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Sakagami T. Advancements in pulmonary alveolar proteinosis treatment: A journey from discovery to GM-CSF inhalation therapy. Respir Investig 2024; 62:375-376. [PMID: 38437758 DOI: 10.1016/j.resinv.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Takuro Sakagami
- Department of Respiratory Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.
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Merckx P, Conickx G, Blomme E, Maes T, Bracke KR, Brusselle G, De Smedt SC, Raemdonck K. Evaluating β 2-agonists as siRNA delivery adjuvants for pulmonary surfactant-coated nanogel inhalation therapy. Eur J Pharm Biopharm 2024; 197:114223. [PMID: 38367760 DOI: 10.1016/j.ejpb.2024.114223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
The lung is an attractive target organ for inhalation of RNA therapeutics, such as small interfering RNA (siRNA). However, clinical translation of siRNA drugs for application in the lung is hampered by many extra- and intracellular barriers. We previously developed hybrid nanoparticles consisting of an siRNA-loaded nanosized hydrogel (nanogel) core coated with Curosurf®, a clinically used pulmonary surfactant. The surfactant shell was shown to markedly improve particle stability and promote intracellular siRNA delivery, both in vitro and in vivo. However, the full potential of siRNA nanocarriers is typically not reached as they are rapidly trafficked towards lysosomes for degradation and only a fraction of the internalized siRNA cargo is able to escape into the cytosol. We recently reported on the repurposing of widely applied cationic amphiphilic drugs (CADs) as siRNA delivery enhancers. Due to their physicochemical properties, CADs passively accumulate in the (endo)lysosomal compartment causing a transient permeabilization of the lysosomal membrane, which facilitates cytosolic drug delivery. In this work, we assessed a selection of cationic amphiphilic β2-agonists (i.e., salbutamol, formoterol, salmeterol and indacaterol) for their ability to enhance siRNA delivery in a lung epithelial and macrophage cell line. These drugs are widely used in the clinic for their bronchodilating effect in obstructive lung disease. As opposed to the least hydrophobic drugs salbutamol and formoterol, the more hydrophobic long-acting β2-agonist (LABA) salmeterol promoted siRNA delivery in both cell types for both uncoated and surfactant-coated nanogels, whereas indacaterol showed this effect solely in lung epithelial cells. Our results demonstrate the potential of both salmeterol and indacaterol to be repurposed as adjuvants for nanocarrier-mediated siRNA delivery to the lung, which could provide opportunities for drug combination therapy.
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Affiliation(s)
- Pieterjan Merckx
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Department of Pharmaceutics, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Griet Conickx
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Faculty of Medicine and Health Sciences, Department of Respiratory Medicine, Ghent University Hospital, Medical Research Building 2, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Evy Blomme
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Faculty of Medicine and Health Sciences, Department of Respiratory Medicine, Ghent University Hospital, Medical Research Building 2, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Tania Maes
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Faculty of Medicine and Health Sciences, Department of Respiratory Medicine, Ghent University Hospital, Medical Research Building 2, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Ken R Bracke
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Faculty of Medicine and Health Sciences, Department of Respiratory Medicine, Ghent University Hospital, Medical Research Building 2, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Guy Brusselle
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Faculty of Medicine and Health Sciences, Department of Respiratory Medicine, Ghent University Hospital, Medical Research Building 2, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Stefaan C De Smedt
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Department of Pharmaceutics, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Koen Raemdonck
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Department of Pharmaceutics, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
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Zheng M, Zhu W, Gao F, Zhuo Y, Zheng M, Wu G, Feng C. Novel inhalation therapy in pulmonary fibrosis: principles, applications and prospects. J Nanobiotechnology 2024; 22:136. [PMID: 38553716 PMCID: PMC10981316 DOI: 10.1186/s12951-024-02407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
Pulmonary fibrosis (PF) threatens millions of people worldwide with its irreversible progression. Although the underlying pathogenesis of PF is not fully understood, there is evidence to suggest that the disease can be blocked at various stages. Inhalation therapy has been applied for lung diseases such as asthma and chronic obstructive pulmonary disease, and its application for treating PF is currently under consideration. New techniques in inhalation therapy, such as the application of microparticles and nanoparticles, traditional Chinese medicine monomers, gene therapy, inhibitors, or agonists of signaling pathways, extracellular vesicle interventions, and other specific drugs, are effective in treating PF. However, the safety and effectiveness of these therapeutic techniques are influenced by the properties of inhaled particles, biological and pathological barriers, and the type of inhalation device used. This review provides a comprehensive overview of the pharmacological, pharmaceutical, technical, preclinical, and clinical experimental aspects of novel inhalation therapy for treating PF and focus on therapeutic methods that significantly improve existing technologies or expand the range of drugs that can be administered via inhalation. Although inhalation therapy for PF has some limitations, the advantages are significant, and further research and innovation about new inhalation techniques and drugs are encouraged.
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Affiliation(s)
- Meiling Zheng
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100010, China
- Peking University People's Hospital, Beijing, 100032, China
| | - Wei Zhu
- Department of Ophthalmology, Changshu No. 2 People's Hospital, Changshu, 215500, China
| | - Fei Gao
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu, 611130, China
| | - Yu Zhuo
- Department of Medical Oncology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 100010, China
| | - Mo Zheng
- Department of Medical Oncology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 100010, China
| | - Guanghao Wu
- School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, China.
| | - Cuiling Feng
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100010, China.
- Peking University People's Hospital, Beijing, 100032, China.
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Dietsch AM, Krishnamurthy R, Young K, Barlow SM. Instrumental Assessment of Aero-Resistive Expiratory Muscle Strength Rehabilitation Devices. J Speech Lang Hear Res 2024; 67:729-739. [PMID: 38324264 DOI: 10.1044/2023_jslhr-23-00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE Expiratory muscle strength training (EMST) is increasingly being used to treat voice, cough, and swallowing deficits in a wide range of conditions. However, a multitude of aero-resistive EMST models are commercially available, and the absence of side-by-side comparative data interferes with clinicians' ability to assess which model is best suited to a particular client's needs. The primary aim of this research was to test and compare the pressure and flow parameters of six currently available EMST models to help inform clinical decision making. METHOD We identified and tested five devices of each of six different EMST models to generate benchmark data for minimum trigger pressures across settings. The reliability was tested within each device and between five devices of the same model across settings using coefficient of variation. RESULTS All six models required higher pressures to initiate flow at the highest setting compared to the lowest setting, as expected. Detailed descriptive statistics for each model/setting combination include average flow-triggering pressure for each model/setting and the variability across trials within a device and across devices of the same model. From these, ranked order of the least to most stable EMST model was derived. CONCLUSIONS Systematic testing of several commercially available expiratory resistance training devices yielded clinical benchmarks and reliability data to aid clinicians in selecting an appropriate therapy device and regimen for a client based on their available airflow and air pressure as well as reliability of the device. These findings allow clinicians to directly compare key parameters across EMST devices.
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Affiliation(s)
- Angela M Dietsch
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
- Center for Brain, Biology and Behavior, University of Nebraska-Lincoln
| | - Rahul Krishnamurthy
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
| | - Kelsey Young
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
| | - Steven M Barlow
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
- Center for Brain, Biology and Behavior, University of Nebraska-Lincoln
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Hong Q, Chang RYK, Assafiri O, Morales S, Chan HK. Optimizing in vitro phage-ciprofloxacin combination formulation for respiratory therapy of multi-drug resistant Pseudomonas aeruginosa infections. Int J Pharm 2024; 652:123853. [PMID: 38280500 DOI: 10.1016/j.ijpharm.2024.123853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
Respiratory infection caused by multi-drug resistant (MDR) Pseudomonas aeruginosa is challenging to treat. In this study, we investigate the optimal dose of anti-pseudomonas phage PEV31 (103, 105, and 108 PFU/mL) combined with ciprofloxacin (ranging from 1/8× MIC to 8× MIC) to treat the MDR P. aeruginosa strain FADD1-PA001 using time-kill studies. We determined the impact of phage growth kinetics in the presence of ciprofloxacin through one-step growth analysis. Single treatments with either phage PEV31 or ciprofloxacin (except at 8× MIC) showed limited bactericidal efficiency, with bacterial regrowth observed at 48 h. The most effective treatments were PEV31 at multiplicity of infection (MOI) of 0.1 and 100 combined with ciprofloxacin at concentrations above 1× MIC, resulting in a >4 log10 reduction in bacterial counts. While the burst size of phage PEV31 was decreased with increasing ciprofloxacin concentration, robust antimicrobial effects were still maintained in the combination treatment. Aerosol samples collected from vibrating mesh nebulization of the combination formulation at phage MOI of 100 with 2× MIC effectively inhibited bacterial density. In summary, our combination treatments eradicated in vitro bacterial growth and sustained antimicrobial effects for 48 h. These results indicated the potential application of nebulization-based strategies for the combination treatment against MDR lung infections.
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Affiliation(s)
- Qixuan Hong
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Rachel Yoon Kyung Chang
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Omar Assafiri
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | | | - Hak-Kim Chan
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
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Yu Y, Ni M, Zheng Y, Huang Y. Airway epithelial-targeted nanoparticle reverses asthma in inhalation therapy. J Control Release 2024; 367:223-234. [PMID: 38272396 DOI: 10.1016/j.jconrel.2024.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/26/2023] [Accepted: 01/22/2024] [Indexed: 01/27/2024]
Abstract
Despite extensive research on corticosteroids for treating asthma, their short residence time in the lungs has limited their therapeutic effects in vivo. Nanoparticles have been widely investigated for inhaled drug delivery due to their potential benefits in prolonging drugs' residence time in the lungs. However, the retention of nanoparticles may be limited by mucus and ciliated epithelium clearance mechanisms in the airway. Herein, we anchored a neonatal-Fc-receptor-targeted peptide (FcBP) onto "mucus-penetrating" polyethylene glycol (PEG) nanoparticles (PEG-NP). Interestingly, the mucus-permeability of PEG-NP was not impaired by FcBP-functionalization. Moreover, FcBP modification enhanced cellular internalization and exocytosis via specific receptor-mediated processes, which subsequently ameliorated transepithelial transport and prolonged pulmonary retention. Importantly, after loading dexamethasone, FcBP-functionalization could effectively help nanoparticles cross the airway epithelial layer and be endocytosed by inflammatory cells, resulting in a marked decrease in inflammatory cytokines. Finally, FcBP modification significantly enhanced the therapeutic effect of dexamethasone-loaded nanoparticles in asthma mice. This study demonstrates that FcBP-functionalized PEG-NP can overcome multiple obstacles in the airway to prolong the pulmonary retention of drugs, providing a promising strategy for inhalation therapy.
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Affiliation(s)
- Yinglan Yu
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China
| | - Mingjie Ni
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Yaxian Zheng
- Department of Pharmacy, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu 610031, Sichuan, China; Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu 610031, Sichuan, China
| | - Yuan Huang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China.
