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Rashed SS, Okeel FM, Yousef AM, Kamel KM, Osman DA. Effect of adding diaphragmatic breathing to corrective exercises on kyphotic angle and diaphragmatic excursion in postmenopausal kyphotic women: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2100. [PMID: 38821882 DOI: 10.1002/pri.2100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/07/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Age-related thoracic kyphosis can impair posture, diaphragmatic excursion, respiratory function, and overall quality of life (QoL). PURPOSE This randomized controlled trial aimed to compare the effects of corrective exercises alone versus combined with diaphragmatic breathing exercises on thoracic kyphosis, diaphragmatic excursion, thoracic pain, and QoL in postmenopausal kyphotic women. METHODS Forty postmenopausal women diagnosed with thoracic kyphosis were randomly divided into two groups. Group A received corrective exercises for 12 weeks (n = 20), while Group B received both diaphragmatic breathing exercises and corrective exercises for the same duration (n = 20). Primary outcome measures were thoracic kyphosis angle and diaphragmatic excursion, while secondary outcome measures were thoracic pain and QoL. Both groups were assessed pre- and post-intervention using a flexible curve ruler for the thoracic kyphosis angle, ultrasonography for the diaphragmatic excursion, the visual analog scale for thoracic pain, and the Arabic version of the QoL Questionnaire of the European Foundation for Osteoporosis for QoL. RESULTS Both groups showed significant within-group improvements in all measures post-intervention (p < 0.05). Between-group comparisons post-intervention revealed no significant differences (p > 0.05) except for diaphragmatic excursion, where Group B showed significantly greater improvement (p < 0.05). CONCLUSIONS A 12-week program of corrective exercises alone or combined with diaphragmatic breathing exercises significantly improved kyphosis angle, thoracic pain, and QoL in postmenopausal kyphotic women. The addition of diaphragmatic breathing exercises provided further benefits by increasing diaphragmatic excursion to a greater degree compared with corrective exercises alone.
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Affiliation(s)
| | - Fahema M Okeel
- Department of Physical Therapy for Women's Health, Cairo University, Giza, Egypt
| | - Amel M Yousef
- Department of Physical Therapy for Women's Health, Cairo University, Giza, Egypt
| | - Khaled M Kamel
- Department of Chest Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa A Osman
- Department of Physical Therapy for Women's Health, Cairo University, Giza, Egypt
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Silva HVC, Lunardi AC, Pinto ACPN, de Macedo JRFF, dos Santos EDC. Is Incentive Spirometry Superior to Standard Care in Postoperative Cardiac Surgery on Clinical Outcomes and Length of Hospital and Intensive Care Unit Stay? A Systematic Review with Meta-Analysis. Braz J Cardiovasc Surg 2024; 39:e20220319. [PMID: 38629953 PMCID: PMC11020284 DOI: 10.21470/1678-9741-2022-0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/16/2023] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Cardiac surgery is a frequent surgical procedure and may present a high risk of complications. Among the prophylactic strategies studied to decrease the rates of negative outcomes, respiratory care seems to reduce pulmonary complications. Incentive spirometry (IS) is a low-cost, respiratory exercise technique, used for the prevention and treatment of postoperative pulmonary complications (PPC). The aim of this review was to evaluate whether IS is superior to respiratory care, mobilization exercises, and noninvasive ventilation on PPC, and clinical outcomes. METHODS Systematic review. Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase®, Cochrane Central Register of Controlled Trials (or CENTRAL), Physiotherapy Evidence Database (or PEDro), Cumulative Index of Nursing and Allied Health (or CINAHL®), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Allied, Scopus®, and OpenGrey databases, clinical trial registration sites, conferences, congresses, and symposiums were searched. RESULTS Twenty-one randomized trials and one quasi-randomized trial (1,677 participants) were included. For partial pressure of oxygen (PaO2), IS was inferior to respiratory care (mean difference [MD] -4.48; 95% confidence interval [CI] -8.32 to -0.63). Flow-oriented IS was inferior to respiratory care on PaO2 (MD -4.53; 95% CI -8.88 to -0.18). However, compared to respiratory care, flow-oriented IS was superior on recovery vital capacity. CONCLUSIONS This meta-analysis revealed that IS was not superior to standard respiratory care for PPCs and clinical outcomes, therefore its use should not be widely recommended until further studies with high quality be performed to ensure this clinical guidance.
