Respiratory Pressure Research Articles

Effect of Body Position on Electrical Activity of Respiratory Muscles During Mouth and Nasal Maximal Respiratory Pressure in Healthy Adults: A Pilot Study.

Background: This study aimed to analyze the impact of seated, 45° inclined, and supine positions on respiratory muscle strength (Maximal Inspiratory Pressure-MIP, Maximal Expiratory Pressure-MEP, Sniff Nasal Inspiratory Pressure-SNIP and Sniff Nasal Expiratory Pressure-SNEP) and the electrical activity of respiratory muscles in healthy adults. Ten healthy subjects were evaluated. Methods: Personal, anthropometric data (weight, height, BMI) and lung function (spirometry) were collected, followed by random assessments of inspiratory (MIP, SNIP) and expiratory (MEP, SNEP) muscle strength. Respiratory muscle strength maneuvers and surface electromyographic (sEMG) activity were assessed in sitting, 45° inclined, and supine positions. Results: present that MIP was statistically higher in the sitting position compared to the supine position (p < 0.05) and the 45° supine position (p < 0.05), with SNIP: p < 0.05 and SNEP: p < 0.05 as well. Intercostal muscle activity was higher during MIP, MEP, and SNEP maneuvers in the sitting position (p < 0.05). Additionally, rectus abdominis muscle activity was higher in this position during MIP and SNEP maneuvers. Conclusions: The results suggest there are significant differences in inspiratory pressures between positions, with the difference in activity muscle pattern. In conclusion, body position affected maximal respiratory pressures and influences EMG activation of specific respiratory muscles during MIP.

Clinical characteristics of hemodynamics and laboratory parameters of recipients during orthotopic heart transplantation

Objective. To study the clinical and laboratory characteristics of recipients during orthotopic heart transplantation according to intraoperative monitoring. Materials and methods. The clinical and laboratory data of 38 patients who underwent orthotopic heart transplantation for vital indications in the period from 2022 to 2024 were studied. The average age of patients was (38.5 ± 13.5) years. There were 35 men (92.1%) and 3 women (7.9%). Peripheral oxygen saturation, arterial and central venous pressure were measured in each recipient delivered to the operating room at 5 stages of the operation during orthotopic heart transplantation. Results. The main cause of chronic heart failure with subsequent heart transplantation in all 38 (100%) patients was dilated cardiomyopathy. Statistically significant (p &lt; 0.05) acidosis and hypercapnia in recipients during heart transplantation were most pronounced at the first stage of surgery, before the connection of a heart–lung machine. Acidosis during heart transplantation had a mixed metabolic and respiratory genesis with hypercapnia and lactatacidosis. A statistically significant (p &lt; 0.05) increased lactate content at the first and second stages and statistically significant (p &lt; 0.05) hyperglycemia at all stages of surgery were found. Central venous pressure was statistically significantly (p&lt;0.05) higher than the reference values at the stages of sternum cutting and before the connection of the heart–lung machine. A direct statistically significant (p&lt;0.05) correlation between the level of arterial blood pH and the level of central venous pressure (r=0.334) was established, with the corresponding linear regression equation: pH=4.7043+central venous pressure × 0.02391. Conclusions. Clinical and laboratory characteristics of recipients undergoing orthotopic heart transplantation demonstrated a direct correlation between mixed metabolic and respiratory acidosis and central venous pressure. Peripheral hemodynamic parameters in orthotopic heart transplantation were characterized by instability at the stage of heart–lung machine disconnection.

