-
Thorax Sep 2016In patients who have been mechanically ventilated, inspiratory muscles remain weak and fatigable following ventilatory weaning, which may contribute to dyspnoea and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In patients who have been mechanically ventilated, inspiratory muscles remain weak and fatigable following ventilatory weaning, which may contribute to dyspnoea and limited functional recovery. Inspiratory muscle training may improve inspiratory muscle strength and endurance following weaning, potentially improving dyspnoea and quality of life in this patient group.
METHODS
We conducted a randomised trial with assessor-blinding and intention-to-treat analysis. Following 48 hours of successful weaning, 70 participants (mechanically ventilated ≥7 days) were randomised to receive inspiratory muscle training once daily 5 days/week for 2 weeks in addition to usual care, or usual care (control). Primary endpoints were inspiratory muscle strength and fatigue resistance index (FRI) 2 weeks following enrolment. Secondary endpoints included dyspnoea, physical function and quality of life, post-intensive care length of stay and in-hospital mortality.
RESULTS
34 participants were randomly allocated to the training group and 36 to control. The training group demonstrated greater improvements in inspiratory strength (training: 17%, control: 6%, mean difference: 11%, p=0.02). There were no statistically significant differences in FRI (0.03 vs 0.02, p=0.81), physical function (0.25 vs 0.25, p=0.97) or dyspnoea (-0.5 vs 0.2, p=0.22). Improvement in quality of life was greater in the training group (14% vs 2%, mean difference 12%, p=0.03). In-hospital mortality was higher in the training group (4 vs 0, 12% vs 0%, p=0.051).
CONCLUSIONS
Inspiratory muscle training following successful weaning increases inspiratory muscle strength and quality of life, but we cannot confidently rule out an associated increased risk of in-hospital mortality.
TRIAL REGISTRATION NUMBER
ACTRN12610001089022, results.
Topics: Adult; Aged; Breathing Exercises; Dyspnea; Female; Humans; Inhalation; Length of Stay; Male; Middle Aged; Patient Compliance; Quality of Life; Respiration, Artificial; Respiratory Muscles; Respiratory Therapy; Single-Blind Method; Ventilator Weaning
PubMed: 27257003
DOI: 10.1136/thoraxjnl-2016-208279 -
Respiratory Care Sep 2021The word "quality" refers to the features of a product or service to which a certain value is ascribed. When it comes to hospital-based practices, quality has often been... (Review)
Review
The word "quality" refers to the features of a product or service to which a certain value is ascribed. When it comes to hospital-based practices, quality has often been considered to be specific to the care provided. However, this specific perspective is transitioning toward a broader concept after the evolution of quality-improvement projects and quality frameworks at the organizational level. Respiratory therapy departments have been identified as an essential part of any hospital because the key nature of discipline for respiratory therapists is widely understood. Due to their professional accountability and professional values, respiratory therapists often have administrative roles in infection control practices and quality-improvement projects. Therefore, it would be ideal to have a core team of respiratory therapists trained in quality management and to initiate quality-improvement processes at the departmental level. Every respiratory therapy department should have its own quality-improvement team to assist with the process of training, implementation, and analysis. Thus, this article aimed to discuss the role of respiratory therapists and respiratory therapy departments in quality-improvement processes and projects to set benchmarks and enhance outcomes.
Topics: Hospitals; Humans; Quality Improvement; Respiratory Therapy
PubMed: 34408082
DOI: 10.4187/respcare.08820 -
Chest Aug 2021
Topics: Clinical Competence; Education, Graduate; Humans; Lung Diseases; Professional Role; Respiratory Therapy; United States
PubMed: 33819470
DOI: 10.1016/j.chest.2021.03.053 -
NeoReviews Apr 2019Respiratory support is frequently required during neonatal transport. This review identifies the various modalities of respiratory support available during neonatal... (Review)
Review
Respiratory support is frequently required during neonatal transport. This review identifies the various modalities of respiratory support available during neonatal transport and their appropriate clinical uses. The respiratory equipment required during neonatal transport and appropriate safety checks are also reviewed. In addition, we discuss potential respiratory emergencies and how to respond to them to decrease the risk of complications during transport and improve health outcomes.
Topics: Humans; Infant, Newborn; Respiratory Distress Syndrome, Newborn; Respiratory Therapy; Transportation of Patients
PubMed: 31261061
DOI: 10.1542/neo.20-4-e202 -
Respiratory Care Jan 2024
Topics: Humans; Respiratory Therapy
PubMed: 38267233
DOI: 10.4187/respcare.11857 -
Journal of Burn Care & Research :... Jun 2019Smoke inhalation injury (SII) is a major morbidity and cause of mortality in patients with burns. Damage caused by inhalation of thermal or chemical irritants, including... (Review)
Review
Smoke inhalation injury (SII) is a major morbidity and cause of mortality in patients with burns. Damage caused by inhalation of thermal or chemical irritants, including toxic fumes and chemicals, leads to respiratory cilia and epithelial cell injuries, which turn to severe bronchospasm and alveolar damage and results in acute respiratory distress syndrome. Respiratory management plays a vital role in the treatment of SII. In this review, we provide an overview of SII with emphasis on respiratory management, including aerosol therapy, bronchial hygiene therapy, advanced ventilation modes, and heated humidified high-flow nasal cannula. In summary, the information may be helpful for further improvements in outcomes.
