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Kawaguchi A, Bernier G, Adler A, Emeriaud G, Jouvet PA. Incremental effect of non-invasive oscillating device on chest physiotherapy in critically ill children: a cross-over randomised trial. BMJ Open 2020; 10:e038648. [PMID: 33020101 PMCID: PMC7537431 DOI: 10.1136/bmjopen-2020-038648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Chest physiotherapy (CPT) and intrathoracic percussion ventilation have been recognised as to encourage dislodging the secretions; nonetheless, the tolerance to the procedure and its efficiency have not been proven to be sufficient. METHOD AND ANALYSES This study aims to examine the tolerance, feasibility and physiological effects in airway clearance by using a novel extrathoracic non-invasive oscillating transducer device (NIOD) in critically ill children. A two-stage cross-over randomised controlled study in a paediatric intensive care unit in a Canadian Academic Children's Hospital will be applied. Children under 24 months old, for whom CPT is prescribed for airway clearance, will be included. The study consists of two stages; (1) Stage 1 'Frequency Level': we will apply two different frequencies of the NIOD (40 Hz vs 60 Hz) for 12 min each, on each patient 3 hours apart, and (2) Stage 2 'NIOD versus CPT': we will implement NIOD and CPT alternatingly for 3 hours apart. The order of the procedures will be randomly allocated for each case. We will compare the average Δchanges of tidal lung volume measured by a 3D imaging system and regional lung functions using electrical impedance tomography, between the two different frequencies and between the NIOD periods and the CPT periods. We will also examine tolerance by seeing COMFORT Scales and related complications during the procedures. We estimate necessary sample size as 6 for each arm (Total 12 cases) for stage 1 and 48 cases for Stage 2, with power of 0.8 and alpha of 0.05. ETHICS AND DISSEMINATION This study has been approved by the Health Research Ethics Board of University of Montreal, Canada (REB number: 2020-2471). We will disseminate our findings through peer-reviewed publications and conference presentations in paediatric or/and critical care fields. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03821389).
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Affiliation(s)
- Atsushi Kawaguchi
- Pediatrics, University of Montreal, Montreal, Quebec, Canada
- Pediatrics, University of Ottawa, Children's Hospital Eastern Ontario, Ottawa, Ontario, Canada
| | - Gabrielle Bernier
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Andy Adler
- Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
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Wilson LM, Morrison L, Robinson KA. Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2019; 1:CD011231. [PMID: 30676656 PMCID: PMC6353051 DOI: 10.1002/14651858.cd011231.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cystic fibrosis is a life-limiting genetic condition in which thick mucus builds up in the lungs, leading to infections, inflammation, and eventually, deterioration in lung function. To clear their lungs of mucus, people with cystic fibrosis perform airway clearance techniques daily. There are various airway clearance techniques, which differ in terms of the need for assistance or equipment, and cost. OBJECTIVES To summarise the evidence from Cochrane Reviews on the effectiveness and safety of various airway clearance techniques in people with cystic fibrosis. METHODS For this overview, we included Cochrane Reviews of randomised or quasi-randomised controlled trials (including cross-over trials) that evaluated an airway clearance technique (conventional chest physiotherapy, positive expiratory pressure (PEP) therapy, high-pressure PEP therapy, active cycle of breathing techniques, autogenic drainage, airway oscillating devices, external high frequency chest compression devices and exercise) in people with cystic fibrosis.We searched the Cochrane Database of Systematic Reviews on 29 November 2018.Two review authors independently evaluated reviews for eligibility. One review author extracted data from included reviews and a second author checked the data for accuracy. Two review authors independently graded the quality of reviews using the ROBIS tool. We used the GRADE approach for assessing the overall strength of the evidence for each primary outcome (forced expiratory volume in one second (FEV1), individual preference and quality of life). MAIN RESULTS We included six Cochrane Reviews, one of which compared any type of chest physiotherapy with no chest physiotherapy or coughing alone and the remaining five reviews included head-to-head comparisons of different airway clearance techniques. All the reviews were considered to have a low risk of bias. However, the individual trials included in the reviews often did not report sufficient information to adequately assess risk of bias. Many trials did not sufficiently report on outcome measures and had a high risk of reporting bias.We are unable to draw definitive conclusions for comparisons of airway clearance techniques in terms of FEV1, except for reporting no difference between PEP therapy and oscillating devices after six months of treatment, mean difference -1.43% predicted (95% confidence interval -5.72 to 2.87); the quality of the body of evidence was graded as moderate. The quality of the body of evidence comparing different airway clearance techniques for other outcomes was either low or very low. AUTHORS' CONCLUSIONS There is little evidence to support the use of one airway clearance technique over another. People with cystic fibrosis should choose the airway clearance technique that best meets their needs, after considering comfort, convenience, flexibility, practicality, cost, or some other factor. More long-term, high-quality randomised controlled trials comparing airway clearance techniques among people with cystic fibrosis are needed.