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Affiliation(s)
| | - Adriana Claudia Lunardi
- Programa de Pós-Graduação Stricto Sensu em
Fisioterapia, Universidade Cidade de São Paulo, São Paulo, São
Paulo, Brazil
- Department of Physical Therapy, Escola de Medicina, Universidade de
São Paulo, São Paulo, São Paulo, Brazil
| | - Ana Carolina Pereira Nunes Pinto
- Department of Biological and Health Sciences, Universidade Federal
do Amapá, Macapá, Amapá, Brazil
- Department of Physical Therapy, University of Pittsburgh,
Pennsylvania, United States of America
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Ghoniem NG, Abd-Allah ES, Said AM, El-Fattah FMAA. Pulmonary function and complication prevention: A randomized controlled trial on lung expansion modalities of older adults undergoing upper abdominal surgery. Geriatr Nurs 2023; 50:165-173. [PMID: 36780714 DOI: 10.1016/j.gerinurse.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 02/13/2023]
Abstract
Postoperative pulmonary complications (PPCs) are a major catastrophic consequence of upper abdominal surgery, resulting in morbidity and mortality. Therefore, the study aims to assess the effect of lung expansion modalities (LEMs) on older adults' pulmonary function and the incidence of pulmonary complications. The study randomly allocated 80 older adults (40 cases and 40 controls). Pulmonary function testing revealed a significant improvement in the study group's forced expiratory volume in one second, sixth second, and oxygen saturation on the fifth postoperative day (POD) compared to the first day [55.23%, 38.41%, and 2.87%; P0.001]. The reported PPCs incidence of the intervention group was less than the control group (15% and 30% on the third POD; 15% and 37.5% on the fifth POD). In conclusion, LEMs provide practical enhancement for the postoperative care of older adults by reducing PPCs by restoring measured pulmonary volumes.
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Affiliation(s)
- Noha Gamal Ghoniem
- Department of Gerontological Nursing, Faculty of Nursing, Zagazig University, 44519, Egypt.
| | - Eman Shokry Abd-Allah
- Department of Gerontological Nursing, Faculty of Nursing, Zagazig University, 44519, Egypt
| | - Ahmed Mohammed Said
- Department of Chest Medicine, Faculty of Medicine, Zagazig University, 44519, Egypt
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Bastamizad N, Abbasi P, Salari N, Jalali R. Comparing the Effect of Incentive Spirometry and Deep Breathing Exercises on the Level of Shoulder Pain and Nausea Following Laparoscopic Cholecystectomy Surgery: A Clinical Trial Study. Gastroenterol Nurs 2023; 46:14-22. [PMID: 36706138 DOI: 10.1097/sga.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 04/01/2022] [Indexed: 01/28/2023] Open
Abstract
Cholecystitis treated by laparoscopy results in patients experiencing shoulder pain and nausea. Thus, the aim of the present study was to compare the effect of incentive spirometry and deep breathing exercises on the level of shoulder pain and nausea following laparoscopy. In this clinical trial, 105 patients were enrolled into three groups: use of incentive spirometry, deep breathing exercises, and control. Data were collected using a checklist and a visual analog scale and analyzed through the χ2, the Kruskal-Wallis, the Friedman, and the paired t test by SPSS Version 25. In the deep breathing exercise, incentive spirometry, and control groups, mean pain scores immediately after surgery but within 24 hours following the intervention were 3.8, 2.6, and 4.4, respectively. The mean score of severity of nausea for patients in the deep breathing exercise and incentive spirometry groups showed a significant difference immediately after the procedure, as well as at 12 and 24 hours post-intervention. Breathing exercises and incentive spirometry can be effective in reducing pain and nausea in patients undergoing cholecystectomy through laparoscopy. Because of the effectiveness of the two methods, nurses can use incentive spirometery and deep breathing exercises to diminish patients' pain post-cholecystectomy.
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Affiliation(s)
- Nasrin Bastamizad
- Nasrin Bastamizad, MSc, is Nurse, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Parvin Abbasi, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Nader Salari, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Rostam Jalali, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parvin Abbasi
- Nasrin Bastamizad, MSc, is Nurse, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Parvin Abbasi, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Nader Salari, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Rostam Jalali, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Nasrin Bastamizad, MSc, is Nurse, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Parvin Abbasi, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Nader Salari, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Rostam Jalali, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Nasrin Bastamizad, MSc, is Nurse, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Parvin Abbasi, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Nader Salari, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Rostam Jalali, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Zhao CH, Sun YH, Mao XM. Volume Incentive Spirometry Reduces Pulmonary Complications in Patients After Open Abdominal Surgery: A Randomized Clinical Trial. Int J Gen Med 2023; 16:793-801. [PMID: 36883125 PMCID: PMC9985979 DOI: 10.2147/ijgm.s400030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
Objective To compare the effect of diaphragmatic breathing and volume incentive spirometry (VIS) on hemodynamics, pulmonary function, and blood gas in patients following open abdominal surgery under general anesthesia. Methods A total of 58 patients who received open abdominal surgery were randomly assigned to the control group (n=29) undergoing diaphragmatic breathing exercises and the VIS group (n=29) undergoing VIS exercises. All the participants performed the six-minute walk test (6MWT) preoperatively to evaluate their functional capacity. Hemodynamic indexes, pulmonary function tests, and blood gas indexes were recorded before surgery and on the 1st, 3rd, and 5th postoperative day. Results The functional capacity was not significantly different between the two groups during the preoperative period (P >0.05). At 3 days and 5 days postoperatively, patients in the VIS group had a significantly higher SpO2 than that in the control group (P <0.05). Pulmonary function test values were reduced in both two groups postoperatively when compared to the preoperative values but improved for three and five days afterward (P <0.05). Of note, the significantly elevated levels of peak expiratory flow (PEF), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were observed on the 1st, 3rd, and 5th postoperative days in the VIS group compared with those in the control group (P <0.05). Besides, bass excess (BE), and pH values were significantly higher in the VIS group on the 1st postoperative day than those in the control group (P <0.05). Conclusion Diaphragmatic breathing and VIS could improve postoperative pulmonary function, but VIS exercise might be a better option for improving hemodynamics, pulmonary function, and blood gas for patients after open abdominal surgery, hence lowering the incidence of postoperative pulmonary complications.
