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Quintero OI, Chavarro PA, Martínez W, García C, Castro AM, Manzano-Nunez R, Ospina GA. Improvement in Lung Insufflation in Spontaneously Breathing Tracheostomized Patients by Using a New Pulmonary Expansion Device: A Pilot Study. J Med Device 2020. [DOI: 10.1115/1.4048801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Lung expansion techniques (LETs) are a key component of pulmonary rehabilitation. Nevertheless, these can be limited in tracheostomized patients because of the infraglottic position of tracheostomy cannulas. We propose a novel pulmonary expansion device (PED) that allows deep inspiration with a postinspiratory pause for a few seconds by means of a unidirectional valve and an occlusion/flow release cap. It is equipped with a relief valve that opens at 60 cm H2O in cases in which this threshold is attained. We aimed to evaluate the impact on lung volume and pressure in spontaneously breathing tracheostomized patients subjected to LETs. A single-arm pilot interventional study was conducted in an adult intensive care unit (ICU), including spontaneously breathing tracheostomized patients. 80 treatments were performed on 10 patients with tracheostomies with PED over a period of 3 months. The maximal inspiratory volume (MIV) was significantly increased by using PED (MIV-PED) at both day 1 (725 (600–820) mL versus 1550 (1250–1700) mL, P < 0.001) and day 3 (870 (750–950) mL versus 1662 (1550–1900) mL, P < 0.001). Inspiratory pause pressure (PIP-PED) did not significantly change from day 1 to day 3 (18 (14–20) cm H2O versus 14 (12–22) cm H2O, P = 0.36). The use of the PED in tracheostomy patients acted as an artificial glottis by performing a novel pulmonary re-expansion maneuver, and increased volumes and intrapulmonary pressure with prolongation of maximum inspiration were achieved.
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Affiliation(s)
- Oscar I. Quintero
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760026, Colombia
| | - Paola A. Chavarro
- Facultad de Salud, Escuela de Rehabilitación Humana, Universidad del Valle, Cali 760043, Colombia
| | - William Martínez
- Departamento de Neumología, Fundación Valle del Lili, Cali 760026, Colombia; Facultad de ciencias de la salud, Universidad Icesi, Cali 760031, Colombia
| | - Carlos García
- Departamento de Radiología, Fundación Valle del Lili, Cali 760026, Colombia
| | - Andrés M. Castro
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760026, Colombia
| | - Ramiro Manzano-Nunez
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760026, Colombia
| | - Gustavo A. Ospina
- Departamento de Cuidado Intensivo Adulto, Fundación Valle del Lili, Cali 760026, Colombia
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Lalmolda C, Prados H, Mateu G, Noray M, Pomares X, Luján M. Titration of Mechanical Insufflation-Exsufflation Optimal Pressure Combinations in Neuromuscular Diseases by Flow/Pressure Waveform Analysis. Arch Bronconeumol 2019; 55:246-251. [PMID: 30598235 DOI: 10.1016/j.arbres.2018.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/21/2018] [Accepted: 10/19/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to assess several air-pressure settings for MI-E to determine their effect on peak cough flow (PCF), and to compare the best pressures with those are more common used in the literature (±40cmH2O) in patients with neuromuscular disorders (NMD). METHODS Adults with NMD in whom MI-E was indicated were recruited. Assisted PCF was measured by an external pneumotachograph. The protocol included 9 PCF measures per patient: 1 baseline (non-assisted), 4 with increasing inspiratory pressures without negative pressure (10, 20, 30 and 40cmH2O or maximum tolerated), and then 4 adding expiratory pressures (-10, -20, -30 and -40cmH2O or maximum tolerated) with maximum inspiratory pressure previously achieved. RESULTS Twenty one patients were included, 61% with amyotrophic lateral sclerosis (ALS). Mean PCFs with recommended pressures (±40cmH2O) were lower than the scored in the individualized steps of the titration protocol (197.7±67l/min vs 214.2±60l/min, p<0.05). Regarding subgroups, mean PCFmax values in ALS patients with bulbar symptoms were significantly higher than those achieved with recommended pressures (163.6±80 vs 189±66l/min, p<0.05). CONCLUSION The PCFmax obtained with the protocol did not always match the recommended settings. It may be advisable to perform MI-E titration assessed by non-invasive PCF monitoring in patients with NMD, especially in ALS with bulbar involvement to improve the therapy detecting airway collapse induced by high pressures.
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Affiliation(s)
- Cristina Lalmolda
- Fundación Parc Tauli, Sabadell, Barcelona, Spain; Centro de Investigación Biomédica en Red, enfermedades respiratorias, CIBERES, Barcelona, Spain.
