Respiratory Care呼吸护理
Respiratory Care(英文缩写 RESP CARE),ISSN 0020-1324,eISSN 1943-3654,中文译名:呼吸护理 是一本学术期刊。本页汇总该期刊的最新影响因子、分区信息以及最新收录于 PubMed 的文献,帮助您快速了解期刊全貌。
发文量统计区间：2025-09-27 至 2026-09-27，按本站收录文献的发表日期统计。
期刊介绍
历年影响因子趋势
| JCR 数据年份 | 影响因子 | JCR 分区 |
|---|---|---|
| 2021 | 2.339 | Q4 |
| 2022 | 2.500 | Q4 |
| 2023 | 2.400 | Q2 |
| 2024 | 2.100 | Q3 |
| 2025 | 2.300 | Q3 |
Respiratory Care 最新收录文献
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1. The Response of Dorsal Lung Compliance to Prone Positioning Differs by Body Mass Index in ARDS.
1. ARDS中背侧肺顺应性对俯卧位通气的反应因体质指数而异PMID:日期:2026-09-23Excess adipose tissue compresses dorsal lung regions that PEEP may not fully reverse in the supine position. Prone positioning, in combination with PEEP, can unload the lung, but whether regional responses differ by obesity is unknown. We measured regional lung compliance using electrical impedance tomography in 14 mechanically ventilated subjects with COVID-19 ARDS (6 with BMI ≥35 kg/m and 8 with BMI <30 kg/m). Measurements were taken during decremental PEEP titration in supine and prone positions, following recruitment maneuvers. Regional compliance was derived from pixel-level impedance change within each region of interest, divided by driving pressure and predicted body weight. Bayesian multilevel gamma regression models with patient-level random effects estimated the 3-way interaction between position, BMI group, and lung region on regional compliance, adjusted for age. The overall cohort had a median P/F of 108 mm Hg and median respiratory system compliance of 29 mL/cm HO in the supine position. At the PEEP that produced the highest total respiratory system compliance in each position, the increase in dorsal regional compliance with prone positioning was greater in subjects with BMI ≥35 kg/m compared with subjects with BMI <30 kg/m (difference-in-differences: 0.16 mL/cm HO/kg, 95% credible interval: 0.01 to 0.37; posterior probability: 98.0%). Regional compliance in ventral and central lung regions did not credibly differ between BMI groups. The direction and magnitude of the change in dorsal lung compliance between BMI groups were consistent across PEEP levels. Prone positioning was associated with a greater increase in dorsal lung compliance in subjects with BMI ≥35 kg/m compared with subjects with BMI <30 kg/m. Our findings suggest that the response of regional compliance to prone positioning in ARDS differs by body mass index, identifying obesity as a population in whom positional unloading may be more effective.
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3. Drug Delivery via Vibrating Mesh Nebulizer With Symmetrical and Asymmetrical High Flow Nasal Cannulas in an Adult Model.
PMID:日期:2026-09-17Aerosol delivery via high-flow nasal cannula (HFNC) is widely used. Although an asymmetrical cannula may improve clearance of gases within the anatomical dead space, its impact on aerosol delivery compared with the standard symmetrical cannula remains unclear. This study compared drug delivery efficiency between the symmetrical and asymmetrical cannulas under standardized conditions. An adult airway model, comprising a manikin and a ventilator-driven dual-chamber lung model, simulated spontaneous breathing to evaluate aerosol delivery. Filter-captured albuterol from a vibrating mesh nebulizer was quantified by spectrophotometry (230 nm) to determine delivery efficiency (the percentage of an inhaled dose of 2.5-mg nominal dose) for the symmetrical and asymmetrical cannulas over HFNC flows of 10-60 L/min with 4 breathing patterns combining quiet (15 breaths/min) or distressed breathing frequency (30 breaths/min) with low (300 mL) or high (600 mL) tidal volume (V). During quiet breathing with low V, the maximum efficiency of albuterol delivery was higher for the asymmetrical versus the symmetrical cannula (mean ± SD, 6.8 ± 1.7% vs 3.3 ± 1.7% at HFNC flow 20 L/min, respectively = .002) but not different with high V (17.4 ± 1.1% vs 17.6 ± 1.1% at HFNC flow 10 L/min = .89). Conversely, during distressed breathing, the maximum delivery efficiency was higher for the symmetrical versus the asymmetrical cannula with both low V (8.1 ± 1% vs 4.8 ± 0.4% at HFNC flow 10 L/min, respectively = .008) and high V (24.2 ± 1.4% vs 16.2 ± 1.4% at HFNC flow 20 L/min < .001). The asymmetrical cannula improved aerosol delivery compared with the symmetrical cannula during quiet breathing with low V. During distressed breathing, however, the symmetrical cannula was more efficient, regardless of V. Thus, the asymmetrical and symmetrical cannulas may be selected for drug delivery via a vibrating mesh nebulizer with an HFNC in patients with quiet and distressed breathing, respectively.
