{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T03:02:01Z","timestamp":1785898921112,"version":"3.56.0"},"reference-count":48,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The EzPAP Positive Airway Pressure System (EzPAP) is a noninvasive positive expiratory pressure (PEP) device designed to promote lung expansion. The aim of this study was to evaluate the effects of PEP on gas exchange. Secondary objectives included assessing the early effects of PEP on radiological atelectasis score (RAS), hemodynamics, and dyspnea. These outcomes were compared between spontaneously breathing subjects with and without tracheostomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This observational single-center study was conducted at a university hospital. Inclusion criteria were spontaneously breathing adult subjects with RAS \u2265 2 and a worsened P\n                      <jats:sub>\n                        aO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      \/F\n                      <jats:sub>\n                        IO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      . Exclusion criteria included life-threatening conditions, intracranial hypertension, hemodynamic instability, and pneumothorax. Gas-exchange, hemodynamic parameters, and dyspnea measured with the Respiratory Distress Observation Scale (RDOS) were assessed at 3 time points: T0 (before PEP), T1 (immediately after PEP), and T2 (2 h after PEP). RAS was assessed at T0 and 1-week post treatment (T3).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of 213 patients assessed for eligibility, 186 were excluded for various reasons, leaving 27 subjects (19 without and 8 with tracheostomy) enrolled in the study. The median [interquartile range] age was 65 [58\u201374] y, with 66.7% being male. In the overall sample and in subjects without tracheostomy, P\n                      <jats:sub>\n                        aO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      \/F\n                      <jats:sub>\n                        IO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      did not differ significantly between T1 and T0 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .52 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .54, respectively) or between T2 and T0 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .47 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .85, respectively). In subjects with tracheostomy, P\n                      <jats:sub>\n                        aO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      \/F\n                      <jats:sub>\n                        IO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      was higher at T1 compared to T0 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .039) but not between T2 and T0 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .58). Arterial P\n                      <jats:sub>\n                        aO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      and hemodynamic parameters remained unchanged in the overall cohort. The RAS improved within 1 week of treatment in the overall cohort (T3 vs T0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001) and in subjects without tracheostomy (T3 vs T0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .001). However, PEP therapy did not improve RDOS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In critically ill, spontaneously breathing subjects, PEP therapy significantly improved RAS without affecting hemodynamic stability or respiratory symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.12000","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T09:40:39Z","timestamp":1732009239000},"page":"233-242","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Effects of Positive Expiratory Pressure on Gas Exchange, Atelectasis, Hemodynamics, and Dyspnea in Spontaneously Breathing Critically Ill Subjects"],"prefix":"10.1177","volume":"70","author":[{"given":"Denise","family":"Masuello","sequence":"first","affiliation":[{"name":"Ms. Masuello is affiliated with Hospital General de Agudos D. F. Santojanni, Buenos Aires, Argentina; Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Universit\u00e0 degli Studi di Genova, Genova, Italy; and Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriano","family":"Servetti","sequence":"additional","affiliation":[{"name":"Drs. Servetti, Ball, Robba, Patroniti, and Battaglini are affiliated with Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Universit\u00e0 degli Studi di Genova, Genova, Italy; and Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Caiffa","sequence":"additional","affiliation":[{"name":"Mr. Caiffa, Mss. Cara and Chiara Pieri, and Dr. Brunetti are affiliated with Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robertina","family":"Cara","sequence":"additional","affiliation":[{"name":"Mr. Caiffa, Mss. Cara and Chiara Pieri, and Dr. Brunetti are affiliated with Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Pieri","sequence":"additional","affiliation":[{"name":"Mr. Caiffa, Mss. Cara and Chiara Pieri, and Dr. Brunetti are affiliated with Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Arriagada","sequence":"additional","affiliation":[{"name":"Mr. Arriagada is affiliated with Unidad de Paciente Cr\u00edtico Adulto, Hospital Las Higueras de Talcahuano, Chile."