Respiratory Care Reports

High-flow nasal cannula (HFNC) is the most frequently used noninvasive respiratory support (NRS) modality for pediatric critical asthma and is often administered with continuous short-acting β-agonists. However, aerosol delivery is inversely related to flow, whereas higher HFNC flows can reduce work of breathing—complicating simultaneous optimization of drug delivery and support. Although infants may benefit from 1.5 to 2.0 L/kg/min, older children may benefit from lower flows (0.5–1.0 L/kg/min). In addition to flow, cannula and circuit caliber may influence delivery. This study quantified continuous aerosol delivery during HFNC across four cannula–circuit configurations at flows of 0.5–1.0 L/kg/min in a simulated pediatric model.

A pediatric manikin was connected to a lung simulator (V_T 150 mL, rate 28/min, I:E 1:2.4, PIF 22 L/min) via a collecting filter. Albuterol (15 mg/h) was nebulized via a vibrating mesh nebulizer placed upstream of a heated humidifier (37°C). Four cannula–circuit configurations were tested at 11 and 22 L/min (0.5–1.0 L/kg/min). Continuous nebulization ran 3 h per condition with hourly collections (three repeated measurements per condition). Albuterol was quantified by spectrophotometry. One-way ANOVA) with Holm–Sidak tests, one-way RM ANOVA, and multiple linear regression (flow, circuit, cannula, flow × circuit) were used.

Inhaled dose ranged 0.7–5.4% of nominal. Increasing flow from 0.5 to 1.0 L/kg/min reduced delivery by ∼50–60% across configurations. Adult circuits delivered 2–3 times higher inhaled dose than junior circuits at both flows (e.g., 5.2–5.4% vs 1.6–1.9% at 0.5 L/kg/min; 2.3–2.6% vs 0.7–0.9% at 1.0 L/kg/min, P < .001). Regression identified circuit type as the strongest independent predictor with a significant flow × circuit interaction; cannula-related differences were modest by comparison.

In this simulated pediatric model, inhaled dose during HFNC was driven primarily by the interaction between gas flow and circuit caliber, with cannula design contributing more modestly. At flows of 0.5 and 1.0 L/kg/min, adult-caliber circuits delivered approximately two- to threefold higher inhaled dose than junior circuits. Pairing an appropriately sized cannula with an adult-caliber circuit may result in substantially higher relative inhaled dose during HFNC therapy.

Individuals with asthma are disproportionately affected by depression relative to those without asthma. However, this relationship in those ≥65 years of age with asthma remains unclear. This study aims to determine the association between asthma and depression in individuals aged ≥65 receiving Medicare support.

A pooled cross-sectional analysis of Medicare Current Beneficiary Survey data examined the association between asthma and depression from 2018 to 2020. Depression was defined as a score of ≥10 from the Patient Health Questionnaire-9. Disease-related variables were recorded if the subject met Medicare claims criteria for the calendar year regardless of sufficient fee-for-service coverage. Adjusted regression models were developed to determine the association between prevalent asthma, comorbidities, gender, area deprivation index, and depression.

Among 31,064 individuals available for analysis, the weighted prevalence of depression in subjects with asthma was 38.6%. The adjusted regression model indicated that asthma was not independently associated with depression in this population (odds ratio (OR) = 1.18, 95% confidence interval (CI) [0.96–1.45]). Subjects with asthma and anxiety (OR = 1.11, 95% CI [1.06–1.16]), cardiovascular disease (OR = 1.24, 95% confidence interval (CI) [1.15–1.32]), or diabetes (OR = 1.30, 95% CI [1.24–1.36]) were more likely to report concomitant depression. Women ≥65 years of age with asthma had greater odds of reporting depression compared to men with asthma (OR = 1.09, 95% CI [1.06–1.12]).

Based on our findings, in older adults in the United States, asthma is not independently associated with greater odds of depression when compared to those without asthma.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative motor neuron disease. Due to its progressiveness, respiratory muscle weakness can lead to hypoventilation and subsequent sleep-disordered breathing (SDB).

