Breathing In Patients Research Articles

Relationship between changes in the electrical axis of the heart during inspiration and the structural and functional state of the heart according to echocardiography in patients with precapillary pulmonary hypertension

Introduction. A deep breath causes a whole range of physiological effects that are reflected in the electrocardiogram. The purpose of the study is to assess the position of the electrical axis of the heart during deep inspiration compared to quiet breathing in patients with precapillary pulmonary hypertension and compare these data with echocardiographic characteristics of the structural and functional state of the heart. Materials and methods. The study included 40 patients with idiopathic pulmonary hypertension and 40 patients with chronic thromboembolic pulmonary hypertension. Echocardiography assessed the size of the heart chambers, systolic and diastolic function of the right and left ventricles, pulmonary artery pressure, pulmonary vascular resistance and indicators of cardiovascular coupling. Results. The values of the electrical axis of the heart during free breathing were 106° [84°; 123°], on inspiration – 89° [87°; 120°] (p = 0.68). In 50 (62.5 %) patients, during a deep inspiration, the electrical axis of the heart shifted to the left from the original one, and in 30 (37.5 %) patients – to the right. In patients with a displacement of the electrical axis of the heart to the left from the original, compared with the others, the end-diastolic size of the left ventricle, end-diastolic and end-systolic volumes of the left ventricle, stroke volume, cardiac output were statistically significantly lower, and the eccentricity index, pulmonary vascular resistance and effective aortic stiffness – significantly larger. Conclusion. In patients with precapillary pulmonary hypertension, two variants of changes of the heart electrical axis during deep inspiration were identified: a shift to the right from the original and to the left from the original. Patients with a displacement of the electrical axis to the left from the original were characterized by a significantly greater increase in pulmonary vascular resistance, a decrease in left ventricular volumes, stroke volume and cardiac output.

Early Detection of Ventilator-associated Pneumonia From Exhaled Breath in Intensive Care Unit Patients.

Evaluate associations between volatile organic compounds (VOCs) in heat and moisture exchange (HME) filters and the presence of ventilator-associated pneumonia (VAP). Clinical diagnostic criteria for VAP have poor interobserver reliability, and cultures are slow to result. Exhaled breath contains VOCs related to gram-negative bacterial proliferation, the most identified organisms in VAP. We hypothesized that exhaled VOCs on HME filters can predict nascent VAP in mechanically ventilated intensive care unit patients. Gas chromatography-mass spectrometry was used to analyze 111 HME filters from 12 intubated patients who developed VAP. Identities and relative amounts of VOCs were associated with dates of clinical suspicion and culture confirmation of VAP. Matched pairs t tests were performed to compare VOC abundances in HME filters collected within 3 days pre and postclinical suspicion of VAP (pneumonia days), versus outside of these days (non-pneumonia days). A receiver operating characteristic curve was generated to determine the diagnostic potential of VOCs. Carbon disulfide, associated with the proliferation of certain gram-negative bacteria, was found in samples collected during pneumonia days for 11 of 12 patients. Carbon disulfide levels were significantly greater ( P = 0.0163) for filters on pneumonia days. The Area Under the Curve of the Reciever Operating Characteristic curve (AUC ROC) for carbon disulfide was 0.649 (95% CI: 0.419-0.88). Carbon disulfide associated with gram-negative VAP can be identified on HME filters up to 3 days before the initial clinical suspicion, and approximately a week before culture confirmation. This suggests VOC sensors may have potential as an adjunctive method for early detection of VAP.

Bimetallic PtAu-Decorated SnO2 Nanospheres Exhibiting Enhanced Gas Sensitivity for Ppb-Level Acetone Detection.

