Canadian Journal of Respiratory Therapy : CJRT

BACKGROUND: Many medical devices in pediatric and newborn intensive care units can potentially expose healthcare workers (HCWs) and others to transmission of respiratory and other viruses and bacteria. Such fomites include ventilators, nebulizers, and monitoring equipment. APPROACH: We report the general, novel approach we have taken to identify and mitigate these risks and to protect HCWs, visitors and patients from exposure while maintaining the optimal performance of such respiratory equipment...

BACKGROUND: Positive airway pressure (PAP) therapy is prescribed to patients with obstructive sleep apnea (OSA). A commonly used definition for PAP therapy adherence is based upon the minimum requirements to receive Medicare coverage in the US, defined as PAP usage of four or more hours per night on 70 percent of nights for at least 30 consecutive days. However, little evidence exists to support this definition for PAP therapy adherence. Therefore, the present study sought to determine the efficacy of the present definition of PAP therapy adherence on longitudinal outcomes in patients with OSA, using objectively measured PAP device usage time...

PURPOSE: Limited evidence exists to assess the sensitivity, specificity, and accuracy of point-of-care lung ultrasound (LUS) across all age groups. This review aimed to investigate the benefits of point-of-care LUS for the early diagnosis of pneumonia compared to traditional chest X-rays (CXR) in a subgroup analysis including pediatric, adult, and geriatric populations. MATERIAL AND METHODS: This systematic review examined systematic reviews, meta-analyses, and original research from 2017 to 2021, comparing point-of-care LUS and CXR in diagnosing pneumonia among adults, pediatrics and geriatrics...

BACKGROUND: Respiratory therapists (RTs) are expected to stay updated on technology, treatments, research, and best practices to provide high-quality patient care. They must possess the skills to interpret, evaluate, and contribute to evidence-based practices. However, RTs often rely on research from other professions that may not fully address their specific needs, leading to insufficient guidance for their practice. Additionally, there has been no exploration of knowledge gaps and research needs from RTs' perspectives to enhance their practice and patient outcomes...

RATIONALE: Extremes of temperature and humidity are associated with adverse respiratory symptoms, reduced lung function, and increased exacerbations among individuals living with chronic obstructive pulmonary disease (COPD). OBJECTIVES: To describe the reported effects of temperature and humidity extremes on the health outcomes, health status and physical activity (PA) in individuals living with COPD. METHODS: A cross-sectional self-reported survey collected the effects on health status (COPD Assessment Test [CAT]), PA, and health outcomes in 1) moderate/ideal (14 to 21°C, 30 to 50% relative humidity [RH]), 2) hot and humid (≥ 25°C, > 50% RH) and 3) cold and dry (≤ 5°C, < 30% RH) weather conditions...

BACKGROUND: The educational component is a comprehensive part of Pulmonary Rehabilitation (PR), and telephone follow-up (TFU) is an alternative to reinforce face-to-face education. The objective was to determine the effect of telephone follow-up on educational needs, dyspnea, quality of life and functional capacity in Chronic Obstructive Pulmonary Disease (COPD) patients undergoing PR. METHODS: Double-blind randomized controlled clinical trial in patients with COPD in a PR program in Cali-Colombia, allocation by randomization tables...

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BACKGROUND: Primary studies have demonstrated the effectiveness of noninvasive respiratory supports, including noninvasive positive pressure ventilation (NIPPV) and high flow nasal cannula (HFNC), for improving oxygenation and ventilation in patients with interstitial lung diseases (ILDs) and acute respiratory failure (ARF). These studies have not been synthesized and are not included in current practice guidelines. This systematic review with meta-analysis synthesizes studies that compared the effectiveness of NIPPV, HFNC and conventional oxygen therapy (COT) for improving oxygenation and ventilation in ILD patients with ARF...

BACKGROUND: Inhaled hypertonic saline (HS) is an effective mucolytic agent in patients with cystic fibrosis (CF). However, adverse events can impair the clinical utility of hypertonic saline (HS) in this patient population. In this study, we aimed to investigate the effectiveness of hyaluronic acid (HA) in reducing these adverse events. METHODS: A literature search was conducted across three electronic databases (Medline, Cochrane Central, and EMBASE) from inception through February 2023...

RATIONALE: Ventilator Assisted Individuals (VAIs) frequently remain in intensive care units (ICUs) for a prolonged period once clinically stable due to a lack of transition options. These VAIs occupy ICU beds and resources that patients with more acute needs could better utilize. Moreover, VAIs experience improved outcomes and quality of life in long-term and community-based environments. OBJECTIVE: To better understand the perspectives of healthcare providers (HCPs) working in an Ontario ICU regarding barriers and facilitators to referral and transition of VAIs from the ICU to a long-term setting...