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Affiliation(s)
- Chun-Hui Zhao
- Department of Respiratory Medicine, Haining People's Hospital, Haining, Zhejiang, 314400, People's Republic of China
| | - Ya-Hong Sun
- Department of Respiratory Medicine, Haining People's Hospital, Haining, Zhejiang, 314400, People's Republic of China
| | - Xiao-Min Mao
- Department of Infectious Diseases, Haining People's Hospital, Haining, Zhejiang, 314400, People's Republic of China
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Huang YT, Lin YJ, Hung CH, Cheng HC, Yang HL, Kuo YL, Chu PM, Tsai YF, Tsai KL. The fully engaged inspiratory muscle training reduces postoperative pulmonary complications rate and increased respiratory muscle function in patients with upper abdominal surgery: a randomized controlled trial. Ann Med 2022; 54:2222-2232. [PMID: 35942800 PMCID: PMC9455324 DOI: 10.1080/07853890.2022.2106511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Upper abdominal surgical treatment may reduce respiratory muscle function and mucociliary clearance, which might be a cause of postoperative pulmonary complications (PPCs). Threshold inspiratory muscle training (IMT) may serve as an effective modality to improve respiratory muscle strength and endurance in patients. However, whether this training could help patients with upper abdominal surgery remains to be determined. The aim of the present investigation was to determine the effect of a fully engaged IMT on PPCs and respiratory function in patients undergoing upper abdominal surgery. We hypothesized that the fully engaged IMT could reduce PPCs and improve respiratory muscle function in patients with upper abdominal surgery. METHODS This is a randomized controlled trial (RCT) with 28 patients who underwent upper abdominal surgery. Patients were randomly assigned to the control (CLT) group or the IMT group. The CTL group received regular health care. The IMT group received 3 weeks of IMT with 50% of MIP as the initial intensity before the operation. The intensity of MIP increased by 5-10% per week. The IMT was continued for 4 weeks after the operation. The study investigated the outcomes including PPCs, respiratory muscle strength, diaphragmatic function, cardiopulmonary function, and quality of life (QoL). RESULTS We found that IMT improved respiratory muscle strength and diaphragmatic excursion. IMT also had a beneficial effect on the incidence of postoperative pulmonary complications (PPCs) compared to CLT care. CONCLUSION The results from this study revealed that IMT provided positive effects on parameters associated with the respiratory muscle function and reduced the incidence of PPCs. We propose that fully engaged IMT should be a part of clinical management in patients with upper abdominal surgery.KEY MESSAGESThe fully engaged inspiratory muscle training reduces postoperative pulmonary complications rate in patients with upper abdominal surgery.The fully engaged inspiratory muscle training increases maximal inspiratory pressure in patients with upper abdominal surgery.The fully engaged inspiratory muscle training increases diaphragm function in patients with upper abdominal surgery.The fully engaged inspiratory muscle training increases the quality of life in patients with upper abdominal surgery.
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Affiliation(s)
- Yu-Ting Huang
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yih-Jyh Lin
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Hsia Hung
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Ching Cheng
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Lun Yang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Liang Kuo
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Ming Chu
- Department of Anatomy, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yi-Fang Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kun-Ling Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Anwar S, Arsalan A, Zafar H, Ahmad A, Hanif A. Effects of breathing reeducation on cervical and pulmonary outcomes in patients with non specific chronic neck pain: A double blind randomized controlled trial. PLoS One 2022; 17:e0273471. [PMID: 36006997 PMCID: PMC9409509 DOI: 10.1371/journal.pone.0273471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/01/2022] [Indexed: 11/19/2022] Open
Abstract
Objective The purpose of this randomized controlled trial was to study effects of breathing reeducation in the treatment of patients with non specific chronic neck pain. Methods A total of sixty eight eligible patients with chronic neck pain were randomly allocated to breathing reeducation (BR) group (n = 34) and routine physical therapy (RPT) group (n = 34). Clinical outcomes were neck pain measured through visual analogue score, cervical active range of motion through CROM device, strength of neck muscles through hand held dynamometer and endurance of neck muscles measured through craniocervical flexion test. The neck disability was measured through neck disability index (NDI) and pulmonary outcomes such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC ratio were measured through Spirolab 4. The outcomes were assessed at baseline and at 4 and at 8 weeks from baseline. Results There were significant improvements in the BR group compared with the RPT group (P = 0.002) for cervical flexion, extension (P = 0.029), endurance (P = 0.042), strength of neck flexors (P <0.001), neck extensors (P = 0.034). Likewise there was a significant change in NDI (P = 0.011), FEV1 (P = 0.045), FVC (P <0.001), and FEV1/FVC ratio (P <0.001) in the BR group compared with the RPT group. The cervical side flexion and rotation showed no significant difference in breathing reeducation group with p > 0.05. Conclusion Breathing reeducation combined with routine physical therapy is an effective treatment in patients with non specific chronic neck pain. Trial registration IRCT 20200226046623N1, https://www.irct.ir/trial/46240.