Topics: Burns, Inhalation; Humans; Monitoring, Physiologic; Respiration, Artificial; Respiratory Distress Syndrome; Respiratory Function Tests; Respiratory Therapy; Smoke Inhalation Injury
PubMed: 30893426
DOI: 10.1093/jbcr/irz043 -
Intensive Care Medicine Feb 2017Nasal continuous positive airway pressure (nCPAP) is currently the gold standard for respiratory support for moderate to severe acute viral bronchiolitis (AVB). Although... (Randomized Controlled Trial)
Randomized Controlled Trial
High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study).
PURPOSE
Nasal continuous positive airway pressure (nCPAP) is currently the gold standard for respiratory support for moderate to severe acute viral bronchiolitis (AVB). Although oxygen delivery via high flow nasal cannula (HFNC) is increasingly used, evidence of its efficacy and safety is lacking in infants.
METHODS
A randomized controlled trial was performed in five pediatric intensive care units (PICUs) to compare 7 cmHO nCPAP with 2 L/kg/min oxygen therapy administered with HFNC in infants up to 6 months old with moderate to severe AVB. The primary endpoint was the percentage of failure within 24 h of randomization using prespecified criteria. To satisfy noninferiority, the failure rate of HFNC had to lie within 15% of the failure rate of nCPAP. Secondary outcomes included success rate after crossover, intubation rate, length of stay, and serious adverse events.
RESULTS
From November 2014 to March 2015, 142 infants were included and equally distributed into groups. The risk difference of -19% (95% CI -35 to -3%) did not allow the conclusion of HFNC noninferiority (p = 0.707). Superiority analysis suggested a relative risk of success 1.63 (95% CI 1.02-2.63) higher with nCPAP. The success rate with the alternative respiratory support, intubation rate, durations of noninvasive and invasive ventilation, skin lesions, and length of PICU stay were comparable between groups. No patient had air leak syndrome or died.
CONCLUSION
In young infants with moderate to severe AVB, initial management with HFNC did not have a failure rate similar to that of nCPAP. This clinical trial was recorded in the National Library of Medicine registry (NCT 02457013).
Topics: Acute Disease; Bronchiolitis, Viral; Cannula; Continuous Positive Airway Pressure; Humans; Infant; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Oxygen Inhalation Therapy; Respiratory Distress Syndrome, Newborn; Treatment Failure
PubMed: 28124736
DOI: 10.1007/s00134-016-4617-8 -
Brazilian Journal of Physical Therapy 2015
Topics: Brazil; Curriculum; Europe; Humans; Physical Therapy Specialty; Respiratory Therapy; Societies, Medical
PubMed: 25993622
DOI: 10.1590/bjpt-rbf.2014.0094 -
American Family Physician Nov 2021Vocal cord dysfunction (i.e., vocal cords closing when they should be opening, particularly during inspiration) should be suspected in patients presenting with... (Review)
Review
Vocal cord dysfunction (i.e., vocal cords closing when they should be opening, particularly during inspiration) should be suspected in patients presenting with inspiratory stridor or wheezing; sudden, severe dyspnea (without hypoxia, tachypnea, or increased work of breathing); throat or chest tightness; and anxiety, particularly in females. Common triggers include exercise, asthma, gastroesophageal reflux disease, postnasal drip, upper or lower respiratory tract infection, and irritants. Nasolaryngoscopy and pulmonary function testing, with provocative exercise and methacholine, can help diagnose vocal cord dysfunction and are helpful to evaluate for other etiologies. Conditions that can trigger vocal cord dysfunction should be optimally treated, particularly asthma, gastroesophageal reflux disease, and postnasal drip, while avoiding potential irritants. Therapeutic breathing maneuvers and vocal cord relaxation techniques are first-line therapy for dyspnea that occurs with vocal cord dysfunction. A subset of vocal cord dysfunction leads to dysphonia, as opposed to dyspnea, secondary to abnormal laryngeal muscle spasms (vocal cord closure is less severe). OnabotulinumtoxinA injections may be helpful for spasmodic dysphonia and for treating dyspnea in certain cases, although evidence is limited.
Topics: Airway Management; Humans; Laryngoscopy; Respiratory Function Tests; Respiratory Therapy; Speech Therapy; Vocal Cord Dysfunction; Vocal Cords
PubMed: 34783512
DOI: No ID Found -
Cleveland Clinic Journal of Medicine Sep 2019Positive airway pressure (PAP) therapy is the gold standard treatment for patients with obstructive sleep apnea (OSA) and has been shown to positively impact quality of... (Review)
Review
Positive airway pressure (PAP) therapy is the gold standard treatment for patients with obstructive sleep apnea (OSA) and has been shown to positively impact quality of life and cardiovascular outcomes. However, not all patients with OSA can use or tolerate PAP therapy. Alternative interventions to PAP include lifestyle measures, surgical interventions, hypoglossal nerve stimulation, oral appliance therapy, and expiratory PAP devices for OSA. While these alternative interventions may benefit patients and have demonstrated improvements in OSA and quality-of-life measures, the cardiovascular impact of these interventions is uncertain as data are limited.
Topics: Electric Stimulation Therapy; Humans; Hypoglossal Nerve; Life Style; Nasal Surgical Procedures; Positive-Pressure Respiration; Respiratory Therapy; Sleep Apnea, Obstructive
PubMed: 31509502
DOI: 10.3949/ccjm.86.s1.06