Benefits of osteopathic manipulative treatment for hospitalized elderly patients with pneumonia

While osteopathic manipulative treatment (OMT) is thought to be beneficial for patients with pneumonia, there have been few clinical trials--especially in the elderly. The authors' pilot study suggested that duration of intravenous antibiotic use and length of hospital stay were promising measures of outcome. Therefore, a larger randomized controlled study was conducted. Elderly patients hospitalized with acute pneumonia were recruited and randomly placed into two groups: 28 in the treatment group and 30 in the control group. The treatment group received a standardized OMT protocol, while the control group received a light touch protocol. There was no statistical difference between groups for age, sex, or simplified acute physiology scores. The treatment group had a significantly shorter duration of intravenous antibiotic treatment and a shorter hospital stay.

[The rehabilitation of patients with acute pneumonia in the convalescence phase by using balneotherapy procedures]

Effects of balneotherapy (underwater douche-massage, Gauffe baths, contrast douche) on clinical course of acute pneumonia (AP), external respiration function, cardiohemodynamics, surface activity of pulmonary surfactant, lipid peroxidation were studied in 88 AP convalescents. It was found that underwater douche-massage is indicated in prevailing hemodynamic disorders and moderate obstruction of the large bronchi. The efficacy of the douche was 93.8%. Gauffe baths were preferable (clinical response 88.9%) in marked bronchial obstruction with affection of all the bronchi but in satisfactory cardiovascular function. Contrast douche was not effective in AP convalescents (response--56.9%).

[The use of an aerosol of natural brine and of sinusoidal modulated currents in chronic pneumonias in children]

Inhalations of 1% natural brine in combination with SMC electrophoresis of 1% natural brine above the lesion proved to ensure good correction of the defense of respiratory tract mucosa and to prolong remission to 15-18 months. This method can be applied in sanatoria, in rehabilitation centers, in pulmonary disease departments.

Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study

OBJECTIVE

To investigate the efficacy of respiratory rehabilitation in preventing postoperative pulmonary complications (PPC) and to define which patients can benefit.

DESIGN

A randomized clinical trial.

SETTING

A public hospital.

PATIENTS

Eighty-one patients who had upper abdominal surgery were distributed into two homogeneous groups: control (n = 41) and rehabilitation (n = 40).

INTERVENTION

Breathing exercises in the rehabilitation group.

MAIN OUTCOME MEASURES

Preoperative and postoperative clinical evaluation, spirometry, arterial gasometry, and simple chest X-rays.

RESULTS

The incidence of PPC was 7.5% in the rehabilitation group and 19.5% in the control group; the control group also had more radiologic alterations (p = .01). Stratified PPC analysis did not reveal significant differences between groups. However, high- and moderate-risk patients in the rehabilitation group had fewer PPC. Multivariate analysis showed a greater PPC risk associated with pulmonary history (p = .02) and duration of surgery longer than 120 min (p = .03), while rehabilitation exerted a protective effect (p = .06). Significant postoperative decreases in pulmonary volumes and arterial gas values were recorded in both groups, without significant differences.

CONCLUSIONS

Respiratory rehabilitation protects against PPC and is more effective in moderate- and high-risk patients, but does not affect surgery-induced functional alterations.

[Rehabilitation of cystic fibrosis in adulthood]

By the example of 2 adult patients with cystic fibrosis (CF) problems of pulmonary manifestation of CF and its complications are discussed. In both patients disease manifested late. Life expectancy of CF-patients has markedly increased over the last decades. In the adult distinct complications appear more often such as exacerbation of bronchitis due to pseudomonas aeruginosa, colonisation of air ways by Burkholderia cepacia or by atypical mycobacteria, development of allergic bronchopulmonary aspergillosis, bronchiectases and spontaneous pneumothorax. Today, even in adults with chronic bronchitis of unknown origin the possibility of CF has to be considered. Optimized treatment under clinical conditions, in combination with a physical training program and a diet rich in calories will ameliorate subjective physical performance as well as objective pulmonary function and work capacity. Regular rehabilitation programs contribute to better compliance. In patients with CF direct transition from pediatric to pneumologic/internistic treatment for adults is mandatory in order to optimize expectancy and quality of life.

