STOP-BANG: a Mandatory Tool for Targeted Respiratory Therapy in Bariatric Patients

Identification of patients with obstructive sleep apnea syndrome and high respiratory risk, optimization of the screening algorithm for these patients and administration of preventive non-invasive lung ventilation, makes it possible to prevent the development of perioperative complications, reduce duration of hospital stay and reduce mortality in patients undergoing surgery and bariatric surgery specifically.The objective: to evaluate the effectiveness of STOP-BANG questionnaire for preventive targeted respiratory therapy to reduce the risk of complications in bariatric patients. Subjects and Methods. We examined 60 patients with BMI above 30 kg/m2 referred to elective secondary surgery, the age made 44.2 ± 10.1 years, 23 men and 37 women. Before the operation, patients underwent STOP-BANG questionnaire survey, night respiratory monitoring with the calculation of the apnea/hypopnea index (AHI) and/or saturation during sleep. The standard preoperative examination included clinical and biochemical analyzes.Results. Based on results of STOP-BANG survey, a correlation was revealed between the score and AHI as well as the score and average saturation. The higher score the patients had according to the STOP-BANG questionnaire, the higher AHI was (r = 0.4748, p = 0.002), and the lower mean SpO2 was (r = -0.6958, p < 0.001). Using the ROC analysis, we chose the optimal threshold value - 4 points according to STOP-BANG questionnaire, where the sensitivity of the method was 93% for the AHI, the specificity was 56%, and for the average saturation it was 100% and 63%, respectively. Of the total number of bariatric patients included in the study, 30% required preventive ventilation. In the high respiratory risk group, no significant intraoperative incidents and deaths were reported by the surgical and anesthetic teams. All patients were discharged on time (5‒7 days). Based on the results, a screening procedure has been offered for bariatric patients with high respiratory risk associated with obstructive sleep apnea syndrome.Conclusion. The STOP-BANG questionnaire is a reliable screening tool for high respiratory risk in morbid obese patients. Early diagnosis of high respiratory risk and implementation of preventive ventilation reduces the incidence of perioperative respiratory and cardiovascular complications.

STATE OF THE PROBLEM OF ORGANIZATION OF RESPIRATORY CARE FOR NEWBORN CHILDREN IN TODAY’S RUSSIA: SURVEY RESULTS OF A OF NEONATOLOGISTS AND INTENSIVE CARE SPECIALISTS

Objective of the study: to study the current situation regarding the introduction of modern methods of respiratory therapy in neonatal practice in the Russian Federation, on the basis of the results of the questionnaire, and to assess the dynamics of changes from 2013 to 2021. Materials and methods of research: the article analyzes the results of the survey of neonatologists and anesthesiologistsresuscitators from 163 settlements in 81 regions of the Russian Federation on various issues of providing respiratory care to newborns for the period from January 18, 2021 to May 7, 2021. The questionnaire included 82 question. Results: 489 Russian specialists took part in the survey. More than 90% of respondents were trained in respiratory therapy, most of whom worked in level 2 medical organizations (191 doctors) and level 3a perinatal centers (192 doctors). The main changes in respiratory therapy over the past 9 years have been mainly work in the delivery room: the proportion of doctors (from 9,4% to 54,7%) increased statistically significantly (p<0,001) (from 9,4% to 54,7%) who, according to indications, used CPAP as a starting method of respiratory therapy in premature infants at birth, oxygen mixers were used statistically significantly (p<0,001) (from 44,2% to 62,5%), statistically significant (p<0.001) increased the proportion of doctors (from 46,3% to 92, 1%) who performed the first administration of surfactant in the delivery room, introduced new respiratory strategies, 57% of doctors refused from «prolonged lung inflation» in the delivery room. Conclusion: a survey of specialists from almost all regions of the Russian Federation made it possible to obtain a clear picture of the problem of respiratory care for newborn children. The material obtained objectively demonstrated the evolution in the development and implementation of the most modern neonatal respiratory strategies in the Russian Federation over the past decade.

Seeking Inspiration: Examining the Validity and Reliability of a New Smartphone Respiratory Therapy Exergame App

Background: Clinically valid and reliable simulated inspiratory sounds were required for the development and evaluation of a new therapeutic respiratory exergame application (i.e., QUT Inspire). This smartphone application virtualises incentive spirometry, a longstanding respiratory therapy technique. Objectives: Inspiratory flows were simulated using a 3 litre calibration syringe and validated using clinical reference devices. Syringe flow nozzles of decreasing diameter were applied to model the influence of mouth shape on audible sound levels generated. Methods: A library of calibrated audio inspiratory sounds was created to determine the reliability and range of inspiratory sound detection at increasing distances separating the sound source and smartphones running the app. Results: Simulated inspiratory sounds were reliably detected by the new application at higher air inflows (high, medium), using smaller mouth diameters (<25 mm) and where smartphones were held proximal (< = 5 cm) to the mouth (or at distances up to 50 cm for higher airflows). Performance was comparable for popular smartphone types and using different phone orientations (i.e., held horizontally, at 45° or 90°). Conclusions: These observations inform future application refinements, including prompts to reduce mouth diameter, increase inspiratory flow and maintain proximity to the phone to optimise sound detection. This library of calibrated inspiratory sounds offers reproducible non-human reference data suitable for development, evaluation and regression testing of a therapeutic respiratory exergame application for smartphones.

Acceptability of Capnography Assisted Respiratory Therapy (CART): a new mind-body intervention for chronic obstructive pulmonary disease

Dyspnea self-management is often suboptimal for patients with chronic obstructive pulmonary disease (COPD). Many patients with COPD experience chronic dyspnea as distressing and disabling, especially during physical activities. Breathing therapy is a behavioral intervention that targets reducing the distress and impact of dyspnea on exertion in daily living.Using a qualitative design, we conducted interviews with 14 patients after they participated in a novel mind-body breathing therapy intervention adjunct, capnography-assisted respiratory therapy (CART), combined with outpatient pulmonary rehabilitation. Comprehensive CART consisted of patient-centered biofeedback, tailored breathing exercises, home exercise program, and motivational interviewing counseling. We assessed participants’ perceptions and reported experiences to gauge the acceptability of CART and refine CART based on feedback. Constant comparative analysis was used to identify commonalities and themes.We identified three main themes relating to the acceptability and reported benefits of CART: (1) Self-regulating breathing; (2) Impact on health; and (3) Patient satisfaction. Our findings were used to refine and optimise CART (i.e., its intensity, timing, and format) for COPD. By addressing dysfunctional breathing behaviors and dysregulated interoception, CART offers a promising new paradigm for relieving dyspnea and related anxiety in patients with COPD.

Weak evidence, supplemented with common sense for reduction in postoperative pulmonary complications

A clinical decision report appraising: Kaminski PN, Forgiarini LA, Jr., Andrade CF. Early respiratory therapy reduces postoperative atelectasis in children undergoing lung resection. Respir Care. 2013;58(5):805-809. https://doi.org/10.4187/respcare.01870 for prevention of postoperative pulmonary complications following thoracic surgery for a patient who is not able to participate in incentive spirometry.