Spontaneous Breathing Patterns During Maximum Extracorporeal CO2 Removal in Subjects With Early Severe ARDS.


BACKGROUND:Switching patients affected by early severe ARDS and undergoing extracorporeal membrane oxygenation (ECMO) from controlled ventilation to spontaneous breathing can be either beneficial or harmful, depending on how effectively the breathing pattern is controlled with ECMO. Identifying the factors associated with ineffective control of spontaneous breathing with ECMO may advance our pathophysiologic understanding of this syndrome. METHODS:We conducted a prospective study in subjects with severe ARDS who were on ECMO support ≤ 7 d. Subjects were switched to minimal sedation and pressure-support ventilation while extracorporeal CO2 removal was increased to approximate the subject's total CO2 production ([Formula: see text]). We calculated the rapid shallow breathing index (RSBI) as breathing frequency divided by tidal volume. We explored the correlation between certain characteristics recorded during pretest controlled ventilation and the development of apnea (ie, expiratory pause lasting > 10 s; n= 3), normal breathing pattern (ie, apnea to RSBI ≤ 105 breaths/min/L; n= 6), and rapid shallow breathing (RSBI > 105 breaths/min/L; n= 6) that occurred during the test study. RESULTS:The ratio of extracorporeal CO2 removal to the subjects' [Formula: see text] was >90% in all 15 subjects, and arterial blood gases remained within normal ranges. Baseline pretest Sequential Organ Failure Assessment score, total [Formula: see text] and ventilatory ratio increased steadily, whereas [Formula: see text]/[Formula: see text] was higher in subjects with apnea compared to intermediate RSBI ≤105 breaths/min/L and elevated RSBI >105 breaths/min/L. In subjects with rapid shallow breathing, baseline lung weight measured with quantitative computed tomography scored higher, as well. CONCLUSIONS:In early severe ARDS, the factors associated with rapid shallow breathing despite maximum extracorporeal CO2 extraction include less efficient CO2 and O2 exchange by the natural lung, higher severity of organ failure, and greater magnitude of lung edema.


Respir Care


Respiratory care


Spinelli E,Mauri T,Lissoni A,Crotti S,Langer T,Albanese M,Volta CA,Fornari C,Tagliabue P,Grasselli G,Pesenti A




Has Abstract


2020-07-01 00:00:00














  • Inspiratory flow-volume curve evaluation for detecting upper airway disease.

    abstract:BACKGROUND:The 2005 American Thoracic Society/European Respiratory Society guidelines on spirometry emphasize examination of the inspiratory curve of the flow-volume loop for evidence of intrathoracic or extrathoracic upper airway obstruction. We sought to determine how frequently evaluations are performed for abnormal...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Sterner JB,Morris MJ,Sill JM,Hayes JA

    更新日期:2009-04-01 00:00:00

  • Physiologic Effects of High-Flow Nasal Cannula Oxygen in Critical Care Subjects.

    abstract:INTRODUCTION:High-flow nasal cannula (HFNC) can deliver heated and humidified gas (up to 100% oxygen) at a maximum flow of 60 L/min via nasal prongs or cannula. The aim of this study was to assess the short-term physiologic effects of HFNC. Inspiratory muscle effort, gas exchange, dyspnea score, and comfort were evalua...

    journal_title:Respiratory care



    authors: Vargas F,Saint-Leger M,Boyer A,Bui NH,Hilbert G

    更新日期:2015-10-01 00:00:00

  • Increased Accuracy After Adjustment of Spirometry Threshold for Diagnosing COPD Based on Pre-Bronchodilator FEV1/FVC.

    abstract:BACKGROUND:COPD is a leading cause of morbidity and mortality worldwide. Spirometry is the most common lung function test for diagnosing COPD with a post-bronchodilator FEV1/FVC < 0.70 confirming the presence of the disease. However, diagnosticians appear reluctant to use bronchodilators, which have been linked to the ...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Kronborg T,Hangaard S,Cichosz SL,Hejlesen O

    更新日期:2019-01-01 00:00:00

  • Care of the ventilator circuit and its relation to ventilator-associated pneumonia.

    abstract::Ventilator circuits should not be changed routinely for infection control purposes. The maximum duration of time that circuits can be used safely is unknown. Evidence is lacking related to ventilator-associated pneumonia (VAP) and issues of heated versus unheated circuits, type of heated humidifier, method for filling...

    journal_title:Respiratory care

    pub_type: 指南,杂志文章,实务指引


    authors: Hess DR,Kallstrom TJ,Mottram CD,Myers TR,Sorenson HM,Vines DL,American Association for Respiratory Care.