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5. Early Respiratory Physiotherapy and Mobilization in Mechanically Ventilated ICU Patients: A Before-After Study of Ventilation, ICU Weakness, and Survival Outcomes.
PMID:日期:2026-09-10Prolonged immobilization and invasive mechanical ventilation promote ICU-acquired weakness, delayed ventilator liberation, and poor long-term outcomes. We evaluated a structured respiratory physiotherapy and early mobilization pathway in a real-world ICU. We conducted a prospective before-after study of critically ill adults admitted to ASST Valcamonica ICU, Italy, from January 2022 to December 2025. Subjects treated before implementation (2022-2023; 602) were compared with those treated after implementation (2024-2025; 646). The intervention included respiratory physiotherapy, secretion management, early mobilization, progressive verticalization, assisted ambulation, and individualized ICU rehabilitation. Primary outcomes were ventilation duration and ventilator-free days at day 28. Secondary outcomes included ICU-acquired weakness, electromyography (EMG)-confirmed neuromuscular dysfunction, ICU and hospital stay, discharge disposition, and long-term survival. Implementation of the physiotherapy pathway increased rehabilitation exposure and early mobilization. Physiotherapy assessment within 48 h increased from 18.6% to 82.4% ( < .001), and mobilization within 72 h from 21.3% to 74.8% ( < .001). Duration of invasive ventilation decreased from 8 [4-15] to 5 [3-10] days ( = .002), while ventilator-free days increased. ICU stay decreased from 11 [6-21] to 8 [5-15] days ( < .001). ICU-acquired weakness decreased from 31.4% to 20.7% ( < .001), and EMG-confirmed neuromuscular dysfunction from 15.1% to 9.8% ( = .005). Ventilator-associated pneumonia and tracheostomy rates were also reduced. Mortality through 180 days was lower in the post-intervention cohort (41.9% vs 31.9%, = .001). In Cox analysis censored at 180 days, structured physiotherapy implementation (adjusted hazard ratio [HR] 0.69, 95% CI: 0.56-0.85, = .001) and mobilization within 72 h (adjusted HR 0.78, 95% CI: 0.63-0.97, = .02) were independently associated with lower mortality risk. Structured ICU physiotherapy and early mobilization were associated with shorter duration of invasive ventilation, fewer neuromuscular complications, better functional recovery, and lower 180-day mortality; given the before-after design, these are associations, not causal effects.
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6. Transpulmonary Driving Pressure, End-Expiratory Transpulmonary Pressure, and Mortality in Pediatric ARDS.
PMID:日期:2026-09-08Respiratory system driving pressure (ΔP) reflects the combined mechanics of the lung and chest wall and may not represent the distending pressure transmitted specifically to the lung. Transpulmonary driving pressure (ΔP) offers a lung-specific estimate of cyclic mechanical stress, while end-expiratory transpulmonary pressure (P) may indicate end-expiratory lung stability. We evaluated the associations of ΔP and P with 28-day mortality in pediatric ARDS. This retrospective, multi-center cohort study included invasively ventilated children with ARDS treated in 5 tertiary pediatric ICUs between January 2019 and February 2025. Respiratory mechanics, esophageal pressure, ventilator variables, and arterial blood gases were collected during the first valid assessment within 24 h of ARDS diagnosis. The primary outcome was 28-day mortality. Logistic regression models were used to evaluate the associations between ΔP and P and mortality. Youden-derived thresholds were applied to explore transpulmonary pressure phenotypes. Among 154 subjects, 29 (18.8%) died within 28 days. Nonsurvivors had higher ΔP, lower P, lower lung compliance, higher lung elastance, and higher predicted body weight-normalized mechanical power than survivors. ΔP was independently associated with 28-day mortality after adjustment for age, sex, ARDS severity, and Pediatric Logistic Organ Dysfunction-2 score (adjusted odds ratio [OR] = 1.47 per 1 cm HO increase, 95% CI: 1.19-1.81, < .001; area under the curve [AUC] = 0.759). Lower P was also independently associated with mortality (adjusted OR = 0.48 per 1 cm HO increase, 95% CI: 0.32-0.72, < .001; AUC = 0.744). Exploratory thresholds were ΔP ≥11.9 cm HO and P ≤0.8 cm HO. Mortality increased across phenotypes, from 8.4% in subjects with low ΔP/preserved P to 54.2% in those with high ΔP/low P. In children with ARDS, higher ΔP was independently associated with 28-day mortality. Lower P provided complementary prognostic information, and the combination of elevated ΔP and reduced P suggested a high-risk mechanical profile. Prospective validation of these exploratory thresholds is required before clinical implementation.
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7. Improving Cuff Leak Test Documentation: A Single Center Quality Improvement Project.
