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Introduction Methods Results Conclusion The aim of this study was to clarify the safety and efficacy of breath‐hold irradiation in liver stereotactic body radiotherapy (SBRT).A retrospective analysis was conducted on 57 consecutive patients who received SBRT for hepatocellular carcinoma or liver metastases between 2013 and 2021. Breath‐hold irradiation was implemented for patients treated after April 2020.The median follow‐up period for all patients was 16.4 months (IQR: 7.36–20.9). The 2‐year overall survival rate was 64.4% (95% CI: 47.4–77.2), and the local control rate was 84.3% (95% CI: 69.7–92.3) for all patients. The 1‐year overall survival was 80.0% (95% CI: 60.8–90.5) versus 82.0% (95% CI: 53.5–93.9) in the free‐respiratory (FR) group versus the breath‐hold (BH) group, respectively (P = 0.60). The 1‐year local control rates were 78.1% (95% CI: 57.5–89.5) in the FR group and 95.7% (95% CI: 72.9–99.4) in the BH group, respectively (P = 0.16). Radiation‐induced liver injury, defined by an escalation of ≥2 in Child–Pugh score, was observed in four patients within each group (FR 13% vs. BH 15%). There were no gastrointestinal adverse events of Grade 3 or higher.Breath‐hold irradiation can be safely administered and has demonstrated clinical potential in improving local control. Further research into dose escalation using breath‐hold techniques is warranted. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of esketamine on respiration, complications and acute phase inflammatory factors in patients undergoing single-port thoracoscopic surgery under general anesthesia with preserved spontaneous respiration. Methods Ninety patients, aged 16 ~ 74 years, BMI 18 ~ 28 kg/m2, ASA physical status ? or ?, who were scheduled to undergo single-port thoracoscopic surgery under general anesthesia were selected. Patients were randomly divided into two groups by random number table: esketamine group (group E, n = 45) and control group (group C, n = 45) . Esketamine 0.5 mg/kg was given for induction of anesthesia, and 0.25 mg/kg again before cutting skin. In group C, sufentanilwas given at 0.15 μg/kg for induction of anesthesia. Other anesthesia induction and maintenance durgs in both groups were the same.Sp02, PaCO2 and PaO2 were recorded at the patient's entrance (T0), before pleuraopening (T1), 15 min after pleuraopening (T2), 30 min after pleuraopening (T3), and beforelaryngeal mask removal (T4) . 3 mL of blood was extracted from themedian cubital vein at T0 and 24 h after surgery (T5) to detect the concentrations of TNF- α and IL-6. The length of spontaneous respiration recovery and laryngeal mask removal, the number of respiratory intervention, the incidence of body movement during operation, nausea, vomiting, psychiatric symptom, awareness, the length of hospital stay was recorded. Results Compared with group C, PaO2 was significantly decreased and PaCO2 was significantly increased in group E at T1, PaO2 was significantly increased and PaCO2 was significantly decreased at T2 (P < 0.01). Compared with group C, the length of spontaneous respiration recovery was significantly shortened and the number of respiratory intervention was significantly decreased in group E (P < 0.01). Compared with group C, the concentrations of TNF-α and IL-6 in venous blood in group E at T5 was significantly decreased (P < 0.01). There were no significant difference in the length of laryngeal mask removal, and the incidenceofcomplications,hospitalstay between the two groups. Conclusion Esketamine reducesintraoperative respiratory depression, shortens spontaneous respiration recovery, maintains respiratory stability and reduces acute inflammatory response in patients under general anesthesia with preserved spontaneous respiration for single-port thoracoscopic surgery. [ABSTRACT FROM AUTHOR]

Background. Traumatic spinal cord injury is a medical condition which often results in disability and mortality. The most common lesion was cervical level, which is around 60-75% of all cases, where at this level there is a risk of respiratory problems which often require mechanical ventilation. Case report. In the case discussed, a 28-years-old male was referred from other hospital with traumatic cervical spinal cord injury (C5-C6) ASIA score A with a history of falling from a height of 3 meters. The patient underwent decompressive laminectomy on the tenth day of onset, followed by mechanical ventilation. During treatment, the patient received pharmacological therapy, tracheostomy, acupuncture, physiotherapy, and neuromuscular electrical stimulation for ventilator weaning. The patient was hospitalized for 66 days, with mechanical ventilation duration for 32 days. Conclusions. Factors that can influence the duration of ventilation weaning are the level and severity of spinal cord injury, time of transfer to a health facility, and complications related to ventilator installation. Multidisciplinary management, including pharmacological, physiotherapy, acupuncture, surgical, neuromuscular electrical stimulation, can increase the chances and decreasing the duration of mechanical ventilation, and reducing complications related to spinal cord injury and prolonged ventilation. [ABSTRACT FROM AUTHOR]

Purpose: For many thoracic tumors, patient respiration can introduce a significant amount of variability in tumor position that must be accounted for during radiotherapy. Of all existing techniques, real-time dynamic tumor tracking (DTT) represents the most ideal motion management strategy but can be limited by the treatment delivery technique. Our objective was to analyze the dosimetric performance of a dynamic conformal arc (DCA) approach to tumor tracking on standard linear accelerators that may offer similar dosimetric benefit, but with less complexity compared to intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT). Methods: Ten patients who previously received free-breathing VMAT for lung cancer were retrospectively analyzed. Patient 4D-CT and respiratory traces were simultaneously acquired prior to treatment and re-planned with DCA and VMAT using the Eclipse v15.6 Treatment Planning System with gated, deep inspiration breath hold (DIBH), and motion encompassment techniques taken into consideration, generating seven new plans per patient. DTT with DCA was simulated using an in-house MATLAB script to parse the radiation dose into each phase of the 4D-CT based on the patient's respiratory trace.Dose distributions were normalized to the same prescription and analyzed using dose volume histograms (DVHs).DVH metrics were assessed using ANOVA with subsequent paired t-tests. Results: The DCA-based DTT plans outperformed or showed comparable performance in their DVH metrics compared to all other combinations of treatment techniques while using motion management in normal lung sparing (p < 0.05). Normal lung sparing was not significantly different when comparing DCA-based DTT to gated and DIBH VMAT (p > 0.05), while both outperformed the corresponding DCA plans (p < 0.05). Simulated treatment times using DCA-based DTT were significantly shorter than both gating and DIBH plans (p < 0.05). Conclusions: A DCA-based DTT technique showed significant advantages over conventional motion encompassment treatments in lung cancer radiotherapy, with comparable performance to stricter techniques like gating and DIBH while conferring greater time-saving benefits. [ABSTRACT FROM AUTHOR]