The 2021 Healthcare Cost and Utilization Project (H-CUP) National Inpatient Sample (NIS) data were analyzed for this retrospective observational cohort study. Multinomial logistic regression was used to calculate the adjusted odds ratio, and chi-square was used to determine the significance (P ≤ .05) of the association between the variables and the primary outcome of mortality.

2273 patient encounters in 2021 were coded as having ALS; 201 (8.8%) also had an ICD-10 code for some form of SDB. Significant findings for the whole sample include a decrease in odds of mortality with a longer hospital length of stay, 0.71 (0.52 to 0.96); a decrease in odds of mortality for the East South Central hospital region, 0.38 (0.16 to 0.91); and an increase in mortality in those ≥ 50 years old, 3.76 (1.17 to 12.11). There was a significant association between having ALS and SDB overlap and experiencing lower inpatient mortality, especially in those who were receiving palliative care, had respiratory failure, and were ventilator-dependent. Primary reasons for hospital admission outside of the ALS diagnosis could be categorized into infectious conditions and respiratory-related complications.

A notable subset of the inpatients with ALS also presented with concomitant SDB. Those with overlap tended to have lower mortality rates, possibly due to the use of noninvasive respiratory support. Increased age, male gender, and being White were the primary characteristics of those with ALS. Ventilator dependence can prolong life, hospital region can impact patient outcomes, and utilization of palliative care services is on the rise. Respiratory failure continues to be a primary driver of hospitalization in those with ALS.

The rising demand for respiratory care practitioners creates a need for qualified faculty members to teach and mentor the next generation of respiratory therapists (RTs). Key personnel (Program Directors (PDs) and Directors of Clinical Education (DCEs)) turnover can adversely affect student outcomes and the sustainability of RT programming. Recruiting qualified faculty has proven challenging for some, if not most, RT programs. This study aimed to identify the characteristics of current key personnel (PD and DCE) in Commission on Accreditation for Respiratory Care (CoARC)-accredited Entry into Practice and Degree Advancement programs and the self-reported benefits of undertaking a role in RT education.

The study employed a cross-sectional survey research design using a 20-item electronic instrument. There were 11 demographic questions and nine questions that specifically inquired about the benefits and rewards of becoming and continuing to serve as key personnel. Two questions were open-ended. Associations between the key personnel role and sociodemographic variables were examined using the chi-square tests of independence and an alpha significance level of .05.

There were 294 usable survey responses (35.4% response rate). Key findings include that over half (51%) of respondents have less than 5 years of experience in their administrative role, 24% are currently pursuing an advanced degree, and over 80% receive education-focused professional development. PDs were more likely to report having earned a doctoral degree, more experience within the profession, a higher likelihood of having been promoted, and a higher salary. In contrast, the DCE role was more closely associated with currently pursuing an advanced degree and having completed the Key Personnel Academy through the CoARC. The highest reported benefit of becoming key personnel was the ability to impact the profession through educating future RTs.

PDs and DCEs have important distinctions. PDs often hold advanced credentials and receive higher compensation, whereas DCEs are earlier in their careers and are frequently pursuing degrees. Both share a strong motivation to educate future RTs. Sustaining respiratory care education will require institutional support for career development, along with attention to work–life balance to improve RT educator recruitment and retention.

Palliative care (PC) enhances quality of life for patients with serious illnesses, and respiratory therapists (RTs) are vital in supporting those patients. However, many RTs feel unprepared for engaging in PC due to limited training in their entry-to-practice education. The purpose of this study was to investigate the extent and quality of PC education within respiratory care (RC) programs in the United States.

This mixed-methods study employed an electronic survey and semi-structured interviews. The survey was sent to all RC program directors and gathered data on program demographics, the integration of PC into the curriculum, and the perceived quality and quantity of PC integration into the RC program. The interviews explored challenges and opportunities to integrate PC into the curriculum in greater detail.

Survey responses were received from 72 RC programs (17.4% response rate), representing all degree levels of entry-to-practice RC programs. Among these, only 45.1% considered the number of hours dedicated to PC to be adequate, while 55.8% rated the quality of the content as effective. Didactic coursework was the most reported method for incorporating PC content into the curriculum (94.2%), and the most cited barrier to incorporating PC into the RC program was limited curricular time (85.9%). Five RC program directors participated in the semi-structured interviews, resulting in four themes related to integrating PC content: resources, staff and program readiness, curriculum integration, and student impact.

