Background: Exercise-induced bronchoconstriction (EIB) is common in children with asthma, but whether it is a phenomenon of central versus peripheral airway reactivity is unknown. The purpose of this study was to investigate central and peripheral airway responses after an exercise challenge test among children with asthma. Methods: Sixteen children with asthma underwent exercise challenge testing on 2 separate visits: one without any medications (control) and another with pretreatment with 180 µg albuterol (bronchodilator). Central airway EIB was defined as a >10% reduction in FEV1 after exercise assessed with spirometry. Peripheral airway EIB was assessed as a >40% increase in resistance between 5 Hz and 20 Hz with impulse oscillometry. Spirometry and impulse oscillometry were measured before the condition and periodically for up to 30 min after exercise. Results: Three of 16 children (19%) experienced only central airway EIB. Ten of 16 children (62%), including all 3 who experienced

BACKGROUND: A lung-protective mechanical ventilation strategy has become the hallmark of ventilation management for patients with acute respiratory failure. However, some patients progress to more severe forms of acute respiratory failure with refractory hypoxemia. In such circumstances, individualized titration of mechanical ventilation according to the patient’s specific respiratory and cardiovascular pathophysiology is desirable. A lung rescue team (LRT) was recently established at our institution to improve the medical care of patients with acute respiratory failure when conventional treatment fails. The aim of this report is to describe the consultation processes, the cardiopulmonary assessment, and the procedures of the LRT. METHODS: This was a retrospective review of the LRT management of patients with acute respiratory failure and refractory hypoxemia at Massachusetts General Hospital in Boston, Massachusetts. The LRT is composed of a critical care physician, the ICU respirator

Background: There has been a push toward degree advancement throughout respiratory care (RC), with many academic institutions creating graduate-level programs. However, many practitioners are apprehensive about advancing their degrees past the entry-into-practice level. Little research exists regarding the benefits of a graduate-level degree in RC. Methods: A web-based survey was developed to identify the perceived benefits of completing a master’s of science in RC (MSRC) program. Graduates from 7 MSRC programs were asked to identify how efficacious the program was in preparing them for new or expanded roles, what types of financial support were received, whether there exists a financial benefit to obtain the degree, and whether the degree supported professional advancement. Two hundred ninety-nine graduates were invited to complete the anonymous web-based survey. One hundred one surveys were initiated, and 98 (32.8%) responses were analyzed. Results: Seventy-two percent of respondents

BACKGROUND: ARDS remains a source of significant morbidity and mortality in the critically ill patient. The mainstay of therapy entails invasive mechanical ventilation utilizing a lung-protective strategy designed to limit lung injury associated with excessive stress and strain while the underlying etiology of respiratory failure is identified and treated. Less is understood about what to do once conventional ventilation parameters have been optimized but the patient’s respiratory status remains unchanged or worsens. In 2015, a protocolized, stepwise approach to mechanical ventilation with partially automated and clearly defined thresholds for management changes was implemented at our institution. We hypothesized that, by identifying appropriate patients earlier, time-to-escalation and rescue therapy implementation would be shortened. METHODS: Subjects with severe ARDS, treated with prone positioning based on our institution’s protocolized approach from December 2013 to August 2016 wer

Background: Personalized education and treatment selection can improve health behaviors and outcomes in patients with COPD. However, many patients with COPD have incomplete knowledge of their disease, which leads to undertreated symptoms. We hypothesized that an interdisciplinary care approach to COPD with respiratory therapists (RTs) integrated in our dedicated clinic will significantly affect care as measured by COPD Assessment Test (CAT) scores, exacerbation rates, and COPD-related hospitalizations. Methods: This study was a retrospective analysis of patients enrolled in the UC Davis Comprehensive COPD Clinic registry. Between January 2018–January 2020, 241 patients were seen. Patients screened (n = 101) had been followed 12 months post initial COPD clinic visit. Two subjects were excluded from analysis due to discrepancies in CAT assessments, leaving 99 subjects in total. The clinic RT provided assessment, education, and treatment recommendations. We collected CAT scores, exacerbat

Respiratory Care