Abstract Background General anesthesia for tracheal stenting is challenging because of difficult ventilation and accompanying hypoxia. We report the use of oxygen reserve index (ORi™) during tracheal stenting. Case presentation Cauterization of an intratracheal tumor and tracheal stenting was scheduled in a patient. ORi decreased from 0.3 to 0.2 after starting cauterization using a flexible bronchoscope through a tracheal tube with 28% oxygen, while SpO2 was maintained at 100%. ORi further decreased to 0, followed by a decrease of SpO 2

Extremely preterm infants frequently require some form of respiratory assistance to facilitate the cardiopulmonary transition that occurs in the first hours of life. Current resuscitation guidelines identify as a primary determinant of overall newborn survival the establishment, immediately after birth, of adequate lung inflation and ventilation to ensure an adequate functional residual capacity. Any respiratory support provided, however, is an important contributing factor to the development of bronchopulmonary dysplasia. The risks correlated to invasive ventilatory techniques increase inversely with gestational age. Preterm infants are born at an early stage of lung development and are more susceptible to lung injury deriving from mechanical ventilation. Any approach aiming to reduce the global burden of preterm lung disease must implement lung-protective ventilation strategies that begin from the newborn's first breaths in the delivery room. Neonatologists today must be able to manage both invasive and noninvasive forms of respiratory assistance to treat a spectrum of lung diseases ranging from acute to chronic conditions. We searched PubMed for articles on preterm infant respiratory assistance. Our narrative review provides an evidence-based overview on the respiratory management of preterm infants, especially in the acute phase of neonatal respiratory distress syndrome, starting from the delivery room and continuing in the neonatal intensive care unit, including a section regarding exogenous surfactant therapy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Laser retinopexy is the current standard treatment for babies with type I retinopathy of prematurity (ROP). No guidelines exist for respiratory management during this procedure. Although neonatologists prefer to avoid intubation to prevent delays in extubation, feeding and discharge, ophthalmologists often request intubation, because sedation alone may lead to respiratory collapse. Little evidence is available regarding which treatment provides the most benefit to vulnerable infants. OBJECTIVE: This study investigated relevant associations or underlying conditions that may help guide decision-making in respiratory management during laser retinopexy. METHODS: A retrospective chart review was performed to analyze data from babies who underwent retinopexy from 2006 to 2011 at the Montefiore Medical Center. The main outcome measures included respiratory support before, during and after laser therapy; time from treatment to extubation; and time from treatment to discharge. RESULTS: The main outcomes were analyzed in four groups: never intubated (n = 27), emergently intubated (n = 7), already intubated (n = 8) and electively intubated (n = 28). No significant differences were observed in the number of pre-operative apneic/bradycardic events, postoperative time to extubation, time to discharge and delays in feeding among groups. CONCLUSIONS: No specific comorbid conditions were found to predict a need for intubation. Elective intubation did not cause delays in feedings, extubation or discharge. A selective approach to respiratory support would result in 20% of initially non-intubated patients requiring emergent intubation. [ABSTRACT FROM AUTHOR]

Conventional mechanical ventilation (CMV) has been recommended as the first-line mode of respiratory support for neonates born with a congenital diaphragmatic hernia (CDH). However, older studies suggested that protective high-frequency oscillatory ventilation (HFOV) with low-mean airway pressure (MAP) may limit lung injury. We aimed to compare low-MAP HFOV with CMV in neonates with CDH in terms of patient outcomes. This retrospective cohort study was conducted in two French neonatal intensive care units: center 1 mainly used CMV, and center 2 mainly used HFOV with a low MAP. All term neonates with CDH born between 2010 and 2018 in these two centers were included. The primary outcome was the duration of oxygen therapy. Secondary outcomes were survival and duration of mechanical ventilation. A total of 170 patients (105 in center 1, 65 in center 2) were included. In center 2, 96% of patients were ventilated with HFOV versus 19% in center 1. After adjustment for perinatal data, there was no significant difference regarding duration of oxygen therapy (SHR 0.83, 95% CI [0.55-1.23], p = 0.35) or survival (HR 1.73, 95% CI [0.64-4.64], p = 0.28). Center 2 patients required longer mechanical ventilation and sedation.Conclusion: First-line mode of mechanical ventilation was not associated with the duration of oxygen therapy or survival in neonates with CDH.What Is Known: • Recommendations were given in favour of using the conventional mechanical ventilation in first intention in neonates with a congenital diaphragmatic hernia, since High frequency oscillation (HFO) has been associated with a higher morbidity.What Is New: • No differences between HFO and conventional mechanical ventilation were observed concerning the length of oxygen supply and the survival.. [ABSTRACT FROM AUTHOR]