Effectiveness of Vibrapep (OPEP) on Pulmonary functions in phase one of cardiac rehabilitation-A Randomized controlled trial

Background and Aims: According to the WHO report 2022, coronary artery disease is the most prevalent cardiac disease worldwide. Impaired respiratory muscle function, increased secretions and reduced vital capacity are pulmonary complications commonly associated with CABG and Valve replacement surgeries. The purpose of this study was to compare the effect of Vibrapep and standard phase one of cardiac rehabilitation exercises on pulmonary functions. Methods: A Randomized Controlled Trial was conducted on 46 participants. Participants were randomly allocated into two groups, Vibrapep and phase one of cardiac exercises were given to Group A (n = 23), while Group B (n = 23) received only phase one cardiac rehabilitation exercises. The intervention was administered for twice a day for 5 days. Outcome measures such as Sputum volume, maximal inspiratory and expiratory pressure, thoracic expansion, SPO2 level, blood pressure and Peak expiratory flow rate were evaluated at baseline and on 5th day of the study. Results: Wilcoxon test of within-group analysis revealed statistically significant improvements in all parameters for both the interventional and control groups (p&lt;0.05*), except in diastolic blood pressure, whereas, between group analysis done using Mann Whitney U test also showed statistical improvement in both groups on all parameters with (p&lt;0.05*). Conclusion: Vibrapep exhibited to be an effective bronchial hygiene therapy in phase one of cardiac rehabilitation with respect to enhancing pulmonary functions such as sputum reduction, chest expansion, improved respiratory pressure’s, Peak Expiratory Flow Rate along with Cardiac rehabilitation.

The role of Yoga in Preventing Lifestyle Disorders among Children

This article is meant to deal with stress, sedentary lifestyle and keep oneself happy because today's lifestyle is causing many types of diseases and these diseases are increasing rapidly in children. On an average, 60% of children are suffering from overweight/obesity. Many have at least one additional risk factor for cardiovascular disease, such as high blood pressure, or hyperinsulinemia. Yoga is a medium through which you can stay healthy and happy. Yoga gives you the strength to fight physical diseases, heals your mental health and helps in developing and strengthening the self. and it also has a positive effect on motor, physical, cognitive and social aspects. Surya Namaskar should be done to improve the current life style in children and it helps in improving the physical and mental health of children and also Surya Namaskar is effective in pulmonary functions, respiratory pressure, handgrip strength, endurance and cardiovascular diseases.

Numerical study on structural design and mechanical analysis of anti-migration tracheal stent with non-uniform Poisson's ratio

Stent migration is one of the common complications after tracheal stent implantation. The causes of stent migration include size mismatch between the stent and the trachea, physiological movement of the trachea, and so on. In order to solve the above problems, this study designed a non-uniform Poisson ratio tracheal stent by combining the size and structure of the trachea and the physiological movement of the trachea to improve the migration of the stent, meanwhile ensuring the support of the stent. In this study, the stent corresponding to cartilage was constructed with negative Poisson's ratio, and the stent corresponding to the circular connective tissue and muscular membrane was constructed with positive Poisson's ratio. And four kinds of non-uniform Poisson's ratio tracheal stents with different link lengths and negative Poisson's ratio were designed. Then, this paper numerically simulated the expansion and rebound process of the stent after implantation to observe the support of the stent, and further simulated the stretch movement of the trachea to calculate the diameter changes of the stent corresponding to different negative Poisson's ratio structures. The axial migration of the stent was recorded by applying different respiratory pressure to the wall of the tracheal wall to evaluate whether the stent has anti-migration effect. The research results show that the non-uniform Poisson ratio stent with connecting rod length of 3 mm has the largest diameter expansion in the negative Poisson ratio section when the trachea was stretched. Compared with the positive Poisson's ratio structure, the axial migration during vigorous breathing was reduced from 0.024 mm to 0.012 mm. The negative Poisson's ratio structure of the non-uniform Poisson's ratio stent designed in this study did not fail in the tracheal expansion effect. Compared with the traditional stent, the non-uniform Poisson's ratio tracheal stent has an anti-migration effect under the normal movement of the trachea while ensuring the support force of the stent.