Acetone is a biomarker found in the expired air of patients suffering from diabetes. Therefore, early and accurate detection of its concentration in the breath of such patients is extremely important. We prepared Tin(IV) oxide (SnO2) nanospheres via hydrothermal treatment and then decorated them with bimetallic PtAu nanoparticles (NPs) employing the approach of in situ reduction. The topology, elemental composition, as well as crystal structure of the prepared materials were studied via field emission scanning electron microscopy, transmission electron microscopy, X-ray photoelectron spectroscopy, and X-ray diffraction. The findings revealed that bimetallic PtAu-decorated SnO2 nanospheres (PtAu/SnO2) were effectively synthesized as well as PtAu NPs evenly deposited onto the surface of the SnO2 nanospheres. Pure SnO2 nanospheres and PtAu/SnO2 sensors were prepared, and their acetone gas sensitivity was explored. The findings demonstrated that in comparison to pristine SnO2 nanosphere sensors, the sensors based on PtAu/SnO2 displayed superior sensitivity to acetone of 0.166-100 ppm at 300 °C, providing a low theoretical limit of detection equal to 158 ppm. Moreover, the PtAu/SnO2 sensors showed excellent gas response (Ra/Rg = 492.3 to 100 ppm), along with fast response and recovery (14 s/13 s to 10 ppm), good linearity of correlation, excellent repeatability, long-term stability, and satisfactory selectivity at 300 °C. This improved gas sensitivity was because of the electron sensitization of the Pt NPs, the chemical sensitization of the Au NPs, as well as the synergistic effects of bimetallic PtAu. The PtAu/SnO2 sensors have considerable potential for the early diagnosis and screening of diabetes.

Improving breathing effort estimation in mechanical ventilation via optimal experiment design

Estimation of the breathing effort and relevant lung parameters of a ventilated patient is essential to keep track of a patient’s clinical condition. The aim of this paper is to increase estimation accuracy through experiment design. The main method is an experiment design approach across multiple breaths within a linear regression framework to accurately identify the patient’s condition. Identifiability and persistence of excitation are used to formulate an estimation problem with a unique solution. Furthermore, Fisher information is used for assessing the parameters sensitivity to slight changes of the ventilator settings to improve the variance of the estimation. The estimation method is applied to simulated patients who breathe regularly but also to patients who have variable breathing patterns. A virtual experiment is conducted for both situations to generate estimation results. The results are analyzed using mathematical tools and show that uniquely estimating the lung parameters and breathing effort over multiple breaths for both regularly and variably breathing patients is possible in the presented framework. The proposed estimation method obtains clinically relevant estimates for a large set of breathing disturbances from the simulation case-study.

Prediction of fluid responsiveness in spontaneously breathing patients with hemodynamic stability: a prospective repeated-measures study

Evaluating fluid responsiveness with dynamic parameters is recommended for fluid management. However, in hemodynamically stable patients who are breathing spontaneously, accurately measuring stroke volume variation via echocardiography and passive leg raising is challenging due to subtle SV changes. This study aimed to identify normal SV changes in healthy volunteers and evaluate the precision of hemodynamic parameters in screening mild hypovolemia in patients. This prospective, repeated-measures, cross-sectional study screened 269 subjects via echocardiography. Initially, 45 healthy volunteers underwent a fluid challenge test, the outcomes of which served as criteria to screen 215 ICU patients. Among these patients, 53 underwent additional fluid challenge testing. Hemodynamic parameters, including medians of maximum velocity time integrals (VTImaxs), peak velocity of VTImax (PV), internal jugular vein diameters (IJVD), and area (IJVA) were repeatedly measured first at a 60° upper body elevation (UBE), second in a supine position, third at UBE, fourth in a supine position, and lastly in a supine position after fluid loading. The hemodynamic responses to the position changes were compared between 83 fluid non-responders and 15 fluid responders. Fluid responsiveness was defined as fluid-induced medians’ change of VTImaxs (fluid-induced median VTImax change) ≥ 10%. None of the healthy volunteers showed the mean value of repeatedly measured medians of VTImaxs ≥ 7%, following either UBE position (UBE-induced median VTImax change) or fluid loading (fluid-induced median VTImax change). UBE-induced median VTImax and PV changes were significantly correlated with fluid responsiveness (p < 0.001, AUC 0.959; p < 0.001, AUC 0.804). The significant correlations were demonstrated via multivariable analysis using binary logistic regression (p = 0.001, OR 90.1) and the correlation coefficient (R2 = 0.793) using linear regression analysis. UBE-induced median VTImax changes (≥ 11.8% and 7.98%) predicted fluid-induced median VTImax changes ≥ 10% and 7% (AUC 0.959 and 0.939). The collapsibility and variation of IJVD and IJVA showed no significant correlation. An increase in the mean value of medians of repeatedly measured VTImaxs transitioning from an UBE to a supine position, effectively screened mild hypovolemia and demonstrated a significant correlation with fluid responsiveness in spontaneously breathing patients maintaining hemodynamic stability.

Screening Strategies for Sleep-Disordered Breathing in Patients With Spinal Cord Injury in a Tertiary Care Rehabilitation Center.