Abstract Background Neonates with severe acute respiratory syndrome coronavirus 2 infection are usually asymptomatic or have mild to moderate symptoms. Acute respiratory distress syndrome due to severe acute respiratory syndrome coronavirus 2 with respiratory insufficiency is rare. Therefore, information about the best intensive care strategy for neonates requiring mechanical ventilation is lacking. We report a neonatal case of severe acute respiratory distress syndrome, probably due to vertical transmission of severe acute respiratory syndrome coronavirus 2, complicated by Staphylococcus aureus sepsis. We aim to inform pediatric providers on the clinical course and acute management considerations in coronavirus disease-related neonatal acute respiratory distress syndrome. Case presentation A late preterm (gestational age 36 0/7 weeks) Caucasian girl was born from a severe acute respiratory syndrome coronavirus 2-positive mother and tested positive for severe acute respiratory syndrome coronavirus 2 at 19 hours after birth. She developed acute respiratory distress syndrome requiring intensive care admission and mechanical ventilation. The clinical course was complicated by S. aureus pneumonia and bacteremia. Multimodal management included well-established interventions for respiratory distress syndrome such as surfactant therapy, high-frequency oscillatory ventilation, and inhaled nitric oxide, combined with therapies extrapolated from adult care for severe acute respiratory syndrome coronavirus 2 patients such as dexamethasone, coronavirus disease 2019-specific immunoglobins, and prophylactic low-molecular-weight heparin. The neonate was successfully weaned from the ventilator and improved clinically. Conclusion This case shows a rare but serious neonatal severe acute respiratory syndrome coronavirus 2 infection, leading to severe acute respiratory distress syndrome. Because of limited therapy guidelines for neonates, we suggest multimodal management with awareness of the possibility of S. aureus coinfection, to treat this age group successful.

Abstract Question We evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae. Materials and methods Prospective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge. Results We included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29–4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42–4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of − 10.77 (95% CI − 18.40 to − 3.15), with a greater number of affected lobes (+ 1.51 [95% CI 0.89–2.13]) and a greater TSS (+ 4.35 [95% CI 2.41–6.27]) in the chest CT scan. Conclusions Among critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up.

Background: Neonates with severe acute respiratory syndrome coronavirus 2 infection are usually asymptomatic or have mild to moderate symptoms. Acute respiratory distress syndrome due to severe acute respiratory syndrome coronavirus 2 with respiratory insufficiency is rare. Therefore, information about the best intensive care strategy for neonates requiring mechanical ventilation is lacking. We report a neonatal case of severe acute respiratory distress syndrome, probably due to vertical transmission of severe acute respiratory syndrome coronavirus 2, complicated by Staphylococcus aureus sepsis. We aim to inform pediatric providers on the clinical course and acute management considerations in coronavirus disease-related neonatal acute respiratory distress syndrome. Case presentation: A late preterm (gestational age 36 0/7 weeks) Caucasian girl was born from a severe acute respiratory syndrome coronavirus 2-positive mother and tested positive for severe acute respiratory syndrome coronavirus 2 at 19 hours after birth. She developed acute respiratory distress syndrome requiring intensive care admission and mechanical ventilation. The clinical course was complicated by S. aureus pneumonia and bacteremia. Multimodal management included well-established interventions for respiratory distress syndrome such as surfactant therapy, high-frequency oscillatory ventilation, and inhaled nitric oxide, combined with therapies extrapolated from adult care for severe acute respiratory syndrome coronavirus 2 patients such as dexamethasone, coronavirus disease 2019-specific immunoglobins, and prophylactic low-molecular-weight heparin. The neonate was successfully weaned from the ventilator and improved clinically. Conclusion: This case shows a rare but serious neonatal severe acute respiratory syndrome coronavirus 2 infection, leading to severe acute respiratory distress syndrome. Because of limited therapy guidelines for neonates, we suggest multimodal management with awareness of the possibility of S. aureus coinfection, to treat this age group successful. [ABSTRACT FROM AUTHOR]

Background: General anesthesia for tracheal stenting is challenging because of difficult ventilation and accompanying hypoxia. We report the use of oxygen reserve index (ORi™) during tracheal stenting. Case presentation: Cauterization of an intratracheal tumor and tracheal stenting was scheduled in a patient. ORi decreased from 0.3 to 0.2 after starting cauterization using a flexible bronchoscope through a tracheal tube with 28% oxygen, while SpO2 was maintained at 100%. ORi further decreased to 0, followed by a decrease of SpO2 < 90%, and surgery was interrupted. SpO2 was increased shortly after increasing FiO2 to 1.0, but ORi remained 0 when surgery was resumed; it was increased after completion of cauterization. Both ORi and SpO2 were maintained above 0.4 and 98%, respectively, during tracheal stenting through a rigid bronchoscope under intrapulmonary percussive ventilation. Conclusion: ORi was useful for predicting a decrease of SpO2 under general anesthesia for tracheal stenting. [ABSTRACT FROM AUTHOR]

Extremely preterm infants frequently require some form of respiratory assistance to facilitate the cardiopulmonary transition that occurs in the first hours of life. Current resuscitation guidelines identify as a primary determinant of overall newborn survival the establishment, immediately after birth, of adequate lung inflation and ventilation to ensure an adequate functional residual capacity. Any respiratory support provided, however, is an important contributing factor to the development of bronchopulmonary dysplasia. The risks correlated to invasive ventilatory techniques increase inversely with gestational age. Preterm infants are born at an early stage of lung development and are more susceptible to lung injury deriving from mechanical ventilation. Any approach aiming to reduce the global burden of preterm lung disease must implement lung-protective ventilation strategies that begin from the newborn’s first breaths in the delivery room. Neonatologists today must be able to manage both invasive and noninvasive forms of respiratory assistance to treat a spectrum of lung diseases ranging from acute to chronic conditions. We searched PubMed for articles on preterm infant respiratory assistance. Our narrative review provides an evidence-based overview on the respiratory management of preterm infants, especially in the acute phase of neonatal respiratory distress syndrome, starting from the delivery room and continuing in the neonatal intensive care unit, including a section regarding exogenous surfactant therapy.

