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Chest Apr 2023Respiratory therapists (RTs) are credentialed health professionals who specialize in assessment of pulmonary conditions, performing assessment of pulmonary function and... (Review)
Review
Respiratory therapists (RTs) are credentialed health professionals who specialize in assessment of pulmonary conditions, performing assessment of pulmonary function and delivering pulmonary therapeutics including aerosol therapy, and noninvasive and invasive mechanical ventilation. Respiratory therapists work closely with various clinicians including physicians, nurses, and therapy staff in a number of different settings including outpatient clinics, long-term facilities, EDs, and ICUs. RTs are integral in the treatment of patients with several acute and chronic conditions. In this review, we outline the importance, the elements of, and an approach to building a comprehensive RT program that allows delivery of high-quality care while ensuring RTs practice at the full scope of their licensure. Over the last two decades, we have implemented a suite of changes to the training, functioning, deployment, continuing education, and capacity building in our Lung Partners Program practice, under the supervision of a medical director, that have allowed us to create an effective inpatient and outpatient model of primary respiratory care.
Topics: Humans; Respiratory Therapy; Respiration, Artificial; Administration, Inhalation; Lung; Intensive Care Units
PubMed: 36906506
DOI: 10.1016/j.chest.2022.12.024 -
Otolaryngologia Polska = the Polish... Aug 2017Background Radon-222-enriched hot spring therapy, which is characterized by a safe level of radioactivity, is used for the treatment of rheumatic disorders, and its... (Review)
Review
Background Radon-222-enriched hot spring therapy, which is characterized by a safe level of radioactivity, is used for the treatment of rheumatic disorders, and its efficacy has already been studied in several clinical trials. Radon-water inhalation therapy for the treatment of upper and lower airway inflammatory diseases is used in many hot springs centers. However, its application has not been reviewed to date. Methods We systematically searched the PubMed and Scopus databases for clinical trials published in the last 20 years in which objective parameters of upper and lower airway function had been tested before and after radon-enriched inhalation treatment. Results Four prospective studies were found: 1 asthma trial, 1 placebo-controlled chronic rhinosinusitis trial, 1 upper respiratory tract inflammation with nasal obstruction trial, and 1 case-control allergic rhinitis trial. Patients were treated with nasal inhalations of radon-enriched water for 12 to 28 days and were assessed at baseline and after therapy. After 2 weeks of treatment, nasal resistance decreased, flow increased, mucociliary clearance was enhanced, ciliated-to-muciparous cell ratio increased, and %FEV1 increased in asthmatic patients. Conclusion Radon-enriched inhalation therapy improves objective indicators of nasal function in allergic rhinitis and chronic rhinosinusitis, and causes relief of pulmonary obstruction in asthma.
Topics: Chronic Disease; Hot Temperature; Humans; Prospective Studies; Radon; Respiratory Therapy; Respiratory Tract Diseases; Rhinitis; Sinusitis; Water
PubMed: 29116046
DOI: 10.5604/01.3001.0010.2242 -
Respiratory Care Jun 2017CPAP and noninvasive ventilation (NIV) offer an alternative to intubation and mechanical ventilation in the treatment of acute and chronic respiratory disorders commonly... (Review)
Review
CPAP and noninvasive ventilation (NIV) offer an alternative to intubation and mechanical ventilation in the treatment of acute and chronic respiratory disorders commonly encountered in infants and children. There are many distinct challenges associated with the application, management, and safety of CPAP and NIV in the pediatric population. This review attempts to identify indications, contraindications, management strategies, and safety measures associated with the application of CPAP or NIV delivery in children. More recently, high-flow nasal cannula (HFNC) has emerged as an alternative to CPAP and NIV. Evidence related to the use of CPAP, NIV, and HFNC is included in this review.
Topics: Child; Continuous Positive Airway Pressure; Humans; Infant; Noninvasive Ventilation; Respiration Disorders
PubMed: 28546373
DOI: 10.4187/respcare.05244 -
Respiratory Care Aug 2019A respiratory therapy consult service (RTCS) may reduce misallocation of treatments. Misallocation consists of over-ordering (ie, therapy not indicated but ordered) or...
BACKGROUND
A respiratory therapy consult service (RTCS) may reduce misallocation of treatments. Misallocation consists of over-ordering (ie, therapy not indicated but ordered) or under-ordering (ie, therapy indicated but not ordered). The rate of agreement with RTCS-based orders is defined as the percentage of patients with no misallocation. This study was undertaken to compare current misallocation and agreement with historical benchmark rates at a hospital with an RTCS (ie, the Main Campus, or "on-MC") and 2 hospitals that did not have an RTCS (ie, off-Main Campus, or "off-MC").
METHODS
After approval by the institutional review board, data were collected during normal rounds. A respiratory therapist (RT) determined if the patient had an order for RTCS, what their treatments were, and whether treatment indications were present. RTCS treatments included aerosol therapy, bronchopulmonary hygiene, re-inflation, supplemental oxygen, oxygen monitoring, and suctioning. Agreement and misallocation were compared with chi-square or z-tests with < .05 indicating significance.
RESULTS
The agreement rate for the RTCS on-MC was less than the benchmark rate established 20 years ago (63% vs 86%, = .004), ascribed to misallocation of a single therapy, bronchopulmonary hygiene. The agreement rate with the RTCS on-MC was higher than that with off-MC RTCS (63% vs 33%, < .001). Non-RTCS-based orders on-MC also had higher rates of agreement than orders with off-MC RTCS.