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lou\u2019i","family":"Al-Husinat","sequence":"additional","affiliation":[{"name":"Dr. Al-Husinat is affiliated with Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Ball","sequence":"additional","affiliation":[{"name":"Drs. Servetti, Ball, Robba, Patroniti, and Battaglini are affiliated with Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Universit\u00e0 degli Studi di Genova, Genova, Italy; and Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Robba","sequence":"additional","affiliation":[{"name":"Mr. Caiffa, Mss. Cara and Chiara Pieri, and Dr. Brunetti are affiliated with Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iole","family":"Brunetti","sequence":"additional","affiliation":[{"name":"Mr. Caiffa, Mss. Cara and Chiara Pieri, and Dr. Brunetti are affiliated with Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2","family":"Patroniti","sequence":"additional","affiliation":[{"name":"Drs. Servetti, Ball, Robba, Patroniti, and Battaglini are affiliated with Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Universit\u00e0 degli Studi di Genova, Genova, Italy; and Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Leme","family":"Silva","sequence":"additional","affiliation":[{"name":"Drs. Silva and Rocco are affiliated with Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia RM","family":"Rocco","sequence":"additional","affiliation":[{"name":"Drs. Silva and Rocco are affiliated with Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Battaglini","sequence":"additional","affiliation":[{"name":"Drs. Servetti, Ball, Robba, Patroniti, and Battaglini are affiliated with Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Universit\u00e0 degli Studi di Genova, Genova, Italy; and Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,3,3]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-05980-0"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-1744447"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-019-0565-0"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31827ca637"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2209083"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-2829"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/crj.12965"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2020.103529"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10102139"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.06812"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.10227"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.08150"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00101-012-2083-4"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/84.6.524"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.02668"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1080\/09593985.2018.1443185"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1377483"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"issue":"3","key":"e_1_3_4_20_2","first-page":"14","article-title":"World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects","volume":"81","author":"General Assembly of the World Medical Association","year":"2014","unstructured":"General Assembly of the World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Coll Dent. 2014; 81(3):14\u201318.","journal-title":"J Am Coll Dent"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01706199"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-024-07532-2"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1086\/677144"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc10135"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2010783"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2007.0090"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2018.10.506"},{"key":"e_1_3_4_28_2","unstructured":"Smiths Medical ASD Inc. Positive Airway Pressure System EzPAP. Available at: https:\/\/mms.mckesson.com\/product\/784338\/Smiths-Medical-ASD-Inc-23-0747. Accessed May 20 2024."},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14202263"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-024-07351-5"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2010.10.018"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.134.1.59"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-018-5413-4"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-017-1905-9"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.01870"},{"issue":"5","key":"e_1_3_4_36_2","first-page":"236","article-title":"Pulmonary atelectasis in anaesthesia and critical care","volume":"14","author":"Ray K","year":"2014","unstructured":"Ray K, , Bodenham A, , Paramasivam E. Pulmonary atelectasis in anaesthesia and critical care. Continuing Education in Anaesthesia Critical Care and Pain. 2014; 14(5):236\u2013245.","journal-title":"Continuing Education in Anaesthesia Critical Care and Pain"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19052982"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00010206"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24917"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/715434"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2017.08.010"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10877-023-01042-0"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc3877"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.2000.88.3.926"},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40635-020-00330-2"},{"key":"e_1_3_4_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2014.04.002"},{"key":"e_1_3_4_47_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-53152-y"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.03.012"},{"key":"e_1_3_4_49_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00466.2014"}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.4187\/respcare.12000","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.12000","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.12000","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:19:48Z","timestamp":1777616388000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.4187\/respcare.12000"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":48,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.4187\/respcare.12000"],"URL":"https:\/\/doi.org\/10.4187\/respcare.12000","relation":{},"ISSN":["1943-3654","1943-3654"],"issn-type":[{"value":"1943-3654","type":"print"},{"value":"1943-3654","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}