There is a significant gap in PC education within RC programs. Time constraints remain the primary obstacle to broader integration, though gaining subject matter expertise is also a factor. Enhancing curriculum content across all program levels is essential to ensure RTs deliver patient-centered care for individuals with serious or life-limiting illnesses.

Bedside assessments of lung recruitability using the static pressure-volume (PV) curve are crucial in managing acute respiratory distress syndrome (ARDS). We hypothesized that quantitative recruitability indices, such as the hysteresis ratio (HR) and normalized maximal distance (NMD), are inherently influenced by the peak airway pressure used during the measurement maneuver.

We conducted a secondary analysis of data from 17 sheep with lavage-induced ARDS. Static PV curves were generated using the super-syringe method at peak airway pressures of 40 and 60 cm H₂O. HR and NMD were calculated and compared between the two pressure conditions using a two-tailed paired t-test.

Both indices were significantly higher at a peak pressure of 60 cm H₂O compared to 40 cm H₂O. The mean HR increased from 0.18 ± 0.05 at 40 cm H₂O to 0.22 ± 0.06 at 60 cm H₂O (P = .01). Similarly, the mean NMD increased significantly from 0.33 ± 0.08 at 40 cm H₂O to 0.39 ± 0.07 at 60 cm H₂O (P = .008).

Lung recruitability quantified by HR and NMD increased significantly when higher airway pressures were used during the assessment. Clinicians must cautiously interpret PV curve-based assessments, recognizing that assessments performed at lower pressures may underestimate the lung’s true recruitment potential.

Limited research exists regarding predictors of success on the National Board for Respiratory Care Therapist Multiple Choice (TMC) exam. This research examined whether 26 academic and nonacademic variables predicted first-attempt TMC passage of graduates from two Midwestern community colleges’ associate degree respiratory therapy programs.

A non-experimental, ex post facto research design was used to analyze data that included 254 graduates. Stepwise logistic regression identified variables significantly associated with first-attempt TMC success.

Grades in four courses (Pre-Program Biology Anatomy and Physiology, Pharmacology, Cardiovascular Physiology, and Pediatric/Neonatal Critical Care) were significantly associated with first-time TMC passage. A model including these four predictors correctly classified 91.9% of pass or fail outcomes.

This is the only study found that examined 26 independent variables as potential predictors of first-time TMC passage for associate degree respiratory therapy graduates. Identification of four course-level predictors provides opportunities for early academic monitoring, targeted remediation, and curriculum refinement to improve credentialing outcomes.

The respiratory care profession faces significant workforce shortages, exacerbated by increasing retirements, declining enrollment in respiratory therapy (RT) programs, and rising demand for RT services. To address these challenges effectively, organizations need to understand the factors that influence employer selection among senior respiratory care students and early-career RTs, enabling improved recruitment strategies.

A nationwide cross-sectional survey was conducted to identify factors influencing employer selection among RT students in the final year of their entry-to-practice programs and early-career RTs who graduated within the past 5 years. Respondents ranked their top five decision-making factors across three primary domains: employment preferences, shift preferences, and workplace preferences.

A total of 295 respondents (178 students and 117 RTs) were included. Salary was ranked as the most influential factor in employer selection across both groups. Among students, the next most important factors were autonomy, workplace environment, benefits, and schedule flexibility. For RTs, the order was work environment, autonomy, schedule flexibility, and benefits. Most respondents favored 12-hour day shifts, emphasizing the importance of work–life balance. Academic hospitals and trauma centers were identified as the most preferred workplace settings among RT students. More than 90% of respondents expressed interest in new graduate residency programs, with no significant differences across degree levels, age, or residential locations.

When selecting employers, senior RT students and early-career RTs prioritize competitive salaries, professional autonomy, flexible scheduling, comprehensive benefits, and initiatives that support work–life balance. Additionally, senior RT students expressed high interest in new graduate residency programs.