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Affiliation(s)
- Sahreen Anwar
- Department of Physical Therapy, Independent Medical College Faisalabad, Faisalabad, Pakistan
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
- * E-mail:
| | - Asadullah Arsalan
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | - Hamayun Zafar
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ashfaq Ahmad
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | - Asif Hanif
- University Institute of Public Health, University of Lahore, Lahore, Pakistan
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A Cross-Sectional Study on the Application of IS in Perioperative Pulmonary Function Training in Spine and Orthopedics. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:4546549. [PMID: 35845918 PMCID: PMC9279051 DOI: 10.1155/2022/4546549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022]
Abstract
Background The incentive spirometer (IS) is a mechanical device that promotes lung expansion and can be used to prevent and treat postoperative pulmonary complications. In this study, the preventive effect of pulmonary function training with IS on the improvement of pulmonary function and pulmonary complications was observed. Methods From May 2019 to April 2021, 69 scoliosis patients with impaired moderate and severe lung function were divided into the traditional pulmonary training group (n = 32) and IS-enhanced pulmonary training group (n = 35). The patient underwent lung function testing after admission and one week after the start of training and chest CT on the third day after surgery. Results The average age was 13.47 and 15.66, respectively (p = 0.223). The Cobb angles were 83.84 and 83.97 (p = 0.756), respectively, and no statistical difference between the parameters of lung function was detected. After 1 week of respiratory function training, significant improvement in lung function testing parameters including VC%, FVC%, FEV1%, FEV1/FVC, FEV1/VC, and MVV% was found in both groups. Analysis of covariance showed more significant improvement in IS-enhanced group compared to the conventional training group (p < 0.05). The incidence of postoperative pulmonary atelectasis was lower in IS-enhanced group than in traditional groups (2.9% vs. 21.9%, p = 0.043) with no difference in the overall incidence of pulmonary complications (p = 0.164) and shorter preoperative and total hospitalization in the IS-enhanced group. Conclusion Compared to traditional pulmonary function training, IS-enhanced training can significantly accelerate the improvement of pulmonary function testing parameters, shorten the preoperative pulmonary function training time, reduce the incidence of postoperative pulmonary tension complications, and accelerate postoperative rehabilitation.
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Yazdani M, Malekzadeh J, Sedaghat A, Mazlom SR, Pasandideh Khajebeyk A. The Effects of Manual Lung Hyperinflation on Pulmonary Function after Weaning from Mechanical Ventilation among Patients with Abdominal Surgeries: Randomized Clinical Trial. J Caring Sci 2021; 10:216-222. [PMID: 34849368 PMCID: PMC8609125 DOI: 10.34172/jcs.2021.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction: After abdominal surgery, the patients who are separated from mechanical ventilation and provided with oxygen therapy via a T-piece are at risk for respiratory complications. Therefore, they need additional respiratory support. This study aimed to evaluate the effects of manual hyperinflation (MHI) on pulmonary function after weaning. Methods: This randomized clinical trial included 40 patients who had undergone abdominal surgery and were receiving oxygen via a T-piece. Patients were selected from the intensive care units (ICU) of two hospitals in Mashhad, Iran. The subjects were randomly allocated to intervention (MHI) and control groups. Patients in the MHI group were provided with three 20-minute MHI rounds using the Mapleson C, while the control group received routine cares. Tidal volume (Vt), Rapid Shallow Breathing Index (RSBI), and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) were measured before the intervention, as well as 5 and 20 minutes after the intervention. Atelectasis prevalence was assessed before and 24 hours after the intervention. Data were analysed by SPSS software version 13. Results: At baseline, there were no significant differences between the groups regarding Vt, RSBI, P/F ratio, and atelectasis rate. No significant difference was also found between the groups regarding atelectasis rate 24 hours after the intervention. However, at both posttests, Vt, RSBI, and P/F ratio in the MHI group were significantly better than the control group. Conclusion: In patients with artificial airway and spontaneous breathing, MHI improves pulmonary function.
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Affiliation(s)
- Mahboube Yazdani
- Department Intensive Care Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Malekzadeh
- Department of Prehospital Emergency Care, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Sedaghat
- Department of Anesthesia, Faculty of Medical Science, Mashhad University of Medical Science, Mashhad, Iran
| | - Seyed Reza Mazlom
- Department of Medical- Surgical Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aliyeh Pasandideh Khajebeyk
- Department Intensive Care Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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The Effect of Balloon-Blowing Exercise on Postoperative Pulmonary Functions in Patients Undergoing Total Hip Arthroplasty. Orthop Nurs 2021; 40:182-188. [PMID: 34004618 DOI: 10.1097/nor.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
General anesthesia, prolonged immobilization, and pain may adversely affect pulmonary function in patients undergoing prosthetic surgery. The aim of this study was to evaluate the effect of balloon-blowing exercises on pulmonary functions in patients undergoing total hip arthroplasty. The patients in the experimental group performed three sets of balloon-blowing exercises in the morning, at noon, and in the evening on the first to third days postoperatively. The increase in forced vital capacity (FVC) values between the control and experimental groups in the postoperative period was statistically significant (p < .001), in favor of the experimental group. The increase in forced expiratory volume during the first second (FEV1)/FVC ratio was found to be significantly higher in the experimental group than in the control group (p < .001). Patients who performed balloon-blowing exercises increased their FVC and FEV1/FVC ratio.
