This Month’s Editor’s Choice paper evaluates the impact of prone positioning on hemodynamic performance in non-ventilated subjects. Jacquet-Lagrèze and others used transthoracic echocardiography to measure cardiac performance in 26 subjects with COVID-19 during awake prone positioning. They found improvements in right ventricular systolic function and increases in cardiac index, but surprisingly no change in PaO2/FIO2. Ibarra-Estrada and others provide commentary suggesting that this data should give clinicians the confidence to use prone positioning, even in subjects with hemodynamic compromise to both improve gas exchange and cardiac performance.
Colaianni-Alfonso studied the delivery of aerosolized bronchodilators via HFNC in subjects with COPD exacerbation. This prospective observational study included 31 subjects who received a bronchodilator via HFNC. They demonstrated statistically significant but clinically small changes in the FEV1 and FVC. No changes in SpO2 or Borg dyspnea score were observed. Saunders and Davis provide commentary. They point out that the ability to deliver aerosol therapy simply via HFNC is not the equivalent of proving safety and efficacy.
Aguirre-Bermeo and others compared oxygenation in subjects undergoing bronchoscopy using both standard oxygen therapy and HFNC. This quasi-random study compared 20 subjects in each group with the main outcome variable being SpO2. They reported that the lowest SpO2 and smallest change in SpO2 were seen with HFNC. They suggest that in spontaneously breathing subjects, HFNC may be the preferred method of supplemental oxygen therapy during bronchoscopy.
Al-Subu and colleagues studied the impact on patient important outcomes of the preservative benzalkonium chloride in albuterol solutions. Using a retrospective study design they compared outcomes in subjects delivered therapy with benzalkonium chloride-containing solutions to a historical control of subjects treated with preservative-free solutions. They reported that there were no differences between groups with respect to length of stay or duration of therapy.
Benguerfi et al performed a post-hoc analysis of a multinational study to evaluate the outcomes of immunocompromised subjects with ARDS and solid tumors. They found that infections were the leading cause of ARDS and mortality was associated with severity of illness at admission, lung cancer and chronic cardiac failure. The overall mortality rate exceeded 50%.
Allender et al studied the second victim experience and support tool to examine the second victim responses of respiratory therapists. Using an anonymous survey of a large academic healthcare system in 4 states, they recorded responses related to a stressful or traumatic work-related event. The most common events were physical or emotional distress associated with a clinical occurrence. Half of these occurred during the COVID-19 pandemic. They concluded that stressful clinical events are common for RTs and COVID-19 had a significant impact on the incidence.
Rigault and co-workers performed a bench study of methods for providing gas flow during a spontaneous breathing trial (SBT). They compared a T-piece with no flow to high flow oxygen at 40 L/min and 60 L/min. The lung model included 3 conditions of compliance and resistance and three degrees of inspiratory effort (low, normal and high). They found that inspiratory tidal volume was greater with T-piece, while work of breathing was lower with high flow oxygen.
Sameed et al evaluated the work of breathing during an SBT with a T-piece vs using zero pressure support and zero PEEP in a lung model with three different ventilators. The lung model simulated subjects with normal lung mechanics, ARDS, and COPD. They found significant differences in WOB associated with variable levels of PSV provided, even with PSV set a 0 cm H2O. These findings may help explain the variability outcomes associated with performance of an SBT.
Caetano and others provide a short report on the use of electrical impedance tomography to monitor areas of hypoventilation in the lungs of subjects with COVID-19 and ARDS. They found a typical response to PEEP and recruitability with half of patients demonstrating reduced consolidation and half with no change. Another short report by Guerreiro et al describes the use of the S3-NIV questionnaire to describe comfort of patients receiving home non-invasive ventilation.
Yang and colleagues provide a narrative review on early mobilization of critically ill patients. They suggest that the lack of standard mobilization protocols might be responsible for conflicting results in the literature.
Honor lectures at the AARC Congress are invited presentations that are followed by an expert review by the presenter. Rob Chatburn presented the Kacmarek lecture and his paper on teaching mechanical ventilation and the importance of the adoption of common terminology is stressed in his review. This paper details the process of describing modes of ventilatory support uncoupled from trade names. Dean Hess delivered the Petty lecture on the respiratory care management of patients with COPD exacerbations. His paper is an expert review of the appropriate use of oxygen therapy, NIV, aerosol therapy and invasive ventilation in this population.
Rehder and Allbrahim provide the first of the New Horizons papers on best practices for mechanical ventilation during extracorporeal membrane oxygenation. The intensity of ventilation during ECMO continues to be a point of contention. Burnett and Skinner provide our first 2022 Year in Review on long COVID and pulmonary rehabilitation.
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