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Affiliation(s)
- Lisa M Wilson
- Johns Hopkins UniversityEvidence‐based Practice CenterHampton House, 6th Floor624 North BroadwayBaltimoreMDUSA21205‐1901
| | - Lisa Morrison
- Queen Elizabeth University Hospital (The Southern General Hospital)West of Scotland Adult CF Unit1345 Govan RoadGlasgowUKG51 4TF
| | - Karen A Robinson
- Johns Hopkins UniversityDepartment of Medicine1830 E. Monument St., Suite 8068BaltimoreMDUSA21287
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Rocha G, Soares P, Gonçalves A, Silva AI, Almeida D, Figueiredo S, Pissarra S, Costa S, Soares H, Flôr-de-Lima F, Guimarães H. Respiratory Care for the Ventilated Neonate. Can Respir J 2018; 2018:7472964. [PMID: 30186538 PMCID: PMC6110042 DOI: 10.1155/2018/7472964] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
Invasive ventilation is often necessary for the treatment of newborn infants with respiratory insufficiency. The neonatal patient has unique physiological characteristics such as small airway caliber, few collateral airways, compliant chest wall, poor airway stability, and low functional residual capacity. Pathologies affecting the newborn's lung are also different from many others observed later in life. Several different ventilation modes and strategies are available to optimize mechanical ventilation and to prevent ventilator-induced lung injury. Important aspects to be considered in ventilating neonates include the use of correct sized endotracheal tube to minimize airway resistance and work of breathing, positioning of the patient, the nursing care, respiratory kinesiotherapy, sedation and analgesia, and infection prevention, namely, the ventilator-associated pneumonia and nosocomial infection, as well as prevention and treatment of complications such as air leaks and pulmonary hemorrhage. Aspects of ventilation in patients under ECMO (extracorporeal membrane oxygenation) and in palliative care are of increasing interest nowadays. Online pulmonary mechanics and function testing as well as capnography are becoming more commonly used. Echocardiography is now a routine in most neonatal units. Near infrared spectroscopy (NIRS) is an attractive tool potentially helping in preventing intraventricular hemorrhage and periventricular leukomalacia. Lung ultrasound is an emerging tool of diagnosis and can be of added value in helping monitoring the ventilated neonate. The aim of this scientific literature review is to address relevant aspects concerning the respiratory care and monitoring of the invasively ventilated newborn in order to help physicians to optimize the efficacy of care.
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Affiliation(s)
- Gustavo Rocha
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Paulo Soares
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Américo Gonçalves
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Ana Isabel Silva
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Diana Almeida
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Sara Figueiredo
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Susana Pissarra
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Costa
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Henrique Soares
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipa Flôr-de-Lima
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hercília Guimarães
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Goddard T, Andersen C, Tai A. Successful survival of an extreme premature infant with cystic fibrosis. BMJ Case Rep 2017; 2017:bcr-2016-218324. [PMID: 28062439 DOI: 10.1136/bcr-2016-218324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Extreme premature infants with cystic fibrosis typically do not survive the neonatal phase. This case report describes the youngest survivor of a premature infant with cystic fibrosis and highlights the importance of advanced neonatal care with cystic fibrosis therapy.