CONCLUSIONS
While the overall rate of agreement was lower with the RTCS currently than in the past, the decline seems solely attributable to a decline in the appropriateness of orders for bronchopulmonary hygiene. In addition, the rate of agreement for non-RTCS-based orders on-MC (71%), where the RTCS has been available for over 20 years, was higher than agreement rate for non-RTCS-based therapies off-MC (20%), where the RTCS has not yet been available. These findings suggest continued efficacy of the RTCS with the need for ongoing vigilance to assure optimal RTCS performance.
Topics: Humans; Medical Overuse; Referral and Consultation; Respiratory Therapy
PubMed: 31040205
DOI: 10.4187/respcare.06710 -
Medicina Intensiva May 2018
Review
Topics: Airway Extubation; Humans; Models, Theoretical; Noninvasive Ventilation; Oxygen Inhalation Therapy; Patient Selection; Procedures and Techniques Utilization; Respiratory Insufficiency; Respiratory Therapy; Risk; Severity of Illness Index
PubMed: 29122291
DOI: 10.1016/j.medin.2017.09.005 -
The European Respiratory Journal Oct 2023
Topics: Humans; Numismatics; Bronchiectasis; Respiratory Therapy; Exercise
PubMed: 37827549
DOI: 10.1183/13993003.00741-2023 -
Acta Neurologica Belgica Oct 2023
Topics: Humans; Seizures; Electroencephalography; Respiratory Therapy
PubMed: 36115916
DOI: 10.1007/s13760-022-02088-8 -
Respiratory Care May 2018Caring for patients with neuromuscular disease (NMD) is challenging. Respiratory care is of the utmost importance because it is a major determinant of quality of life... (Review)
Review
Caring for patients with neuromuscular disease (NMD) is challenging. Respiratory care is of the utmost importance because it is a major determinant of quality of life and survival. Noninvasive ventilation (NIV) is one of the few modalities that has shown survival benefit in the NMD patient population. Newer modes with smart technologies are being developed to assist in better ventilation. Some noninvasive methods have shown success in the management of sialorrhea, which is of paramount importance in the initiation of NIV. This review will summarize the management of respiratory symptomatology in patients with NMD with recent advances made in NIV.
Topics: Humans; Neuromuscular Diseases; Respiratory Insufficiency; Respiratory Therapy; Treatment Outcome
PubMed: 29692352
DOI: 10.4187/respcare.06210 -
Best Practice & Research. Clinical... Jun 2017Long-term management of end-stage lung disease differs from interstitial lung disease to chronic obstructive pulmonary disease to cystic fibrosis to pulmonary vascular... (Review)
Review
Long-term management of end-stage lung disease differs from interstitial lung disease to chronic obstructive pulmonary disease to cystic fibrosis to pulmonary vascular disease. The management includes pharmacological therapy that is disease specific such as antibiotic therapy for cystic fibrosis, antifibrotic drugs in idiopathic pulmonary fibrosis; long-acting beta-agonists, long-acting muscarinic antagonist, and inhaled corticosteroids in chronic obstructive pulmonary disease; and vasodilators in pulmonary arterial hypertension. Moreover, non-pharmacological therapy is essential in the treatment of these diseases, in particular, rehabilitation and supportive therapy, which are necessary in all end-stage lung diseases and specific intervention such as non-invasive ventilation in chronic obstructive pulmonary disease and cystic fibrosis, surgical therapy in chronic obstructive pulmonary disease, and airway clearance in cystic fibrosis. The goal is not only to prolong survival, but it is fundamental to keep patients in good general conditions for transplantation. Transplantation, indeed, remains the only therapeutic option that could prolong survival in patients with terminal lung disease when medical or surgical therapies are not available or not effective anymore.
Topics: Cystic Fibrosis; Disease Management; Humans; Lung Diseases; Muscarinic Antagonists; Pulmonary Disease, Chronic Obstructive; Respiratory Therapy; Time Factors
PubMed: 29110790
DOI: 10.1016/j.bpa.2017.07.007 -
Current Opinion in Pediatrics Jun 2017To summarize current literature describing the respiratory complications of neuromuscular disease (NMD) and the effect of respiratory interventions and to explore new... (Review)
Review
PURPOSE OF REVIEW
To summarize current literature describing the respiratory complications of neuromuscular disease (NMD) and the effect of respiratory interventions and to explore new gene therapies for patients with NMD.
RECENT FINDINGS
Measurements of respiratory function focus on vital capacity and maximal inspiratory and expiratory pressure and show decline over time. Management of respiratory complications includes lung volume recruitment, mechanical insufflation-exsufflation, chest physiotherapy and assisted ventilation. Lung volume recruitment can slow the progression of lung restriction. New gene-specific therapies for Duchenne muscular dystrophy and spinal muscular atrophy have the potential to preserve respiratory function longitudinally. However, the long-term therapeutic benefit remains unknown.
SUMMARY
Although NMDs are heterogeneous, many lead to progressive muscle weakness that compromises the function of the respiratory system including upper airway tone, cough and secretion clearance and chest wall support. Respiratory therapies augment or support the normal function of these components of the respiratory system. From a respiratory perspective, the new mutation and gene-specific therapies for NMD are likely to confer long-term therapeutic benefit. More sensitive and standard tools to assess respiratory function longitudinally are needed to monitor respiratory complications in children with NMD, particularly the youngest patients.
Topics: Child; Genetic Therapy; Humans; Neuromuscular Diseases; Practice Guidelines as Topic; Respiratory Insufficiency; Respiratory Therapy; Risk Assessment
PubMed: 28338488
DOI: 10.1097/MOP.0000000000000498