Question: We evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae. Materials and methods: Prospective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge. Results: We included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29–4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42–4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of − 10.77 (95% CI − 18.40 to − 3.15), with a greater number of affected lobes (+ 1.51 [95% CI 0.89–2.13]) and a greater TSS (+ 4.35 [95% CI 2.41–6.27]) in the chest CT scan. Conclusions: Among critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up. [ABSTRACT FROM AUTHOR]

The use of medical imaging as a non-invasive or minimally invasive method to assess disease or treatment response continues to grow. A similar trend is observed in pre-clinical research, in general, and more specifically in macaques, enabling longitudinal assessment of disease in individual animals. Computed tomography (CT) is such an imaging technique used to obtain clinically applicable data. To acquire a chest CT using a cone beam tomography system, some kind of respiration control is needed. A commonly used technique for this is endotracheal intubation and mechanical ventilation. However, although routinely performed this can increase the risk of impact on welfare in comparison with non-invasive imaging. Therefore, we studied the option of retrospectively gated CTs: acquiring high resolution chest CTs in freely breathing macaques. For this, we compared 748 CTs obtained during free breathing with 881 CTs obtained with mechanical ventilation in combination with a breath-hold procedure predominantly on the appearance of misregistration artifacts. The scans were obtained during different stages of multiple experimentally induced respiratory diseases. The comparison shows that although there are still streaking artifacts present in the retrospective gated scans, the amount of shading artifacts is reduced to such a level that it possibly dominates underlying lesions, causing misdiagnosis. Our data reveal that the use of retrospective gating in high resolution CTs for macaques can be successfully applied. With the use of this technique, artifacts due to free breathing are reduced to a diagnostically appropriate level. Most importantly, this technique makes chest CTs with this instrumentation a non-invasive modality. [ABSTRACT FROM AUTHOR]

Structural and functional cardiovascular abnormalities associated with single ventricle physiology are particularly challenging in terms of perioperative management. The modified Fick principle is considered to be one of the most effective tools for evaluating a patient’s clinical status as well as the parameters of respiratory and hemodynamic support.

Background: Respiratory morbidity is common in children with neuromuscular diseases (NMD) owing to chronic hypoventilation and impaired cough. Optimal, cost-effective respiratory management requires implementation of clinical practice guidelines and a coordinated multidisciplinary team approach. Objectives: To explore South African physiotherapists’ knowledge, perception and implementation of respiratory clinical practice guidelines for non-ventilated children with NMD. Methods: An online survey was conducted amongst members of the South African Society of Physiotherapy’s Cardiopulmonary Rehabilitation (CPRG) and Paediatric special interest groups and purposive sampling of non-member South African physiotherapists with respiratory paediatrics expertise (N= 481). Results: Most respondents worked in private healthcare, with 1–10 years’ experience treating patients with NMD. For acute and chronic management, most participants recommended nebulisation and 24-h postural management for general respiratory care. Percussions, vibrations, positioning, adapted postural drainage, breathing exercises and manually assisted cough were favoured as airway clearance techniques. In addition, participants supported non-invasive ventilation, oscillatory devices and respiratory muscle training for chronic management. Conclusion: Respondents seemed aware of internationally-endorsed NMD clinical practice guidelines and recommendations, but traditional manual airway clearance techniques were favoured. This survey provided novel insight into the knowledge, perspectives and implementation of NMD clinical practice guidelines amongst South African physiotherapists. Clinical implications: There is an urgent need to increase the abilities of South African physiotherapists who manage children with NMD, as well as the establishment of specialised centres with the relevant equipment, ventilatory support and expertise in order to provide safe, cost-effective and individualised patient care.

Summary: Retinopathy of prematurity (nROP) among extremely low gestational age newborns (ELGAN) in Slovenia has increased in recent years. At the same time mortality has further decreased and less invasive approaches for treatment of respiratory distress syndrome have been established. With the aim to study the possible association between the incidence of ROP and the duration of noninvasive ventilation, this retrospective study comprised ELGANs born during the first period (2010/2011), when invasive respiratory support was the prevalent method and in the second period (2015/2016), when noninvasive respiratory support was adopted. The results showed that the duration of noninvasive ventilation is a potential risk factor for ROP. Controlling for known risk factors for ROP and then adjusting for gestational age, number of transfusions and fraction of inspired oxygen (FiO2), the odds of ROP were 1.22 times greater (95% confidence interval, CI 1.01–1.48) with every additional week of noninvasive ventilation (p = 0.03). [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with cervical spinal cord injury will have serious complications in the early stage, of which respiratory complications are the most common. Therefore, respiratory tract management is particularly important for the rehabilitation of patients with cervical spinal cord injury. OBJECTIVE: To introduce the neuroanatomical and pathological features of cervical spinal cord injury, and to summarize the multiple treatments of respiratory complications in patients with cervical spinal cord injury and the application of fiberoptic bronchoscopy in patients with cervical spinal cord injury in recent years. METHODS: By inputting the key words of "cervical spinal cord injury, pulmonary infection, respiratory tract management, antibiotics, nerve transfer, tracheotomy, mechanical ventilation, fiberoptic bronchoscope, pneumonia" in Chinese and "cervical spinal cord injury, fibrobronchoscopy, bronchoalveolar lavage, tracheotomy, pneumonia" in English, we searched the CNKI, Wanfang, SinoMed, PubMed, and Web of Science for the related literature on the application of fiberoptic bronchoscopy in spinal cord injury in recent years. Through the preliminary screening of reading titles and abstracts, the articles with low relevance to the topic were excluded, and a total of 57 articles were included for review. RESULTS AND CONCLUSION: (1) At present, the treatment strategies of respiratory complications in patients with cervical spinal cord injury include supine position and use of abdominal band, respiratory training, mechanically assisted cough, mechanical ventilation, tracheotomy, diaphragm pacemaker, nerve transfer technique, fibrobronchoscopic sputum suction and bronchoalveolar lavage, and antibiotics use. (2) At present, the positive effects of early tracheotomy, non-invasive ventilation and auxiliary cough on patients with high spinal cord injury have been gradually recognized by the academic circles, which can improve the respiratory function of patients, while posture, respiratory training, and auxiliary cough have been widely used in clinical practice and achieved satisfactory results. (3) In recent years, bronchofiberscope suction and bronchoalveolar lavage have been widely used in the treatment of patients with pulmonary infection, and have a good therapeutic effect. For patients with cervical spinal cord injury with respiratory complications, fiberoptic bronchoscopy and bronchoalveolar lavage can also improve dyspnea and pulmonary function, which may become a new direction of diagnosis and treatment of cervical spinal cord injury patients. [ABSTRACT FROM AUTHOR]