75 Lung ultrasound severity scores and its utility in predicting success of weaning off respiratory support in neonates born preterm

Abstract Background Preterm infants often require respiratory support in the newborn intensive care unit. Complete trial off around 30-34 weeks post-menstrual age (PMA) is by trial and error based on clinical and physiological variables. Lung ultrasound (LUS) is a reliable adjunct in the diagnosis and management of most neonatal lung conditions. However, its utility in accessing readiness for successful weaning off respiratory pressure support in preterm neonates has not been explored. Objectives To determine the utility of LUS severity score (LUS-sc) in predicting successful weaning off of respiratory pressure support after 32weeks CGA in neonates born ≤32 weeks gestational age (GA). Design/Methods Prospective cohort study involving preterm neonates born ≤32 weeks needing any respiratory pressure support modes, admitted to a single tertiary care center in Canada between Sept 2022-Sept 2023. Eligible neonates were assessed by LUS at two time points- LUS1 at 30-30 + 6 weeks for those born &amp;lt;30weeks GA and between 48-72hours of life for those born at 30-32 + 6 weeks GA; LUS2 within 12hours prior to trial off respiratory pressure support to room air or low flow after 32weeks PMA. LUS were scored for disease severity by two independent reviewers using the LUS-sc by Brat et al. Receiver operator characteristics (ROC) curves analyzed the reliability of LUS-sc to predict the successful cessation of respiratory pressure support to room air or low flow post LUS2. Results Of 50 preterm neonates included in the study, 32 (64%) were successfully weaned from pressure support after LUS2 at a mean (SD) GA of 33.03 (0.29). The mean (SD) GA at birth was 28.78 (0.46) in the successful group and 27.78 (0.62) in the unsuccessful group (p=0.197). The mean (SD) LUS-sc for LUS2 at which cessation of support was possible was significantly lower from those who failed [6.95(0.33) vs 8.69(0.55), p=0.006] (Table 1). The ROC curve (Figure 1) showed AUC of 0.717 (95%CI=0.56-0.86), for a cut-off of LUS-sc of 7.75, with sensitivity of 0.75 (95%CI=0.60-0.90) and specificity of 0.61 (95%CI=0.38-0.84). Independent of GA at birth and at respiratory pressure support trial off, LUS-sc ≤8 was associated with an increased odd of cessation of support by 9.0 (95%CI=1.9-42.6), p=0.005, and each additional week of GA at first trial off increased the odds of cessation by 2.2 (95%CI=1.1-4.4), p=0.031. Conclusion LUS is a reliable tool to assess readiness for successful non-invasive respiratory pressure support trial off. A LUS-sc ≤8 was associated with higher successful weaning off of non-invasive pressure support after 32weeks GA.

Environmental impact of pressurised metered dose inhalers versus dry powder and soft mist inhalers at a tertiary Melbourne hospital.

The carbon footprint of devices to deliver inhaled respiratory medications has come into focus as climate change has been identified as a worldwide emergency. Metered dose inhalers (MDIs) contain hydrofluorocarbons that have significant global warming potential compared to dry powder inhalers (DPIs) and soft mist inhalers (SMIs), which do not use a propellant gas. A 12-month pharmacy inpatient dispensing audit demonstrated that inpatient MDI use significantly outweighed that of DPIs and SMIs and accounted for approximately 99% of inhaler-related greenhouse gas emissions at our hospital.

Closure of a secondary tracheoesophageal fistula in severe pneumonia using an Amplatzer Duct Occluder II during invasive mechanical ventilation: A case report.

Early and timely closure of secondary tracheoesophageal fistula (TEF) is crucial for critically ill patients. For those requiring invasive mechanical ventilation, the Amplatzer Duct Occluder II (ADO II) can be used as an emergency therapeutic option to rapidly close secondary TEF, providing opportunities for subsequent treatments. Secondary tracheoesophageal fistula (TEF) is a life-threatening condition characterized by high mortality, high recurrence rates, and multiple complications. Reports on the management of secondary TEF in critically ill patients are limited due to the challenges in treatment and the lack of suitable therapeutic options. We report a case of secondary TEF in a 69-year-old male diagnosed with severe pneumonia, whose condition deteriorated rapidly following the onset of TEF. Despite invasive mechanical ventilation, maintaining blood oxygen saturation above 80% was unachievable due to the TEF. Bedside bronchoscopy revealed expansion TEF expansion caused by gastrointestinal fluid reflux and respiratory machine pressure. The TEF was urgently closed using an ADO II device during invasive mechanical ventilation to prevent further deterioration. After the patient's condition stabilized, the ADO II was replaced with a Y-shaped tracheal membrane-covered stent for further TEF management. The patient's condition improved, meeting the criteria for liberation from invasive mechanical ventilation, and bedside chest X-rays revealed a gradual resolution of pulmonary inflammation. Selecting appropriate treatment modalities for early and timely closure of secondary TEF is crucial for critically ill patients. ADO II can serve as a rescue therapy to achieve rapid closure of secondary TEF in critically ill patients requiring invasive mechanical ventilation support, providing opportunities and time for subsequent treatment.