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Alaparthi GK, Amin R, Gatty A, Raghavan H, Bairapareddy KC, Vaishali K, Borghi-Silva A, Hegazy FA. Contrasting effects of three breathing techniques on pulmonary function, functional capacity and daily life functional tasks in patients following valve replacement surgery- A pilot randomized clinical trial. Heliyon 2021; 7:e07643. [PMID: 34377862 PMCID: PMC8327348 DOI: 10.1016/j.heliyon.2021.e07643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background Valve replacement surgeries affect the physiological mechanisms of patients leading to various postoperative pulmonary complications. Lung expansion therapy consisting of numerous techniques is routinely used for the prevention and treatment of these complications. Objectives Our study aimed to compare the effects of diaphragmatic breathing (DB), flow (FS) and volume-oriented incentive spirometer (VS) in patients following valve replacement surgery. Methods 29 patients posted valve replacement surgeries were randomly assigned to VS, FS and DB groups. Patients underwent preoperative training and seven-day rehabilitation post-surgery. Pulmonary function tests were performed before surgery and for seven days afterward. On the seventh postoperative day, patients performed a six-minute walk test and completed a functional difficulties questionnaire (FDQ). Results Pulmonary function test values reduced in all three groups postoperatively when compared to the preoperative values but improved by the seventh postoperative day (p < 0.05). On comparing the seventh postoperative day values to the preoperative values, the VS group had no significant difference (p = 1.00) (Forced Vital Capacity- % change: DB-37.76, VS-1.59, FS-27.98), indicating that the value had nearly returned to the baseline. As compared to the DB and FS groups, FVC showed a greater improvement in the VS group (p = 0.01 and p = 0.06 respectively). No significant differences were observed between groups for distance walked (p > 0.05), however, FDQ scores demonstrated positive changes in favor of VS when contrasted with FS or DB (p < 0.05). Conclusion Diaphragmatic breathing, flow or volume-oriented spirometer could improve pulmonary function in the postoperative period. The volume-oriented spirometer, however, was found to be the most beneficial among the three techniques in improving patients’ pulmonary function and daily life functional tasks. Further research is warranted to confirm these findings. The present pilot randomized clinical trial is the first of a kind that exhibits the effects of three breathing exercises in patients following valve replacement cardiac surgery. The study demonstrates the individual and contrasting effects of volume spirometry, volume spirometry and deep breathing exercise between preoperative day until postoperative day 7 in terms of pulmonary function and function activities.
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Affiliation(s)
- Gopala Krishna Alaparthi
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Revati Amin
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Aishwarya Gatty
- College of Physiotherapy, Srinivas University, Mangaluru, India
| | - Harish Raghavan
- Department of Cardiothoracic Surgery, Kasturba Medical College Hospital, Mangalore, Karnataka, India
| | | | - K Vaishali
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Audrey Borghi-Silva
- Laboratório de Fisioterapia Cardiopulmonar, Universidade Federal De São Carlos, São Carlos, SP, Brazil
| | - Fatma A Hegazy
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Öterkuş M, Dönmez İ, Nadir AH, Rencüzoğulları İ, Karabağ Y, Binnetoğlu K. The effect of low flow anesthesia on hemodynamic and peripheral oxygenation parameters in obesity surgery. Saudi Med J 2021; 42:264-269. [PMID: 33632904 PMCID: PMC7989260 DOI: 10.15537/smj.2021.42.3.20200575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/24/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: To investigate the effects of low-flow anesthesia on hemodynamic parameters and recovery from anesthesia in obese individuals undergoing laparoscopic surgery. Methods: This randomized-controlled and prospective study included 44 obese patients who underwent laparoscopic sleeve gastrectomy operation. The patients were randomly allocated into 2 groups as low-flow and high-flow anesthesia. Further, the groups compared in terms of hemodynamic parameters, anesthesia recovery times, operation times, and arterial blood gas parameters. Results: The groups were similar with respect to demographic data. Heart rate, peripheral oxygen saturation, arterial blood pressure measurements, end-tidal, and CO2, lactate levels measurements were similar in both groups during the entire procedure. There was also no statistically significant difference in terms of arterial blood gas parameters or anesthesia recovery periods. Conclusion: Low-flow anesthesia in laparoscopic obesity surgery seems to be safer compared to high-flow anesthesia in terms of the adequacy of tissue perfusion, depth of anesthesia, and postoperative recovery.
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Affiliation(s)
- Mesut Öterkuş
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
- Address correspondence and reprint request to: Dr. Mesut Öterkuş, Assistant Professor, Department of Anesthesiology and Reanimation, Faculty of Medicine, Malatya Turgut Özal University, Malatya, Turkey. E-mail: ORCID ID: http://orcid.org/0000-0003-1025-7662
| | - İlksen Dönmez
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| | - Aysu H. Nadir
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| | - İbrahim Rencüzoğulları
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| | - Yavuz Karabağ
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| | - Kenan Binnetoğlu
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
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Rain M, Subramaniam B, Avti P, Mahajan P, Anand A. Can Yogic Breathing Techniques Like Simha Kriya and Isha Kriya Regulate COVID-19-Related Stress? Front Psychol 2021; 12:635816. [PMID: 33935886 PMCID: PMC8081973 DOI: 10.3389/fpsyg.2021.635816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/23/2021] [Indexed: 12/19/2022] Open
Abstract
The global impact of Coronavirus Disease 2019 (COVID-19) is tremendous on human life, not only affecting the physical and mental health of population but also impacting the economic system of countries and individual itself. The present situation demands prompt response toward COVID-19 by equipping the humans with strategies to overcome the infection and stress associated with it. These strategies must not only be limited to preventive and therapeutic measures, but also aim at improving immunity and mental health. This can be achieved by yogic breathing techniques. In this perspective, we emphasize the importance of yogic breathing, Simha Kriya and Isha kriya, the simple yet effective breathing techniques.