Post-COVID-19 fatigue is the most prevalent symptom among people who have overcome the disease, whether they were hospitalized or not. The aim was to analyze fatigue in subjects who had experienced COVID-19, with or without hospitalization, compared to their pre-infection status. We also sought to examine the relationship between descriptive characteristics of subjects and various holistic health indicators with the presence or absence of fatigue, as well as the fatigue severity.

A cross-sectional observational study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology guideline. Subjects were classified into 2 groups: hospitalized and non-hospitalized. Both groups were divided into 2 subgroups based on the absence or presence of fatigue: non-fatigue and fatigue. Descriptive characteristics, fatigue before versus after COVID-19, and holistic health indicators were measured. Correlation and regression analyses were conducted.

A total of 262 subjects were divided into hospitalized (n = 70) and non-hospitalized (n = 192) groups and non-fatigue and fatigue subgroups. Results showed increased fatigue after COVID-19 in both groups, with hospitalized subjects experiencing more fatigue (p < .001). Before COVID-19, neither group exceeds the cut-off point for fatigue, but after the disease, the hospitalized group surpassed it. Hospitalization and body mass index (BMI) emerged as key predictors of the presence of post-COVID-19 fatigue. In addition, post-COVID-19 fatigue was associated with poorer quality of life, health status, functionality, and physical activity, as well as greater frailty, anxiety, depression, and dysphagia. Functionality and frailty were the most relevant predictors of post-COVID-19 fatigue.

These findings underscore the need for personalized rehabilitation strategies that address both descriptive characteristics and holistic health indicators. However, further studies with larger sample sizes are recommended to validate and expand upon these results.

High-flow nasal cannula therapy has multiple proposed benefits, one of which is the clearance of exhaled CO₂ from the upper airway. The removal of exhaled CO₂ is made more difficult when the patient has a closed or partially closed mouth, as this removes or restricts the primary escape route for CO₂-laden exhaled flow. It is proposed that this increased flush difficulty could be partially alleviated by using a single-prong cannula design, therefore allowing exhaled flow to be evacuated out of the open naris.

Unsteady simulations were run to investigate the effect that the proposed single-prong high-flow therapy has on CO₂ flush at intermediate and high flush difficulty scenarios. Single- and dual-prong geometries were tested under identical conditions including simulated mouth opening, respiratory cycle, airway geometry, and therapy flow setting. Therapy flows tested with both cannula geometries ranged from 12 to 45 L/min. All data discussed in this study was collected from computational models.

The single-prong geometry resulted in less CO₂ inhalation when all other factors were equal. The distinction between cannula geometries grew as therapy flow was decreased and as the mouth opening was decreased. Pathlines, colored by residence time in the upper airway, were released from the trachea. The pathlines showed longer expiratory flow residence times in the airway for the dual-prong cannula, reinforcing the notion that that the single-prong cannula improves the efficiency of expiratory flow removal.

The results can be used to provide a framework for clinical studies investigating the potential benefits of single-prong cannulas. This would be particularly important in difficult-to-flush scenarios such as when the patient’s mouth is fully closed.

Respiratory therapy education includes both associate (AAS/AS) and baccalaureate (BS) degree programs. This dichotomy has created discussions about the potential benefits of academic progression for entry-level practice. Little empirical evidence exists comparing the critical-thinking abilities of participants from these different educational pathways. This study was undertaken to investigate whether differences in critical-thinking skills exist between participants nearing graduation from AS and BS respiratory therapy programs.

This cross-sectional study recruited respiratory therapy participants (1 month pre- to 3 months post-graduation) from associate and baccalaureate programs nationwide. Critical thinking was assessed using the Health Sciences Reasoning Test-Numeracy (HSRT-N). Independent samples t-tests compared HSRT-N scores between degree types, gender, and ethnicity, with statistical significance set at P ≤ .05.

A total of 184 participants (81 associate and 103 baccalaureate) completed the HSRT-N. No significant differences were found in any critical-thinking measure between associate and baccalaureate participants. Gender analysis showed borderline significance for numeracy (P = .05) with male participants scoring higher, though the sample had substantially more women (n = 150) than men (n = 34). Significant differences were observed between white and non-white participants in all measures except evaluation (P < .01), with white participants scoring higher.