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Affiliation(s)
- Thomas Goddard
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Chad Andersen
- Department of Neonatology, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Andrew Tai
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
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S Gonçalves RA, Feitosa S, de Castro Selestrin C, Valenti VE, de Sousa FH, F Siqueira AA, Petenusso M, de Abreu LC. Evaluation of physiological parameters before and after respiratory physiotherapy in newborns with acute viral bronchiolitis. Int Arch Med 2014; 7:3. [PMID: 24401198 PMCID: PMC3897977 DOI: 10.1186/1755-7682-7-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 12/13/2013] [Indexed: 11/14/2022] Open
Abstract
Background Acute viral bronchiolitis is a respiratory disease with high morbidity that affects newborn in the first two years of life. Its treatment with physiotherapy has been highlighted as an important tool, however, there is no consensus regarding its effects on patients improvement. We aimed to evaluate the physiological parameters before and after the procedure respiratory therapy in newborn with acute viral bronchiolitis. Method This was a cross sectional observational study in 30 newborns with acute viral bronchiolitis and indicated for physiotherapy care in a hospitalized Urgency and Emergency Unit. It was collected the clinical data of newborn through evaluation form, and we measured heart rate (HR), oxygen saturation (SpO2) and respiratory rate (RR). We measured the variables before physiotherapy treatment, 3, 6 and 9 minutes after the physiotherapy treatment. Results There has been no change in HR, however, we observed a decrease in RR at 6 and 9 min compared to 3 min and increase in SpO2 at 3, 6 and 9 min compared to before physiotherapy. Conclusion Respiratory physiotherapy may be an effective therapy for the treatment of newborn with Acute Viral Bronchitis.
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Affiliation(s)
- Rodrigo A S Gonçalves
- Laboratório de Escrita Científica, Departamento de Morfologia e Fisiologia, Faculdade de Medicina do ABC, Av, Príncipe de Gales, 821, 09060-650 Santo André, SP, Brazil.
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What Does the Cochrane Collaboration Say about Respiratory Physiotherapy? Physiother Can 2013; 64:216. [PMID: 23450910 DOI: 10.3138/ptc.64.2.cochrane] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Protracted mechanical ventilation is associated with increased morbidity and mortality in preterm infants and thus the earliest possible weaning from mechanical ventilation is desirable. Weaning protocols may be helpful in achieving more rapid reduction in support. There is no clear consensus regarding the level of support at which an infant is ready for extubation. An improved ability to predict when a preterm infant has a high likelihood of successful extubation is highly desirable. In this article, available evidence is reviewed and reasonable evidence-based recommendations for expeditious weaning and extubation are provided.
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Affiliation(s)
- G M Sant'Anna
- McGill University Health Center, 2300 Tupper Street, Montreal, Québec, Canada, H3Z1L2
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de Abreu LC, Valenti VE, de Oliveira AG, Leone C, Siqueira AAF, Herreiro D, Wajnsztejn R, Manhabusque KV, Júnior HM, de Mello Monteiro CB, Fernandes LL, Saldiva PHN. Chest associated to motor physiotherapy improves cardiovascular variables in newborns with respiratory distress syndrome. Int Arch Med 2011; 4:37. [PMID: 22029840 PMCID: PMC3219586 DOI: 10.1186/1755-7682-4-37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 10/26/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We aimed to evaluate the effects of chest and motor physiotherapy treatment on hemodynamic variables in preterm newborns with respiratory distress syndrome. METHODS We evaluated heart rate (HR), respiratory rate (RR), systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP), temperature and oxygen saturation (SO2%) in 44 newborns with respiratory distress syndrome. We compared all variables between before physiotherapy treatment vs. after the last physiotherapy treatment. Newborns were treated during 11 days. Variables were measured 2 minutes before and 5 minutes after each physiotherapy treatment. We applied paired Student t test to compare variables between the two periods. RESULTS HR (148.5 ± 8.5 bpm vs. 137.1 ± 6.8 bpm - p < 0.001), SAP (72.3 ± 11.3 mmHg vs. 63.6 ± 6.7 mmHg - p = 0.001) and MAP (57.5 ± 12 mmHg vs. 47.7 ± 5.8 mmHg - p = 0.001) were significantly reduced after 11 days of physiotherapy treatment compared to before the first session. There were no significant changes regarding RR, temperature, DAP and SO2%. CONCLUSIONS Chest and motor physiotherapy improved cardiovascular parameters in respiratory distress syndrome newborns.