    更新日期:2003-09-01 00:00:00

  • Pressurized Metered-Dose Inhalers Versus Nebulizers in the Treatment of Mechanically Ventilated Subjects With Artificial Airways: An In Vitro Study.

    abstract:BACKGROUND:The primary focus of previous aerosol research during mechanical ventilation was the endotracheal tube (ETT). Consequently, there are limited data in the literature on the delivery of inhaled medications administered with different aerosol devices in mechanically ventilated patients with a tracheostomy tube ...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Ari A,Harwood RJ,Sheard MM,Fink JB

    更新日期:2015-11-01 00:00:00

  • Staffing exercise sessions in pulmonary rehabilitation.

    abstract:INTRODUCTION:There is no published standard for the ratio of staff to patients during exercise sessions in outpatient pulmonary rehabilitation. This lack of a standard raises concern about patient safety and the ability to monitor patients adequately. OBJECTIVE:Determine a staff-to-patient ratio standard by examining ...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Hoberty PD,Chiu CY,Hoberty RJ

    更新日期:2001-07-01 00:00:00

  • Deep Breathing Improves End-Tidal Carbon Dioxide Monitoring of an Oxygen Nasal Cannula-Based Capnometry Device in Subjects Extubated After Abdominal Surgery.

    abstract:BACKGROUND:Capnometry detects hypoventilation earlier than pulse oximetry while supplemental oxygen is being administered. We compared the end-tidal CO2 (PETCO2 ) measured using a newly developed oxygen nasal cannula with a CO2-sampling port and the PaCO2 in extubated subjects after abdominal surgery. We also investiga...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Takaki S,Mizutani K,Fukuchi M,Yoshida T,Idei M,Matsuda Y,Yamaguchi Y,Miyashita T,Nomura T,Yamaguchi O,Goto T

    更新日期:2017-01-01 00:00:00

  • The role of the respiratory care practitioner in the evaluation of medical devices.

    abstract::Health care costs continue to skyrocket, and a large portion of these costs can be attributed to technology. Some technology, such as oximetry, is relatively inexpensive compared to CAT scanning and magnetic resonance imaging. Therefore, it may elude close scrutiny and direct health care planning and, with little fanf...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Harris KW

    更新日期:1988-04-01 00:00:00

  • Cough Augmentation Techniques in the Critically Ill: A Canadian National Survey.

    abstract:BACKGROUND:Critically ill mechanically ventilated patients experience impaired airway clearance due to ineffective cough and impaired secretion mobilization. Cough augmentation techniques, including mechanical insufflation-exsufflation (MI-E), manually assisted cough, and lung volume recruitment, improve cough efficien...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Rose L,Adhikari NK,Poon J,Leasa D,McKim DA,CANuVENT Group.

    更新日期:2016-10-01 00:00:00

  • Congenital pulmonary airway malformation: a case report and review of the literature.

    abstract::Congenital parenchymal lung malformations have an estimated incidence at 1:25,000-1:35,000 births. We present a case of this rare congenital abnormality in a 38 year-old male, review the current literature with discussion of proposed causes, malignant potential, and management strategies. A 38-year-old white male pre...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审


    authors: McDonough RJ,Niven AS,Havenstrite KA

    更新日期:2012-02-01 00:00:00

  • Acute inhalation injury with evidence of diffuse bronchiolitis following chlorine gas exposure at a swimming pool.

    abstract::A previously healthy 23-year-old man with nonproductive cough and sore throat presented to the hospital a few hours after chlorine gas exposure at a fitness center swimming pool. Initial physical examination and chest radiograph were normal. Thirty-six hours later he developed worsening dyspnea and cough, with develop...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Parimon T,Kanne JP,Pierson DJ

    更新日期:2004-03-01 00:00:00

  • Correlation between spirometry values and pulmonary artery pressure in young healthy subjects.

    abstract:BACKGROUND:Pulmonary hypertension is frequently associated with parenchymal lung disease. We evaluated the association between spirometry values and pulmonary artery systolic pressure (PASP) in young subjects without lung disease METHODS:: We studied applicants to the Israeli Air Force, who undergo routine evaluation ...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Grossman A,Benderly M,Prokupetz A,Gordon B,Kalter-Leibovici O