BACKGROUND: The shortage of mechanical ventilators during the COVID-19 pandemic led doctors to use alternative noninvasive ventilation systems, including a modified snorkel mask. Data on the use of the modified snorkel mask is limited. PURPOSE: The study aims to describe the effect and clinical characteristics of patients with COVID-19 treated with a snorkel mask and to investigate the factors associated with the failure to use noninvasive ventilation with a snorkel mask...

OBJECTIVE: To evaluate the ability of the Perme Score to detect changes in the level of mobility of patients with COVID-19 outside the intensive care unit. METHOD: A retrospective cohort study was conducted in inpatient units of a private hospital. Patients older than 18, diagnosed with COVID-19, who were discharged from the intensive care unit and remained in the inpatient units were included. The variables collected included demographic characterization data, length of hospital stay, respiratory support, Perme Score values at admission to the inpatient unit and at hospital discharge and the mobilization phases performed during physical therapy...

BACKGROUND: Minimally invasive surfactant therapy (MIST), a method of surfactant delivery via a thin catheter during spontaneous breathing, is an increasingly popular alternative to intubation and surfactant administration. Recently, purpose-built catheters for MIST received regulatory approval in Canada and became available for use. However, procedural success and user experience with such catheters have not been described. METHODS: This retrospective cohort study included neonates who received MIST using purpose-built catheters between January 1, 2021, and March 31, 2022...

BACKGROUND: Although invasive mechanical ventilation (IMV) has contributed to the survival of preterm infants with extremely low birth weight (ELBW), it is also associated with unsatisfactory clinical outcomes when used for prolonged periods. This study aimed to identify factors that may be decisive for extubation success in very low birth weight (VLBW) and extremely low birth weight (ELBW) preterm infants. METHODS: The cohort study included preterm infants with gestational age (GA) <36 weeks, birth weight (BW) <1500 grams who underwent IMV, born between 2015 and 2018...

BACKGROUND: More than six million people died due to COVID-19, and 10-15% of infected individuals suffer from post-covid syndrome. Corticosteroids are widely used in the management of severe COVID-19 and post-acute COVID-19 symptoms. This study synthesizes current evidence of the effectiveness of inhaled corticosteroids (ICS) on mortality, hospital length-of-stay (LOS), and improvement of smell scores in patients with COVID-19. METHODS: We searched Embase, Web of Science, PubMed, Cochrane Library, and Scopus until Aug 2022...

BACKGROUND: There is a lack of data assessing the influence of respiratory therapist (RT) education on clinical outcomes. The primary objective of this study was to evaluate the impact of RTs holding advanced degrees or completing adult critical care competencies on discharge outcomes of patients with COVID-19 pneumonia. STUDY DESIGN AND METHODS: This retrospective, cross-sectional study included adults with confirmed COVID-19 admitted to the hospital for at least three days between March-May 2020...

INTRODUCTION: Serum vitamin D deficiency is thought to be associated with worse clinical outcomes in COVID-19 patients. METHODS: This single-centre observational study evaluated the association between serum vitamin D levels and negative outcomes in hospitalized COVID-19 patients in Ukraine. We included hospitalized patients with COVID-19 confirmed by PCR and serum vitamin D measurement on admission. Patients were divided into two groups based on their serum vitamin D level: with adequate vitamin D (≥ 30 ng/ml) and with low vitamin D (<30 ng/ml)...

OBJECTIVE: To mitigate trauma for infants on high-frequency jet ventilation by decreasing exposure to noise and facilitating skin-to-skin therapy. DESIGN: Key drivers were identified, and we designed and implemented equipment and processes through a series of interventions. A mixed methods evaluation was used. Retrospective chart reviews assessed safety (unplanned extubation) and stability parameters. Semi-structured interviews were conducted to understand parent and staff experiences...

OBJECTIVES: The present study was designed to evaluate the role of chest ultrasound in the diagnosis of acute pulmonary embolism (PE) and determine its accuracy using multi-detector CT-pulmonary angiography (MD-CTPA) as a gold standard technique for PE diagnosis. PATIENTS AND METHODS: A prospective case-control study was performed with 75 patients who presented to the emergency department of Minia Cardiothoracic University Hospital with clinical suspicion of PE...

BACKGROUND: Extubation failure occurs in 5%-20% of patients and is associated with poor clinical outcomes. The primary aim of this project was to determine the predictive ability of the Respiratory Insufficiency (RI) index, Respiratory Oxygenation (ROX) index and Modified Early Warning Score (MEWS) in identifying extubation failure. METHODS: This was a secondary analysis of a prior cross-sectional retrospective study conducted from February 2018 through December 2018 among adult subjects who received mechanical ventilation for more than 24 h...