Sleep-disordered breathing (SDB) is frequent in patients with spinal-cord injury (SCI). However, SDB is frequently underdiagnosed due to limited access to diagnostic testing and knowledge about the condition. Moreover, SDB heterogeneity (sleep apnea, obstructive sleep apnea or central sleep apnea and nocturnal alveolar hypoventilation) implies complex evaluation of both nocturnal respiratory effort and hypercapnia. The aim of this study was to compare different screening strategies for an SDB diagnosis in patients with SCI. This was a retrospective analysis of data from subjects with SCI followed up in a tertiary-care rehabilitation center with a specialized sleep unit. Subjective (questionnaires) and objective data (polysomnography [PSG]), [Formula: see text] extracted from the PSG, morning blood gases, and nocturnal transcutaneous CO2 (PtcCO2 ) were collected and analyzed. A retrospective comparison of different strategies for SDB screening was carried out. Each strategy was compared (alone and in combination) with the standard of care for sleep apnea (PSG) and nocturnal alveolar hypoventilation (PtcCO2 ) diagnosis. The performance of the usual cutoff and visual analysis was studied. Among 190 subjects with SCI who underwent a full night's PSG, data were available for 104 questionnaires and 162 with oximetry. Nocturnal alveolar hypoventilation was screened by PtcCO2 and blood gases in 52 subjects with SCI. Questionnaires (the modified Screening for Obstructive Sleep Apnea in Tetraplegia and the Epworth Sleepiness Scale) had poor performance for identifying sleep apnea and did not identify nocturnal alveolar hypoventilation. [Formula: see text] (oxygen desaturation index score ≥ 13) and visual analysis of [Formula: see text] were good at identifying sleep apnea but insufficient to identify nocturnal alveolar hypoventilation. Diurnal blood gases were poor predictors of nocturnal alveolar hypoventilation. Questionnaires were of limited use in subjects with SCI, but the oxygen desaturation index derived from oximetry performed well for sleep apnea screening. Both diurnal blood gases and oximetry visual analysis were insufficient for nocturnal alveolar hypoventilation screening. PtcCO2 monitoring should be mandatory and ideally combined with PSG given the heterogeneity of SDB phenotypes and associated sleep comorbidities of patients with SCI.

The Three-Dimensional Hierarchical Structure of Bi x -Sn1-x O2 Used for Ultrasensitive Detection of Butanone under UV Irradiation.

Recent studies have identified butanone as a promising biomarker in the breath of lung cancer patients, yet the understanding of its gas-sensing properties remains limited. A key challenge has been to enhance the gas-sensing performance of materials toward butanone, particularly under ultraviolet light exposure. Herein, we report the synthesis of a novel three-dimensional composite material composed of SnO2 incorporated with Bi2O3 using facile hydrothermal and impregnation precipitation methods. Detailed physical and chemical characterizations were performed to assess the properties of the developed material. Upon activation with ultraviolet light, our composite exhibited exceptionally high sensitivity to butanone. Remarkably, the butanone response was nearly 3 times greater for the Bi2O3-loaded SnO2 composite than for pristine SnO2, achieving a response value of 70. This substantial improvement is due to the synergistic effect of the material's distinctive three-dimensional architecture and the presence of Bi2O3, which significantly augmented the gas-sensing capability of butanone. To elucidate the underlying gas-sensing mechanism, we conducted first-principles calculations using density functional theory (DFT). The computational analysis revealed that the Bi2O3-containing system possesses superior adsorption energy for butanone. Ultimately, our findings suggest that the Bi-SnO2 composite holds great promise as an optimal sensing material for the detection of butanone under ultraviolet illumination.

The effectiveness of Slow Deep Breathing in DM patients who experience anxiety

Diabetes mellitus (DM) is a chronic metabolic disease characterised by persistent hyperglycemia. The etiology of the condition could stem from issues related to insulin secretion, peripheral insulin resistance, or a combination of both factors. Slow deep breathing (SDB) is abdominal breathing with a slow or slow frequency, rhythmic and comfortable which is done by closing the eyes and blowing air through the lips. SDB technique is done for 15 minutes 3 times a day, can be accomplished at any time. It is anticipated that there will be a globally recognised standard for Sleep-Disordered Breathing (SDB) procedures. This will facilitate further research utilizing larger sample sizes for more robust analysis. Aims: to detect the effect of the application of SDB to DM Type II patient experiencing anxiety during the treatment at Royal Prima Hospital. Study design: the chosen design was a quasi experiment with a case study with the use of the SPSS. The sample size comprised a singular participant meeting the criteria of Type 2 Diabetes Mellitus (DM) accompanied by comorbid anxiety and undergoing treatment for a duration exceeding 48 hours. Data collection methods encompassed interviews, interventions, observations, documentation, and subsequent evaluations. Place and Duration of Study: Royal Prima Hospital and 1 month Methodology: quantitative methods were employed, adhering to ethical guidelines that included obtaining informed consent from participants who agreed to partake as respondents. Results: after SDB intervention the blood pressure was reduced from the first examination, and the period of sleep from 4 to 6-8 hours, the patient's anxiety was reduced as well as the dizziness. The patient exhibited a noticeable reduction in signs of tension. Conclusion: Slow Deep Breathing (SDB) can reduce anxiety in DM Type II patients.