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Sarac DC, Bayraktar D, Ozer Kaya D, Altug Gucenmez O, Oskay D. The effects of inspiratory muscle training on cardiorespiratory functions in juvenile idiopathic arthritis: A randomized controlled trial. Pediatr Pulmonol 2024; 59:562-573. [PMID: 38038160 DOI: 10.1002/ppul.26783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/16/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Although inspiratory muscle training (IMT) has proven effective in adult rheumatic diseases, its impact on juvenile idiopathic arthritis (JIA) remains unexplored. The present study aimed to investigate the effects of IMT in children with JIA. METHODS Thirty-three children (13-18 years) with JIA were divided into two groups as exercise (n = 17) and control (n = 16). The exercise group performed IMT at home daily for 8 weeks. The initial IMT load was set as 60% of maximal inspiratory pressure (PImax ) and increased by %10 of the initial load every 2 weeks. The control group received no additional intervention. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), FVC/FEV1 , PImax , and maximal expiratory pressure (PEmax ) were evaluated. Peak oxygen consumption (VO2max ), metabolic equivalents (METs), and maximal heart rate were measured with cardiopulmonary exercise test. Functional capacity and quality of life were assessed with 6-min walk distance and Pediatric Quality of Life Inventory 3.0 Arthritis Module. All participants were evaluated at baseline and post-treatment. RESULTS FVC ( ↑ 0.20 (95% CI: 0.07/0.32) liters), FEV1 ( ↑ 0.14 (95% CI: 0.02/0.25) liters), PImax (↑19.11 (95% CI: 9.52/28.71) cmH2 O), PEmax (↑12.41 (95% CI: 3.09/21.72) cmH2 O), VO2peak (↑158.29 (95% CI: 63.85/252.73) ml/min), and METs (↑0.92 (95% CI: 0.34/1.49) [ml/kg/min]) significantly improved only in the exercise group (p < .05). The difference over time in FVC, FEV1 , PImax , VO2peak , and METs were significantly higher in exercise group compared to control group (p < .05). CONCLUSIONS IMT seems to be an effective option for improving respiratory functions and aerobic exercise capacity in JIA.
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Affiliation(s)
- Devrim Can Sarac
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | - Deniz Bayraktar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | - Derya Ozer Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | - Ozge Altug Gucenmez
- Clinic of Pediatric Rheumatology, University of Health Sciences Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkiye
| | - Deran Oskay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkiye
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Deana C, Vecchiato M, Vetrugno L, Petri R, Overbeek MC, Reijneveld EA, Valkenet K, van Adrichem EJ, Dronkers JJ, Ruurda JP, Veenhof C. Comment on The Association Between Preoperative Inspiratory Muscle Training Variables and Postoperative Pulmonary Complications in Subjects With Esophageal Cancer. Respir Care 2024; 69:376-378. [PMID: 38416657 PMCID: PMC10984593 DOI: 10.4187/respcare.11744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive CareAcademic Hospital of UdineUdine, Italy
| | - Massimo Vecchiato
- General Surgery UnitDepartment of SurgeryAcademic Hospital of UdineUdine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological SciencesUniversity of Chieti-PescaraChieti, ItalyDepartment of Anesthesiology, Critical Care Medicine and EmergencySS. Annunziata HospitalChieti, Italy
| | - Roberto Petri
- General Surgery UnitDepartment of SurgeryAcademic Hospital of UdineUdine, Italy
| | - Meike C Overbeek
- Department of Anesthesia and Intensive CareAcademic Hospital of UdineUdine, Italy
| | - Elja Ae Reijneveld
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the Netherlands
| | - Karin Valkenet
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the NetherlandsDepartment of Rehabilitation Physiotherapy Science and SportUniversity Medical Center UtrechtBrain CentreUtrecht, the Netherlands
| | | | - Jaap J Dronkers
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the Netherlands
| | - Jelle P Ruurda
- Department of SurgeryUniversity Medical Center UtrechtUtrecht, the Netherlands
| | - Cindy Veenhof
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the NetherlandsDepartment of Rehabilitation Physiotherapy Science and SportUniversity Medical Center UtrechtBrain CentreUtrecht, the Netherlands
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Overbeek MC, Reijneveld EA, Valkenet K, van Adrichem EJ, Dronkers JJ, Ruurda JP, Veenhof C. Response to Comment on Associations Between Preoperative Inspiratory Muscle Training Variables and Postoperative Pulmonary Complications in Subjects With Esophageal Cancer. Respir Care 2024; 69:1-2. [PMID: 38416656 PMCID: PMC10984594 DOI: 10.4187/respcare.11841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Affiliation(s)
- Meike C Overbeek
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the Netherlands
| | - Elja Ae Reijneveld
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the Netherlands
| | - Karin Valkenet
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the NetherlandsDepartment of Rehabilitation Physiotherapy Science and SportUniversity Medical Center UtrechtBrain CentreUtrecht, the Netherlands
| | | | - Jaap J Dronkers
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the Netherlands
| | - Jelle P Ruurda
- Department of SurgeryUniversity Medical Center UtrechtUtrecht, the Netherlands
| | - Cindy Veenhof
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the NetherlandsDepartment of Rehabilitation Physiotherapy Science and SportUniversity Medical Center UtrechtBrain CentreUtrecht, the Netherlands
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10
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Ekkapat G, Berra L, Nagrebetsky A. Navigating Uncertainty: Should We Consider Inspiratory Muscle Training Following Esophagectomy? Respir Care 2024; 69:382-383. [PMID: 38416654 PMCID: PMC10984603 DOI: 10.4187/respcare.11901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Affiliation(s)
- Gamonmas Ekkapat
- Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital and Harvard Medical SchoolBoston, MassachusettsDepartment of AnesthesiologyChulalongkorn UniversityKing Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkok, Thailand
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital and Harvard Medical SchoolBoston, Massachusetts
| | - Alexander Nagrebetsky
- Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital and Harvard Medical SchoolBoston, Massachusetts
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11
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Kuitunen I, Renko M. Inhaled nitric oxide in acute bronchiolitis: A systematic review and meta-analysis. Pediatr Pulmonol 2024; 59:426-432. [PMID: 37988259 DOI: 10.1002/ppul.26767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Until date there is lack of effective therapies in acute bronchiolitis in infants. The aim was to analyze inhaled nitric oxide efficacy in acute bronchiolitis. DESIGN Systematic review and meta-analysis of randomized controlled trials. SETTING Pediatric specialized healthcare. PATIENTS All infants (age less than 2 years) having acute bronchiolitis, which requires emergency room visit or hospitalization. INTERVENTION Inhaled nitric oxide. MAIN OUTCOME MEASURES Need for intensive care unit admission. Secondary outcomes were length of hospital stay and adverse events. Risk ratios (RR) and mean differences with 95% confidence intervals (CI) calculated by random-effects DerSimonian and Laird inverse variance method. Peto Odds ratios were used for rare outcomes. Evidence certainty assessed according to GRADE. RESULTS 186 studies were screened and three included for analysis. Two had low risk of bias and one had some concerns. Three studies (166 infants) analyzed length of hospital stay and the duration was -11.3 h (CI: -26.8 to +4.2 h) shorter in the nitric oxide group. Evidence certainty was ranked as low. Overall adverse event rates were similar (3 studies, 166 infants, RR: 0.94, CI: 0.70-1.26), but treatment related harms were more common in nitric oxide group (2 studies, 98 infants, OR: 3.86, CI: 1.04-14.40). Evidence certainty in both was rated as low. CONCLUSIONS Low certainty evidence suggests that inhaled nitric oxide does not reduce length of hospital stay but may have higher rate of treatment associated harms. Future studies with larger sample sizes are needed to better estimate both the efficacy and adverse events.
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Affiliation(s)
- Ilari Kuitunen
- Department of Pediatrics, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Marjo Renko
- Department of Pediatrics, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
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Craighead DH, Freeberg KA, Heinbockel TC, Rossman MJ, Jackman RA, McCarty NP, Jankowski LR, Nemkov T, Reisz JA, D’Alessandro A, Chonchol M, Bailey EF, Seals DR. Time-Efficient, High-Resistance Inspiratory Muscle Strength Training Increases Exercise Tolerance in Midlife and Older Adults. Med Sci Sports Exerc 2024; 56:266-276. [PMID: 37707508 PMCID: PMC10840713 DOI: 10.1249/mss.0000000000003291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
PURPOSE This study aimed to determine if time-efficient, high-resistance inspiratory muscle strength training (IMST), comprising 30 inhalation-resisted breaths per day, improves cardiorespiratory fitness, exercise tolerance, physical function, and/or regional body composition in healthy midlife and older adults. METHODS We performed a double-blind, randomized, sham-controlled clinical trial (NCT03266510) testing 6 wk of IMST (30 breaths per day, 6 d·wk -1 , 55%-75% maximal inspiratory pressure) versus low-resistance sham training (15% maximal inspiratory pressure) in healthy men and women 50-79 yr old. Subjects performed a graded treadmill exercise test to exhaustion, physical performance battery (e.g., handgrip strength, leg press), and body composition testing (dual x-ray absorptiometry) at baseline and after 6 wk of training. RESULTS Thirty-five participants (17 women, 18 men) completed high-resistance IMST ( n = 17) or sham training ( n = 18). Cardiorespiratory fitness (V̇O 2peak ) was unchanged, but exercise tolerance, measured as treadmill exercise time during a graded exercise treadmill test, increased with IMST (baseline, 539 ± 42 s; end intervention, 606 ± 42 s; P = 0.01) but not sham training (baseline, 562 ± 39 s; end intervention, 553 ± 38 s; P = 0.69). IMST increased peak RER (baseline, 1.09 ± 0.02; end intervention, 1.13 ± 0.02; P = 0.012), peak ventilatory efficiency (baseline, 25.2 ± 0.8; end intervention, 24.6 ± 0.8; P = 0.036), and improved submaximal exercise economy (baseline, 23.5 ± 1.1 mL·kg -1 ⋅min -1 ; end intervention, 22.1 ± 1.1 mL·kg -1 ⋅min -1 ; P < 0.001); none of these factors were altered by sham training (all P > 0.05). Changes in plasma acylcarnitines (targeted metabolomics analysis) were consistently positively correlated with changes in exercise tolerance after IMST but not sham training. IMST was associated with regional increases in thorax lean mass (+4.4%, P = 0.06) and reductions in trunk fat mass (-4.8%, P = 0.04); however, peripheral muscle strength, muscle power, dexterity, and mobility were unchanged. CONCLUSIONS These data suggest that high-resistance IMST is an effective, time-efficient lifestyle intervention for improving exercise tolerance in healthy midlife and older adults.
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Affiliation(s)
- Daniel H. Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Kaitlin A. Freeberg
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Thomas C. Heinbockel
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Matthew J. Rossman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Rachel A. Jackman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Narissa P. McCarty
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Lindsey R. Jankowski
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Julie A. Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - E. Fiona Bailey
- Department of Physiology, University of Arizona College of Medicine, Tucson, AZ
| | - Douglas R. Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
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13
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Goodfellow LT. The Continuum of Research in Entry-Level Education and Post-Graduate Clinical Respiratory Care. Respir Care 2024; 69:250-255. [PMID: 37875316 PMCID: PMC10898461 DOI: 10.4187/respcare.11504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
The greater and stronger your knowledge about a subject, the more you will be able to address a new problem in that subject. In entry-level respiratory care education, incorporating research into curricula can be challenging due to the limited time to cover all necessary topics. This is also true in clinical post-graduate respiratory care practice. This paper addresses the need and the rationale for research integration into respiratory therapy education and post-graduate respiratory care practice as a continuum. Without learning the importance of being a consumer of research and being immersed in research-oriented teaching and practice, the respiratory care profession cannot provide evidence-based care to patients. Devoting resources to develop research expectations and priorities should be a joint effort of educators and leaders. Mentorship is critically important to guide and nurture those with an inquisitive mindset. However, first, educators must cultivate an interest in research.