PMID:日期:2026-09-03The cuff leak test is commonly performed before extubation in critically ill children to estimate the risk of postextubation upper-airway obstruction (UAO). Therefore, documentation of cuff leak test results is important for clinical decision-making. We noted delays in extubation related to the absence of clearly documented cuff leak test results and sought to address this through electronic medical record (EMR) enhancement. We conducted a single-center quality improvement project with multiple Plan-Do-Study-Act cycles to improve cuff leak test documentation. Interventions included test standardization and the addition of a dedicated EMR flowsheet row for documentation. Outcomes were compared before and after flowsheet row implementation using run charts. The primary outcome was cuff leak test documentation, with UAO requiring treatment and postextubation dexamethasone as balancing measures. Following flowsheet row implementation, overall cuff leak documentation increased from 78% to 91% ( < .001), respiratory therapist (RT) documentation increased from 60% to 86% ( < .001), and inclusion in a progress or extubation note increased from 47% to 83% ( < .001). More subjects had a documented cuff leak before extubation (74% vs 63%, < .001), and fewer received dexamethasone before extubation (28% vs 34%, = .03). Run charts demonstrated a statistically significant shift in overall documentation from 78% to 92% following flowsheet row implementation, RT documentation increased from 61% to 91% before declining to 83%, while provider documentation increased from 45% to 79%, followed by a second shift to 89%. No changes were observed in UAO requiring treatment or dexamethasone administration. Addition of a dedicated EMR flowsheet row significantly improved overall cuff leak documentation, RT documentation, and provider documentation. It was also associated with reduced pre-extubation dexamethasone exposure with no change in UAO requiring treatment.
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8. Electrical Impedance Tomography for Monitoring Prone Positioning in ARDS.
PMID:日期:2026-09-03Prone positioning (PP) has evolved from an experimental maneuver into a cornerstone therapy for moderate-to-severe ARDS, supported by robust evidence of survival benefit. Its physiological rationale includes reducing dorsoventral mechanical heterogeneity, promoting dependent alveolar recruitment, improving ventilation-perfusion () matching, and attenuating ventilator-induced lung injury (VILI). In preclinical models, PP also homogenizes the pleural pressure response to spontaneous breathing effort, thereby attenuating effort-dependent lung injury, a mechanism particularly relevant for awake PP. Despite these well-characterized mechanisms, the clinical response to PP is highly individualized, and a substantial proportion of patients do not show meaningful improvement in oxygenation. Furthermore, optimal PEEP during PP cannot be reliably inferred from conventional global monitoring parameters or from supine PEEP settings. Electrical impedance tomography (EIT) is a radiation-free, continuous bedside imaging tool that enables real-time spatial assessment of regional lung ventilation, perfusion, and alveolar recruitment. Applied during PP, EIT can directly visualize the redistribution of tidal ventilation toward dorsal lung regions, identify persistent collapse or overdistention, guide individualized PEEP titration, and quantify matching, all of which are inaccessible from global metrics alone. This narrative review examines the physiological mechanisms of PP, the temporal dynamics of ventilation and perfusion responses, and the clinical heterogeneity of mechanical response. It evaluates the current evidence base for EIT as a tool to guide individualized ventilator management during PP in ARDS, distinguishing established findings from physiologically derived rationale and areas requiring future clinical validation. Clinical implications and future directions, including awake proning, serial sessions, and PP during extracorporeal membrane oxygenation, are also discussed.
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10. Elastic Ventilatory Energy Predicts ARDS Severity and Mortality: A Bayesian Retrospective Analysis.
PMID:日期:2026-09-01Mechanical power integrates the energy delivered to the respiratory system during mechanical ventilation but may not reflect the mechanical stress applied to lung tissue. Metrics focused on the elastic component of ventilatory energy may provide a more physiologically relevant estimate of parenchymal stress. We evaluated elastic static power and elastic static power normalized to predicted body weight (PBW) and their association with ARDS severity and mortalityMethods:We conducted a single-center retrospective cohort study in an ICU, analyzed using Bayesian modeling. Adult subjects ( 137) receiving volume-controlled invasive mechanical ventilation for COVID-19 pneumonia were included, encompassing individuals without ARDS and with mild, moderate, or severe ARDS. Elastic static power and PBW-normalized elastic static power were derived from ventilatory parameters recorded within the first 24 h after initiation of mechanical ventilation. Bayesian regression models were used to evaluate associations between these variables and ARDS severity, ICU mortality, and 28-day mortality. Posterior distributions for elastic load metrics favored greater ARDS severity and increased mortality. Elastic static power favored moderate-to-severe ARDS (relative risk 1.32, 95% credible interval [CrI] 1.10-1.57), ICU mortality (hazard ratio [HR] 1.36, 95% CrI 1.16-1.60), and 28-day mortality (HR: 1.31, 95% CrI: 1.17-1.48). Similar patterns were observed after normalization to PBW. Posterior distributions for elastic ventilatory energy, in both its nonnormalized and PBW-normalized forms, consistently favored greater ARDS severity and mortality. These findings support the use of elastic load metrics as physiologically relevant indicators of ventilatory stress.