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Respiratory Care Mar 2021Although tobacco use is the leading cause of numerous preventable diseases, including respiratory illnesses, respiratory therapy students historically have received...
BACKGROUND
Although tobacco use is the leading cause of numerous preventable diseases, including respiratory illnesses, respiratory therapy students historically have received inadequate education for treating tobacco use and dependence. To address this gap, a respiratory-specific tobacco cessation training program was created and disseminated via a train-the-trainer approach for faculty in respiratory therapy and respiratory care programs across the United States. The purpose of this study was to estimate the impact of the live, web-based, train-the-trainer programs on participating faculty, and to assess changes in the extent of adoption of tobacco cessation content in respiratory therapy curricula across institutions in the United States.
METHODS
Five live, 2.5-h web-based train-the-trainer programs for respiratory therapy faculty were conducted. To characterize impact of this national initiative, surveys were administered at baseline, immediately after training, and then at the end of the subsequent academic year.
RESULTS
A total of 270 respiratory therapy faculty members participated in a live webinar training, representing 248 of the 402 (61.7%) respiratory therapy schools in the United States. At the end of the subsequent academic year, faculty reported significant improvement in their overall ability to teach tobacco cessation ( < .001). Nearly all (97.4%) agreed that the webinar train-the-trainer format was conducive to learning, and high self-ratings were reported for skills to teach the tobacco cessation content. During the 2016-2017 academic year, 1,248 respiratory therapy students received training. Faculty anticipated teaching a median of 3 h of tobacco cessation in the subsequent academic year.
CONCLUSIONS
Training respiratory therapy faculty using a train-the-trainer approach had a positive impact on faculty's perceived confidence and ability to teach tobacco cessation at their institutions.
Topics: Curriculum; Faculty; Humans; Program Evaluation; Respiratory Therapy; Tobacco Use Cessation; United States
PubMed: 32900914
DOI: 10.4187/respcare.07791 -
Respiratory Care Feb 2010Despite a plethora of publications on the art and science of respiratory care, a number of basic issues remain unanswered. These clinical controversies are often settled...
Despite a plethora of publications on the art and science of respiratory care, a number of basic issues remain unanswered. These clinical controversies are often settled by expert opinion and personal bias. By definition, a controversy has compelling arguments for each side of the issue. This Respiratory Care Journal Conference addressed 12 clinical controversies, ranging from spirometry screening for chronic lung disease to the timing of tracheostomy. This paper is a concise synopsis of the salient points of each side of each argument and provides the points of consensus and points of contention. When appropriate, further research is suggested to address still unanswered questions.
Topics: Humans; Respiratory Therapy
PubMed: 20105347
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... Mar 2010To secure the airway has the highest priority when handling critically ill and injured patients. The aim of this article is to present simple and new devices and... (Review)
Review
BACKGROUND
To secure the airway has the highest priority when handling critically ill and injured patients. The aim of this article is to present simple and new devices and techniques to secure the airway.
MATERIAL AND METHODS
The paper is based on international algorithms for optimal treatment of patients with acute airway problems, and the authors' experience from clinical work and organizing of courses.
RESULTS
Unconscious patients have obstructed airways because the tongue slides back and blocks the airway. This can be prevented by lifting the jaw, possibly supplemented by insertion of an oropharyngeal airway. When these active techniques are not used, patients must be placed in the semi-prone position and air passage checked. The non-breathing patient must be ventilated with simple devices: mouth-to-mouth, pocket-mask or face-mask and bag. Endotracheal intubation is difficult and supraglottic devices are easier and safer to handle. Anaesthetists may use special equipment when securing of airway is particularly difficult. Hospitals routinely intubate with bronchoscopy when presented with patients who breathe spontaneously and for whom airway is expected to have very difficult access. Direct transtracheal access can be obtained by emergency tracheotomy or with various puncturing techniques.
INTERPRETATION
In the unconscious patient, it is of vital importance to maintain a secure airway with simple devices. Hypoxia subsequent to obstructed airways in unconscious patients will become life-threatening, and may cause cerebral ischemia and cardiac arrest within 5-6 minutes. All doctors should be able to ventilate patients with face-mask and bag-valve device. Intubation and tracheotomy should only be performed by trained personnel.
