供稿：臺灣中國醫藥大學附屬醫院呼吸治療科朱家成主任
播音：臺灣中國醫藥大學附屬醫院劉金蓉老師
Welcome to the December 2016 Respiratory Care podcast. Once again, this is Dean Hess, editor of the Journal.
您好!歡迎來到2016年12月份呼吸照護期刊的網路播音。我是劉金蓉呼吸治療師，代表期刊主編Dean Hess博士進行中文網路播音，現在開始宣讀由Dean Hess博士為您精選的論文。
In our Editor’s Choice paper, Powell et al implemented a rapid cycle plan, do, study, act initiative to reduce unplanned extubations in the neonatal ICU. They found that staff underestimated the prevalence of unplanned extubation, but recognized the need for improvement. A rapid cycle plan significantly reduced the unplanned extubation rate. As stated by Hulse and Mai, this work adds to a growing number of studies demonstrating the success of individual NICUs in reducing unplanned extubations by applying quality improvement processes.
第1篇文摘是包威爾(Powell)等人在新生兒加護病房執行快速循環PDSA(計劃、做、研究及行動) 降低非計劃性拔管的成效分析。結果發現，工作人員低估了非計劃性拔管的普及性，快速循環PDSA可以明顯降低非計劃性拔管率。Hulse和Mai表示，本研究為越來越多的新生兒加護病房的品質改進研究再添一筆，從認知到需要改進的快速循環計劃，顯示成功地經由應用過程來減少非計劃性拔管成效。
Cockerham and colleagues report the results of a quality improvement project to improve timeliness between bronchodilator treatments when patients are moved from the emergency department to medical wards. They were able to significantly decrease the time between the last assessment and bronchodilator treatment in the ED and the first assessment and treatment in the medical ward for subjects with asthma. Improvement was seen in all studied parameters despite similar volumes in ED visits. As pointed out by Habib and Maselli, this study exemplifies how a problem was identified in the delivery of asthma care and strategies were initiated to address this problem.
第2篇文摘是Cockerham等人分析改善病人急診轉一般病房時支氣管擴張劑治療的及時性的品質改善計畫。結果顯示，此改善計畫能夠顯著縮短氣喘病人在急診室最後一次評估和支氣管擴張劑治療和在一般病房接受第一次評估和治療的時間。雖然肺容積與剛到急診室時相近，但在其它所有的研究參數都觀察到改善。正如Habib和Maselli指出的，這項研究說明了在氣喘照護的提供中如何識別問題，並且開始了解決這個問題的策略。
The objective of the study by Nyland and colleagues was to assess the effectiveness of a proactive respiratory protocol on an in-patient ward to identify trauma subjects at risk for pulmonary complications, administer appropriate therapies, and prevent deterioration requiring transfer to the ICU. The respiratory protocol was associated with an elimination of unplanned admissions to the ICU. After controlling for injury severity and other important clinical factors, the protocol significantly decreased hospital length of stay by approximately 1.5 days. More subjects were admitted from the ED directly to the ward, avoiding the ICU. Greiffenstein and Forrette observe that this respiratory protocol constituted a significant impact on respiratory care resource utilization.
第3篇文摘是Nyland等人評估主動呼吸協議在住院病房中辨識創傷病人處於肺部併發症的風險、給予適當的治療以及防止惡化造成需要轉送到加護病房的有效性。呼吸協議合併有減少非計畫性入住加護病房有關。在控制損傷嚴重程度和其他重要的臨床因素後，該協議可明顯減少住院時間約1.5天。讓更多由急診室的病人直接進入一般病房，避免入住加護病房。Greiffenstein和Forrette觀察到這種呼吸協議對呼吸治療資源利用產生了重大影響。
The purpose of the study by Poureslami et al was to evaluate understanding of physician instructions on asthma management and inhaler techniques in Punjabi and Chinese subjects using educational interventions in their native languages. The educational interventions developed were successful in behavioral modification, and beneficial beyond usual care in terms of improving proper use of inhalers and understanding of physician instructions. The findings can be translated to health education practice, promoting the development of short, simple, and culturally and linguistically appropriate learning materials for patients.