Abstract Background Current guidelines for management of respiratory distress syndrome (RDS) recommend continuous positive airway pressure (CPAP) as the primary mode of respiratory support even in the most premature neonates, reserving endotracheal intubation (ETI) for rescue surfactant or respiratory failure. The incidence and timing of ETI in practice is poorly documented. Methods In 27 Level III NICUs in the US (n = 19), Canada (n = 3) and Poland (n = 5), demographics and baseline characteristics, respiratory support modalities including timing of ETI, administration of surfactant and caffeine/other methylxanthines, and neonatal morbidities were prospectively recorded in consecutive preterm neonates following written parental consent. Infants were divided into three groups according to gestational age (GA) at birth, namely 26–28, 29–32 and 33–34 weeks. Statistical comparisons between groups were done using Chi-Square tests. Results Of 2093 neonates (US = 1507, 254 Canada, 332 Poland), 378 (18%) were 26–28 weeks gestational age (GA), 835 (40%) were 29–32 weeks, and 880 (42%) were 33–34 weeks. Antenatal steroid use was 81% overall, and approximately 89% in neonates ≤32 weeks. RDS incidence and use of ventilatory or supplemental oxygen support were similar across all sites. CPAP was initiated in 43% of all infants, being highest in the 29–32-week group, with a lower proportion in other GA categories (p

Although maternal antenatal transfer is the preferred option, some infants inevitably need urgent transport to a tertiary neonatal care facility after birth. This study aimed to investigate trends over time in patient characteristics and respiratory management in a large series of neonatal emergency transfers, in order to provide health caregivers an up-to-date profile of such patients and their therapeutic needs. Trends in patient characteristics and respiratory management were evaluated in 3337 transfers by the Eastern Veneto Neonatal Emergency Transport Service in 2000–2019. Joinpoint regression analysis was performed to evaluate trends and to estimate annual percentage changes (APCs). Proportions of preterm neonates increased (APC2000–2012 2.25%), then decreased (APC2012–2019 − 6.04%). Transfers at birth increased (APC2000–2013 2.69%), then decreased (APC2013–2019 − 5.76%). Proportion of neonates with cardiac and surgical diseases declined (APCs2000–2019 − 6.82% and − 3.32%), while proportion of neonates with neurologic diseases increased (APC2000–2019 8.62%). Use of nasal-continuous-positive-airway-pressure (APC2000–2019 9.72%) and high-flow-nasal-cannula (APC2007–2019 58.51%) at call, and nasal-continuous-positive-airway-pressure (APC2000–2019 13.87%) and nasal-intermittent-mandatory-ventilation (APC2000–2019 32.46%) during transfer increased. Mechanical ventilation during transfer decreased (APC2014–2019 − 10.77%). Use of oxygen concentrations at 21% increased at call and during transfer (APCs 2000–2019 2.24% and 2.44%), while oxygen concentrations above 40% decreased at call and during transfer (APCs 2000–2019 − 3.93% and − 5.12%). Conclusion: Our findings revealed a shift toward a more "gentle" approach and the reduced use of oxygen in respiratory management. Equipment and team expertise should meet the requirements of such changing patients and their therapeutic needs. What is Known: • Although antenatal transfer is the preferred option, some infants inevitably need urgent transport to a tertiary neonatal care facility after birth. • Trend studies investigating cohort information with appropriate statistical methods represent useful instruments to detect changes over time. What is New: • Our findings revealed marked changes in patient characteristics and respiratory management in a large series of neonatal emergency transfers during the last two decades. • Equipment and team expertise should meet the requirements of such changing patients and their therapeutic needs. [ABSTRACT FROM AUTHOR]

Background: Respiratory morbidity is common in children with neuromuscular diseases (NMD) owing to chronic hypoventilation and impaired cough. Optimal, cost-effective respiratory management requires implementation of clinical practice guidelines and a coordinated multidisciplinary team approach. Objectives: To explore South African physiotherapists' knowledge, perception and implementation of respiratory clinical practice guidelines for non-ventilated children with NMD. Methods: An online survey was conducted amongst members of the South African Society of Physiotherapy's Cardiopulmonary Rehabilitation (CPRG) and Paediatric special interest groups and purposive sampling of non-member South African physiotherapists with respiratory paediatrics expertise (N = 481). Results: Most respondents worked in private healthcare, with 1–10 years' experience treating patients with NMD. For acute and chronic management, most participants recommended nebulisation and 24-h postural management for general respiratory care. Percussions, vibrations, positioning, adapted postural drainage, breathing exercises and manually assisted cough were favoured as airway clearance techniques. In addition, participants supported non-invasive ventilation, oscillatory devices and respiratory muscle training for chronic management. Conclusion: Respondents seemed aware of internationally-endorsed NMD clinical practice guidelines and recommendations, but traditional manual airway clearance techniques were favoured. This survey provided novel insight into the knowledge, perspectives and implementation of NMD clinical practice guidelines amongst South African physiotherapists. Clinical implications: There is an urgent need to increase the abilities of South African physiotherapists who manage children with NMD, as well as the establishment of specialised centres with the relevant equipment, ventilatory support and expertise in order to provide safe, cost-effective and individualised patient care. [ABSTRACT FROM AUTHOR]