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Affiliation(s)
- Manjari Rain
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Balachundhar Subramaniam
- Center for Anesthesia Research Excellence, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Pramod Avti
- Department of Biophysics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranay Mahajan
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Anand
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.,Centre for Mind Body Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.,Centre of Phenomenology and Cognitive Sciences, Panjab University, Chandigarh, India
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Amin R, Alaparthi GK, Samuel SR, Bairapareddy KC, Raghavan H, Vaishali K. Effects of three pulmonary ventilation regimes in patients undergoing coronary artery bypass graft surgery: a randomized clinical trial. Sci Rep 2021; 11:6730. [PMID: 33762655 PMCID: PMC7990944 DOI: 10.1038/s41598-021-86281-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/25/2021] [Indexed: 11/21/2022] Open
Abstract
The aim was to compare the effect of diaphragmatic breathing exercise (DBE), flow- (FIS) and volume-oriented incentive spirometry (VIS) on pulmonary function- (PFT), functional capacity-6-Minute Walk Test (6 MWT) and Functional Difficulties Questionnaire (FDQ) in subjects undergoing Coronary Artery Bypass Graft surgery (CABG). The purpose of incorporating pulmonary ventilator regimes is to improve ventilation and avoid post-operative pulmonary complications. CABG patients (n = 72) were allocated to FIS, VIS and DBE groups (n = 24 each) by block randomization. Preoperative and postoperative values for PFT were taken until day 7 for all three groups. On 7th postoperative day, 6 MWT and FDQ was analyzed using ANOVA and post-hoc analysis. PFT values were found to be decreased on postoperative day 1(Forced Vital Capacity (FVC) = FIS group-65%, VIS group-47%, DBE group-68%) compared to preoperative day (p < 0.001). PFT values for all 3 groups recovered until postoperative day 7 (FVC = FIS group-67%, VIS group-95%, DBE group-59%) but was found to reach the baseline in VIS group (p < 0.001). When compared between 3 groups, statistically significant improvement was observed in VIS group (p < 0.001) in 6 MWT and FDQ assessment. In conclusion, VIS was proven to be more beneficial in improving the pulmonary function (FVC), functional capacity and FDQ when compared to FIS and DBE.
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Affiliation(s)
- Revati Amin
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Bejai, Mangalore, 575004, India
| | - Gopala Krishna Alaparthi
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
| | - Stephen R Samuel
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Bejai, Mangalore, 575004, India
| | | | - Harish Raghavan
- Department of Cardiothoracic Surgery, Kasturba Medical Hospital, Mangalore, 575004, India
| | - K Vaishali
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, India
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Dote H, Homma Y, Sakuraya M, Funakoshi H, Tanaka S, Atsumi T. Incentive spirometry to prevent pulmonary complications after chest trauma: a retrospective observational study. Acute Med Surg 2020; 7:e619. [PMID: 33408872 PMCID: PMC7775185 DOI: 10.1002/ams2.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 11/07/2022] Open
Abstract
Aim Pulmonary complications (PCs) are a major cause of poor prognosis in chest trauma. Evidence on the effectiveness of incentive spirometry (IS) in trauma is scarce. This study investigated the effectiveness of IS in preventing PCs in patients with chest trauma with rib fractures. Methods This retrospective observational study analyzed the data obtained from the electronic medical records of patients with chest trauma with rib fractures admitted between 2011 and 2019. We included patients 18 years of age or older with risk of worsening respiratory failure. Early IS was the primary exposure and PCs (pulmonary infection or respiratory failure requiring escalating oxygen therapy) were the primary outcomes. Secondary outcomes were length of hospital stay, duration of oxygenation therapy, and adverse events of IS. Logistic regression analysis with a propensity score was used. Results We extracted 514 patients from the electronic medical records; 299 patients were included. The early IS group had a higher proportion of hypoxemia at admission, opioid analgesia use, invasive positive pressure ventilation, and respiratory physiotherapy. The severity of trauma was higher in the early IS group. There was no significant difference in the occurrence of the PCs between groups (adjusted odds ratio 0.71; 95% confidence interval, 0.24–2.16). No statistical differences were seen in the secondary outcomes. Conclusion For patients with chest trauma with rib fractures at risk of worsening respiratory failure, IS early after injury did not reduce the rate of PCs. No adverse event of IS was observed and IS was shown to be safe.