| | - Hector Prados
- Hospital Universitario Parc Tauli, Sabadell, Barcelona, Spain
| | - Georgina Mateu
- Hospital Universitario Parc Tauli, Sabadell, Barcelona, Spain
| | - Mariona Noray
- Hospital Universitario Parc Tauli, Sabadell, Barcelona, Spain
| | - Xavier Pomares
- Fundación Parc Tauli, Sabadell, Barcelona, Spain; Centro de Investigación Biomédica en Red, enfermedades respiratorias, CIBERES, Barcelona, Spain; Hospital Universitario Parc Tauli, Sabadell, Barcelona, Spain
| | - Manel Luján
- Fundación Parc Tauli, Sabadell, Barcelona, Spain; Centro de Investigación Biomédica en Red, enfermedades respiratorias, CIBERES, Barcelona, Spain; Hospital Universitario Parc Tauli, Sabadell, Barcelona, Spain
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İlker Akçam T, Kavurmacı Ö, Özdil A, Ergönül AG, Turhan K, Çakan A. Larinks ve akciğer maligniteli olgularda akciğer rezeksiyonu. EGE TIP DERGISI 2017. [DOI: 10.19161/etd.395206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Paz C, Suárez E, Parga O, Vence J. Glottis effects on the cough clearance process simulated with a CFD dynamic mesh and Eulerian wall film model. Comput Methods Biomech Biomed Engin 2017; 20:1326-1338. [PMID: 28782386 DOI: 10.1080/10255842.2017.1360872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this study, we have reproduced the cough clearance process with an Eulerian wall film model. The simulated domain is based on realistic geometry from the literature, which has been improved by adding the glottis and epiglottis. The vocal fold movement has been included due to the dynamic mesh method, considering different abduction and adduction angles and velocities. The proposed methodology captures the deformation of the flexible tissue, considers non-Newtonian properties for the mucus, and enables us to reproduce a single cough or a cough epoch. The cough efficiency (CE) has been used to quantify the overall performance of the cough, considering many different boundary conditions, for the analysis of the glottis effect. It was observed that a viscous shear force is the main mechanism in the cough clearance process, while the glottis closure time and the epiglottis position do not have a significant effect on the CE. The cough assistance devices improve the CE, and the enhancement rate grows logarithmically with the operating pressure. The cough can achieve an effective mucus clearance process, even with a fixed glottis. Nevertheless, the glottis closure substantially improves the CE results.
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Affiliation(s)
- Concepción Paz
- a School of Industrial Engineering , University of Vigo , Vigo , Spain.,b Biofluids Research Group , Galicia Sur Heath Research Institute (IIS Galicia Sur), SERGAS-UVIGO , Vigo , Spain
| | - Eduardo Suárez
- a School of Industrial Engineering , University of Vigo , Vigo , Spain.,b Biofluids Research Group , Galicia Sur Heath Research Institute (IIS Galicia Sur), SERGAS-UVIGO , Vigo , Spain
| | - Oscar Parga
- a School of Industrial Engineering , University of Vigo , Vigo , Spain
| | - Jesús Vence
- a School of Industrial Engineering , University of Vigo , Vigo , Spain
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Nozawa H, Shoji K, Uda K, Nakamura T, Kubota M, Ishiguro A, Miyairi I. Pertussis without apparent cough in a disabled girl with a tracheostomy. J Infect Chemother 2017. [PMID: 28623110 DOI: 10.1016/j.jiac.2017.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pertussis is characterized by intense, prolonged coughing in children often followed by a distinctive whooping sound on inspiration. However, the clinical manifestations and natural course of pertussis in disabled children are largely unknown. We experienced a case of pertussis in a disabled girl who had previously undergone a tracheostomy and laryngotracheal separation. She presented with increased tracheal secretions and required hospitalization but did not develop a cough. Pertussis was suspected from the sputum Gram stain, which revealed numerous, short gram-negative rods that did not grow on chocolate agar. A nucleic acid amplification test was positive for Bordetella pertussis and the patient improved on azithromycin. Pertussis may present without its cardinal symptoms in disabled children.
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Affiliation(s)
- Hisataka Nozawa
- Department of Postgraduate Education and Training, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Kazuhiro Uda
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Tomoo Nakamura
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Akira Ishiguro
- Department of Postgraduate Education and Training, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan.
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Kang SW, Choi WA, Won YH, Lee JW, Lee HY, Kim DJ. Clinical Implications of Assisted Peak Cough Flow Measured With an External Glottic Control Device for Tracheostomy Decannulation in Patients With Neuromuscular Diseases and Cervical Spinal Cord Injuries: A Pilot Study. Arch Phys Med Rehabil 2016; 97:1509-1514. [DOI: 10.1016/j.apmr.2016.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
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Abstract
PURPOSE To survey the use of invasive and noninvasive home mechanical ventilation (HMV) methods in South Korea from the perspective of physical medicine and rehabilitation (PM&R). MATERIALS AND METHODS For 413 users of HMV, retrospective reviews of PM&R interventions and survey of HMV methods employed from Mar 2000 to Dec 2009. RESULTS Of the 413 users, the majority of whom with progressive neuromuscular disorders (NMDs) (n=358), 284 patients initially used noninvasive mechanical ventilation (NIV), while 63 others who were using tracheostomy mechanical ventilation switched to NIV as part of their rehabilitation. The NMD patients began HMV at an earlier age (34.9±20.3 yrs), and used for longer (14.7±7.5) hours than patients with non-neuromuscular causes of respiratory impairment. CONCLUSION Noninvasive management was preferred over invasive ones, and transition to the former was a result of PM&R interventions.
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Affiliation(s)
- Dong Hyun Kim
- Department of Rehabilitation Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seong-Woong Kang
- Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromusular Disease, Yonsei University College of Medicine, Seoul, Korea.
| | - Won Ah Choi
- Department of Rehabilitation Medicine, Gangnam Severance Hospital and Rehabilitation Institute of Neuromusular Disease, Yonsei University College of Medicine, Seoul, Korea
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