Respiratory muscle dysfunction in acute and chronic respiratory failure: how to diagnose and how to treat?

Assessing and treating respiratory muscle dysfunction is crucial for patients with both acute and chronic respiratory failure. Respiratory muscle dysfunction can contribute to the onset of respiratory failure and may also worsen due to interventions aimed at treatment. Evaluating respiratory muscle function is particularly valuable for diagnosing, phenotyping and assessing treatment efficacy in these patients. This review outlines established methods, such as measuring respiratory pressures, and explores novel techniques, including respiratory muscle neurophysiology assessments using electromyography and imaging with ultrasound.Additionally, we review various treatment strategies designed to support and alleviate the burden on overworked respiratory muscles or to enhance their capacity through training interventions. These strategies range from invasive and noninvasive mechanical ventilation approaches to specialised respiratory muscle training programmes. By summarising both established techniques and recent methodological advancements, this review aims to provide a comprehensive overview of the tools available in clinical practice for evaluating and treating respiratory muscle dysfunction. Our goal is to present a clear understanding of the current capabilities and limitations of these diagnostic and therapeutic approaches. Integrating advanced diagnostic methods and innovative treatment strategies should help improve patient management and outcomes. This comprehensive review serves as a resource for clinicians, equipping them with the necessary knowledge to effectively diagnose and treat respiratory muscle dysfunction in both acute and chronic respiratory failure scenarios.

Effects of Sports Bras and Breast Volume on Pulmonary System and Respiratory Symptom Responses to Exercise in Healthy Females.

This study assessed the individual and combined effects of sports bras and breast volume on pulmonary system and respiratory symptom responses to exercise in recreationally-active females. Twenty-three healthy females (18-27 y; bra sizes 32B-36DDD) were divided into small and large breast volume groups (SBV and LBV, respectively) around median volume (324 ml; mean ± SD SBV: 284 ± 38 ml vs. LBV: 560 ± 97 ml; p < 0.001, g = 3.84). Participants completed three 5-minute bouts of constant-load cycle exercise at 30, 60, and 90% of their peak power output while wearing a high-support sports bra, low-support sports bralette, or their own (self-selected) sports bra in randomized order. Measurements included ventilation, breathing pattern, respiratory pressures, diaphragm electromyogram (EMGdi), and ratings of perceived exertion (RPE), breathlessness (intensity and unpleasantness) and chest tightness due to bra. Compared to low-support and personal sports bras, the high-support sports bra evoked stronger sensations of restricted breathing and chest tightness ('slight' to 'moderate' restriction in n = 7 [30%] vs. n = 1 [4%] in low-support and personal bras; p = 0.014). There was, however, no evidence of greater concomitant inspiratory constraints, EMGdi, or inspiratory muscle pressure generation in either bra (all p > 0.05). Notably, LBV compared to SBV participants reported greater RPE (p = 0.037, ηp2 = 0.20), breathlessness intensity (p = 0.039, ηp2 = 0.20) and unpleasantness (p = 0.041; ηp2 = 0.19), which, in the setting of comparable pulmonary system responses to exercise, was likely driven by stronger perceived chest tightness and/or bra awareness in LBV participants. Despite evoking mild-to-moderately severe chest tightness due to bra during exercise - correctly fitted sports bras, whether low- or high-support, do not impose a physiological burden to the respiratory system and its response to mild-to-heavy intensity exercise in otherwise healthy females.

Small Airways Disease Affects Aerosol Deposition in Children with Severe Asthma: A Functional Respiratory Imaging Study.