    更新日期:2014-03-01 00:00:00

  • Effect of Heated Humidification on CPAP Therapy Adherence in Subjects With Obstructive Sleep Apnea With Nasopharyngeal Symptoms.

    abstract:BACKGROUND:The addition of heated humidification to CPAP has been shown to improve nasal adverse effects in subjects with obstructive sleep apnea (OSA). However, current data regarding improvement in CPAP adherence is conflicting. Furthermore, there are no data from a tropical climate area with a high humidity level. ...

    journal_title:Respiratory care

    pub_type: 杂志文章,随机对照试验


    authors: Soudorn C,Muntham D,Reutrakul S,Chirakalwasan N

    更新日期:2016-09-01 00:00:00

  • The long-term outcomes of mechanical ventilation: what are they and how should they be used?

    abstract::In the critical care setting, usually the most important outcome is survival. However, this is not the only important outcome of critical care. There are increasing data that the patient's quality of life and functional status can be affected long after an intensive care unit stay, and some data suggest that mechanica...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审


    authors: Curtis JR

    更新日期:2002-04-01 00:00:00

  • Nintedanib: a novel therapeutic approach for idiopathic pulmonary fibrosis.

    abstract::Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic lung disease with no clear etiology and few therapeutic options. Growth factors that act as mediators in the development of this disease might be important therapeutic targets. Nintedanib is a triple-tyrosine kinase inhibitor and a potent antagoni...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审


    authors: Dimitroulis IA

    更新日期:2014-09-01 00:00:00

  • Race/Ethnicity and 30-Day Readmission Rates in Medicare Beneficiaries With COPD.

    abstract:BACKGROUND:COPD is now included in Medicare's hospital readmission reduction program. Hospitals with excessive risk-adjusted 30-d readmission rates receive financial penalties. Race/ethnicity is not included in the risk-adjustment models. We examined whether race/ethnicity was independently associated with readmission ...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Nastars DR,Rojas JD,Ottenbacher KJ,Graham JE

    更新日期:2019-08-01 00:00:00

  • A computer program for quality control in the blood gas laboratory.

    abstract::In blood gas laboratory quality-assurance programs, which are routinely included with materials sold for quality control, raw data are sent to a data processing center for reduction to statistics meaningful to the laboratory's quality-control effort. This data reduction service usually requires a turn-around time of 2...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: DeWitt AL

    更新日期:1984-04-01 00:00:00

  • Chest radiography validity in screening pulmonary tuberculosis in immigrants from a high-burden country.

    abstract:BACKGROUND:Chest x-ray (CXR) is widely used for diagnosing and screening pulmonary tuberculosis (PTB), yet its validity is debatable and its costs are relatively high. This study aimed to determine the validity of CXR screening in detecting radiological findings compatible with active PTB or with old healed tuberculos...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Mor Z,Leventhal A,Weiler-Ravell D,Peled N,Lerman Y

    更新日期:2012-07-01 00:00:00

  • Successful extracorporeal membrane oxygenation for respiratory failure in an infant with DiGeorge anomaly, following thymus transplantation.

    abstract::We report the first successful use of venovenous extracorporeal membrane oxygenation (ECMO) for refractory respiratory failure in an infant with DiGeorge anomaly, following thymus transplantation. A 23-month-old female with complete immune-incompetent DiGeorge anomaly 65 days after allogenic thymus transplantation was...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Hornik CP,Hartman ME,Markert ML,Lodge AJ,Cheifetz IM,Turner DA

    更新日期:2011-06-01 00:00:00

  • Year in Review 2018: Pediatric Mechanical Ventilation.

    abstract::Mechanical ventilation is frequently used in pediatric patients to ensure adequate gas exchange, ameliorate respiratory distress, and enable resolution of pulmonary or other disorders. However, a number of important challenges remain in the pediatric population because there is a paucity of large-scale randomized cont...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审


    authors: Smallwood CD,Davis MD

    更新日期:2019-07-01 00:00:00

  • A case of unexplained hypoxemia.

    abstract::We present a patient with acute-onset dyspnea and unexplained severe hypoxemia. No signs of severe cardiopulmonary disease, pulmonary arterial hypertension, or pulmonary embolism were present. The patient was diagnosed with hepatopulmonary syndrome, since liver disease of alcoholic origin was present, markedly increa...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Madsen PH,Hess S,Madsen HD

    更新日期:2012-11-01 00:00:00

  • Health Coaching in Severe COPD After a Hospitalization: A Qualitative Analysis of a Large Randomized Study.