Bottle-blowing in hospital-treated patients with community-acquired pneumonia

A study was carried out to determine whether bottle-blowing has any positive effects in patients with pneumonia. In a prospective open study 145 adults with untreated community-acquired pneumonia requiring hospitalization were randomized to early mobilization (group A), to sit up and take 20 deep breaths on 10 occasions daily (group B), or to sit up and to blow bubbles in a bottle containing 10 cm water through a plastic tube 20 times on 10 occasions daily (group C). Peak expiratory flow (PEF), vital capacity (VC), forced expiratory volume in 1 sec (FEV1) and serum concentration of C-reactive protein (CRP) were determined on admission, and on days 4 and 42. Fever duration and hospital stay were recorded. In a subset of 16 patients, single breath diffusion capacity of carbon monoxide was measured on 3 occasions. The patients in group A were hospitalized for a mean of 5.3 days, group B for 4.6 days and group C for 3.9 days. Treatment was a significant factor (p = 0.037) in a Cox regression model, with group C significantly better than group A (p = 0.01). The number of days with fever was 2.3, 1.7 and 1.6 in groups A, B and C respectively. These differences were not significant (p = 0.28). No significant differences were found between the groups regarding CRP, PEF, VC, FEV1, or diffusion capacity. Intensive bottle-blowing shortens the hospital stay in patients with pneumonia. The underlying mechanism is not clear.

[Changes in the immunity indices of children suffering from inflammatory lung diseases undergoing cold exposures]

Cooling and heating the feet in children with pulmonary inflammatory diseases in remission improved immunity. Air baths in addition to stimulating immunity enhanced bactericidal potential of blood neutrophils. Cool and warm showers decreased this potential.

[The effect of cold exposure on the respiratory function in children suffering from inflammatory lung diseases]

Single total (air bath, douche) and local (cooling of the feet with water) exposure to mild cold do not arise noticeable disorders of the respiration function in children suffering from recurrent and asthmatic bronchitis in remission. Local cold procedures improve bronchial patency while the exposure to heat results in its worsening.

[Adaptational reactions in patients with acute pneumonia]

Adaptive reactions were studied in 80 patients with acute pneumonia. In the hospital 94.1% patients showed reactions of stress and incomplete reactions of training and activation. With improvement of the clinical condition the number of stress reactions reduces, while the number of physiological reactions of training and activation increased. The stress reaction is an unfavourable factor as to transition of acute pneumonia into chronic unspecific pulmonary diseases. These studies may be of value for evaluation of the prognosis and care of acute pneumonia.

[The use of sea mud in the combined therapy of patients with acute pneumonia at a hospital]

Basing on the observation on 246 patients with acute pneumonia, it is inferred that application of mud can be beneficial since the hospital treatment day 4-5. Compared to conventional, combined treatment with application of mud seems more favourable permitting more rapid attenuation of clinical symptoms and DIC syndrome, promoting active enzyme fibrinolysis and antithrombin-III, x-ray infiltration disappeared 4 days earlier, respiratory reserves and forced expiration grew.

[The rehabilitation of young patients with a history of acute pneumonia]

The author reports data on 1120 patients with acute pneumonia. Age of the patients varied from 19 to 23 years. Complex treatment resulted in 52.7% of patients in normalization of clinico-roentgenological, laboratory findings and ventilation capacity of the lungs while 30.3% retained asthenic syndrome within 2-3 weeks after discharge from the hospital, 17% showed moderate disorders of the ventilatory pulmonary function before discharge from the hospital. For normalization of pulmonary ventilation rehabilitation measures were carried in out-patient conditions from 3 to 10 months. Determination of spirographic rates and spirographic bicycle ergometry are valuable criteria in assessment of the functional rehabilitation of the above category of patients.

[Thermovibrotherapy in the combined rehabilitation of children with a history of acute pneumonia]

A clinical response and the effect on local bronchopulmonary immunity have been assessed for thermotherapy and vibrotherapeutics used in convalescent young children who had acute pneumonia. The clinical and immunological appearance of the children was found to improve due to combined rehabilitation measures involving thermovibrotherapy.