This month’s Editor’s Choice is a paper by Miller and colleagues from Duke University describing a program to increase research publications by respiratory therapists following abstract presentation. They developed a research committee with approval of projects and mentorship in study design. Following implementation, the number of abstracts presented fell, but the number of manuscripts published increased over two-fold. They attribute the outcome to better preparation and mentoring of investigators. Branson and Kallet comment on the importance of such programs and the need for advanced training in research for respiratory therapists.
Lauderbaugh and coworkers evaluated the Braden Q and Braden QD scoring tools to identify risk of pressure injuries in children receiving noninvasive ventilation (NIV). This retrospective trial evaluated medical records of 45 pediatric subjects using a dichotomized score of risk versus no risk. The analysis suggests that the Braden QD tool would have been a better predictor of pressure injury risk. Miura and Kawaguchi provide an accompanying editorial commenting on the limitations of a retrospective trial and inability to determine specificity of the Braden QD score. They also highlight the importance of interrater agreement and the need for future trials with clinically important outcomes.
Gates et al evaluated the use of high-flow nasal cannula (HFNC) coupled with aerosol therapy in children with asthma. They retrospectively reviewed 171 cases, with 104 subjects receiving aerosol therapy via HFNC and 67 receiving aerosol therapy by face mask with concomitant HFNC. There were no differences between groups related to ICU or hospital length of stay. They concluded that delivery of aerosol via HFNC was equivalent to therapy via a face mask. Napolitano provides commentary, noting the limitations of the retrospective nature of the trial and suggests that escalation to NIV might be a more sensitive metric for comparing the two techniques.
Nikolla and others retrospectively reviewed changes in the use of noninvasive respiratory support in critically ill children from 17 pediatric ICUs over a 10-year period. Use of invasive ventilation fell by almost 20% and use of noninvasive support increased by almost 30%. In 2017, the use of noninvasive support including HFNC exceeded invasive ventilation use.
Carter and colleagues performed a bench evaluation of a system to provide inhaled nitric oxide (INO) via a transport ventilator during magnetic resonance imaging. The system was capable of delivering INO of 12–41 ppm at FIO2 of 0.67–0.97. They developed a look up table for approximating values.
Trias-Sabria et al performed a prospective study of 36 subjects using lung ultrasound score (LUS) to evaluate the severity of lung injury in COVID-19. Significant correlations were observed between LUS and SpO2/FIO2, serum D-dimer, C-reactive protein, lactate dehydrogenase, and lymphocyte count. They concluded that an LUS ≥ 24 points can help identify COVID-19 patients likely to require ICU admission or die, and that LUS correlated with other markers of COVID-19 severity.
Janssen and coworkers evaluated a pulmonary rehabilitation program in subjects with obstructive lung disease. This observational trial evaluated 70 subjects with the primary endpoint defined as changes in self-management. They compared subject response using a number of questionnaires to measure health literacy and selfefficacy. The largest improvements were seen in domains related to self-management.
Haverkamp and others retrospectively evaluated the spirometric response to bronchodilator delivery and voluntary hyperpnea in adults with asthma. They evaluated data from 39 volunteers and found a poor association between response to bronchodilators and methacholine responsiveness. The authors suggest that bronchodilator response should be interpreted with caution owing to limitations and confounders.
Subat et al measured aerosol generation during peak flow testing to help inform safety in the era of COVID-19. They measured ambient particles in the laboratory during masked and unmasked peak expiratory flow maneuvers from 5 healthy volunteers. Aerosol generation during peak flow testing was present, but concentrations were small compared to background particle concentrations in a clinical setting.
Urner and others evaluated the use of mental practice before simulation practice to determine the impact on individuals training to perform bronchoscopy. They evaluated 24 trainees, including physicians and respiratory therapists, participating in a bronchoscopy curriculum. Trainees who participated in mental practice, had reduced incidences of ‘red outs’. They concluded that an intervention including mental practice exercises was a valuable learning strategy promoting the performance and skill acquisition of novice learners learning bronchoscopy procedures.
Amaru and colleagues performed a randomized trial of recruitment maneuvers and two levels of PEEP following cardiothoracic surgery in 192 obese subjects. Post-operatively subjects were randomized to volume control ventilation and 5 H2O of PEEP or to a recruitment maneuver and 10 cm H2O PEEP. The primary outcome was a composite of reintubation or use of HFNC or NIV in the first 48 h. They concluded that the routine recruitment maneuvers followed by 10 or 5 cm H2O of PEEP did not decrease the frequency of respiratory failure in obese subjects undergoing cardiac surgery.
Qaqish and Berlinski evaluated the effect of shake-actuation delay on delivered dose from an albuterol pressurized metered dose inhaler (pMDI) in a bench study. They compared pMDI dose with and without a 30-s delay between shaking of the cannister and actuation with and without a valved holding chamber. They report that the 30-s delay reduced the dose at the beginning and end of the pMDI life.
Andrade Filho and others evaluated the indices of oxygenation including PaO2/FIO2, SpO2/FIO2, and the ROX index (SpO2 to FIO2/breathing frequency) to predict extubation failure in subjects with COVID-19. They prospectively evaluated 69 subjects and found no differences in the median values for oxygenation indices and that both SpO2/FIO2 and ROX were good discriminators of extubation failure in this population.
Moustaki and coworkers contribute a narrative review of NIV in subjects with cystic fibrosis. They conclude that NIV use in CF has been increasing, mainly in adult CF centers, offering patients an opportunity to reach lung transplantation or to treat acute hypercapnic respiratory failure.
Meier and colleagues contribute to the New Horizons symposium with a review of intraoperative ventilation in the high-risk surgical patient. Rich Kallet provides an encyclopedic Year in Review of mechanical ventilation in the first year of COVID-19. The sheer volume of literature in such a short timeframe detailing treatment for the worst pandemic of our lifetime is daunting.
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