Topics: Anesthesia; Bronchoscopy; Cardiopulmonary Resuscitation; Critical Illness; Emergencies; Humans; Intubation, Intratracheal; Laryngeal Masks; Practice Guidelines as Topic; Respiration, Artificial; Respiratory Therapy; Tracheotomy
PubMed: 20224621
DOI: 10.4045/tidsskr.08.0548 -
The Cochrane Database of Systematic... Sep 2013In some people with asthma, expiratory airflow limitation, premature closure of small airways, activity of inspiratory muscles at the end of expiration and reduced... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In some people with asthma, expiratory airflow limitation, premature closure of small airways, activity of inspiratory muscles at the end of expiration and reduced pulmonary compliance may lead to lung hyperinflation. With the increase in lung volume, chest wall geometry is modified, shortening the inspiratory muscles and leaving them at a sub-optimal position in their length-tension relationship. Thus, the capacity of these muscles to generate tension is reduced. An increase in cross-sectional area of the inspiratory muscles caused by hypertrophy could offset the functional weakening induced by hyperinflation. Previous studies have shown that inspiratory muscle training promotes diaphragm hypertrophy in healthy people and patients with chronic heart failure, and increases the proportion of type I fibres and the size of type II fibres of the external intercostal muscles in patients with chronic obstructive pulmonary disease. However, its effects on clinical outcomes in patients with asthma are unclear.
OBJECTIVES
To evaluate the efficacy of inspiratory muscle training with either an external resistive device or threshold loading in people with asthma.
SEARCH METHODS
We searched the Cochrane Airways Group Specialised Register of trials, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov and reference lists of included studies. The latest search was performed in November 2012.
SELECTION CRITERIA
We included randomised controlled trials that involved the use of an external inspiratory muscle training device versus a control (sham or no inspiratory training device) in people with stable asthma.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by The Cochrane Collaboration.
MAIN RESULTS
We included five studies involving 113 adults. Participants in four studies had mild to moderate asthma and the fifth study included participants independent of their asthma severity. There were substantial differences between the studies, including the training protocol, duration of training sessions (10 to 30 minutes) and duration of the intervention (3 to 25 weeks). Three clinical trials were produced by the same research group. Risk of bias in the included studies was difficult to ascertain accurately due to poor reporting of methods.The included studies showed a statistically significant increase in inspiratory muscle strength, measured by maximal inspiratory pressure (PImax) (mean difference (MD) 13.34 cmH2O, 95% CI 4.70 to 21.98, 4 studies, 84 participants, low quality evidence). Our other primary outcome, exacerbations requiring a course of oral or inhaled corticosteroids or emergency department visits, was not reported. For the secondary outcomes, results from one trial showed no statistically significant difference between the inspiratory muscle training group and the control group for maximal expiratory pressure, peak expiratory flow rate, forced expiratory volume in one second, forced vital capacity, sensation of dyspnoea and use of beta2-agonist. There were no studies describing inspiratory muscle endurance, hospital admissions or days off work or school.
AUTHORS' CONCLUSIONS
There is no conclusive evidence in this review to support or refute inspiratory muscle training for asthma. The evidence was limited by the small number of trials with few participants together with the risk of bias. More well conducted randomised controlled trials are needed. Future trials should investigate the following outcomes: lung function, exacerbation rate, asthma symptoms, hospital admissions, use of medications and days off work or school. Inspiratory muscle training should also be assessed in people with more severe asthma and conducted in children with asthma.
Topics: Adult; Asthma; Breathing Exercises; Humans; Muscle Strength; Randomized Controlled Trials as Topic; Respiratory Muscles; Respiratory Therapy
PubMed: 24014205
DOI: 10.1002/14651858.CD003792.pub2 -
Respiratory Care Sep 2014
Topics: Airway Extubation; Female; Humans; Male; Observer Variation; Respiratory Therapy; Ventilator Weaning
PubMed: 25161308
DOI: 10.4187/respcare.03430 -
Respiratory Care Jun 2015Aerosolized medications are frequently used in the pulmonary function laboratory. The 2 most common implementations are bronchodilators and bronchial challenge agents.... (Review)
Review
Aerosolized medications are frequently used in the pulmonary function laboratory. The 2 most common implementations are bronchodilators and bronchial challenge agents. Bronchodilator administration is not well standardized, largely because of the various methods of delivery available for clinical practice. Metered-dose inhalers used with spacer devices are the most common route for bronchodilator administration, but many laboratories use small-volume nebulizers. Interpretation of pre- and post-bronchodilator studies is confounded by the definitions of airway obstruction and bronchodilator responsiveness. Protocols for administering bronchial challenge aerosols (methacholine, mannitol, hypertonic saline) are well defined but are susceptible to some of the same problems that limit comparison of bronchodilator techniques. Bronchial challenges with inhaled aerosols are influenced not only by the delivery device but by the patient's breathing pattern, particularly in protocols that include deep inspiratory efforts.