Background: Patient positioning is an independent nursing intervention and may increase peripheral oxygenation for patients with lung disease. Few studies have been conducted on the effect of body positions on oxygenation in patients with lung disease. Aims and objectives: To investigate the effects of five different positions on peripheral oxygen saturation (SpO2) and vital signs in patients with lung disease. Design: A semi‐experimental study was conducted. Methods: Consecutive samples were recorded from critical care patients followed in the chest clinic of a university hospital. A total of 109 patients with lung disease were recruited. Patients who were able to lie in all positions, and who had unilateral or bilateral lung disease documented by a medical diagnosis by a physician were included in this study. The SpO2 and vital signs were measured at each position three times. Results: For patients with right, left, and bilateral lung disease, lying on the right side of the body at 45 in bed, the SpO2 was higher, but this difference was not statistically significant. There was a significant difference at 40 minutes between the pulse rate in patients with left and bilateral lung disease, but not in patients with right lung disease. No significant differences were found between respiratory rates and body temperature in patients in any of the three groups at 10, 25, and 40 minutes. Conclusions: Although this difference was not statistically significant, lying on the right side of the body at 45 in bed can be an effective position for improving oxygenation in all patients with lung disease. Relevance to Clinical Practice: As there is insufficient evidence to suggest a specific position, further studies are needed. This study provides evidence that the best oxygenation in patients with unilateral and bilateral lung disease can be obtained by determining the appropriate position for critical care nurses. [ABSTRACT FROM AUTHOR]

Among the most common causes of U.S. adult hospitalizations, pneumonia accounted for nearly 50,000 deaths in the United States in 2017. This article provides nurses with a thorough update on pneumonia risk factors, signs and symptoms, and diagnostic criteria, as well as inpatient treatment recommendations and recommendations for discharge and prevention, including the nurse's role in patient and family teaching. The article also details key similarities and differences between the new 2019 guideline jointly developed by the American Thoracic Society and the Infectious Diseases Society of America on diagnosis and treatment of adults with community-acquired pneumonia and their earlier 2007 guideline. One crucial difference is the growing recognition that the etiology of pneumonia is changing, necessitating the abandonment of prior categorizations of pneumonia type when determining antibiotic coverage in favor of reliance on local epidemiology and validated risk factors for antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Aim: To investigate the characteristics of infants with neonatal encephalopathy (NE) receiving therapeutic hypothermia (TH) who developed late onset oxygen requirement during or after rewarming.Methods: Infants were stratified by receiving (a) new onset isolated oxygen requirements during or after rewarming; (b) no respiratory support during hospital stay; and (c) invasive and/or non-invasive respiratory support before or during cooling.Results: Of 136 infants treated with TH, 49 (36%) did not require any respiratory support, and 78 (57.4%) received invasive or non-invasive support before or during cooling. Nine infants (6.6%) developed late onset oxygen requirement. The late onset oxygen requirement started at median age of 3.8 days (IQR 3.6-5.2) and ended at median 7.5 days (IQR 5.8-12.7). Total hours of O2 exposure were median 62.0 (IQR 24.4-112.6). Maximum support was low-flow nasal cannula from 100% oxygen source with a flow rate of 40-250 mL/min. Infants in this group had higher Apgar scores, milder metabolic acidosis and no seizures. Three infants had diagnostic investigations without significant findings.Conclusion: A small percentage of neonates with NE developed late onset oxygen requirement during or after rewarming. Late oxygen requirement was associated with evidence of less severe perinatal hypoxia-ischaemia. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the detectability of fiducial markers' positions for real‐time target tracking system equipping with a standard linac. The hypothesis is that the detectability depends on the type of fiducial marker and the gantry angle of acquired triggered images. Methods: Three types of ball fiducials and four slim fiducials with lengths of 3 and 5 mm were prepared for this study. Triggered images with three similar fiducials were acquired at every 10° during the conformal arc irradiation to detect the target position. Although only one type of arrangement was prepared for the ball fiducials, a three‐type arrangement was prepared for the slim fiducials, such as parallel, orthogonal, and oblique with 45° to the gantry‐couch direction. To measure the detectability of the real‐time target tracking system for each fiducial and arrangement, detected marker positions were compared with expected marker positions at every angle of acquired triggered images. Results: For the ball‐type fiducial, the maximum difference between the detected marker positions and expected marker positions was 0.3 mm in all directions. For the slim fiducial arranged parallel and oblique with 45°, the maximum difference was 0.4 mm in all directions. When each slim fiducial was arranged orthogonal to the gantry‐couch direction, the maximum difference was 1.5 mm for the length of 3 mm, and 3.2 mm for the length of 5 mm. Conclusions: The detectability of fiducial markers' positions for the real‐time target tracking system equipping with a standard linac depends on the form and insertion angles of the fiducials. [ABSTRACT FROM AUTHOR]

Acute cardiogenic pulmonary edema (ACPE) is a common and life-threatening condition among patients with heart failure. The literature contains a large number of reviews discussing the respiratory management aspect of this entity; nonetheless, none of these studies has thoroughly probed into the respiratory management of different cardiac pathologies ending with ACPE, together with the different modes of ventilation and invasive and noninvasive ventilation in the same discussion. The present review seeks to discuss the physiologic bases of lung-heart interactions, the hemodynamic effects of positive pressure ventilation, and the results of studies on the effects of the various modes of ventilation having been used until the writing of this article. Also discussed herein are ACPE in different heart pathologies and their respective ventilator management, as well as the indications, complications, and contraindications of noninvasive positive pressure ventilation and intermittent mandatory ventilation.