第4篇文摘是Poureslami等人評估醫師使用教育介入到他們的母語中來對旁使用遮普語和中文的病人教導氣喘管理和吸入器技術的理解度的研究。結果顯示所開發的教育介入在行為改變方面是成功的，並且在改善吸入器的正確使用和理解醫生教導方面的好處超越常規照護。研究結果可以轉化為健康教育實作，促進為病人開發簡短、簡單、具文化性和語言學的適當學習教材。
Wirth and colleagues hypothesized that, by using an active expiration assistance system, larger minute volumes could be generated without causing auto-PEEP, compared to conventional mechanical ventilation, when using small lumen tracheal tubes or a cricothyrotomy catheter. They found that an active expiration system could generate a reasonable minute volume via small lumen tubes or thin catheters.
第5篇文摘是Wirth等人研究使用主動呼氣輔助系統成效，研究假設，當使用小內徑氣管內管或環狀甲狀軟骨切開術導管時，與傳統機械通氣相比，可產生更大的每分鐘通氣量而不引起自發性吐氣末陽壓(auto-PEEP)。結果發現，主動呼氣系統可以通過小內徑氣管內管或薄導管產生合理的每分鐘通氣量。
The purpose of the study by Luedloff et al was to investigate the accuracy of displayed expiratory tidal volume in a ventilator commonly used in small infants, with or without a proximal flow sensor, and using three methods to achieve a target tidal volume in both a healthy and lung-injured neonatal pig model. They found that, when the Servo-i ventilator was used in neonates, circuit compliance compensation or the in-line sensor should be employed due to the large positive bias and imprecision seen with circuit compliance compensation off and no sensor in-line.
第6篇文摘是Luedloff等人利用豬模擬健康和肺損傷的新生兒研究近端流量傳感器的嬰兒呼吸器成效，他們使用三種方法來達到目標潮氣量，研究呼氣潮氣量顯示的準確性。結果發現，當新生兒使用Servo-i呼吸器時，應該採用呼吸管路順應性補償或線上傳感器，因為在呼吸管路順應性補償功能關閉和沒有使用線上傳感器的情況下，看到大的正偏差和不精確性。
The study by Gomes and colleagues compared the immediate effects of retrograde rhinopharyngeal clearance with nasopharyngeal aspiration in children admitted with acute viral bronchiolitis. The use of rhinopharyngeal clearance in the management of infants with acute viral bronchiolitis can be an alternative for the clearance of the upper airways, as it showed immediate positive results on the occurrence of complications and signs of respiratory effort compared with nasopharyngeal aspiration. Children classified with a moderate clinical score appeared to benefit most.
第7篇文摘是Gomes等人比較了逆行鼻咽清除術合併鼻咽抽在吸急性病毒性細支氣管炎患兒的立即效應。結果顯示，使用鼻咽清除在處置急性病毒性細支氣管炎的患兒是另一種上呼吸道清除的替代方案，因為它與鼻咽吸入相比顯示出對併發症發生和呼吸用力的徵象有立即正面結果。對於兒童被分類為中度臨床得分顯示最多受益。
Gruet and colleagues evaluated the 1-minute sit-to-stand test in adults with cystic fibrosis, and its relationships with cardiopulmonary exercise test, 6-minute walk test and quadriceps strength. They found that the sit-to-stand test could not be used as a replacement of cardiopulmonary exercise test to accurately assess peak exercise capacity in subjects with cystic fibrosis. The sit-to-stand test may have utility in detecting patients with cystic fibrosis who may exhibit a high level of oxygen desaturation during heavy exercise.
第8篇文摘是Gruet等人評估囊性纖維化成人的1分鐘坐立測試，與心肺運動試驗、6分鐘走路試驗和四頭肌強度的關係。結果發現，要精確評估囊性纖維化病人的運動能力最高值，坐立測試不能用於替代心肺運動測試。坐立測試可用於檢測患有囊性纖維化的病人，其在重度運動期間表現出高度的氧氣不飽和狀態。
A reduced forced vital capacity can increase the ratio between FEF25-75% and FVC, which is called high dysanapsis. Vilozni et al evaluated the relationship between dysanapsis and the cardiopulmonary response to exercise in children with congenital heart disease. They found that, in children and adolescents with corrected congenital heart disease, high dysanapsis was associated with a lower ventilatory capacity and reduced aerobic fitness.