Background: Small airways disease (SAD) in severe asthma (SA) is associated with high disease burden. Effective treatment of SAD could improve disease control. Reduced end-expiratory flows (forced expiratory flow [FEF]25-75 and FEF75) are considered sensitive indicators of SAD. Inhaled medication should be delivered to the smaller peripheral airways to treat SAD effectively. Aerosol deposition is affected by structural airway changes. Little is known about the effect of SAD on aerosol delivery to the smaller peripheral airways. Functional respiratory imaging (FRI) is a validated technique using 3D reconstructed chest computed tomography (CT) and computational fluid dynamics to predict aerosol deposition in the airways. Aim: This study aims to compare central and peripheral (= small airways) deposition between children with SA and SAD and children with SA without SAD, with different inhaler devices and inhalation profiles. Methods: FRI was used to predict the deposition of beclomethasone/formoterol dry powder inhaler (DPI), beclomethasone/formoterol pressurized metered dose inhaler with valved holding chamber (pMDI/VHC), and salbutamol pMDI/VHC for different device-specific inhalation profiles in chest-CT of 20 children with SA (10 with and 10 without SAD). SAD was defined as FEF25-75 and FEF75 z-score < -1.645 and forced vital capacity (FVC) z-score > -1.645. No SAD was defined as forced expiratory volume (FEV)1, FEF25-75, FEF75, and FVC z-score > -1.645. The intrathoracic, central, and peripheral airways depositions were determined. Primary outcome was difference in central-to-peripheral (C:P) deposition ratio between children with SAD and without SAD. Results: Central deposition was significantly higher (∼3.5%) and peripheral deposition was lower (2.9%) for all inhaler devices and inhalation profiles in children with SAD compared with children without SAD. As a result C:P ratios were significantly higher for all inhaler devices and inhalation profiles, except for beclomethasone administered through DPI (p = .073), in children with SAD compared with children without SAD. Conclusion: Children with SA and SAD have higher C:P ratios, that is, higher central and lower peripheral aerosol deposition, than children without SAD. The intrathoracic, central, and peripheral deposition of beclomethasone/formoterol using DPI was lower than using pMDI/VHC.

Impact of secondary health conditions on the quality of life and wellbeing of Canadians living with spinal cord injury: A comparison of preference-weighted index scores derived from generic standardized instruments

Context/objectives To compare the assessment of the impact of secondary health conditions (SHCs) on the quality of life and wellbeing of Canadians living with spinal cord injury (SCI) using four preference-based outcome measures. Design Secondary analysis of data from a cross-sectional, online survey. Setting Community. Participants Community-dwelling adults (n = 364) living with traumatic or non-traumatic spinal cord injury at least one year post-injury (70% at least 10 years post-injury). Outcome measures A modified version of the Spinal Cord Injury Secondary Conditions Scale (SCI-SCS); three health-related instruments (EQ-5D-5L, Health Utilities Index Mark 3 (HUI3), and the Assessment of Quality of Life 8-dimension questionnaire (AQoL-8D)) and a capability wellbeing instrument (ICEpop CAPability measure for Adults (ICECAP-A)). Results Across unadjusted and controlled analyses (i.e. controlling for associations between index scores and sociodemographic and impairment characteristics), trends were observed that identified lower levels of quality of life/wellbeing with higher problem ratings for each of the SHCs. Despite the trends, there was considerable variation in mean index scores across instruments, with HUI3 scores the lowest of the health-related instruments and ICECAP-A scores the highest overall. Respiratory problems, depression/mood problems, pressure sores, and autonomic dysreflexia were associated with the lowest levels of quality of life and wellbeing. Conclusions Higher problem ratings for SHCs are negatively associated with scores derived from preference-based quality of life and wellbeing instruments. Variation in index scores across instruments – including across the health-related instruments alone – highlights the critical importance of assessing the relative merits of preference-based instruments when using (or considering using) these instruments/estimates in comparative effectiveness research and economic evaluation.

Maximal respiratory pressure after COVID-19 compared with reference material in healthy adults: A prospective cohort study (The SECURe study).