Integration of Electrochemical Sensing and Machine Learning to Detect Tuberculosis via Methyl Nicotinate in Patient Breath.

Tuberculosis (TB) remains a significant global health issue; making early, accurate, and inexpensive point-of-care detection critical for effective treatment. This paper presents a clinical demonstration of an electrochemical sensor that detects methyl-nicotinate (MN), a volatile organic biomarker associated with active pulmonary tuberculosis. The sensor was initially tested on a patient cohort comprised of 57 adults in Kampala, Uganda, of whom 42 were microbiologically confirmed TB-positive and 15 TB-negative. The sensor employed a copper(II) liquid metal salt solution with a square wave voltammetry method tailored for MN detection using commercially available screen-printed electrodes. An exploratory machine learning analysis was performed using XGBOOST. Utilizing this approach, the sensor was 78% accurate with 71% sensitivity and 100% specificity. These initial results suggest the sensing methodology is effective in identifying TB from complex breath samples, providing a promising tool for non-invasive and rapid TB detection in clinical settings.

Construction of mesoporous silica-implanted tungsten oxides for selective acetone gas sensing

As a key biomarker for noninvasive diagnosis of diabetes, the selective detection of trace acetone in exhaled gas using a portable and low-cost device remains a great challenge. Semiconductor metal oxide (SMO) based gas sensors have drawn signification attention due to their potential in miniaturization, user-friendliness, high cost-effectiveness and selective real-time detection for noninvasive clinical diagnosis. Herein, we propose a one-pot solvent evaporation induced tricomponent co-assembly strategy to design a novel ordered mesoporous SMO of silica-implanted WO3 (SiO2/WO3) as sensing materials for trace acetone detection. The controlled co-assembly of silicon and tungsten precursors and amphiphilic diblock copolymer poly(ethylene oxide)-block-polystyrene (PEO-b-PS), and the subsequent thermal treatment enable the local lattice disorder of WO3 induced by the amorphous silica and the formation of ordered mesoporous SiO2/WO3 hybrid walls with a unique metastable ε-phase WO3 framework. The obtained mesoporous SiO2/WO3 composites possess highly crystalline framework with large uniform pore size (12.0–13.3 nm), high surface area (99–113 m2/g) and pore volume (0.17–0.23 cm3/g). Typically, the as-fabricated gas sensor based on mesoporous 2.5 %SiO2/WO3 exhibits rapid response/recovery rate (5/17 s), superior sensitivity (Rair/Rgas = 105 for 50 ppm acetone), as well as high selectivity towards acetone. The limit of detection is as low as 0.25 ppm, which is considerably lower than the thresh value of acetone concentration (>1.1 ppm) in the exhaled breath of diabetic patients, demonstrating its great prospect in real-time monitoring in diabetes diagnosis. Moreover, the mesoporous 2.5 %SiO2/WO3 sensor is integrated into a wireless sensing module connected to a smart phone, providing a convenient real-time detection of acetone.

Management of sleep-disordered breathing in patients with syndromic hemifacial macrosomia.