第9篇文摘是Vilozni等人評估了先天性心臟病兒童在運動時的生長性脫序和心肺反應之間的關係，因為降低的用力肺活量能夠增加FEF25-75％與FVC之間的比率，此被稱為高生長性脫序。結果發現，在患有先天性心臟病矯正後的兒童和青少年中，高生長性脫序合併有較低的通氣能力和減少有氧健身。
The study by Raab et al investigated whether respiratory function was a discriminator of pneumonia in individuals with spinal cord injury, and to determine the best predictive parameter. They found that maximal inspiratory pressure was the best discriminator of spinal cord injured individuals with vs without pneumonia. Individuals with a maximal inspiratory pressure below threshold values are at risk of pneumonia.
第10篇文摘是Raab等人研究呼吸功能是否是脊髓損傷個體中肺炎的鑑別者，並確定最佳預測參數。結果發現，最大吸氣壓力是脊髓損傷個體有無肺炎的最佳鑑別者。最大吸氣壓力低於閾值的個體處於肺炎的危險中。
The purpose of the study by Kera and colleagues was to compare oral and physical characteristics in elderly people with and without a history of pneumonia. In community-dwelling elderly people, pneumonia was not associated with swallowing, but rather with skilled tongue control, which prompts a reexamination of what constitutes being at risk for pneumonia.
第11篇文摘是Kera等人研究老人的口腔和身體特徵與肺炎病史相關性。結果發現。社區老人，肺炎與吞嚥無關，而是與是否熟練的舌頭控制，這促使重新審查什麼構成了肺炎的風險。
Chen et al assessed upper airway configuration in obstructive sleep apnea syndrome using computed tomograpy imaging during Müller's maneuver. Subjects with severe OSA had more significant abnormalities of the upper airway. Obesity and gender should be taken into account when evaluating the abnormalities of upper airway anatomy in snorers and patients with OSA.
第12篇文摘是Chen等人研究在倒氣測試(Müller's maneuver)過程中使用電腦斷層成像來評估阻塞性睡眠呼吸中止綜合徵的上氣道結構。結果發現，嚴重阻塞性睡眠呼吸中止的受試者的上呼吸道異常較明顯。因此，評估打鼾和阻塞性睡眠呼吸中止病人的上氣道解剖異常時，應考慮肥胖和性別。
Tiwari presents a cross sectional study of slate pencil cutting workers to evaluate the effect on peak expiratory flow and the epidemiological factors associated with silica exposure. Peak expiratory flow was found to be significantly reduced in those ≥40 year-old, female, having duration of exposure >10 years, and having respiratory morbidity. The reduction in peak expiratory flow was not significant for smokers.
第13篇文摘是Tiwari等人評估石筆切割工人的呼氣流量尖峰值和二氧化矽暴露相關性的流行病學因素的影響。結果發現，大於等於40歲的女性、暴露時間大於10年，並且具有呼吸道發病率的情況下，發現呼氣尖峰流量顯著降低。在吸菸者，呼氣流量尖峰值的減少不顯著。
The study by Chino et al was conducted to determine the risk factors for post-bronchoscopy pneumothorax. Pneumothorax occurred significantly more frequently when bronchoscopy was performed for subinterlobular pleural lesions. Close attention and care should be taken during bronchoscopy when target lesions are abutting the interlobular pleura.
第14篇文摘是由Chino等人分析支氣管鏡檢查後氣胸的風險因素。結果發現，亞肺小葉間肋膜病變處進行支氣管鏡檢查時，氣胸顯著地頻繁發生。當目標病變鄰接肺小葉間肋膜時，在支氣管鏡檢查時應密切注意和小心。
This month we publish a New Horizons paper on newer pulse oximetry technology. We also publish reviews on respiratory management of perioperative obese patients, and spontaneous breathing trials with T-piece or pressure support ventilation.
本月份我們發表了一份關於新的脈搏血氧飽和度技術的新視野論文。我們還發表手術前後肥胖病人的呼吸處置評論和以T型管或壓力支持通氣的自然呼吸試驗。
以上是12月份的呼吸照護期刊的中文網播，由中國醫藥大學呼吸治療學系劉金蓉呼吸治療師翻譯與播音，朱家成呼吸治療師修稿與審稿。如想進一步了解原文內容或是過去議題，請上美國呼吸照護期刊網站，www.rcjournal.com，您也可以由網路訂閱，自動收到未來的網路廣播議題，謝謝您的參與，再見。