After COVID-19 long term respiratory symptoms and reduced lung function including maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) have been reported. However, no studies have looked at MIP and MEP in all disease groups and the reference materials collection methods differ substantially. We aimed to determine MIP and MEP in individuals after COVID-19 infection with different disease severity using reference material of healthy control group obtained using the same standardized method. Patients with COVID-19 were included March 2020-March 2021 at Rigshospitalet, Denmark. MIP and MEP were measured using microRPM. Predicted MIP and MEP were calculated using reference material obtained from 298 healthy adults aged 18-97 years using the same method. In SECURe, 145 participants were measured median 5 months after COVID-19 diagnosis and of these 16% had reduced MIP and/or MEP. There was reduced spirometry and total lung capacity, but not reduced diffusion capacity in those with abnormal MIP and/or MEP compared with normal MIP and MEP. Of those with reduced MIP and/or MEP at 5 months, 80% still had reduced MIP and/or MEP at 12 months follow-up. In conclusion, few have reduced MIP and/or MEP 5 months after COVID-19 and little improvement was seen over time.

High-intensity intermittent inspiratory and abdominal muscle combined training in respiratory, swallowing and systemic muscles of healthy adults.

Low-intensity continuous inspiratory muscle training improves its strength. The abdominal muscles are the main expiratory muscles, and their training may improve expiratory muscle strength. Respiratory muscle strength regulates coughing effectiveness, which is critical for pneumonia management. In older people, risk factors for the development of pneumonia were respiratory muscle weakness and swallowing impairment. Currently, the impact of high-intensity intermittent inspiratory and abdominal muscle combined training on the respiratory, swallowing, and systemic muscles is unclear. We aimed to explore the effects of high-intensity inspiratory muscle training combined with or without abdominal muscle training on respiratory muscle strength as well as the strength, mass, and performance of swallowing and systemic muscles. Twenty-eight healthy adults were divided into two groups. Participants performed high-intensity intermittent inspiratory muscle single or its combination with abdominal muscle training for 4 weeks. Respiratory muscle strength, swallowing muscle strength and mass, systemic muscle strength, mass and performance were measured at baseline, Week 2 and Week 4. Both groups showed greater maximal respiratory pressures at Week 2 and Week 4 than baseline. Both groups showed improved tongue pressure and geniohyoid muscle thickness at Week 4. In addition, the combined training group improved body trunk muscle mass, handgrip strength and five-time chair stand test, whereas the single training group did not. This study revealed that high-intensity inspiratory muscle training improved inspiratory muscle strength and swallowing muscle strength and mass. Moreover, inspiratory and abdominal muscle combined training showed an additional benefit of improving systemic muscle strength, mass and performance. UMIN000046724; https://upload.umin.ac.jp/cgi-open-bin/ctr/index.cgi?ctrno=UMIN000046724.

Comparative study on combustion and emission of ternary-fuel combined supply SI engine with oxyhydrogen/ethanol/gasoline by different injection modes of fuel

The combination of renewable energy and multifuel combined supply is an efficient way to deal with the energetic crisis and the pollution of environment. Ethanol, gasoline and oxyhydrogen participate in combustion by means of three independent supply paths, which can improve engine power and reduce gasoline consumption and gaseous pollutant emission at the same time. However, the optimization of ternary-fuel combined supply mode is a problem that must be clarified. In this study, the engine performance at four direct injection pressure (DIP), six direct injection timing (DIT), five intake manifold absolute pressures (MAP) and four speeds is studied under the condition of equal ethanol injection ratio and gasoline injection ratio. The experimental results show that ethanol direct injection forms a mixture with a better stratified combustion state than gasoline direct injection. Moreover, oxyhydrogen negatory pressure inhalation (ONPI) can effectually increase Pmax and IMEP, reduce APmax, CA 10–90, CA 0–10, CO emission, HC emission and particulate emission, but increase NOx emission. However, ethanol direct injection (EDI) can reduce NOx emission produced by ONPI, and oxyhydrogen can attenuate the negatory effect on mixture combustion due to the excessive latent heat of vaporization of ethanol. NO emission in EDI mode is reduced by an average of 28.39 % compared to gasoline direct injection (GDI) mode under different MAPs. In conclusion, the combustion and emission characteristics of the engine in EDI + gasoline port injection (GPI) + ONPI mode are better than those in ethanol port injection (EPI) + GDI + ONPI mode. And the control strategy of "9–11 MPa DIP+250–300°CA BTDC DIT +16 L/min oxyhydrogen negative pressure inhalation volume (ONPIv)" can improve the performance of EDI + GPI + ONPI engine while reducing emission.