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Affiliation(s)
- Hisashi Dote
- Department of Emergency and Critical Care MedicineSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Yohichiro Homma
- Department of General Internal MedicineSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Masaaki Sakuraya
- Division of Emergency and Critical Care MedicineJA Hiroshima General HospitalHiroshimaJapan
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care MedicineTokyo Bay Urayasu Ichikawa Medical CenterUrayasuJapan
| | - Shigeru Tanaka
- Department of Emergency and Critical Care MedicineSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Takahiro Atsumi
- Department of Emergency and Critical Care MedicineSeirei Hamamatsu General HospitalHamamatsuJapan
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Shetty N, Samuel SR, Alaparthi GK, Amaravadi SK, Joshua AM, Pai S. Comparison of Diaphragmatic Breathing Exercises, Volume, and Flow-Oriented Incentive Spirometry on Respiratory Function in Stroke Subjects: A Non-randomized Study. Ann Neurosci 2020; 27:232-241. [PMID: 34556964 PMCID: PMC8454997 DOI: 10.1177/0972753121990193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Abstract. BACKGROUND Reduced respiratory muscle strength leads to reduced pulmonary function, chest wall movements in the affected side, and increased chest infections, which thereby reduces oxygenation and ventilation. Respiratory muscle training can be used in acute stroke subjects to increase their pulmonary function. PURPOSE To compare the short-term effects of diaphragmatic breathing exercise, flow, and volume-oriented incentive spirometry on respiratory function following stroke. METHODS A non-randomized hospital-based study was conducted at Kasturba Medical College Hospitals, Mangalore, India. Forty-two sub-acute subjects of either gender, with the first episode of stroke within six months, were assigned to three groups by the consultant, i.e., diaphragmatic breathing group (DBE), Flow oriented-incentive spirometry group (FIS), and volume oriented-incentive spirometry group (VIS; N = 14) each. All subjects received intervention thrice daily, along with conventional stroke rehabilitation protocols throughout the study period. Pre- and post-intervention values were taken on alternate days until day 5 for all the three groups. RESULTS The pulmonary function and maximal respiratory pressures were found to be significantly increased by the end of intervention in all three groups, but FIS and DBE groups had better results than VIS (FVC = FIS group, 13.71%; VIS group, 14.89%; DBE group, 21.27%, FEV1 = FIS group, 25.97%; VIS group, 22.52%; DBE group, 19.38%, PEFR = FIS group, 38.76%; VIS group,9.75%; DBE group, 33.16%, MIP = FIS group, 28.23%; VIS group, 19.36%; DBE group, 52.14%, MEP = FIS group, 43.00%; VIS group, 22.80%; DBE group, 28.68%). CONCLUSION Even though all interventions had positive outcomes in all variables, flow incentive spirometry had better results across all outcomes (pulmonary function and maximal respiratory pressures) when compared to the other two interventions making it a valuable tool for stroke rehabilitation.
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Affiliation(s)
- Natasha Shetty
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Stephen Rajan Samuel
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Gopala Krishna Alaparthi
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Sampath Kumar Amaravadi
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Abraham M Joshua
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Shivanand Pai
- Department of Neurology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
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A randomized-controlled trial of sugammadex versus neostigmine: impact on early postoperative strength. Can J Anaesth 2020; 67:959-969. [PMID: 32405975 DOI: 10.1007/s12630-020-01695-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Residual neuromuscular blockade after surgery is associated with airway obstruction, hypoxia, and respiratory complications. Compared with neostigmine, sugammadex reverses neuromuscular blockade to a train-of-four ratio > 0.9 more rapidly. It is unknown, however, whether the superior reversal profile of sugammadex improves clinically relevant measures of strength in the early postoperative period. METHODS Patients undergoing general, gynecological, or urologic surgery were randomized to receive either neostigmine (70 µg·kg-1, maximum 5 mg) or sugammadex (2 or 4 mg·kg-1) to reverse neuromuscular blockade. The primary outcome was the ability to breathe deeply measured by incentive spirometry at 30, 60, and 120 min after reversal. RESULTS We randomized 62 patients to either a neostigmine (n = 31) or sugammadex (n = 31) group. The incentive spirometry volume recovery trajectory was not different between the two groups (P = 0.35). Median spirometry volumes at baseline, 30, 60, and 120 min postoperatively were 2650 vs 2500 mL, 1775 vs 1750 mL, 1375 vs 2000 mL, and 1800 vs 1950 mL for the sugammadex and neostigmine groups, respectively. Postoperative incentive spirometry decrease from baseline was not different between the two groups. Hand grip strength, the ability to sit unaided, train-of-four ratio on postanesthesia care unit (PACU) admission, time to extubation, time to PACU discharge readiness, and Quality of Recovery-15 scores were also not different between the groups. CONCLUSIONS Measures of postoperative strength, such as incentive spirometry, hand group strength, and the ability to sit up in the early postoperative period were not different in patients who received neostigmine or sugammadex for the reversal of neuromuscular blockade. TRIAL REGISTRATION www.clinicaltrials.gov (NCT02909439); registered: 21 September, 2016.