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Affiliation(s)
- Lynda T Goodfellow
- American Association for Respiratory Care, Irving, TX and Georgia State University, Atlanta, Georgia.
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14
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Branson RD, Ring BJ. Sustainability in Respiratory Therapy: Revisiting Reusables. Respir Care 2024; 69:275-279. [PMID: 38267233 PMCID: PMC10898465 DOI: 10.4187/respcare.11857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Richard D Branson
- Division of Acute Care Surgery, Trauma and Critical Care University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Brian J Ring
- Division of Acute Care Surgery, Trauma and Critical Care University of Cincinnati College of Medicine Cincinnati, Ohio
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15
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Brown CL, Chartrand L, Vollebregt B, Kaur D, Crawford T, Thille P. Primary care occupational, physical, and respiratory therapy role adaptation in the first year of the COVID-19 pandemic. BMC Prim Care 2024; 25:3. [PMID: 38166661 PMCID: PMC10759467 DOI: 10.1186/s12875-023-02247-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Occupational, physical and respiratory therapists are relatively new to primary care settings, and thus their roles are still emerging. The COVID-19 pandemic was a time of abrupt changes in professional roles. Professional role adaptations are integral to the ability of health care teams to respond to day-to-day care delivery challenges, such as the current physician and nurse shortage, as well as disaster situations. This study explored the role adaptation of occupational, physical, and respiratory therapists in Canadian primary care settings throughout the first year of the COVID-19 pandemic, as well as barriers and facilitators to adaptation. METHODS This longitudinal interpretative descriptive study purposively sampled primary care occupational, physical, and respiratory therapists from two Canadian provinces (Manitoba and Ontario). We asked participants to prepare at least 10 semi-structured audio-diary entries during a 12-week period (April - Oct 2020), followed by two semi-structured interviews (Dec 2020, Apr 2021). Questions focused on changes happening in their practice over time. Analysis was iterative, including developing a individual summaries and coding data using both inductive and pre-determined codes. We then entered an immersion/crystallization process to develop key themes related to role adaptation. RESULTS We represent our findings with the metaphor of the game of Role Adaptation Snakes and Ladders (aka Chutes and Ladders). The pandemic was certainly not a game, but this metaphor represents the tension of being a pawn to circumstance while also being expected to take control of one's professional and personal life during a disaster. The object of the game is to move through three phases of role adaptation, from Disorienting, through Coping and Waiting, to Adapting. In the Adapting phase, the therapists creatively found ways to provide vital services for the pandemic response. The therapists were influenced both negatively and positively (snakes and ladders) by their personal circumstances, and professional meso and macro contexts. Each therapist moved across the board in a unique trajectory and timeline based on these contexts. CONCLUSIONS Rehabilitation professionals, with adequate meso and macro system supports, can maximize their role on primary care teams by adapting their services to work to their full scope of practice.
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Affiliation(s)
- Cara L Brown
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, R125, 771 McDermot Ave, Winnipeg, Manitoba, R3E 0T6, Canada.
| | - Louise Chartrand
- Department of Respiratory Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brontë Vollebregt
- Applied Health Sciences Program, Faculty of Graduate Studies, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dayajyot Kaur
- Rehabilitation Sciences Program, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tory Crawford
- Rehabilitation Sciences Program, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia Thille
- Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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16
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Ntoumenopoulos G, Andersen T, Hardingham NM. Upper airway assessment and its implications for interventions by respiratory physiotherapists. Physiother Theory Pract 2024; 40:184-189. [PMID: 35904123 DOI: 10.1080/09593985.2022.2106916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/16/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND When noninvasive interventions such as chest physiotherapy fail, then more aggressive interventions for airway secretion clearance with nasotracheal airway suctioning may be required. Clinicians however have to insert the nasotracheal suction catheter "blindly" and the success of being able to trigger a cough and pass through the vocal folds with a suction catheter is low. CASE DESCRIPTION The patient, a 48-year-old male underwent a heart and lung transplant. Following extubation, the patient developed secretion retention with a weak ineffective cough and swallow and required physiotherapy interventions with frequent "blind" passes of nasotracheal suctioning. OUTCOMES The patient required nasotracheal suction with frequent multiple failed attempts before successful passage of the suction catheter to trigger a cough reflex and clear secretions. A combined physiotherapist and speech and language therapist intervention during fiberoptic endoscopic evaluation of swallow (FEES) was recorded to both evaluate swallow and passage of the suction catheter. The video illustrated the successful passage of a suctioning catheter through the vocal folds leading to an effective cough and airway clearance. DISCUSSION We present a case report demonstrating that it is feasible to visualize the upper airways during nasotracheal suctioning as an objective means to guide the more accurate successful insertion of the suction catheter past the vocal folds. Rather than "blind" placement of nasotracheal suction catheters visualization using transnasal laryngoscopy should be useful to increase chances of passing through the vocal folds.
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Affiliation(s)
| | - Tiina Andersen
- Norwegian Centre of Excellence for Home Mechanical Ventilation, Thoracic Department, Haukeland University Hospital, Bergen, Norway
| | - Nicola M Hardingham
- Speech Pathology Department, St Vincent's Hospital, Sydney, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
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17
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Alkawadri R. Respiratory therapy mimicking electrographic seizures. Acta Neurol Belg 2023; 123:1973-1974. [PMID: 36115916 DOI: 10.1007/s13760-022-02088-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Rafeed Alkawadri
- Department of Neurology, and Human Brain Mapping Program, School of Medicine Pittsburgh, University of Pittsburgh Medical Center, 3471 Fifth avenue LKB eighth floor, Pittsburgh, PA, 15213, USA.
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18
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Satapathy P, Padhi BK, Al Khathlan N. Artificial intelligence in respiratory therapy: Opportunities and ethical challenges. Respir Med 2023; 217:107342. [PMID: 37380092 DOI: 10.1016/j.rmed.2023.107342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/15/2023] [Accepted: 06/25/2023] [Indexed: 06/30/2023]
Affiliation(s)
| | - Bijaya K Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Noor Al Khathlan
- Respiratory Care Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
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19
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Yang QY, Hu XS, Liu YH. [Research and development of an intelligent platform for respiratory therapy]. Zhonghua Jie He He Hu Xi Za Zhi 2023; 46:862-865. [PMID: 37670642 DOI: 10.3760/cma.j.cn112147-20230531-00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
In recent years, the incidence of respiratory diseases has increased year on year. This has become a major global public health issue. To effectively treat respiratory diseases and improve the quality of life and prognosis of patients, the intelligent platform of respiratory therapy was established. Through real-time monitoring patients' important physiological indicators and integrating medical information, visual management, and intelligent decision making can be realized to provide personalized respiratory treatment and rehabilitation programs for critically ill patients. The platform can also provide reliable data support for medical research and further promote the development of the field of respiratory disease treatment. In the future, the platform will continue to improve the level and efficiency of clinical treatment, and truly solve practical problems for patients.
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Affiliation(s)
- Q Y Yang
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital,Beijing 100091,China
| | - X S Hu
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital,Beijing 100091,China
| | - Y H Liu
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital,Beijing 100091,China
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20
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Ge HQ, Pan Q. [Exploration of remote management and an intelligent platform for in-hospital respiratory therapy]. Zhonghua Jie He He Hu Xi Za Zhi 2023; 46:858-861. [PMID: 37670641 DOI: 10.3760/cma.j.cn112147-20230601-00282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The construction of an intelligent remote management platform for respiratory therapy, utilizing artificial intelligence (AI) and the electronic medical record system (EMR), has significant potential to improve the management of respiratory therapy in critically ill patients. This platform includes the development of a dedicated respiratory therapy EMR, the integration of data from multiple mechanical ventilators from different vendors and models, and the utilization of AI-assisted analysis to understand the pathophysiology of respiratory diseases and the complex physiological factors that influence specific interventions, thereby supporting diagnosis, treatment guidance, and prognosis prediction. In addtion, a network will be established to provide seamless connectivity between hospitals and wards. The resulting platform enables the collection of medical device data from multiple points within the hospital, real-time data analysis, and timely alarms, thereby facilitating remote data access, centralization of information, and standardization of data. As a result, the platform enables efficient intra-hospital and inter-hospital doctor-patient management. Despite the benefits offered by this platform, certain challenges need to be addressed, including ensuring data privacy and security, as well as managing the financial and human resources required for its implementation and maintenance. Furthermore, continuous optimization of the platform is crucial, and the clinical use of the platform requires appropriate professional training.
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Affiliation(s)
- H Q Ge
- Respiratory Care Department,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Q Pan
- College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, China
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21
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Yu B, Wanderley HV, Gianni S, Carroll RW, Ichinose F, Zapol WM, Berra L. Development of nitric oxide generators to produce high-dose nitric oxide for inhalation therapy. Nitric Oxide 2023; 138-139:17-25. [PMID: 37277062 PMCID: PMC10526742 DOI: 10.1016/j.niox.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/19/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Several nitric oxide (NO) generating devices have been developed to deliver NO between 1 part per million (ppm) and 80 ppm. Although inhalation of high-dose NO may exert antimicrobial effects, the feasibility and safety of producing high-dose (more than 100 ppm) NO remains to be established. In the current study, we designed, developed, and tested three high-dose NO generating devices. METHODS We constructed three NO generating devices: a double spark plug NO generator, a high-pressure single spark plug NO generator, and a gliding arc NO generator. The NO and NO2 concentrations were measured at different gas flows and under various atmospheric pressures. The double spark plug NO generator was designed to deliver gas through an oxygenator and mixing with pure oxygen. The high-pressure and gliding arc NO generators were used to deliver gas through a ventilator into artificial lungs to mimic delivering high-dose NO in the clinical settings. The energy consumption was measured and compared among the three NO generators. RESULTS The double spark plug NO generator produced 200 ± 2 ppm (mean ± SD) of NO at gas flow of 8 L/min (or 320 ± 3 ppm at gas flow of 5 L/min) with electrode gap of 3 mm. The nitrogen dioxide (NO2) levels were below 3.0 ± 0.1 ppm when mixing with various volumes of pure oxygen. The addition of a second generator increased the delivered NO from 80 (with one spark plug) to 200 ppm. With the high-pressure chamber, the NO concentration reached 407 ± 3 ppm with continuous air flow at 5 L/min when employing the 3 mm electrode gap under 2.0 atmospheric pressure (ATA). When compared to 1 ATA, NO production was increased 22% at 1.5 ATA and 34% at 2 ATA. The NO level was 180 ± 1 ppm when connecting the device to a ventilator with a constant inspiratory airflow of 15 L/min, and NO2 levels were below 1 (0.93 ± 0.02) ppm. The gliding arc NO generator produced up to 180 ± 4 ppm of NO when connecting the device to a ventilator, and the NO2 level was below 1 (0.91 ± 0.02) ppm in all testing conditions. The gliding arc device required more power (in watts) to generate the same concentrations of NO when compared to double spark plug or high-pressure NO generators. CONCLUSIONS Our results demonstrated that it is feasible to enhance NO production (more than 100 ppm) while maintaining NO2 level relatively low (less than 3 ppm) with the three recently developed NO generating devices. Future studies might include these novel designs to deliver high doses of inhaled NO as an antimicrobial used to treat upper and lower respiratory tract infections.