The Respiratory Rate, Age, and Mean Arterial Pressure (RAM) Index: A Novel Prognostic Tool to Predict Mortality among Adult Patients with Acute Heart Failure in the Emergency Department.

Background and Objectives: Acute heart failure (AHF) is a life-threatening condition frequently encountered in the emergency department (ED). Identifying reliable prognostic indicators for in-hospital mortality is crucial for risk stratification and the appropriate management of AHF patients. This study aimed to assess the most effective method for predicting in-hospital mortality among various physiological parameters in patients with AHF presenting to the ED. Additionally, the study evaluated the effectiveness of the RAM index-respiratory rate (RR), age, and mean arterial pressure (MAP)-derived from the shock index (SI) by replacing heart rate with RR, as a novel prognostic tool. This was compared with the SI and its other derivatives to predict in-hospital mortality in adult patients with AHF presenting to the ED. Materials and Methods: This is a retrospective study conducted in the ED of an urban medical center, enrolling adult patients with signs and symptoms of AHF, who met the epidemiological diagnosis criteria, between January 2017 and December 2021. Baseline physiological parameters, including the RR, heart rate, systolic blood pressure, and diastolic blood pressure, were recorded upon ED admission. The RAM index was calculated as the RR multiplied by the age divided by the MAP. Statistical analysis was performed, including univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: A total of 2333 patients were included in the study. A RAM index > 18.6 (area under ROC curve (AUROC): 0.81; 95% confidence interval (CI): 0.79-0.83) had a superior mortality discrimination ability compared to an SI > 0.77 (AUROC: 0.75; 95% CI: 0.72-0.77), modified shock index > 1.11 (AUROC: 0.75; 95% CI: 0.73-0.77), age shock index > 62.7 (AUROC: 0.74; 95% CI: 0.72-0.76), and age-modified shock index > 79.9 (AUROC: 0.75; 95% CI: 0.73-0.77). A RAM index > 18.6 demonstrated a 7.36-fold higher risk of in-hospital mortality with a sensitivity of 0.80, specificity of 0.68, and negative predictive value of 0.97. Conclusions: The RAM index is an effective tool to predict mortality in AHF patients presenting to the ED. Its superior performance compared to traditional SI-based parameters suggests that the RAM index can aid in risk stratification and the early identification of high-risk patients, facilitating timely and aggressive treatment strategies.

Validation of a Low-Cost Manometer to Assess of Tongue, Lip, Cheek, and Respiratory Strength: A Laboratory-Based Study.

The objective of this study was to characterize the level of agreement between three manometers: (1) Iowa Oral Performance Instrument (IOPI)-the reference standard for tongue, lip, and cheek strength assessments; (2) MicroRPM Respiratory Pressure Meter (MicroRPM)-the reference standard for respiratory strength assessments; and (3) Digital Pressure Manometer (DPM)-an alternative, low-cost pressure testing manometer. Manual pressures were simultaneously applied to the IOPI and DPM, and to the MicroRPM and DPM, within a controlled laboratory setting. Agreement in pressure readings were analyzed using descriptive statistics, Lin's concordance correlation, and Bland-Altman Plots. Agreement was interpreted as "poor" if ρc < 0.90, "moderate" if ρc = 0.90 - < 0.95, "substantial" if ρc = 0.95 - < 0.99, and "excellent" if ρc ≥ 0.99. Differences in pressure readings between the DPM and clinical reference standards were consistently present yet highly predictable. There was a median absolute difference of 2.0-3.9 kPa between the IOPI and DPM, and 4.5-9.8 cm H2O between the MicroRPM and DPM. Lin's concordance revealed "substantial" agreement between the IOPI and DPM (ρc = 0.98) and the MicroRPM and DPM (ρc = 0.99). The DPM revealed higher pressure readings when compared to the IOPI and MicroRPM. However, differences in pressure readings were relatively small, highly predictable, and yielded substantial overall agreement. These findings suggest the DPM may be a valid, lower-cost alternative for objective assessments of tongue, lip, cheek, and respiratory muscle strength. Future research should expand on the present findings in clinical patient populations. NA Laryngoscope, 2024.