Patients with syndromic hemifacial microsomia (SHFM) are at risk of obstructive sleep apnea (OSA). The aim of the study was to describe the prevalence of OSA and its management, especially in patients with Goldenhar syndrome (GS). The respiratory polygraphies and clinical management of 15 patients, aged 2 to 23years, evaluated at a national reference center, were analyzed. Four (27%) patients had no OSA, 4 (27%) had mild OSA, and 7 (46%), of whom 5 were ≤ 2years old, had severe OSA. None of the patients had central apneas. Only one patient had alveolar hypoventilation, and another one had nocturnal hypoxemia. Two patients had severe OSA despite prior adenoidectomy or mandibular distraction osteogenesis. Median duration of follow-up was 3.5years (range 0.5-9years). None of the patients without OSA or with mild OSA at baseline respiratory polygraphy developed OSA during the follow up. Among the 7 patients with severe OSA, 3 required continuous positive airway pressure or noninvasive ventilation, and one patient required a tracheostomy. In conclusion, patients with SHFM are at high risk of severe OSA at any age, underlining the importance of systematic sleep studies to diagnose and evaluate the severity of OSA. Individualized treatment should be privileged, based on a careful examination of the entire upper airway, taking in account potential associated risk factors. All patients with SHFM should be managed by a pediatric expert multidisciplinary medical/surgical team until the end of post pubertal growth.

Dyspnea management in patients with pneumonia and coronary artery disease: A case study

Background: Cardiovascular disease, particularly Coronary Artery Disease (CAD), is strongly linked to pneumonia. Patients suffering from both pneumonia and CAD frequently experience dyspnea as a symptom. Dyspnea, caused by both conditions, can significantly impact the patient's quality of life. Consequently, it is crucial to address and manage dyspnea in individuals with pneumonia and CAD. Purpose: To provide a thorough overview of managing dyspnea in patients with pneumonia and CAD in public hospitals in West Java, Indonesia. Method: Employing a case study methodology using a nursing care approach, encompassing nursing assessment, data analysis, diagnosis, intervention, implementation, evaluation, and documentation. The assessment indicated that the patient experienced shortness of breath, with a blood pressure of 145/86 mmHg, a respiratory rate of 24 breaths per minute, a pulse rate of 95 beats per minute, and an oxygen saturation level of 88%. The patient received 5 liters per minute of oxygen via a nasal cannula, and their body temperature measured 36.4ºC. Results: In this case study, dyspnea management involved positioning the patient, administering oxygen therapy in stages, and providing pharmacological treatments, including diuretics and antibiotics. Additional therapies included respiratory muscle training and effective cough exercises. These interventions successfully reduced the patient's respiratory rate to 18 breaths per minute and increased their oxygen saturation to 97% with a nasal cannula. Additionally, the patient's Medical Research Council (MRC) dyspnea scale score decreased to 1 out of 5. Conclusion: Nursing care management that includes positioning the patient in a semi-Fowler's position while resting and a Fowler's position when awake, administering oxygen therapy in stages, providing pharmacological treatments such as diuretics and antibiotics, and conducting respiratory muscle training, can lower the breathing rate and alleviate symptoms of shortness of breath in patients with pneumonia and coronary artery disease.

DIY Ventilator using Arduino

Abstract: This document shows the summaries of the several tests we have taken. Breathing occurs in the human lungs. Every time they inhale, they push a system that triggers motivation and the exhalation process. It is really reasonably priced. This can be used when a patient's vital condition is in jeopardy and they are suffering from the harmful consequences of lung or breathing problems. It usesa stepper motor component to propel the ambulance bag. Heartbeat levels are low during breathing, although this component can be. The levels of respiration and heartbeat are displayed on the LED screen. A ringer is included in the system to sound alert in the event that any anomalies related to a patient's critical condition or breathing problem are discovered. In addition, to prevent over- or under-air pressure, the ventilator should be able to track the patient's blood oxygen saturation level and exhale lung strain. The Arduino-powered ventilator that we are developing here satisfies all of these requirements, making it an affordable and dependable do-it-yourself ventilator that can be useful during a pandemic

FOT Technique Applied for Monitoring of COVID-19 Pneumonia Reveals Small Airways Involvement.

The fact that some SARS-CoV-2 pneumonia patients benefit from changing body position, and some from continuous positive airways pressure (CPAP), indicates the functional character of hypoxia. We hypothesize that such effects could be explained by the closure of small airways. To prove the hypothesis, we evaluated the patency of small airways in 30 oxygen-dependent, spontaneously breathing patients with SARS-CoV-2 pneumonia during their hospital stay using the FOT method and then compared the results with data obtained three months later. During the acute period, total resistance (R5) and peripheral resistance (R5-20) rose above the upper limit of normal (ULN) in 28% and 50% of all patients, respectively. Reactance indices X5, AX and Fres exceeded ULN in 55%, 68% and 66% of cases. Significant correlations were observed between PaO2/FiO2, the time spent in the hospital and R5, X5, AX and Fres. After 3 months, 18 patients were re-examined. During the hospital stay, 11 of them had risen above the upper limit of normal (ULN), for both resistance (R5-20) and reactance (X5, AX) values. Three months later, ULN for R5-20 was exceeded in only four individuals, but ULN for X5 and AX was exceeded in five individuals. Lung function examination revealed a combined restrictive/obstructive ventilatory failure and reduced CO transfer factor. We interpret these changes as lung tissue remodeling due to the process of fibrosis. We conclude that during acute period of SARS-CoV-2 pneumonia, dilated pulmonary blood vessels and parenchymal oedema induce functional closure of small airways, which in turn induce atelectasis with pulmonary right-to-left shunting, followed by the resulting hypoxemia.