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Affiliation(s)
- Binglan Yu
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
| | - Hatus V Wanderley
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Stefano Gianni
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Ryan W Carroll
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Fumito Ichinose
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Warren M Zapol
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Lorenzo Berra
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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22
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Jones M, Moffatt F, Harvey A, Ryan JM. Interventions for improving adherence to airway clearance treatment and exercise in people with cystic fibrosis. Cochrane Database Syst Rev 2023; 7:CD013610. [PMID: 37462324 PMCID: PMC10353490 DOI: 10.1002/14651858.cd013610.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-limiting genetic disorder predominantly affecting the lungs and pancreas. Airway clearance techniques (ACTs) and exercise therapy are key components of physiotherapy, which is considered integral in managing CF; however, low adherence is well-documented. Poor physiotherapy adherence may lead to repeated respiratory infections, reduced exercise tolerance, breathlessness, reduced quality of life, malaise and reduced life expectancy, as well as increased use of pharmacology, healthcare access and hospital admission. Therefore, evidence-based strategies to inform clinical practice and improve adherence to physiotherapy may improve quality of life and reduce treatment burden. OBJECTIVES To assess the effects of interventions to enhance adherence to airway clearance treatment and exercise therapy in people with CF and their effects on health outcomes, such as pulmonary exacerbations, exercise capacity and health-related quality of life. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 1 March 2023. We also searched online trials registries and the reference lists of relevant articles and reviews. Date of last search: 28 March 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of parallel design assessing any intervention aimed at enhancing adherence to physiotherapy in people with CF versus no intervention, another intervention or usual care. DATA COLLECTION AND ANALYSIS Two review authors independently checked search results for eligible studies and independently extracted data. We used standard procedures recommended by Cochrane and assessed the certainty of evidence using the GRADE system. MAIN RESULTS Two RCTs (77 participants with CF; age range 2 to 20 years; 44 (57%) males) met the inclusion criteria of this review. One study employed an intervention to improve adherence to exercise and the second an intervention to improve adherence to ACT. Both studies measured outcomes at baseline and at three months, but neither study formally assessed our primary outcome of adherence in terms of our planned outcome measures, and results were dependent on self-reported data. Adherence to ACTs One RCT (43 participants) assessed using specifically-composed music alongside ACTs compared to self-selected or no music (usual care). The ACT process consisted of nebuliser inhalation treatment, ACTs and relaxation or antibiotic nebuliser treatment. We graded all evidence as very low certainty. This study reported adherence to ACTs using the Morisky-Green questionnaire and also participants' perception of treatment time and enjoyment, which may influence adherence (outcome not reported specifically in this review). We are uncertain whether participants who received specifically-composed music may be more likely to adhere at six and 12 weeks compared to those who received usual care, risk ratio (RR) 1.75 (95% confidence interval (CI) 1.07 to 2.86) and RR 1.56 (95% CI 1.01 to 2.40) respectively. There may not be any difference in adherence when comparing specifically-composed music to self-selected music at six weeks, RR 1.21 (95% CI 0.87 to 1.68) or 12 weeks, RR 1.52 (95% CI 0.97 to 2.38); or self-selected music to usual care at six weeks, RR 1.44 (95% CI 0.82 to 2.52) or 12 weeks, RR 1.03 (95% CI 0.57 to 1.86). The music study also reported the number of respiratory infections requiring hospitalisation at 12 weeks, with no difference seen in the risk of hospitalisation between all groups. Adherence to exercise One RCT (24 participants) compared the provision of a manual of aerobic exercises, recommended exercise prescription plus two-weekly follow-up phone calls to reinforce exercise practice over a period of three months to verbal instructions for aerobic exercise according to the CF centre's protocol. We graded all evidence as very low certainty. We are uncertain whether an educational intervention leads to more participants in the intervention group undertaking increased regular physical activity at three months (self-report), RR 3.67 (95% CI 1.24 to 10.85), and there was no reported difference between groups in the number undertaking physical activity three times per week or undertaking at least 40 minutes of physical activity. No effect was seen on secondary outcome measures of spirometry, exercise capacity or any CF quality of life domains. This study did not report on the frequency of respiratory infections (hospitalised or not) or adverse events. AUTHORS' CONCLUSIONS We are uncertain whether a music-based motivational intervention may increase adherence to ACTs or affect the risk of hospitalisation for a respiratory infection. We are also uncertain whether an educational intervention increases adherence to exercise or reduces the frequency of respiratory infection-related hospital admission. However, these results are largely based on self-reported data and the impact of strategies to improve adherence to ACT and exercise in children and adolescents with stable CF remains inconclusive. Given that adherence to ACT and exercise therapy are fundamental to the clinical management of people with CF, there is an urgent need for well-designed, large-scale clinical trials in this area, which should conform to the CONSORT statement for standards of reporting and use appropriate, validated outcome measures. Studies should also ensure full disclosure of data for all important clinical outcomes.
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Affiliation(s)
- Mandy Jones
- c/o Cochrane Cystic Fibrosis, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alex Harvey
- School of Health Sciences and Social Care, Brunel University London, Uxbridge, UK
| | - Jennifer M Ryan
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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23
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Drummond D, Whelan P, Sperrin M. Association between nebuliser therapies adherence and visit-to-visit variability of FEV1 in patients with cystic fibrosis. J Cyst Fibros 2023; 22:702-705. [PMID: 36922289 DOI: 10.1016/j.jcf.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/14/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
At the same level of lung function, some patients with cystic fibrosis have large variations in their FEV1 percent predicted (FEV1pp) values while others have stable values. We hypothesised that lower adherence to nebuliser therapies was associated with higher FEV1pp variability. We conducted a post hoc analysis of the ACtiF trial data. Adherence was calculated using data from data-logging nebulisers, and FEV1pp variability using the coefficient of variation equation. Amongst the 543 patients included in the analysis, those poorly adherent (adherence < 50%) had a higher FEV1pp variability than patients moderately (50 to < 80%) and highly adherent (≥ 80%), with median values (IQR1-3) of 8.1% (4.9-13.7), 6.3% (3.9-9.8), and 6.3% (3.9-9.3) respectively (p < 0.01). This result was confirmed by a multiple linear regression including adherence as a continuous variable (p < 0.01). Further studies are needed to determine the implications of these differences in FEV1pp variability on the prognosis of patients.
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Affiliation(s)
- David Drummond
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health, United Kingdom; Service de Pneumologie et Allergologie Pédiatriques, Hôpital Necker Enfants Malades, AP-HP Centre Université de Paris, France; Heka Team, Centre de Recherche des Cordeliers, INSERM, Université Paris Cité, Paris, France.
| | - Pauline Whelan
- Centre for Health Informatics, Division of Imaging, Informatics and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, United Kingdom
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health, United Kingdom
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de Araújo Morais L, Cipriano G, Martins WR, Chiappa GR, Formiga MF, Cipriano GFB. Inspiratory muscle training on quality of life in individuals with spinal cord injury: A systematic review and meta-analysis. Spinal Cord 2023; 61:359-367. [PMID: 37393409 DOI: 10.1038/s41393-023-00906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES The objective was to summarize the effectiveness of Inspiratory Muscle Training (IMT) on the quality of life in individuals with Spinal Cord Injury (SCI). METHODS An online systematic literature search was conducted in the following databases: PubMed/MEDLINE, PubMed CENTRAL, EMBASE, ISI Web of Science, SciELO, CINAHL/SPORTDiscus, and PsycINFO. Randomized and non-randomized clinical studies investigating the effectiveness of IMT in quality of life were included in the present study. The results used the mean difference and 95% confidence interval for maximal inspiratory pressure (MIP), forced expiratory volume in 1 s (FEV1), maximal expiratory pressure (MEP), and the standardized mean differences for the quality of life and maximum ventilation volume. RESULTS The search found 232 papers, and after the screening, four studies met the inclusion criteria and were included in the meta-analytical procedures (n = 150 participants). No changes were demonstrated in the quality of life domains (general health, physical function, mental health, vitality, social function, emotional problem, and pain) after IMT. The IMT provided a considerable effect over the MIP but not on FEV1 and MEP. Conversely, it was not able to provide changes in any of the quality of life domains. None of the included studies evaluated the IMT effects on the expiratory muscle maximal expiratory pressure. CONCLUSION Evidence from studies shows that inspiratory muscle training improves the MIP; however, this effect does not seem to translate to any change in the quality of life or respiratory function outcomes in individuals with SCI.
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Affiliation(s)
| | - Gerson Cipriano
- Science and Technology in Health Program (PPGCTS), University of Brasília, Brasília, Brazil
- Rehabilitation Sciences Graduate Program (PPGCR), University of Brasília, Brasília, Brasil
- Graduate Program in Human Movement and Rehabilitation of Evangelical (PPGMHR), UniEVANGÉLICA, Anápolis, Brazil
| | | | - Gaspar R Chiappa
- Graduate Program in Human Movement and Rehabilitation of Evangelical (PPGMHR), UniEVANGÉLICA, Anápolis, Brazil
| | - Magno F Formiga
- Master's Program in Physical Therapy and Functioning, Department of Physical Therapy, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Graziella França Bernardelli Cipriano
- Science and Technology in Health Program (PPGCTS), University of Brasília, Brasília, Brazil
- Rehabilitation Sciences Graduate Program (PPGCR), University of Brasília, Brasília, Brasil
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Oakes JM, Amirav I, Sznitman J. Pediatric inhalation therapy and the aerodynamic rationale for age-based aerosol sizes. Expert Opin Drug Deliv 2023; 20:1037-1040. [PMID: 37127917 DOI: 10.1080/17425247.2023.2209314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/27/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Jessica M Oakes
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - Israel Amirav
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Josué Sznitman
- Department of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel
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Milesi C, Mortamet G, Bordessoule A, Rambaud J, Emeriaud G. Severe bronchiolitis in infants less than 12 months old. Authors' reply. Intensive Care Med 2023; 49:888-889. [PMID: 37256339 DOI: 10.1007/s00134-023-07093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Christophe Milesi
- Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France.
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France.
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Alice Bordessoule
- Pediatric Intensive Care Unit, Geneva University Hospital, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jérôme Rambaud
- Pediatric Intensive Care Unit, Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, Sainte-Justine University Hospital, Montreal, Canada
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Peng Z, Li XJ, Pang C, Zhang JT, Zhu Q, Sun JQ, Wang J, Cao BQ, Zhang YH, Lu Y, Li W, Hang CH, Zhuang Z. Hydrogen inhalation therapy regulates lactic acid metabolism following subarachnoid hemorrhage through the HIF-1α pathway. Biochem Biophys Res Commun 2023; 663:192-201. [PMID: 37141668 DOI: 10.1016/j.bbrc.2023.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
The neuroprotective effects of hydrogen have been demonstrated, but the mechanism is still poorly understood. In a clinical trial of inhaled hydrogen in patients with subarachnoid hemorrhage (SAH), we found that hydrogen reduced the accumulation of lactic acid in the nervous system. There are no studies demonstrating the regulatory effect of hydrogen on lactate and in this study we hope to further clarify the mechanism by which hydrogen regulates lactate metabolism. In cell experiments, PCR and Western Blot showed that HIF-1α was the target related to lactic acid metabolism that changed the most before and after hydrogen intervention. HIF-1α levels were suppressed by hydrogen intervention treatment. Activation of HIF-1α inhibited the lactic acid-lowering effect of hydrogen. We have also demonstrated the lactic acid-lowering effect of hydrogen in animal studies. Our work clarifies that hydrogen can regulate lactate metabolism via the HIF-1αpathway, providing new insights into the neuroprotective mechanisms of hydrogen.