Early menarche and respiratory muscle pressures in middle-aged and older women residents of Temuco - Chile

Early menarche and respiratory muscle pressures in middle-aged and older women residents of Temuco - Chile

Demographic and Asthma-Related Characteristics of Asthmatics Using Pressurized Metered Dose Inhalers and Dry Powder Inhalers.

Background: Asthma controller medications can be delivered via pressurized metered dose inhaler (pMDI) or dry powder inhaler (DPI) devices. Objective: This study aimed to evaluate the frequency of exacerbations and satisfaction rate with device use in asthmatics using pMDIs or DPIs. Methods: A multicenter, cross-sectional study was conducted in adults who used pMDIs or DPIs with correct inhaler technique and good adherence for asthma treatment. Demographic and asthma-related characteristics of the subjects and data regarding device satisfaction were collected through a face-to-face interview in the outpatient clinic. Rates of pMDI and DPI users and the data were compared between the two groups. Results: The study included 338 patients (mean age: 48.6 ± 14.5 years, 253 [74.9%] women). Among participants, 96 (28.4%) were using pMDI and 242 (71.6%) were using DPI. The age of patients using pMDI were significantly lower compared with DPI users. No significant difference was observed in terms of device satisfaction and clinical outcomes of asthma between pMDI and DPI users with good inhaler technique and good adherence. Conclusion: More asthmatics use DPIs, however, pMDIs are used in younger asthmatic patients. No significant difference in terms of device satisfaction and clinical outcomes of asthma was observed between pMDI and DPI users.

Effectiveness of simultaneous bilateral visual diaphragm biofeedback under low back pain: influence of age and sex.

Introduction: The aim of the present study was to determine the effectiveness of simultaneous bilateral visual diaphragm biofeedback (BFB) from ultrasonography in conjunction with inspiratory muscle training (IMT) on diaphragmatic thickness during normal breathing and respiratory and clinical outcomes in patients with non-specific low back pain (NSLBP) and determine the influence of age and sex. Methods: A single-blind randomized clinical trial was carried out (NCT04582812). A total sample of 96 patients with NSLBP was recruited and randomized by sex-based stratification into IMT (n = 48) and BFB + IMT (n = 48) interventions over 8weeks. Bilateral diaphragmatic thickness at maximum inspiration (Tins) and expiration (Texp), respiratory pressures, lung function, pain intensity, bilateral pressure pain threshold (PPT), disability, and quality of life were measured at baseline and after 8weeks. Results: The BFB + IMT group showed significant differences (p < 0.05) with increased left hemidiaphragm thickness at Tins and Tins-exp (d = 0.38-053), and right and left PPT (d = 0.71-0.74) versus the IMT group. The interaction with sex was statistically significant (p = 0.007; F(1,81) = 7.756; ηp 2 = 0.087) and higher left hemidiaphragm thickness at Tins was predicted by the BFB + IMT group (R 2 = 0.099; β = 0.050; F(1,82) = 8.997; p = 0.004) and male sex (R 2 = 0.079; β = 0.045; F(1,81) = 7.756;p = 0.007). Furthermore, greater left hemidiaphragm thickness at Tins-exp was predicted by younger age (R 2 = 0.052; β = -0.001; F(1,82) = 4.540; p = 0.036). Discussion: The simultaneous bilateral visual diaphragm biofeedback by ultrasonography in conjunction with IMT was effective in both increasing the left diaphragmatic thickness during inspiration, which was positively influenced and predicted by male sex and younger age, and increasing the bilateral PPT of the paraspinal muscles in patients with NSLBP.