Commissioning of a novel PET-Linac for biology-guided radiotherapy (BgRT).

Biology-guided radiotherapy (BgRT) is a novel radiotherapy delivery technique that utilizes the tumor itself to guide dynamic delivery of treatment dose to the tumor. The RefleXion X1 system is the first radiotherapy system developed to deliver SCINTIX® BgRT. The X1 is characterized by its split arc design, employing two 90-degree positron emission tomography (PET) arcs to guide therapeutic radiation beams in real time, currently cleared by FDA to treat bone and lung tumors. This study aims to comprehensively evaluate the capabilities of the SCINTIX radiotherapy delivery system by evaluating its sensitivity to changes in PET contrast, its adaptability in the context of patient motion, and its performance across a spectrum of prescription doses. A series of experimental scenarios, both static and dynamic, were designed to assess the SCINTIX BgRT system's performance, including an end-to-end test. These experiments involved a range of factors, including changes in PET contrast, motion, and prescription doses. Measurements were performed using a custom-made ArcCHECK insert which included a 2.2cm spherical target and a c-shape structure that can be filled with a PET tracer with varying concentrations. Sinusoidal and cosine4 motion patterns, simulating patient breathing, was used to test the SCINTIX system's ability to deliver BgRT during motion-induced challenges. Each experiment was evaluated against specific metrics, including Activity Concentration (AC), Normalized Target Signal (NTS), and Biology Tracking Zone (BTZ) bounded dose-volume histogram (bDVH) pass rates. The accuracy of the delivered BgRT doses on ArcCHECK and EBT-XD film were evaluated using gamma 3%/2mm and 3%/3mm analysis. In static scenarios, the X1 system consistently demonstrated precision and robustness in SCINTIX dose delivery. The end-to-end delivery to the spherical target yielded good results, with AC and NTS values surpassing the critical thresholds of 5 kBq/mL and 2, respectively. Furthermore, bDVH analysis consistently confirmed 100% pass rates. These results were reaffirmed in scenarios involving changes in PET contrast, emphasizing the system's ability to adapt to varying PET avidities. Gamma analysis with 3%/2mm (10% dose threshold) criteria consistently achieved pass rates>91.5% for the static tests. In dynamic SCINTIX delivery scenarios, the X1 system exhibited adaptability under conditions of motion. Sinusoidal and cosine4 motion patterns resulted in 3%/3mm gamma pass rates>87%. Moreover, the comparison with gated stereotactic body radiotherapy (SBRT) delivery on a conventional c-arm Linac resulted in 93.9% gamma pass rates and used as comparison to evaluate the interplay effect. The 1cm step shift tests showed low overall gamma pass rates of 60.3% in ArcCHECK measurements, while the doses in the PTV agreed with the plan with 99.9% for 3%/3mm measured with film. The comprehensive evaluation of the X1 radiotherapy delivery system for SCINTIX BgRT demonstrated good agreement for the static tests. The system consistently achieved critical metrics and delivered the BgRT doses per plan. The motion tests demonstrated its ability to co-localize the dose where the PET signal is and deliver acceptable BgRT dose distributions.

TNF-a Receptor 1 Activity Is Differentially Required for Phrenic Long-term Facilitation (pLTF) Over the Course of Motor Neuron Death in Adult Rats