Topics: Administration, Inhalation; Aerosols; Bronchial Provocation Tests; Bronchodilator Agents; Humans; Laboratories; Nebulizers and Vaporizers; Pulmonary Medicine; Respiration; Respiratory Therapy
PubMed: 26070584
DOI: 10.4187/respcare.03493 -
Respiratory Care Feb 2018It is always an exciting challenge to write a Year in Review artcicle identifying the best publications in the preceding year; in this case from October 2016 until the... (Review)
Review
It is always an exciting challenge to write a Year in Review artcicle identifying the best publications in the preceding year; in this case from October 2016 until the AARC meeting in October 2017. This is particularly true for cystic fibrosis (CF), where there has been an explosion of new data, new medications, and new understanding of the pathophysiology of the disease. PubMed lists more than 2,500 papers published during those 12 months, many of them outstanding. I am indebted to many colleagues and friends who are leaders in the CF community, active readers of the pediatric pulmonary listserv, and scientists and clinicians engaged in the care of CF, for offering their suggestions regarding which articles should be included in this review. I believe that you will enjoy reading this curated selection of manuscripts that I have tried to organize by theme.
Topics: Cystic Fibrosis; Humans; Lung; Respiratory Therapy
PubMed: 29279361
DOI: 10.4187/respcare.06052 -
Respiratory Care Jun 2009Cystic fibrosis (CF) patients use several therapies to treat chronic inflammation and infection in the lungs and to improve airway clearance. Inhaled therapies in CF... (Review)
Review
Cystic fibrosis (CF) patients use several therapies to treat chronic inflammation and infection in the lungs and to improve airway clearance. Inhaled therapies in CF typically include bronchodilators, airway wetting agents, mucus-active agents, and antibiotics, among others. There are many variables to take into account when prescribing aerosolized therapies to CF patients, including aerosol factors, patient variables (eg, age, disease severity, and breathing patterns), and the limitations of current aerosol delivery systems. The greatest challenge for patients is dealing with the time burden placed on them to try to fit all the treatments into their day-a burden that is likely to be even greater in the near future due to the exciting pipeline of novel therapies that target the genetic defect of CF as well as the pathophysiologic consequences. Fortunately, novel aerosol delivery systems and drug formulations are being developed to tackle the many challenges of aerosol delivery in CF. If successful, these systems will reduce the time burden and improve the clinical outcomes for the CF community.
Topics: Administration, Inhalation; Aerosols; Cystic Fibrosis; Equipment Design; Humans; Respiratory Therapy
PubMed: 19467162
DOI: 10.4187/002013209790983250 -
The British Journal of General Practice... Nov 2012
Topics: Burns; Common Cold; Female; Humans; Male; Respiratory Therapy; Steam
PubMed: 23211156
DOI: 10.3399/bjgp12X658179 -
Respiratory Care Sep 2007High-frequency airway clearance assist devices generate either positive or negative transrespiratory pressure excursions to produce high-frequency, small-volume... (Review)
Review
High-frequency airway clearance assist devices generate either positive or negative transrespiratory pressure excursions to produce high-frequency, small-volume oscillations in the airways. Intrapulmonary percussive ventilation creates a positive transrespiratory pressure by injecting short, rapid inspiratory flow pulses into the airway opening and relies on chest wall elastic recoil for passive exhalation. High-frequency chest wall compression generates a negative transrespiratory pressure by compressing the chest externally to cause short, rapid expiratory flow pulses, and relies on chest wall elastic recoil to return the lungs to functional residual capacity. High-frequency chest wall oscillation uses a chest cuirass to generate biphasic changes in transrespiratory pressure. In any case (positive or negative pressure pulses or both), the general idea is get air behind secretions and move them toward the larger airways, where they can be coughed up and expectorated. These techniques have become ubiquitous enough to constitute a standard of care. Yet, despite over 20 years of research, clinical evidence of efficacy for them is still lacking. Indeed, there is insufficient evidence to support the use of any single airway clearance technique, let alone judge any one of them superior. Aside from patient preference and capability, cost-effectiveness studies based on existing clinical data are necessary to determine when a given technique is most practical.
Topics: Bronchi; Chest Wall Oscillation; Drainage, Postural; Humans; Lung Diseases, Obstructive; Mucus; Physical Therapy Modalities; Respiratory Mucosa; Respiratory Therapy; Treatment Outcome
PubMed: 17716388
DOI: No ID Found