    abstract:BACKGROUND:We recently demonstrated in a randomized study the feasibility and effectiveness of telephone-based health coaching using motivational interviewing on decreasing hospital readmissions and improving quality of life at 6 and 12 months after hospital discharge. In this qualitative study, we sought to explore th...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Benzo RP,Kirsch JL,Hathaway JC,McEvoy CE,Vickers KS

    更新日期:2017-11-01 00:00:00

  • Testing airway management skills: interactive video courseware vs ACLS instructor.

    abstract:UNLABELLED:Lectures and demonstrations have been the teaching and testing strategies most often employed by the American Heart Association in Advanced Cardiac Life Support (ACLS) training. I compared the abilities of interactive videodisc (IVD) courseware and ACLS instructors to evaluate airway management skills. METH...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Rubens AJ

    更新日期:1991-08-01 00:00:00

  • Comparison of sampler filling times among selected arterial blood samplers.

    abstract:BACKGROUND:True arterial blood samples are essential in making clinical decisions for respiratory patients. Previous studies using only the Portex Pro-Vent arterial sampler have shown a significant difference between arterial and venous filling times. The goal of this study was to determine whether there is a statistic...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: McMillen CN,Adu-Yeboah S,Kagarise E,Morton RL,Yuce B,Douce FH

    更新日期:2015-04-01 00:00:00

  • Use of a noninvasive pulse CO-oximeter to measure blood carboxyhemoglobin levels in bingo players.

    abstract:BACKGROUND:Though smokers are known to have elevated blood carboxyhemoglobin (COHb), due to inhalation of carbon monoxide (CO) in cigarette smoke, limited data exist regarding COHb levels in nonsmokers exposed to secondhand smoke. METHODS:COHb was measured using a new noninvasive pulse CO-oximeter (Rad-57, Masimo, Irv...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Hampson NB,Scott KL

    更新日期:2006-07-01 00:00:00

  • Dexmedetomidine for sedation in the parturient with respiratory failure requiring noninvasive ventilation.

    abstract::Dexmedetomidine is a selective alpha-2 receptor agonist that possesses both sedative and analgesic properties, with minimal respiratory depression. We report the successful administration of dexmedetomidine on a 16-year-old primigravida woman that allowed the patient to tolerate application of bi-level positive airwa...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Duan M,Lee J,Bittner EA

    更新日期:2012-11-01 00:00:00

  • Pleural fluid amino-terminal brain natriuretic peptide in patients with pleural effusions.

    abstract:BACKGROUND:Definite diagnosis of transudative or exudative pleural fluids often presents a diagnostic dilemma. The aim of this study was to evaluate whether amino-terminal brain natriuretic peptide (NT-proBNP) levels in pleural fluid has a diagnostic value for discriminating heart-failure-related pleural effusions from...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Cincin A,Abul Y,Ozben B,Tanrikulu A,Topaloglu N,Ozgul G,Karakurt S,Oktay A

    更新日期:2013-02-01 00:00:00

  • In vitro comparison of the circulaire and AeroTee to a traditional nebulizer T-piece with corrugated tubing.

    abstract:BACKGROUND:Nebulizers are a popular means of delivering aerosolized medication, primarily albuterol, to the bronchial airways of patients, and there has been extensive research done on numerous nebulizers used with nebulizer T-pieces and corrugated tubing. Very little research has been performed on other types of nebul...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Piper SD

    更新日期:2000-03-01 00:00:00

  • Evaluation of auto-regulated inspiratory support during rebreathing and acute lung injury in pigs.

    abstract:BACKGROUND:Auto-regulated inspiratory support mode (ARIS) is an original closed-loop pressure-support system that regulates the slope ("A") and the initial level ("B") of the applied inspiratory pressure, in order to achieve an optimal minute ventilation under constrained respiratory frequency, tidal volume, and maximu...

    journal_title:Respiratory care

    pub_type: 杂志文章


    authors: Desmettre TJ,Chambrin MC,Mangalaboyi J,Pigot A,Chopin C

    更新日期:2005-08-01 00:00:00

  • 2019 Year in Review: Neonatal Respiratory Support.

    abstract::Respiratory support of the critically ill neonate has steadily shifted from invasive to noninvasive forms of support. There have recently been a number of important advances in our understanding of the changes to neonatal resuscitation practices as they pertain to clinically important outcomes, mechanisms of gas excha...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审


    authors: Wheeler CR,Smallwood CD

    更新日期:2020-05-01 00:00:00