Alignment between AS and BS programs in the teaching of critical-thinking skills is essential to ensure those skills are systematically developed and extended through academic progression. Both program types share responsibility for addressing the gaps identified in this study, particularly in the lower-performing domains of interpretation, evaluation, deduction, and numeracy. Future research should incorporate clinical performance measures and examine long-term development of critical-thinking skills throughout respiratory therapists’ careers.

Compassionate extubations (CEs) can be categorized as stressful clinical events that have potential to trigger a second victim response. The Second Victim Experience and Support Tool-Revised (SVEST-R) is a survey used by healthcare organizations to evaluate second victim experiences of their staff. The purpose of this study was to quantify the level of agreement among respiratory therapists (RTs) who participate in CEs resulting in the perception of being a second victim, as well as various desired forms of support.

The study employed a cross-sectional, non-experimental survey design. The SVEST-R was disseminated via an anonymous electronic survey posted to a private social media site for RTs. Data analysis included descriptive statistics for demographic variables, exploratory factor analysis, measures of reliability for the SVEST-R instrument, and comparison of responses across demographic variables.

There were 146 survey responses. The majority of respondents were female (92%), between the ages of 25–40 (49%), had between 11 and 20 years of RT experience (27%), and practiced primarily in adult critical care (87%). Up to 51.4% of the sample reported that physical distress had occurred due to participation in CEs. The majority of respondents (80.8%) agree that colleague support is present. There was general agreement that supervisor (>60%) and organization (>50%) support are present. Perception of professional self-efficacy was preserved, and resilience remained high for the majority of RTs in this sample. There was general disagreement that involvement in CEs resulted in absenteeism from work or turnover intentions. The most frequently desired form of support was a peaceful location to recover and recompose after the event (85.8%).

RTs experience marginal yet meaningful distress as a result of participating in CEs. Respondents desire more opportunities to exist in terms of institutional support. Participating in CEs rarely impacts perceptions of self-efficacy. Respondents identify as resilient and feel the experiences with CEs have promoted professional growth.

Continuous monitoring of breathing frequency ( f ), tidal volume ( V T ), and flow parameters is essential in intensive care units (ICUs) for detecting early respiratory deterioration. In spontaneously breathing ICU patients, these parameters are difficult to measure continuously because spirometry requires cooperation and interrupts care. Non-contact depth-based sensing may offer a practical and real-time alternative for bedside respiratory monitoring.

This prospective study evaluated the accuracy of a Kinect Azure–based RGB-D camera system (3DRespiView) designed for automated and non-invasive respiratory monitoring in an ICU-oriented configuration. Healthy adult volunteers underwent simultaneous recordings with a spirometer (reference) and the 3DRespiView system. Each participant completed three 30-second sessions of spontaneous breathing in the supine position. The system automatically detected the thorax, quantified 3D surface displacement, and extracted respiratory parameters including V T , f , inspiratory time ( T i ), expiratory time ( T e ), and peak inspiratory and expiratory flows (PIF/PEF). Agreement was assessed using Bland–Altman analysis, correlation coefficients, mean absolute error (MAE), and root mean square error (RMSE).

Eight participants completed 24 paired recordings. 3DRespiView demonstrated high accuracy across all parameters. For V T , the Bland–Altman bias was 24.1 mL with limits of agreement −17.7 to +66.0 mL; MAE was 26 mL (3.5%) and RMSE 33 mL (4.9%), with a strong correlation (R² = 0.99). Breathing frequency ( f ) showed perfect agreement with spirometry (MAE = 0%, R² = 1), and T i and T e showed MAEs of 0.10 s (5.2%) and 0.09 s (4.1%), respectively. PIF and PEF showed MAEs of 21 mL/s (3.6%) and 28 mL/s (5.6%), with correlations ranging from R² = 0.93 to 0.98. Volume–time waveform comparison showed close temporal alignment between modalities.

3DRespiView demonstrates the potential for accurate, automated, and real-time estimation of respiratory parameters using a non-contact 3D camera. These findings support the technical validity of the approach and highlight its future potential for continuous bedside respiratory monitoring in the ICU.