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Affiliation(s)
- Luiz Carlos de Abreu
- Departamento de Saúde Materno-infantil, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP. 01246-904, Brazil
- Laboratório de Escrita Científica. Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP. 09060-650, Brazil
| | - Vitor E Valenti
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo (USP), Av. Dr. Arnaldo, 455, São Paulo, SP. 01246903, Brazil
- Laboratório de Escrita Científica. Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP. 09060-650, Brazil
| | - Adriana G de Oliveira
- Departamento de Saúde Materno-infantil, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP. 01246-904, Brazil
| | - Claudio Leone
- Departamento de Saúde Materno-infantil, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP. 01246-904, Brazil
| | - Arnaldo AF Siqueira
- Departamento de Saúde Materno-infantil, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP. 01246-904, Brazil
| | - Dafne Herreiro
- Departamento de Saúde Materno-infantil, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP. 01246-904, Brazil
| | - Rubens Wajnsztejn
- Laboratório de Escrita Científica. Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP. 09060-650, Brazil
| | - Katia V Manhabusque
- Laboratório de Escrita Científica. Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP. 09060-650, Brazil
| | - Hugo Macedo Júnior
- Laboratório de Escrita Científica. Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP. 09060-650, Brazil
| | - Carlos B de Mello Monteiro
- Escola de Artes, Ciência e Humanidades da Universidade de São Paulo (USP), Rua Arlindo Béttio, 1000, São Paulo, SP. 03828-000, Brazil
| | - Laís L Fernandes
- Laboratório de Escrita Científica. Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP. 09060-650, Brazil
| | - Paulo HN Saldiva
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo (USP), Av. Dr. Arnaldo, 455, São Paulo, SP. 01246903, Brazil
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Lanza FDC, Kim AHK, Silva JL, Vasconcelos A, Tsopanoglou SP. A vibração torácica na fisioterapia respiratória de recém-nascidos causa dor? REVISTA PAULISTA DE PEDIATRIA 2010. [DOI: 10.1590/s0103-05822010000100003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Avaliar a dor em recém-nascidos pré-termo (RNPT) submetidos à fisioterapia respiratória em Unidade de Terapia Intensiva Neonatal. MÉTODOS: Estudo transversal realizado com recém-nascidos prematuros, com indicação de fisioterapia respiratória, em respiração espontânea. Foi aplicada uma técnica de vibração torácica com a mão do terapeuta realizando pequenas oscilações sobre o tórax do paciente e feita a avaliação da frequência cardíaca (FC), frequência respiratória (FR), saturação de pulso de oxigênio (SpO2) e do Sistema de Codificação da Atividade Facial Neonatal (NFCS) para a avaliação da dor antes, durante, imediatamente após (pós-i) e 30 minutos após (pós-30) a vibração no tórax do paciente. Utilizou-se a análise de variância para medidas repetidas para comparação entre as fases, considerando-se significante p<0,05. RESULTADOS: Foram avaliados 13 RNPT, com média de idade gestacional 32,5±2,0 semanas e peso de nascimento 1830±442g. Não foi observada pontuação de dor durante toda a avaliação: pré: 0,5±1,7; durante: 1,5±1,4; pós-i: 1,0±1,3; pós-30: 0±0,3, porém houve diferença estatisticamente significativa entre a fase pós-i e pós-30 na escala NFCS (p<0,05). A FC variou de 120 a 150bpm, a SpO2 permaneceu acima de 95%, e a FR entre 40 e 62rpm, sem diferenças entre os períodos. CONCLUSÕES: Neste grupo de pacientes prematuros internados em UTI neonatal e submetidos à realização de fisioterapia respiratória pela técnica de vibração torácica, não foram observadas alterações fisiológicas e comportamentais de dor
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