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Affiliation(s)
- Zheng Peng
- Department of Neurosurgery, Affiliated Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Xiao-Jian Li
- Department of Neurosurgery, Affiliated Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Cong Pang
- Department of Neurosurgery, Affiliated Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China; Department of Neurosurgery, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Jia-Tong Zhang
- Department of Neurosurgery, Affiliated Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Qi Zhu
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, Jiangsu, China
| | - Jia-Qing Sun
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Juan Wang
- Department of Neurosurgery, Affiliated Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Bo-Qiang Cao
- Department of Neurosurgery, Affiliated Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Yu-Hua Zhang
- Department of Neurosurgery, Affiliated Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Yue Lu
- Department of Neurosurgery, Affiliated Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Wei Li
- Department of Neurosurgery, Affiliated Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Chun-Hua Hang
- Department of Neurosurgery, Affiliated Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China.
| | - Zong Zhuang
- Department of Neurosurgery, Affiliated Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China.
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Lambrinos E. Critically appraised paper: Respiratory waveform analysis guides settings for effective mechanical insufflation-exsufflation in patients with amyotrophic lateral sclerosis [commentary]. J Physiother 2023; 69:53. [PMID: 36526561 DOI: 10.1016/j.jphys.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Elizabeth Lambrinos
- Respiratory Support Service, Royal Prince Alfred Hospital, Sydney, Australia
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Song Q, Cheng W, Liu C, Li X, Lin L, Peng Y, Zeng Y, Yi R, Liu Y, Li X, Chen Y, Cai S, Chen P. The future exacerbation and mortality of different inhalation therapies among patients with chronic obstructive pulmonary disease in various GOLD groups: a focus on the GOLD 2017 and GOLD 2023 reports. Ther Adv Respir Dis 2023; 17:17534666231213715. [PMID: 38018090 PMCID: PMC10685753 DOI: 10.1177/17534666231213715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/23/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 report revised the combined assessment, merged the C and D groups into the E group, and revised the initial inhalation therapy recommendation. OBJECTIVES This study aimed to analyze the future exacerbation and mortality of different inhalation therapies among patients with chronic obstructive pulmonary disease (COPD) in various groups based on the GOLD 2017 and GOLD 2023 reports. DESIGN This is a multicenter and retrospective study. METHODS Stable COPD patients from the database setup by 12 hospitals were enrolled. The patients were divided into Groups A, B, C, D, and E according to the GOLD 2017 and GOLD 2023 reports. Then, the patients were classified into long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS), LABA + LAMA, and LABA + LAMA + ICS subgroups. Data on exacerbation and death during 1 year of follow-up were collected. RESULTS A total of 4623 patients were classified into Group A (15.0%), Group B (37.8%), Group C (7.3%), Group D (39.9%), and Group E (47.2%). The exacerbation, frequent exacerbation, and mortality showed no differences between different inhalation therapies in Groups A and C. Patients treated with LABA + LAMA or LABA + LAMA + ICS had a lower incidence of exacerbation and frequent exacerbation than patients treated with LAMA or LABA + ICS in Groups B, D, and E. The exacerbation, frequent exacerbation, and mortality showed no differences between different inhalation therapies after combining Groups A with C. CONCLUSION Patients in Group A should be recommended to undergo mono-LAMA, while patients in Groups B and E should be recommended treatment with LABA + LAMA, which is consistent with the GOLD 2023 report. However, it is worth considering merging Groups A and C into a single group and recommending mono-LAMA as the initial inhalation therapy.
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Affiliation(s)
- Qing Song
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Wei Cheng
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Cong Liu
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Xueshan Li
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Ling Lin
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Yating Peng
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Yuqin Zeng
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Rong Yi
- Department of Pulmonary and Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Yi Liu
- Department of Pulmonary and Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Xin Li
- Division 4 of Occupational Diseases, Hunan Prevention and Treatment Institute for Occupational Diseases, Changsha, Hunan, China
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Shan Cai
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Ping Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan 410011, China
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van Kleef ES, Langer D, van Engelen BG, Ottenheijm CA, Voermans NC, Doorduin J. Inspiratory Muscle Training in Nemaline Myopathy. J Neuromuscul Dis 2023; 10:825-834. [PMID: 37458044 PMCID: PMC10578271 DOI: 10.3233/jnd-221665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Respiratory muscle weakness is a common feature in nemaline myopathy. Inspiratory muscle training (IMT) is an intervention that aims to improve inspiratory muscle strength. OBJECTIVE The aim of this controlled before-and-after pilot study was to investigate if IMT improves respiratory muscle strength in patients with nemaline myopathy. METHODS Nine patients (7 females; 2 males, age 36.6±20.5 years) with respiratory muscle weakness and different clinical phenotypes and genotypes were included. Patients performed eight weeks of sham IMT followed by eight weeks of active threshold IMT. The patients trained twice a day five days a week for 15 minutes at home. The intensity was constant during the training after a gradual increase to 30% of maximal inspiratory pressure (MIP). RESULTS Active IMT significantly improved MIP from 43±15.9 to 47±16.6 cmH2O (p = 0.019). The effect size was 1.22. There was no significant effect of sham IMT. Sniff nasal inspiratory pressure, maximal expiratory pressure, spirometry, and diaphragm thickness and thickening showed no significant improvements. CONCLUSIONS This pilot study shows that threshold IMT is feasible in patients with nemaline myopathy and improves inspiratory muscle strength. Our findings provide valuable preliminary data for the design of a larger, more comprehensive trial.
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Affiliation(s)
- Esmee S.B. van Kleef
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniel Langer
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Cardiovascular and Respiratory Rehabilitation, KU Leuven - University of Leuven, Leuven, Belgium
- Respiratory Rehabilitation and Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Baziel G.M. van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Coen A.C. Ottenheijm
- Department of Physiology, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Saynor ZL, Cunningham S, Morrison L, Main E, Vogiatzis I, Reid S, Urquhart D. Exercise as airway clearance therapy (ExACT) in cystic fibrosis: a UK-based e-Delphi survey of patients, caregivers and health professionals. Thorax 2023; 78:88-91. [PMID: 36599464 DOI: 10.1136/thorax-2022-219213] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/21/2022] [Indexed: 02/07/2023]
Abstract
Replacing traditional airway clearance therapy (tACT) with exercise (ExACT) in people with cystic fibrosis (pwCF) is a top research priority. A UK-based e-Delphi consensus was performed to inform the type(s), duration and intensity of ExACT. The expert panel comprised CF physiotherapists, doctors, pwCF and parents/partners. Exercise ACT was considered to be aerobic activity, of at least 20 min duration and intense enough to elicit deep breathing. Consensus was reached that assessment breaths, coughs and huffs should accompany exercise to remove loose secretions, with support for trials to investigate ExACT versus tACT during times of stable disease but not pulmonary exacerbations.
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Affiliation(s)
- Zoe Louise Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
- Wessex Cystic Fibrosis Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Steve Cunningham
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Lisa Morrison
- West of Scotland Adult CF Unit, Queen Elizabeth University Hospital (The Southern General Hospital), Glasgow, UK
| | - Eleanor Main
- Physiotherapy Section, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Simon Reid
- Person with Cystic Fibrosis, Glasgow, UK
| | - Donald Urquhart
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
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Oishi K, Inage E, Kojima M, Yamada H, Tanaka Y, Yoneyama T, Yamazaki S, Honjo A, Baba Y, Kudo T, Ohtsuka Y, Endo A, Nakabayashi Y, Oyama S, Shimizu T. Evidence of off-label inhalation therapy on pediatric asthma practice in Japan. Pediatr Int 2023; 65:e15595. [PMID: 37515377 DOI: 10.1111/ped.15595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND In Japan, many asthma inhalers do not have formal approval for use in the pediatric population because of the lack of domestic data. In real-world settings, however, numerous off-label medications are prescribed. Currently, the nature of off-label prescriptions of asthma inhalers on pediatric patients in Japan remains unclear. METHODS Using public open-source national medical claims data, we investigated the real-world descriptive epidemiology of off-label prescriptions for asthma inhalers for pediatric patients. We obtained the number of off-label prescriptions of formulations for patients aged 0-14 years from anonymously summarized prescription data for a 7-year period starting from April 2014. The actual prescription numbers and their chronology over time were then analyzed. RESULTS In 2019, 143,439 asthma inhalers were used off label in children and adolescents. Overall, 96.1% were inhaled corticosteroids (ICSs) or long-acting beta stimulants (LABAs), and 3.9% were high-dose ICS. Of ICSs and LABAs, 18.8% were off-label prescriptions. The total number of off-label ICS/LABA prescriptions and their percentage relative to the overall formulations gradually decreased but a notable disparity was observed among inhaler types. CONCLUSIONS There was a surprisingly large number of off-label prescriptions of asthma inhalers in the pediatric population in Japan. The proper use of ICSs/LABAs and expansion of insurance coverage should be advocated to reduce off-label use.
