 4 (2020)
       
  • Extracorporeal Carbon Dioxide Removal During Continuous Renal Replacement
           Therapy as Adjunctive Therapy
    • Authors: Rita Jacobs; Adriaan Sablon, Herbert Spapen
      Pages: 517 - 524
      Abstract: Lung-protective ventilation targeting low tidal volumes and plateau pressures is the mainstay of therapy in patients with ARDS. This ventilation strategy limits pulmonary strain, inflammation, and injury, but it may be associated with profound hypercapnic acidosis. In such conditions, extracorporeal CO2 removal can attenuate or normalize hypercapnia and may even facilitate ultraprotective ventilation. Almost half of patients with ARDS develop renal failure. Pathophysiological cross-talk between the injured lung and kidney may aggravate global organ failure and weighs negatively on outcomes. A substantial number of patients with ARDS require continuous renal replacement therapy. Systems adapted from conventional renal replacement platforms with blood flows < 500 mL/min can achieve significant CO2 elimination. Therefore, incorporating low-flow extracorporeal CO2 removal in a continuous renal replacement therapy circuit is an attractive therapeutic option. We reviewed the relevant literature on combining extracorporeal CO2 removal with continuous renal replacement therapy.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07290
      Issue No: Vol. 65, No. 4 (2020)
       
  • Influence of Noninvasive Ventilation Protocol on Intubation Rates in
           Subjects With De Novo Respiratory Failure
    • Authors: Remi Coudroy; Marie–Anne Hoppe, Rene Robert, Jean–Pierre Frat, Arnaud W Thille
      Pages: 525 - 534
      Abstract: BACKGROUND:The use of noninvasive ventilation (NIV) is debated in de novo respiratory failure. Prolonged sessions, using a dedicated NIV ventilator, with high PEEP levels could be associated with better outcomes than shorter sessions using an ICU ventilator, with low PEEP levels. We performed a systematic review of randomized controlled trials to test whether the incidence of intubation was influenced by the NIV protocol in subjects admitted to the ICU for de novo respiratory failure.METHODS:We selected randomized trials on NIV indexed in medical literature databases from their inception to April 2018. Pediatric studies, those performed outside of the ICU, trials with subjects on NIV for a reason other than de novo respiratory failure, and studies in which NIV protocol was not specified were excluded. Two authors independently extracted intubation rates and the NIV protocol (prolonged or short sessions, type of ventilator, and PEEP levels).RESULTS:Fourteen studies, which included 750 subjects treated with NIV for de novo respiratory failure in ICU, were analyzed. Overall intubation rate was 38%, 95% CI 31–45% and was not influenced by prolonged NIV sessions or the type of ventilator. The 154 subjects treated with PEEP greater than the median overall PEEP (6 cm H2O) had a PEEP level of 8 ± 2 cm H2O and a pressure support level of 7 ± 2 cm H2O. Their intubation rate was lower than the 293 subjects treated with lower PEEP levels (25%, 95% CI 15–37% vs 43%, 95% CI 33–54%, respectively, P = .03). Inclusion criteria were heterogeneous, and critical information on NIV application were frequently lacking.CONCLUSIONS:Except for high PEEP levels that might be associated with lower intubation rates, the protocol for carrying out NIV does not seem to influence intubation rate in patients with de novo respiratory failure.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07104
      Issue No: Vol. 65, No. 4 (2020)
       
  • Effects of Inspiratory Muscle Training in Older Adults
    • Authors: Mariana B Seixas; Leonardo B Almeida, Patricia F Trevizan, Daniel G Martinez, Mateus C Laterza, Luiz Carlos M Vanderlei, Lilian P Silva
      Pages: 535 - 544
      Abstract: BACKGROUND:Inspiratory muscle training (IMT) has been widely applied to different populations, including the general population of older adults. In addition to increasing inspiratory muscle strength, other benefits of IMT in the health of this population have been reported. The primary aim of this study was to review the effects of IMT on the general parameters of health (eg, respiratory, functional, physical, and other variables) in older adults (≥ 60 y), and the secondary aim was to analyze the main IMT protocol used in the studies.METHODS:We searched the MEDLINE, PEDro, SciELO, and LILACS databases to identify relevant randomized controlled clinical trials, and we assessed their methodological quality according to the PEDro scale. The Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines were used to guide the development of the protocol for this systematic review.RESULTS:The search yielded 7 studies involving 248 participants from 917 titles. The main outcomes investigated in response to IMT were related to the respiratory, functional, and physical variables. The results indicate that IMT promotes an increase of inspiratory muscle strength and diaphragmatic thickness in older adults. There was heterogeneity in the protocols described for this population with respect to the total training time (4–8 weeks), intensity (30–80% of the maximum inspiratory pressure), and weekly frequency (5 or 7 sessions).CONCLUSIONS:The reviewed studies revealed a positive trend for the effectiveness of IMT in improving inspiratory muscle performance in elderly subjects. More randomized studies are needed to evaluate other outcomes (eg, functional capacity, exercise capacity, cardiac autonomic control, quality of life, and others) to provide robust evidence that this training modality can promote improvements in health parameters in this population. In addition, the usual IMT prescription in this population is based on sets and repetitions, of mild to moderate intensity, performed on most days of the week, for ≥ 4 weeks.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.06945
      Issue No: Vol. 65, No. 4 (2020)
       
  • Year in Review 2019: High-Flow Nasal Cannula Oxygen Therapy for Adult
           Subjects
    • Authors: Jie Li; Guoqiang Jing, J Brady Scott
      Pages: 545 - 557
      Abstract: Many high-quality clinical trials and meta-analyses on the utilization of high-flow nasal cannula for adult patients have been published in the last 2 years. This review summarizes the recent clinical evidence, with the aim to provide the currently available evidence regarding the utilization of high-flow nasal cannula for the adult patient.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07663
      Issue No: Vol. 65, No. 4 (2020)
       
  • 2019 Year in Review: Patient-Ventilator Synchrony
    • Authors: Robert L Chatburn; Eduardo Mireles-Cabodevila
      Pages: 558 - 572
      Abstract: Patient-ventilator synchrony is a popular topic of research on mechanical ventilation. This review puts this research into both contemporary and historical perspective. Five areas of research are described: literature reviews, manual detection of synchrony problems, automated detection of synchrony problems, modes for improving synchrony, and effects of sedation. We note that this type of research lacks a standardized vocabulary and associated taxonomy, which generates difficulty in communication among students and researchers, as well as in comparison of results. Hence, we conclude this paper with some suggestions for improvement in that regard.
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07635
      Issue No: Vol. 65, No. 4 (2020)
       
  • Should Noninvasive Ventilation Be Used for Treatment of Acute Cardiogenic
           Pulmonary Edema' A Cochrane Review Summary With Commentary
    • Authors: Dean R Hess
      Pages: 573 - 574
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07685
      Issue No: Vol. 65, No. 4 (2020)
       
  • Sustainability of Tobacco Cessation Programs
    • Authors: Lynda T Goodfellow; Rachel E Culbreath
      Pages: 575 - 576
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07765
      Issue No: Vol. 65, No. 4 (2020)
       
  • Management of Severe ARDS: New Strategies and Ongoing Challenges
    • Authors: Damian Ratano; Eddy Fan
      Pages: 577 - 580
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07763
      Issue No: Vol. 65, No. 4 (2020)
       
  • Respiratory Care and the Cochrane Collaboration
    • Authors: Richard D Branson
      Pages: 581 - 581
      PubDate: 2020-03-25T13:08:09-07:00
      DOI: 10.4187/respcare.07800
      Issue No: Vol. 65, No. 4 (2020)
       
 
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