Tumor geometric reproducibility for lung stereotactic body radiotherapy (SBRT) is an important issue in the breath-hold (BH) technique. We investigated the inter-BH reproducibility of the tumor position in expiratory BH using our proposed vector volume histogram (VVH) method. Subjects comprising 14 patients with lung cancer who were treated with lung SBRT under expiratory BH conditions were monitored by the Abches system. Multiple computed tomography (CT) scans were performed to evaluate the inter-BH reproducibility of the tumor position at the expiratory BH in the simulation session. Gross tumor volume was delineated by a physician. Deformable image registration was used to deform the images from the 3 expiratory BH-CTs to the treatment planning expiratory BH-CT. To evaluate the inter-BH reproducibility of the tumor positions, we measured the largest motion extent within the organ of 3 dimensions (left-right, LR; anterior-posterior, AP; cranio-caudal, CC) and a 3D vector using the VVH method. The average and standard deviations of the inter-BH reproducibility of the tumor position in the LR, AP, and CC directions, and the 3D vector were 1.7 ± 0.5, 2.0 ± 0.7, 2.1 ± 0.7, and 2.7 ± 0.7 mm, respectively. Ten patients exhibited inter-BH displacements of the lung tumor >3 mm in the 3D vector. No displacement >5 mm was observed in any direction for all patients. Our study indicated that the inter-BH variation of the tumor position was small for lung cancer patients, using the Abches system and the VVH method. [ABSTRACT FROM AUTHOR]

Objective/background: Currently, obstructive sleep apnea syndrome (OSAS) management in Robin sequence (RS) infants has not been standardized. Sleep laboratory polysomnography (PSG) is the gold standard for OSAS diagnosis, however, access is restricted. This study aimed to compare the respiratory indexes measured in a sleep laboratory using PSG as well as a possible alternative, polygraphy (PG).Patients/methods: This retrospective study was conducted between 2015 and 2017 in a tertiary hospital. PSG performed in RS infants in the sleep laboratory was analysed by a single reviewer. After sleep data removal, anonymized raw data were analysed to obtain only PG data. Respiratory indexes were compared for (i) PSG and PG and (ii) patients with or without OSAS clinical signs.Results: Among the 20 RS (median [IQR] age: 43 [25-114] days at evaluation), 70% of the patients had OSAS clinical signs but all of them had severe OSAS. The median mixed obstructive apnea hypopnea index was not significantly different between PSG and PG (27/h [18-38] versus 26/h [18-56], p = 0.43). The median obstructive apnea index was higher with no significant difference between PG and PSG (19/h [15-31] versus 7/h [4-25], p = 0.05). The median obstructive hypopnea index was significantly lower on PG than on PSG (2/h [0-3] versus 8/h [8-19], p = 0.01). No difference on PSG or PG was observed for patients with and without clinical signs of OSAS.Conclusion: Although PSG remains the gold standard for OSA evaluation, a PG seems to be a useful alternative to measure OSA in RS infants because of their OSAS severity. This evaluation should be recommended in all RS infants, even in the absence of OSAS clinical signs.Clinical Trial Registration: Not applicable. [ABSTRACT FROM AUTHOR]

Imaging is used in human medicine to diagnose disease and monitor treatment efficacy. Computed tomography (CT) positron emission tomography (PET) and magnetic resonance (MR) are applied to animal models of infectious diseases to increase data quality, enhance their relevance to the clinical situation, and to address ethical issues through reduction of numbers and refinement of study designs. The time required for collection of MR and PET-CT scans means that normal breathing produces motion artefacts that can render images unacceptable. We report, for the first time, the use of high frequency jet ventilation (HFJV) for respiratory management during imaging of macaques. HFJV enables continuous gaseous exchange, resulting in cessation of spontaneous breathing motion thus providing a motionless field without the potential stresses induced by repeated breath-hold strategies. [ABSTRACT FROM AUTHOR]

Background: The advent of elexacaftor/tezacaftor/ivacaftor (ETI) resulted in unprecedented clinical benefits for eligible adults with CF. As a result, the question of whether chronic treatments can be safely stopped or adapted to this new situation has become a matter of great interest. Our objective was to derive a consensus among Italian experts on the impact of ETI on the current clinical management of CF lung disease., Methods: From December 2021 to April 2022 a panel of Italian experts endorsed by the national CF scientific society derived and graded a set of statements on the pulmonary management of adults with cystic fibrosis through a modified Delphi methodology., Results: The panel produced 13 statements exploring possible modifications in the fields of inhaled antibiotics and mucoactives; airway clearance and physical activity; chronic macrolides and bronchodilators; and lung transplant referral. The areas that the experts considered most urgent to explore were the impact of ETI on the role of inhaled antibiotics and lung transplant., Conclusions: The list of priorities that emerged from this study could be useful to guide and inform clinical research on the most urgent area of impact of ETI on CF lung disease and its clinical management., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This study was supported by an unrestricted grant supplied by Chiesi Italia., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Mechanical insufflation-exsufflation, or "cough assist," is a commonly used method of clearing tracheal and pulmonary secretions in patients with respiratory insufficiency secondary to spinal cord injury. This report presents a novel technique termed the pharyngeal clearance maneuver, which uses a modified application of the mechanical insufflation-exsufflation device to mobilize "secretion burden" at the portion of the trachea above the tracheostomy cuff during cuff deflation. Utilization of this strategy may reduce the risk of aspiration, infection, and respiratory compromise for patients with high cervical spinal cord injury in the acute rehabilitation setting. It is of particular benefit for those whose cuffs are being deflated for the first time and who may have large secretion volumes above the cuff. It can be further used as needed before speaking trials and swallow therapies. We anticipate that the pharyngeal clearance maneuver may be used in other populations with impaired cough and need for invasive ventilator support because of ventilator pump failure (eg, spinal muscular atrophy, congenital myopathies, obesity hypoventilation, amyotrophic lateral sclerosis, muscular dystrophy, and acute inflammatory demyelinating polyneuropathy). [ABSTRACT FROM AUTHOR]