Intrapleural injection of cholera toxin B fragment conjugated to saporin (CTB-SAP) selectively kills respiratory motor neurons, and mimics aspects of neuromuscular disorders and neurodegenerative diseases including phrenic motor neuron death, decreased phrenic motor output, and increased microglial cell number. Over the course of motor neuron loss, enhanced A2A receptor-dependent phrenic plasticity is observed early (7d), and then constrained 5-HT receptor-dependent phrenic plasticity is observed later (28d). In addition, COX-1/2-induced inflammation differentially impacts breathing and phrenic plasticity in CTB-SAP rats, but the underlying mechanism by which COX-1/2-induced inflammation impacts breathing and plasticity over the course of motor neuron death has not been studied. We observe that increased cervical neuroinflammatory gene expression ( e.g., tumor necrosis factor-a; TNF-a) is reduced back to control levels in the presence of ketoprofen in CTB-SAP rats, and it is known that TNF-a is involved in phrenic plasticity in naïve rats. Thus, we hypothesized that acute TNF-a receptor inhibition attenuates phrenic plasticity at 7d and enhances it at 28d TNF-a following CTB-SAP-induced neuropathology. Using anesthetized, paralyzed and ventilated CTB-SAP-treated adult Sprague Dawley rats, we studied acute intermittent hypoxia (AIH; 3, 5 min bouts of 10.5% O2) induced pLTF following acute intrathecal C4 delivery of a TNF-a receptor 1 inhibitor (soluble TNFR1; sTNFR1; 0.13 ug/ul) or vehicle (aCSF) to rats that received bilateral, intrapleural injections of: 1) CTB-SAP (25ug), or 2) un-conjugated CTB and SAP (control) in rats treated 7d or 28d prior. Surprisingly, preliminary results indicate that acute sTNFR1 delivery does not affect pLTF in 7d CTB-SAP-treated rats (n=5; i.e., pLTF still enhanced) but it enhanced pLTF in 28d CTB-SAP-treated rats (n=6; p&lt;0.05) vs. controls (n=6 at 7d; n=7 at 28d) and vs. vehicle treated rats (controls n=6 for 7d and n=9 for 28d; CTB-SAP, n=4 for 7d and 28d each). These preliminary observations suggest that TNF-a does not contribute to pLTF in 7d CTB-SAP-treated rats, whereas it may undermine pLTF in 28d CTB-SAP-treated rats. Studies are underway to assess the cellular source of TNF-a and the impact of chronic sTNFR1 delivery on pLTF, diaphragm activity, and breathing. Since most patients with neuromuscular disorders or neurodegenerative disease develop respiratory insuffciency and ultimately become ventilator dependent, our long-range goal is to develop new strategies to enhance the functional capacity of spared motor neurons and reduce ventilatory compromise in motor neuron loss pathology. These novel strategies, if successful, will identify new therapeutic targets for future, translational studies to enhance breathing in patients with neuromuscular disorders. Supported by a Spinal Cord Injury and Disease Research grant. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Respiratory rate monitoring in ICU patients and healthy volunteers using electrical impedance tomography: a validation study

Objective. The respiratory rate (RR) is considered one of the most informative vital signals. A well-validated standard for RR measurement in mechanically ventilated patient is capnography; a noninvasive technique for expiratory CO2 measurements. Reliable RR measurements in spontaneously breathing patients remains a challenge as continuous mainstream capnography measurements are not available. This study aimed to assess the accuracy of RR measurement using electrical impedance tomography (EIT) in healthy volunteers and intensive care unit (ICU) patients on mechanical ventilation and spontaneously breathing post-extubation. Comparator methods included RR derived from both capnography and bioimpedance electrocardiogram (ECG) measurements. Approach. Twenty healthy volunteers wore an EIT belt and ECG electrodes while breathing through a capnometer within a 10–40 breaths per minute (BPM) range. Nineteen ICU patients underwent similar measurements during pressure support ventilation and spontaneously breathing after extubation from mechanical ventilation. Stable periods with regular breathing and no artefacts were selected, and agreement between measurement methods was assessed using Bland–Altman analysis for repeated measurements. Main result. Bland–Altman analysis revealed a bias less than 0.2 BPM, with tight limits of agreement (LOA) ±1.5 BPM in healthy volunteers and ventilated ICU patients when comparing EIT to capnography. Spontaneously breathing ICU patients had wider LOA (±2.5 BPM) when comparing EIT to ECG bioimpedance, but gold standard comparison was unavailable. RR measurements were stable for 91% of the time for capnography, 68% for EIT, and 64% of the ECG bioimpedance signals. After extubation, the percentage of stable periods decreased to 48% for EIT signals and to 55% for ECG bioimpedance. Significance. In periods of stable breathing, EIT demonstrated excellent RR measurement accuracy in healthy volunteers and ICU patients. However, stability of both EIT and ECG bioimpedance RR measurements declined in spontaneously breathing patients to approximately 50% of the time.