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Affiliation(s)
- Kenji Oishi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Eisuke Inage
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
- Social Insurance Committee, Japan Pediatric Society, Tokyo, Japan
| | - Mayuki Kojima
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiromichi Yamada
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuko Tanaka
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshiyuki Yoneyama
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Susumu Yamazaki
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Asuka Honjo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yosuke Baba
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshikazu Ohtsuka
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Akifumi Endo
- Social Insurance Committee, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yosuke Nakabayashi
- Social Insurance Committee, Japan Pediatric Society, Tokyo, Japan
- Department of Emergency Medicine, Maebashi Red Cross Hospital, Gunma, Japan
| | - Shoichi Oyama
- Social Insurance Committee, Japan Pediatric Society, Tokyo, Japan
- Department of Pediatrics, Saiseikai Kawaguchi Hospital, Saitama, Japan
- Pediatric Committee, Social Insurance Union of Societies Related to Internal Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Eremenko AA, Zyulyaeva TP, Alferova AP, Fomina DV, Grekova MS, Grin OO, Dmitrieva SS, Molochkov AV, Gens AP, Kotenko KV. [The use of oscillatory respiratory therapy with positive expiratory pressure (PEP-therapy) to restore the functional state of the lungs in patients after cardiac surgery]. Vopr Kurortol Fizioter Lech Fiz Kult 2023; 100:21-30. [PMID: 38289301 DOI: 10.17116/kurort202310006121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Postoperative pulmonary complications in cardiac surgery patients occur in 10-35% of cases, depending on differences in their definition, patient characteristics and type of surgical intervention, most of them are associated with ineffective coughing and evacuation of bronchial secretions. OBJECTIVE To determine the effectiveness of stimulating the evacuation of bronchial secretions with the help of oscillating PEP therapy carried out during the first three days. MATERIAL AND METHODS A randomized prospective study of 60 adult patients after elective cardiac surgery was performed (Clinical Trials.gov. protocol number NCT05159401). Oscillatory PEP-therapy was performed in 30 patients using Acapella DHGreen device (SmithMedicalASD, USA) 10-12 hours after tracheal extubation 3 times a day for 3 days after surgery. The control group (30 patients). The inclusion criteria: age over 18 years, spontaneous breathing after tracheal extubation, clear consciousness and productive contact with the patient, the ability to maintain adequate gas exchange on the low-flow oxygen inhalation, adequate analgesia (<2 points of VAS). Exclusion criteria: the need for re-intubation and mechanical ventilation, non-invasive mask ventilation, high-flow oxygen therapy, acute cerebrovascular accident, ongoing bleeding, cardiac insufficiency (inotropic index >10), shocks syndrome of various etiologies, the use of any extracorporeal support, any neuromuscular disorders, pneumothorax, hydro-or hemothorax. Before each session and 20 minutes after its end, when breathing air, blood oxygen saturation was recorded using a pulse oximeter (SpO2), the maximum inspiratory capacity (MIC) was measured using a Coach-2 incentive spirometer from SmithsMedical and spirometry with a portable ultrasonic spirometer Spiro Scout (Schiller, Switzerland). For the purposes of this work, the total index of the spirometry maximum inspiratory capacity (SMIC) was used - the sum of the respiratory volume and the reserve volume of inspiration in ml. RESULTS Difficulties in evacuation of sputum were noted in 90% of patients. Three-day sessions of oscillating PEP- therapy are accompanied by a significant improvement in the passage of sputum, as evidenced by a 3-fold increase in the number of patients with productive cough. The increase in MIC in the main group was 46.9% and 21.3%, respectively (p=0.042), and the number of patients with values greater than MICo. 1500 ml increased from 23.3% to 7.6% (p<0.001). The effectiveness of oscillatory PEP-therapy is confirmed by a 7-fold decrease in the frequency of radiological changes in the lungs at the end of sessions (p<0.001), while in the control group the frequency of their occurrence practically did not change and remained at a high level. The total number of patients with respiratory insufficiency (SpO2≤92%) decreased by 8.6 times after completion of all PEP- therapy sessions (p=0.001), however, without statistically significant difference with the control group. CONCLUSIONS Oscillatory PEP- therapy in cardiac surgery patients has a positive effect on sputum passage, ventilation parameters and oxygenating lung function. The procedure was well tolerated and there were no complications associated with it.
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Affiliation(s)
- A A Eremenko
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - T P Zyulyaeva
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - A P Alferova
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - D V Fomina
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - M S Grekova
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - O O Grin
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - S S Dmitrieva
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - A V Molochkov
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - A P Gens
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - K V Kotenko
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia
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Liu Y, Zhu Y, Jiang C, Su Z, Yan Y, Feng B, Mao W, Zhang Y, Wang X, Xu Z, Zhang H. An electrochemical nitric oxide generator for in-home inhalation therapy in pulmonary artery hypertension. BMC Med 2022; 20:481. [PMID: 36522645 PMCID: PMC9753075 DOI: 10.1186/s12916-022-02686-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Inhaled NO is a selective pulmonary vasodilator proven to be therapeutic for patients with pulmonary artery hypertension (PAH). The most common NO delivery system in clinical practice is cylinder-based, but unfortunately limited by its high costs, complicated delivery, and the requirement of an extensive supply chain, leaving vast unmet medical needs globally. METHODS To address the need for rapid, affordable, and safe production of nitric oxide (NO) for in-home inhalation therapy in patients with PAH. We developed a novel portable device to derive NO from a nitrite complex solution with a copper(II)-ligand catalyst, and further examined its effectiveness in a porcine model of PAH. This model was established by using female Bama miniature pig and induced by monocrotaline (MCT) administration. RESULTS This generator could rapidly and safely produce therapeutic NO at concentrations ranging from 0 to 100 parts per million (ppm) with the least disproportionated nitrogen dioxide (NO2) and byproducts. It could effectively alleviate pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR) in piglets with PAH, without causing major physiologic disruptions. CONCLUSIONS Our electrochemical NO generator is able to produce the desired NO doses for pulmonary vasodilation in a safe and sustainable way, with low costs, which paves the way for its subsequent clinical trials in the patient with PAH and other common cardiopulmonary conditions with a high disease burden around the world.
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Affiliation(s)
- Yiwei Liu
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yifan Zhu
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Chenyu Jiang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Zhanhao Su
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yi Yan
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Institute for Cardiovascular Prevention (IPEK), Ludwig Maximilian University Munich, 80539, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, 80539, Munich, Germany
| | - Bei Feng
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Wen Mao
- Nanjing Novlead Biotechnology Corporation Limited, Nanjing, 211800, China
| | - Yuyan Zhang
- Nanjing Novlead Biotechnology Corporation Limited, Nanjing, 211800, China
| | - Xiaojian Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Zhuoming Xu
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Hao Zhang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
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35
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Fu Q. [Research on Measurement Uncertainty of Key Parameters of Typical Respiratory Therapy Equipment]. Zhongguo Yi Liao Qi Xie Za Zhi 2022; 46:673-680. [PMID: 36597398 DOI: 10.3969/j.issn.1671-7104.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
According to the measurement uncertainty requirements of the key parameters of the declared tolerances of the products in the industrial standards of respiratory therapy equipment such as GB 9706.212-2020 Medical electrical equipment-Part 2-12: Particular requirements for basic safety and essential performance of critical care ventilators, YY 9706.270-2021 Medical electrical equipment-Part 2-70: Particular requirements for basic safety and essential performance of sleep apnoea breathing therapy equipment, and YY 9706.274-2022 Medical electrical equipment-Part 2-74: Particular requirements for basic safety and essential performance of respiratory humidifying equipment, this study introduces and analyzes the evaluation process of the uncertainty of the key parameters of critical care respiratory, sleep apnoea breathing therapy equipment, and humidifier, and it gives the sources and results of measurement uncertainty. It is expected that it can provide suggestions for the medical device testing laboratory to meet the uncertainty requirements of quality management and provide references for relevant manufacturers to meet the requirements of industrial standards.
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Affiliation(s)
- Qiang Fu
- Shanghai Institute of Medical Device Testing, Shanghai, 200318
- NMPA Key Laboratory of Anaesthetic and Respiratory Equipment, Shanghai, 200318
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36
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Feng Y, Wang W, Zhong Y, Chen X, Yu H, Chen B. [Analysis of International Standard ISO 80601-2-90:2021 for High-flow Respiratory Therapy Equipment]. Zhongguo Yi Liao Qi Xie Za Zhi 2022; 46:668-672. [PMID: 36597397 DOI: 10.3969/j.issn.1671-7104.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The international standard ISO 80601-2-90:2021 specifies basic safety and essential performance requirements, including risks associated with oxygen, flow accuracy, oxygen concentration accuracy, humidification output performance, and corresponding test methods for high-flow respiratory therapy equipment. This study focuses on the key points in ISO 80601-2-90:2021 and the key problems in the test evaluation. This study also briefly introduces the relationship between ISO 80601-2-90:2021 and other standards, and explains the countermeasures that stakeholders should take.
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Affiliation(s)
| | - Wei Wang
- Shanghai Institute of Medical Device Testing, Shanghai, 201318
- NMPA Key Laboratory for Respiratory and Anaesthetic Equipment, Shanghai, 201318
| | - Youjin Zhong
- Center for Medical Device Evaluation, NMPA, Beijing, 100081
| | | | - Hongyi Yu
- Shanghai Institute of Medical Device Testing, Shanghai, 201318
- NMPA Key Laboratory for Respiratory and Anaesthetic Equipment, Shanghai, 201318
| | - Bei Chen
- BMC Medical Co. Ltd., Beijing, 100041
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Papi D, Montigiani G, Bucciardini L. How the work of respiratory physiotherapists changes the tracheostomy management and decannulation in a NICU department: an Italian experience. Monaldi Arch Chest Dis 2022; 93. [PMID: 36426898 DOI: 10.4081/monaldi.2022.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/25/2022] Open
Abstract
Tracheotomy is a clinical procedure that is often necessary though not without complications, hence the need for appropriate and timely decannulation. The inclusion of trained respiratory physiotherapists (RPT) in the staff and the use of shared protocols could help the team to manage the patient with tracheotomy cannula. The objective of this study was to describe the difference in the rate of decannulation and clinical outcomes of tracheostomized patients admitted to a NeuroIntensive Care Unit (NICU) team after the inclusion of a group of physiotherapists specialized in respiratory physiotherapy and a new phoniatric protocol. It is a 6-year retrospective study, in which two periods of 3 years each were compared: in the first period (P1: September 2013-August 2016) physiotherapists were called to treat NICU patients on a consultative basis (2 hours/day for 5 days a week); in the second period (P2: September 2016-August 2019) two full-time respiratory physiotherapists were present on the ward (7 hours/day, 6/7 days/week). In P2 period, a decannulation protocol was used. Patients who had undergone a tracheotomy procedure and who were alive at the time of discharge were retrospectively evaluated. We described the number of decannulations, the length of stay in NICU and decannulation time; the diagnosis of decannulated patients and the number of deaths. 928 total patients were analysed: 468 in P1, 460 in P2. Total length of stay or number of deaths did not change significantly between the two periods, while the number of decannulated patients before the discharge was higher in P2 143 (64%), compared with P1 79 (36%) p<0.001. More patients with neurological pathologies involving possible swallowing disorders, such as cerebral haemorrhage, head trauma and stroke, have been successfully decannulated in P2 than in P1 (120 patients in P2 vs 54 in P1). A multidisciplinary approach, including respiratory physiotherapist, dedicated to tracheostomy management, decannulation and early mobilization in NICU is safe, feasible and seems to improve the number of severe patients decannulated, even if no change was observed in NICU length of stay or deaths. Further studies must confirm our results in other ICU settings.
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Affiliation(s)
- Davide Papi
- NeuroIntensive Care Unit, Careggi University Hospital, Florence.
| | | | - Luca Bucciardini
- NeuroIntensive Care Unit, Careggi University Hospital, Florence.
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Xu M, Zhang L, Guo Y, Bai L, Luo Y, Wang B, Kuang M, Liu X, Sun M, Wang C, Xie J. Nanoemulsion Co-Loaded with XIAP siRNA and Gambogic Acid for Inhalation Therapy of Lung Cancer. Int J Mol Sci 2022; 23:ijms232214294. [PMID: 36430771 PMCID: PMC9696299 DOI: 10.3390/ijms232214294] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Lung cancer is a leading cause of cancer mortality worldwide, with a 5-year survival rate of less than 20%. Gambogic acid (GA) is a naturally occurring and potent anticancer agent that destroys tumor cells through multiple mechanisms. According to the literature, one of the most potent inhibitors of caspases and apoptosis currently known is the X-linked Inhibitor of Apoptosis Protein (XIAP). It is highly expressed in various malignancies but has little or no expression in normal cells, making it an attractive target for cancer treatment. Here we report the development of a chitosan (CS)-based cationic nanoemulsion-based pulmonary delivery (p.d.) system for the co-delivery of antineoplastic drugs (GA) and anti-XIAP small interfering RNA (siRNA). The results showed that the chitosan-modified cationic nanoemulsions could effectively encapsulate gambogic acid as well as protect siRNA against degradation. The apoptosis analysis confirmed that the cationic nanoemulsions could induce more apoptosis in the A549 cell line. In addition, most drugs and siRNAs have a long residence time in the lungs through pulmonary delivery and show greater therapeutic effects compared to systemic administration. In summary, this work demonstrates the applicability of cationic nanoemulsions for combined cancer therapy and as a promising approach for the treatment of lung cancer.