Smoke inhalation injury (SII) is a major morbidity and cause of mortality in patients with burns. Damage caused by inhalation of thermal or chemical irritants, including toxic fumes and chemicals, leads to respiratory cilia and epithelial cell injuries, which turn to severe bronchospasm and alveolar damage and results in acute respiratory distress syndrome. Respiratory management plays a vital role in the treatment of SII. In this review, we provide an overview of SII with emphasis on respiratory management, including aerosol therapy, bronchial hygiene therapy, advanced ventilation modes, and heated humidified high-flow nasal cannula. In summary, the information may be helpful for further improvements in outcomes. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Pneumatically driven intermittent abdominal pressure ventilators were a popular means of daytime ventilatory support until the late 1960s paradigm shift to invasive (tracheostomy) mechanical ventilation. However, although many patients still use intermittent abdominal pressure ventilators, currently available turbine-driven portable home care ventilators are not powerful enough to always successfully operate them. We describe a new mechanically driven intermittent abdominal pressure ventilator operated by a 1-pound motor that provided a depth of abdominal compression of almost 2 in in 1.05 to 1.13 secs to normalize alveolar ventilation for a 72-yr-old postpolio survivor. It increased her autonomous 200- to 320-ml tidal volumes by greater than 300 ml to normalize her respiratory rate, relieve her dyspnea, and maintain normal oxyhemoglobin saturation levels throughout daytime hours for a 9-mo period of continuous ventilatory support. [ABSTRACT FROM AUTHOR]

BACKGROUND: Duchenne muscular dystrophy (DMD) is characterized by progressive degeneration, wasting, and weakness of skeletal musculature, including respiratory muscles. Cough is also compromised with disease progression. Among cough-augmentation techniques, mechanical insufflation-exsufflation (MI-E) has demonstrated several clinical benefits in patients with chronic airway secretion obstruction and muscular weakness. In clinical practice, the use of MI-E in DMD patients is also suggested when they are stable with no airway infections. However, there is a paucity of studies that consider the effect of MI-E specifically on stable DMD patients who have adapted to the use of MI-E. METHODS: Twenty subjects with DMD with no active upper airway or lung infections, who used MI-E device regularly at home, were enrolled. They received a single MI-E treatment consisting of 5 cycles of 5 insufflations-exsufflations with their customary settings. Volume variations during quiet breathing, vital capacity, and cough before and after treatment were measured with optoelectronic plethysmography (OEP). RESULTS: A decrease in breathing frequency (P = .001) and the rapid shallow breathing index emerged (P = .007), while cough peak flow (Spirometer P = .86, OEP P = .58), vital capacity (Spirometer P = .78, OEP total chest wall P = .57), and end-expiratory volumes (Total chest wall P = .97, Ribcage P = .14, Abdomen P = .10) were not affected by the treatment. An increment of the chest wall volume variation during the expiratory cough phase was identified (P = .001), particularly due to an increase in abdominal expansion (P = .005). CONCLUSIONS: A single treatment of MI-E in subjects with stable DMD already adapted to the device can provide beneficial changes in breathing pattern through a significant decrease in breathing frequency and rapid shallow breathing. These findings suggest an improvement in short-term dyspnea, although there were no changes in lung-volume recruitment or unassisted cough peak flow. [ABSTRACT FROM AUTHOR]

Spinal injuries without neurological damage have little effects on respiratory function unless associated with injury to the chest wall. Early verticalisation or mobilisation of these patients is safe and likely to improve vital capacity. Spinal injury with cord damage has a profound effect on the mechanics of respiration and on respiratory function particularly in cervical cord injuries. Around 40% of spinal cord injuries occur in the cervical spine, a trend that is steadily increasing, with respiratory causes being responsible for death in over 20% of individuals. Loss of lung volumes and relative hypoxemia contribute to global hypoxaemia, exacerbating cord ischaemia in the acute period. Respiratory compromise results in the loss of muscle strength generation capacity and reduced lung volumes and in particular vital capacity, of up to 70%, ineffective cough and secretion clearance abilities; reductions in both lung and chest wall compliance and an additional oxygen cost of breathing due to changes in respiratory mechanics, with obstructive sleep apnoea evident in over 50% of acute tetraplegics. While some countries have specialist spinal centres to manage such catastrophic trauma with a demonstrable improvement in health outcomes attributed to their contribution, many individuals are initially admitted to local hospitals where healthcare professionals are less likely to fully appreciate the significant and continued vulnerabilities of such individuals. This article aims to provide a basic understanding of the causes and identification of the main principles of the respiratory management strategies required to maintain pulmonary health for cervical spinal cord injury patients during the initial and early post trauma phase. [ABSTRACT FROM AUTHOR]

Introduction: Advances in neonatal care have made possible the increased survival of extremely preterm infants. Even though there is widespread recognition of the harmful effects of mechanical ventilation on the developing lung, its use has become imperative in the management of micro-/nano-preemies. There is an increased emphasis on the use of less-invasive approaches such as minimally invasive surfactant therapy and non-invasive ventilation that have been proven to result in improved outcomes., Areas Covered: Here, we review the evidence-based practices surrounding the respiratory management of extremely preterm infants including delivery room interventions, invasive and non-invasive ventilation approaches, and specific ventilator strategies in respiratory distress syndrome and bronchopulmonary dysplasia. Adjuvant relevant respiratory pharmacotherapies used in preterm neonates are also discussed., Expert Opinion: Early use of non-invasive ventilation and use of less invasive surfactant administration are key strategies in the management of respiratory distress syndrome in preterm infants. Ventilator management in bronchopulmonary dysplasia must be tailored according to the individual phenotype. There is strong evidence to start caffeine early to improve respiratory outcomes, but evidence is lacking on the use of other pharmacological agents in preterm neonates, and an individualized approach has to be considered for their use.