Nursing Care for Pneumonia Patients

Pneumonia is an acute infectious disease that affects the alveoli and is caused by specific microorganisms, characterized by symptoms of coughing and shortness of breath. In the case of 2019, WHO recorded the most deaths in the world caused by pneumonia, reaching a total of 62,782 cases. In Indonesia alone, in 2021, there were 2.56 million confirmed cases of pneumonia. The prevalence of pneumonia in West Java reached 2.6%. This study aims to provide an overview of nursing care for pneumonia patients admitted to the emergency room of Gunung Jati Hospital. The method used is a descriptive method with a case study design. The results of this study indicate that the intervention carried out for 1 x 7 hours with the cooperation of the emergency room nurse had a positive impact. The author has carried out actions by the nursing plan that has been made. The implementation of Evidence-Based Practice (EBP) Pursed Lift Breathing (PLB). Deep Breathing Exercise (DBE) affects the patient's breathing frequency. Before the implementation of the intervention, the patient's breathing frequency (Respiratory Rate / RR) was 28 x/min. After implementing the intervention, the patient's breathing frequency dropped to 26 x/min. It can be concluded that the pursed lift breathing intervention can significantly reduce shortness of breath in patients with pneumonia. The implication of this study is the importance of applying appropriate and measurable interventions in nursing care for pneumonia patients to improve the quality of care and minimize the risk of complications.

Aerosol drug therapy in critically ill patients (Aero-in-ICU study): A multicentre prospective observational cohort study.

In recent years, a significant understanding of delivering optimal aerosol therapy and the availability of various drugs and devices have led to an increase in its use in clinical practice. There are only a few studies available regarding their use in critically ill patients from a few parts of the world. We aimed to study the practice pattern of aerosol therapy in critically ill patients from Indian intensive care units (ICUs). After ethical approval, this multi-centric prospective observational study was performed over a study period of four weeks. Newly admitted adult patients considered who had an artificial airway and/or ventilation (including non-invasive). Patients were followed up for the next 14 days or until ICU discharge/death (whichever came first) for details of each aerosol therapy, including ongoing respiratory support, drug type, and aerosol-generating device. From the nine participating centers across India, 218 patients were enrolled. Of 218 enrolled patients, 72.48% received 4884 aerosols with 30.91 ± 27.15 (95%CI: 26.6-35.1) aerosols per patient over 1108 patient days. Approximately 62.7% during IMV, 30.2% during NIV, 2.3% in spontaneously breathing patients with an artificial airway during weaning, and 4.7% were given without an artificial airway after weaning or decannulation. In 59%, a single drug was used, and bronchodilators were the most frequent. The jet nebulizer was the most common, followed by the ultrasonic and vibrating mesh aerosol generator. The ventilator setting was changed in only 6.6% of the aerosol sessions with IMV and none with NIV. Aerosol therapy is frequently used with a wide variation in practices; bronchodilators are the most commonly used drugs, and jet nebulizers are the most widely used.

Efficacy of acupuncture for a cough-related symptom cluster in patients with lung cancer: A randomized controlled trial

PurposeThis study was designed to evaluate the effect of acupuncture on cough, expectoration, and shortness of breath in lung cancer patients. MethodsBetween December 2021 and June 2022, a total of 130 lung cancer patients were recruited, and they were split into control and intervention groups at random. Routine nursing was provided to the control group, whereas routine nursing with acupuncture using LU7 (Lie Que), LU9 (Tai Yuan), BL13 (Fei Shu), and BL20 (Pi Shu) was administered to the intervention group for 7 days. The severity of cough, expectoration, and shortness of breath was assessed 1 day before and after the interventions using the lung cancer-specific module of the MDASI. A two-way ANOVA was performed for group comparisons. ResultsCompared with the control group, the symptoms of cough in the intervention group were significantly improved (F = 5.095, MD = −0.32, 95% CI, −0.59 to 0.04, P = 0.025), while expectoration (F = 0.626, MD = −0.11, 95% CI, −0.38 to 0.16, P = 0.430) and shortness of breath (F = 0.165, MD = −0.05, 95% CI, −0.27 to 0.18, P = 0.685) had no significant change. Cough also identified an obvious interaction effect (P = 0.014), and the post-intervention simple main effect test demonstrated a tangible difference between the two groups (MD = −0.66, 95% CI, −0.99 to 0.33, P < 0.001) post-intervention. ConclusionsAcupuncture using LU7, LU9, BL13, and BL20 can relieve the cough of lung cancer patients, but not relieve expectoration and shortness of breath.