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Affiliation(s)
- Minhao Xu
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
| | - Lanfang Zhang
- Chongqing Key Laboratory of Natural Product Synthesis and Drug Research, Innovative Drug Research Center, School of Pharmaceutical Sciences, Chongqing University, 55 South Daxuecheng Road, Chongqing 401331, China
| | - Yue Guo
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
| | - Lu Bai
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
| | - Yi Luo
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
| | - Ben Wang
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
| | - Meiyan Kuang
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
| | - Xingyou Liu
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
| | - Meng Sun
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
| | - Chenhui Wang
- Chongqing Key Laboratory of Natural Product Synthesis and Drug Research, Innovative Drug Research Center, School of Pharmaceutical Sciences, Chongqing University, 55 South Daxuecheng Road, Chongqing 401331, China
| | - Jing Xie
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
- Correspondence: ; Tel.: +86-138-4300-4264
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Tsai YT, Ku HC, Maithreepala SD, Tsai YJ, Chen LF, Ko NY, Konara Mudiyanselage SP. Higher Risk of Acute Respiratory Distress Syndrome and Risk Factors among Patients with COVID-19: A Systematic Review, Meta-Analysis and Meta-Regression. Int J Environ Res Public Health 2022; 19:15125. [PMID: 36429842 PMCID: PMC9690625 DOI: 10.3390/ijerph192215125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To estimate the global risk and risk factors associated with acute respiratory distress syndrome (ARDS) among patients with COVID-19: Design: A systematic review, meta-analysis and meta-regression. SETTING AND PARTICIPANTS Hospitals or nursing homes and patients with acute respiratory distress syndrome after COVID-19. METHODS The literature review was systematically conducted on Embase, MEDLINE, CINAHL, and Web of Science, in addition to manual searches and reference list checking from 1 January 2019 to 2 March 2022. The search terms included coronavirus, acute respiratory syndrome, acute respiratory distress syndrome and observational studies. Three reviewers independently appraised the quality of the studies and extracted the relevant data using the Joanna Briggs Institute abstraction form and critical appraisal tools. A study protocol was registered in PROSPERO (CRD42022311957). Eligible studies were meta-analyzed and underwent meta-regression. RESULTS A total of 12 studies were included, with 148,080 participants. The risk ratio (RR) of ARDS was 23%. Risk factors were age ≥ 41-64 years old (RR = 15.3%, 95% CI =0.14-2.92, p = 0.03); fever (RR = 10.3%, 95% CI = 0.03-2.03, p = 0.04); multilobe involvement of the chest (RR = 33.5%, 95% CI = 0.35-6.36, p = 0.02); lymphopenia (RR = 25.9%, 95% CI = 1.11-4.08, p = 0.01); mechanical ventilation with oxygen therapy (RR = 31.7%, 95% CI = 1.10-5.25, p = 0.002); European region (RR = 16.3%, 95% CI = 0.09-3.17, p = 0.03); sample size ≤ 500 (RR = 18.0%, 95% CI = 0.70-2.89, p = 0.001). CONCLUSIONS AND IMPLICATIONS One in four patients experienced ARDS after having COVID-19. The age group 41-64 years old and the European region were high-risk groups. These findings can be used by policymakers to allocate resources for respiratory care facilities and can also provide scientific evidence in the design of protocols to manage COVID-19 worldwide.
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Affiliation(s)
- Yi-Tseng Tsai
- Department of Nursing, An-Nan Hospital, China Medical University, Tainan 709, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan
| | - Han-Chang Ku
- Department of Nursing, An-Nan Hospital, China Medical University, Tainan 709, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan
| | - Sujeewa Dilhani Maithreepala
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan
- Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Yi-Jing Tsai
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan
| | - Li-Fan Chen
- Department of Nursing, An-Nan Hospital, China Medical University, Tainan 709, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, Tainan 704, Taiwan
| | - Sriyani Padmalatha Konara Mudiyanselage
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan
- Operation Theatre Department, The National Hospital of Sri Lanka, Colombo 00700, Sri Lanka
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Lin CH, Lee CW, Huang CH. Inspiratory Muscle Training Improves Aerobic Fitness in Active Children. Int J Environ Res Public Health 2022; 19:14722. [PMID: 36429439 PMCID: PMC9690705 DOI: 10.3390/ijerph192214722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Research on the effect of inspiratory muscle training (IMT) on exercise performance is inconsistent. IMT has not been applied to fit child athletes, who are more likely to develop inspiratory muscle fatigue, and, consequently, to benefit from IMT. Methods: Thirty children (mean age: 10.7 ± 1.2 years) were recruited and randomly assigned to a high-intensity (HG), a low-intensity (LG), or a control group (CG). For both training groups, a double-blind procedure was applied. In the HG, 80% of maximal inspiratory pressure (MIP) was used as the level of training intensity. The LG used 30% MIP. Training groups were trained at 6 breaths a set, 4 sets a day, totaling 24 breaths a day for 6 weeks. Exercise capacity outcomes include maximal and submaximal aerobic capacity, as measured as VO2max and distance from six-minute walk test (6MWD). Results show improvement in MIP, VO2max, and 6MWD only in the HG. MIP in the HG significantly increases from 108.7 (100.8-143.3) to 144.4 (130.0-175.6) cmH2O. VO2max in the HG increases from 43.0 (40.5-45) to 53.0 (46-63) mL·kg-1·min-1. The 6MWD increases from 792.0 (737.5-818.0) to 862.0 (798.5-953.5) m. Data are presented as median (interquartile range). No difference is found in the LG or CG. Conclusion: high-intensity IMT increases MIP, maximal, and submaximal exercise capacity in the HG, but no difference is found in the LG or CG. Therefore, high-intensity type of IMT improves aerobic fitness in fit children by appropriately applying inspiratory muscle strength training.
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Affiliation(s)
- Ching-Hsin Lin
- Division of Rehabilitation Technology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
| | - Chih-Wei Lee
- Department of Physical Therapy, Tzu Chi University, Hualien 970374, Taiwan
| | - Chien-Hui Huang
- Department of Physical Therapy, Tzu Chi University, Hualien 970374, Taiwan
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Shelley J, Hudson J, Mackintosh KA, Saynor ZL, Duckers J, Lewis K, Davies GA, Berg RMG, McNarry MA. Perceptions of inspiratory muscle training in adults recovering from COVID-19. PLoS One 2022; 17:e0270620. [PMID: 36327314 PMCID: PMC9632882 DOI: 10.1371/journal.pone.0270620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Post COVID-19 condition can occur following infection with SARS-CoV-2 and is characterised by persistent symptoms, including fatigue, breathlessness and cognitive dysfunction, impacting everyday functioning. This study explored how people living with post COVID-19 experienced an eight-week inspiratory muscle training (IMT) rehabilitation programme. Individualised semi-structured interviews with 33 adults (29 female; 49 ± 10 years; 6–11 months post-infection) explored expectations of IMT prior to the intervention, and post intervention interviews explored perceptions of IMT and its impact on recovery. Inductive thematic analysis was used to analyse the data. IMT helped many to feel proactive in managing their symptoms and was associated with perceived improvements in respiratory symptoms, exercise and work capacity, and daily functioning. IMT was well perceived and offers significant potential for use as part of a holistic recovery programme, although it is important to consider the complex, varied symptoms of post COVID-19, necessitating an individually tailored rehabilitation approach.
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Affiliation(s)
- James Shelley
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
| | - Joanne Hudson
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
| | - Kelly A. Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
| | - Zoe L. Saynor
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, United Kingdom
| | - Jamie Duckers
- All Wales Adult CF Centre, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Keir Lewis
- Hywel Dda University Health Board, Carmarthen, United Kingdom
- School of Medicine, Swansea University, Swansea, United Kingdom
| | | | - Ronan M. G. Berg
- Faculty of Health and Medical Sciences, Centre for Physical Activity Research, and Department of Clinical Physiology and Nuclear Medicine, University Hospital Copenhagen–Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Melitta A. McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
- * E-mail:
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Miller AG, Scott BL. 2021 Year in Review: Pediatric Mechanical Ventilation. Respir Care 2022; 67:1476-1488. [PMID: 36100276 PMCID: PMC9993959 DOI: 10.4187/respcare.10311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mechanical ventilation is commonly used in the pediatric intensive care unit. This paper reviews studies of pediatric mechanical ventilation published in 2021. Topics include physiology, ventilator modes, alarms, disease states, airway suctioning, ventilator liberation, prolonged ventilation, and others.
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Affiliation(s)
- Andrew G Miller
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina; and Respiratory Care Services, Duke University Medical Center, Durham, North Carolina.
| | - Briana L Scott
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
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Siraj RA, Aldhahir AM, Alqahtani JS, Almarkhan HM, Alghamdi SM, Alqarni AA, Alhotye M, Algarni SS, Alahmadi FH, Alahmari MA. Burnout and Resilience among Respiratory Therapy (RT) Students during Clinical Training in Saudi Arabia: A Nationwide Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:13047. [PMID: 36293624 PMCID: PMC9602980 DOI: 10.3390/ijerph192013047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The epidemic of burnout has been widely documented among health discipline students. However, there is limited information available on the prevalence of burnout and its association with resilience among clinical-level respiratory therapy (RT) students. METHODS Between March 2022 and May 2022, a descriptive, cross-sectional study using a convenience sample of RT students and interns was conducted. A total of 559 RT students and interns from 15 RT programs responded to socio-demographic questions and the Maslach Burnout Inventory (MBI) and the Brief Resilience Scale (BRS) questionnaires. The data were analyzed using descriptive, inferential, and correlation tests. RESULTS Of the 559 respondents, 78% reported a high level of burnout. Within the three subscales of burnout, 52% reported emotional exhaustion (EE), 59% reported depersonalization (DP), and 55% reported low personal achievement (PA). The prevalence of burnout increased as students proceeded to senior years (p = 0.006). In addition, participants with higher grade point averages (GPA) reported a higher level of burnout. Only 2% of the respondents reported a high level of resiliency. Further, there were negative correlations between resilience and EE (r = -41, p < 0.001) and DP (r = -32, p = 0.03), and a positive correlation with low PA (r = 0.56, p = 0.002). CONCLUSION The findings showed a high prevalence of burnout among RT students and interns during clinical training in Saudi Arabia. Resilience was associated with all domains of burnout and is likely to play a protective role. Therefore, there is a need for collaborative interventions to promote resiliency during clinical training to alleviate and overcome burnout symptoms.
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Affiliation(s)
- Rayan A. Siraj
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa 31982, Saudi Arabia
| | - Abdulelah M. Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Hussam M. Almarkhan
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Saeed M. Alghamdi
- Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 21961, Saudi Arabia
| | - Abdullah A. Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22254, Saudi Arabia
| | - Munyra Alhotye
- Department of Respiratory Therapy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 12271, Saudi Arabia
| | - Saleh S. Algarni
- Department of Respiratory Therapy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 12271, Saudi Arabia
| | - Fahad H. Alahmadi
- Respiratory Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Medina 42353, Saudi Arabia
| | - Mushabbab A. Alahmari
- Department of Respiratory Therapy, Faculty of Applied Medical Sciences, University of Bisha, Bisha 67714, Saudi Arabia
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Ge HQ, Xu PF, Qian XL, Shen WM. [The role of respiratory therapy in respiratory rehabilitation of critically ill patients]. Zhonghua Jie He He Hu Xi Za Zhi 2022; 45:848-851. [PMID: 36097920 DOI: 10.3760/cma.j.cn112147-20220531-00471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The job description of respiratory therapists can cover emergency room, intensive care unit (ICU), post-ICU ward and specialized wards. Therefore, patient-centered respiratory rehabilitation in critically ill patients includes prevention of admission to ICU, respiratory care during ICU, and respiratory care after ICU. Respiratory therapists evaluate, diagnose and treat patients' respiratory function, forming a closed-loop management scheme of prevention, evaluation, treatment, reassessment, and adjustment.
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Affiliation(s)
- H Q Ge
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,Hangzhou 310016,China
| | - P F Xu
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,Hangzhou 310016,China
| | - X L Qian
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,Hangzhou 310016,China
| | - W M Shen
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,Hangzhou 310016,China
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45
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Nunes ADM, Fernandes ATDNSF, de Castro Silva AT, Pereira Costa MF, Monteiro KS, Pereira SA. Effects of respiratory physiotherapy interventions on pulmonary mechanics of newborns: a protocol for a systematic review. BMJ Open 2022; 12:e062910. [PMID: 36028273 PMCID: PMC9422847 DOI: 10.1136/bmjopen-2022-062910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Although respiratory physiotherapy techniques may reduce respiratory load in newborns, manual contact with the ribcage may interfere with pulmonary mechanics. Therefore, this systematic review aims to evaluate the effects of conventional and non-conventional respiratory physiotherapies on pulmonary mechanics of newborns. METHODS AND ANALYSIS We will search PubMed, LILACS, SciELO, ScienceDirect, Cochrane Central and Web of Science databases. Searches will be conducted from September 2022. We will include randomised clinical trials reporting thoracoabdominal synchrony, lung volumes and capacities, respiratory discomfort and pain in newborns aged between 1 hour and 28 days and admitted to neonatal intensive care units. We will exclude studies not fully available or incomplete and studies conducted with newborns presenting structural alterations. Two independent researchers will perform the study selection, data extraction and quality assessment. After consensus, one reviewer will proceed with the process. We will include studies published in English or Portuguese, without publication date restriction. An overview of the included studies and extracted information will be reported and the quality of studies will be assessed. A meta-analysis will be conducted if data regarding between-group comparisons are available. ETHICS AND DISSEMINATION Ethics approval is not required for this systematic review. Results will be presented in journals and national and international conferences, and findings will be shared on social media using accessible language. PROSPERO REGISTRATION NUMBER CRD42021266729.
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Affiliation(s)
- Adriele de Morais Nunes
- Postgraduate program in Rehabilitation Sciences, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
| | | | | | - Mayara Fabiana Pereira Costa
- Postgraduate program in Rehabilitation Sciences, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
| | - Karolinne Souza Monteiro
- Postgraduate program in Rehabilitation Sciences, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
| | - Silvana Alves Pereira
- Postgraduate program in Rehabilitation Sciences, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
- Maternidade Escola Januario Cicco - Ebserh, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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Chinese Geriatrics Thoracic Society, Committee of Pulmonary Rehabilitation of China Rehabilitation Hospital Association. [Expert consensus on the application of inhalation therapy in pulmonary rehabilitation in China]. Zhonghua Jie He He Hu Xi Za Zhi 2022; 45:753-61. [PMID: 35927045 DOI: 10.3760/cma.j.cn112147-20220119-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As an important component of disease management, pulmonary rehabilitation delays disease progression, alleviates symptoms, improves exercise tolerance and quality of life (QOL) in patients with chronic respiratory diseases (CRDs) and other types of respiratory dysfunction. Due to the disease characteristics of patients with respiratory dysfunction, patients generally have problems such as reduced exercise tolerance and impaired airway mucus clearance capability during pulmonary rehabilitation. Inhalation therapy has a unique and significant role in the treatment of respiratory diseases, complementing and promoting each other with pulmonary rehabilitation. Rational application of inhalation therapy can effectively prevent and treat the loss of exercise tolerance and improve the effect of airway clearance in pulmonary rehabilitation,while pulmonary rehabilitation techniques can help to improve the strength of inspiratory muscles, patient self-management, and improve the safety and effectiveness of inhalation therapy. However, there are still difficulties in clinical application due to different knowledge systems of clinical medicine and rehabilitation medicine. In order to further promote the discipline integration and better guide clinical practice,the Respiratory Branch of the Chinese Geriatrics Society (CGS) and the China Rehabilitation Hospital Association (CRHA) organized respiratory and rehabilitation experts to jointly formulate the Chinese expert consensus on the application of inhalation therapy in pulmonary rehabilitation.
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Cortez-Jugo C, Masoumi S, Chan PPY, Friend J, Yeo L. Nebulization of siRNA for inhalation therapy based on a microfluidic surface acoustic wave platform. Ultrason Sonochem 2022; 88:106088. [PMID: 35797825 PMCID: PMC9263997 DOI: 10.1016/j.ultsonch.2022.106088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 05/14/2023]
Abstract
The local delivery of therapeutic small interfering RNA or siRNA to the lungs has the potential to improve the prognosis for patients suffering debilitating lung diseases. Recent advances in materials science have been aimed at addressing delivery challenges including biodistribution, bioavailability and cell internalization, but an equally important challenge to overcome is the development of an inhalation device that can deliver the siRNA effectively to the lung, without degrading the therapeutic itself. Here, we report the nebulization of siRNA, either naked siRNA or complexed with polyethyleneimine (PEI) or a commercial transfection agent, using a miniaturizable acoustomicrofluidic nebulization device. The siRNA solution could be nebulised without significant degradation into an aerosol mist with tunable mean aerodynamic diameters of approximately 3 µm, which is appropriate for deep lung deposition via inhalation. The nebulized siRNA was tested for its stability, as well as its toxicity and gene silencing properties using the mammalian lung carcinoma cell line A549, which demonstrated that the gene silencing capability of siRNA is retained after nebulization. This highlights the potential application of the acoustomicrofluidic device for the delivery of efficacious siRNA via inhalation, either for systemic delivery via the alveolar epithelium or local therapeutic delivery to the lung.
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Affiliation(s)
- Christina Cortez-Jugo
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia; Melbourne Centre for Nanofabrication, 151 Wellington Road, Clayton, Victoria 3168, Australia.
| | - Sarah Masoumi
- Micro/Nanophysics Research Laboratory, RMIT University, Melbourne, Victoria 3001, Australia
| | - Peggy P Y Chan
- School of Software and Electrical Engineering, Swinburne University, Hawthorn, Victoria 3122, Australia; Melbourne Centre for Nanofabrication, 151 Wellington Road, Clayton, Victoria 3168, Australia
| | - James Friend
- Micro/Nanophysics Research Laboratory, RMIT University, Melbourne, Victoria 3001, Australia; Melbourne Centre for Nanofabrication, 151 Wellington Road, Clayton, Victoria 3168, Australia
| | - Leslie Yeo
- Micro/Nanophysics Research Laboratory, RMIT University, Melbourne, Victoria 3001, Australia.
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Baker JA. Finding the Value of a Respiratory Therapist Home Visit Program for COPD. Respir Care 2022; 67:769-771. [PMID: 35606002 PMCID: PMC9994202 DOI: 10.4187/respcare.10133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Joyce A Baker
- Breathing InstituteChildren's Hospital ColoradoAurora, Colorado
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Świątkowska-Bury M, Kulus M, Olczak-Kowalczyk D. The use of anti-asthmatic inhalation therapy and the risk of dental caries in a group of Polish children: a prospective study. Eur J Paediatr Dent 2022; 23:157-162. [PMID: 35722850 DOI: 10.23804/ejpd.2022.23.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM Assessment of the effect of inhaled therapy with anti-asthmatic medications on the development of caries in children between 3 and 17 years old. METHODS Study design: The study involved 208 patients, 114 in the study group and 94 in the control group. Data on general health condition of patients, use of medications, dietary habits and oral hygiene were obtained. Information on the onset of asthma, its severity and type, doses and method of administration of asthma medications were obtained from the available medical records by the paediatrician. Dental examination was performed using the DMFT/dmft and DMFS/dmfs index, ICDAS II classification and Nyvad's criteria for noncavitated white spot lesion differentiation. Additionally, an assessment of salivary S. mutans (SM) and Lactobacillus spp. (LA) was carried out using the CRT Bacteria (Ivoclar Vivadent) test. CONCLUSION There is still no clear consensus among the authors as to whether asthma and medications used in its treatment increase the risk of caries. Nowadays, despite better access to various sources of information, there is still a need for increased awareness in patients and medical doctors on the dental care and caries prevention in patients with asthma.
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Affiliation(s)
- M Świątkowska-Bury
- Department of Pediatric Dentistry, Medical University of Warsaw, Warsaw, Poland (Head of the Department: Prof. Dorota Olczak-Kowalczyk, PhD, D.M.D.)
| | - M Kulus
- Department of Child Pneumonology and Allergology, Medical University of Warsaw, Poland (Head of the Department: Prof. Marek Kulus, PhD, M.D.)
| | - D Olczak-Kowalczyk
- Department of Pediatric Dentistry, Medical University of Warsaw, Warsaw, Poland (Head of the Department: Prof. Dorota Olczak-Kowalczyk, PhD, D.M.D.)
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50
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Zheng P, Jiang D, Liu C, Wei X, Li S. Nitric Oxide Inhalation Therapy Attenuates Postoperative Hypoxemia in Obese Patients with Acute Type A Aortic Dissection. Comput Math Methods Med 2022; 2022:9612548. [PMID: 35360551 PMCID: PMC8964131 DOI: 10.1155/2022/9612548] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 12/21/2022]
Abstract
Objective To investigate the differences between inhaled nitric oxide (iNO) treatment and conventional therapy in the treatment of postoperative hypoxemia in obese patients with acute type A aortic dissection (ATAAD). Methods ATAAD patients diagnosed and treated with emergency surgery in our hospital from June 2017 to December 2019 were retrospectively analyzed. Patients with postoperative hypoxemia were divided into the iNO group and control group. Propensity score matching was used to analyze clinical characteristics and results of the two groups. Results A total of 218 ATAAD patients with BMI ≥ 25 were treated with surgery. Among them, 115 patients developed refractory hypoxemia (64 in the control group and 51 in the iNO group). Patients in the iNO group had significantly shorter invasive mechanical ventilation time, intensive care unit (ICU) stay, and hospital stay. After 6 h of iNO treatment, the PaO2/FiO2 ratio in the iNO group increased significantly, and this ratio was higher than that in the control group at 6, 12, 24, 48, and 72 h after treatment. Conclusion Low-dose iNO could improve oxygenation and shorten mechanical ventilation and ICU stay in patients with hypoxemia after ATAAD surgery, but without significant side effects or increase in postoperative mortality or morbidity. These findings provide a basis for a randomized multicenter controlled trial to assess the efficacy of iNO in the treatment of hypoxemia after ATAAD surgery.
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Affiliation(s)
- Ping Zheng
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Dingsheng Jiang
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Chun Liu
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xiang Wei
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Shiliang Li
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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