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Sum SK, Peng YC, Yin SY, Huang PF, Wang YC, Chen TP, Tung HH, Yeh CH. Using an incentive spirometer reduces pulmonary complications in patients with traumatic rib fractures: a randomized controlled trial. Trials 2019; 20:797. [PMID: 31888765 PMCID: PMC6937666 DOI: 10.1186/s13063-019-3943-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/28/2019] [Indexed: 11/13/2022] Open
Abstract
Background An incentive spirometer (IS) is a mechanical device that promotes lung expansion. It is commonly used to prevent postoperative lung atelectasis and decrease pulmonary complications after cardiac, lung, or abdominal surgery. This study explored its effect on lung function and pulmonary complication rates in patients with rib fractures. Methods Between June 2014 and May 2017, 50 adult patients with traumatic rib fractures were prospectively investigated. Patients who were unconscious, had a history of chronic obstructive pulmonary disease or asthma, or an Injury Severity Score (ISS) ≥ 16 were excluded. Patients were randomly divided into a study group (n = 24), who underwent IS therapy, and a control group (n = 26). All patients received the same analgesic protocol. Chest X-rays and pulmonary function tests (PFTs) were performed on the 5th and 7th days after trauma. Results The groups were considered demographically homogeneous. The mean age was 55.2 years and 68% were male. Mean pretreatment ISSs and mean number of ribs fractured were not significantly different (8.23 vs. 8.08 and 4 vs. 4, respectively). Of 50 patients, 28 (56%) developed pulmonary complications, which were more prevalent in the control group (80.7% vs. 29.2%; p = 0.001). Altogether, 25 patients had delayed hemothorax, which was more prevalent in the control group (69.2% vs. 29.2%; p = 0.005). Two patients in the control group developed atelectasis, one patient developed pneumothorax, and five patients required thoracostomy. PFT results showed decreased forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) in the control group. Comparing pre- and posttreatment FVC and FEV1, the study group had significantly greater improvements (p < 0.001). Conclusions In conclusion, the use of an IS reduced pulmonary complications and improved PFT results in patients with rib fractures. The IS is a cost-effective device for patients with rib fractures and its use has clinical benefits without harmful effects. Trial registration ClinicalTrials.gov, NCT04006587. Registered on 3 July 2019.
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Affiliation(s)
- Shao-Kai Sum
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China
| | - Ya-Chuan Peng
- Department of Nursing, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shun-Ying Yin
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China
| | - Pin-Fu Huang
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China
| | - Yao-Chang Wang
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China
| | - Tzu-Ping Chen
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China
| | - Heng-Hsin Tung
- School of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Chi-Hsiao Yeh
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan, Republic of China. .,School of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
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Serin SO, Işıklar A, Karaören G, El-Khatib MF, Caldeira V, Esquinas A. Atelectasis in Bariatric Surgery: Review Analysis and Key Practical Recommendations. Turk J Anaesthesiol Reanim 2019; 47:431-438. [PMID: 31828239 DOI: 10.5152/tjar.2019.66564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/14/2019] [Indexed: 11/22/2022] Open
Abstract
Obesity is a condition that affects multiple organ systems, particularly the cardiovascular and respiratory system. In recent years, bariatric surgery has been reported to be the gold standard in the treatment of morbid obesity. Body mass index alone is insufficient to predict risks related to anaesthesia and surgery. Obesity contributes to significant postoperative atelectasis and is considered an independent risk factor for postoperative atelectasis owing to decreased functional residual capacity. The treatment and reversibility of atelectasis developed in obese patients undergoing bariatric surgery are challenging. Therefore, an optimisation of pulmonary functions before surgery, lung-sparing ventilation during the perioperative period, awareness of potential postoperative complications and knowledge about preventive measures and therapeutic approaches have become increasingly important in bariatric surgery. The aim of this review was to aid clinicians in the management of atelectasis in patients undergoing bariatric surgery during the perioperative and postoperative period.
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Affiliation(s)
- Sibel Ocak Serin
- Department of Internal Medicine, Health Sciences University, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Aysun Işıklar
- Department of Internal Medicine, Martyr Professor İlhan Varank Sancaktepe Training and Research Hospital, İstanbul, Turkey
| | - Gülşah Karaören
- Department of Anaesthesiology and Reanimation, Health Sciences University, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Mohamed Fawzy El-Khatib
- Department of Anaesthesiology, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Vania Caldeira
- Department of Pneumology, Hospital Santa Maria, Lisboa, Portugal
| | - Antonio Esquinas
- Department of Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain
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Miralpeix E, Mancebo G, Gayete S, Corcoy M, Solé-Sedeño JM. Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program. Int J Gynecol Cancer 2019; 29:1235-1243. [DOI: 10.1136/ijgc-2019-000597] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
Patients undergoing major surgery are predisposed to a decrease in functional capacity as a response to surgical stress that can delay post-operative recovery. A prehabilitation program consists of patient preparation strategies before surgery, and include pre-operative measures to improve functional capacity and enhance post-operative recovery. Multimodal prehabilitation may include exercise, nutritional counseling, psychological support, and optimization of underlying medical conditions, as well as cessation of unfavorable health behaviors such as smoking and drinking. Currently, there are no standardized guidelines for prehabilitation, and the existent studies are heterogeneous; however, multimodal approaches are likely to have a greater impact on functional outcomes than single management programs. We have reviewed the literature on prehabilitation in general, and in gynecologic surgery in particular, to identify tools to establish an optimal prehabilitation program within an Enhanced Recovery After Surgery (ERAS) protocol for gynecologic oncology patients. We suggest a safe, reproducible, functional, and easy-to-apply multimodal prehabilitation program for gynecologic oncology practice based on patient-tailored pre-operative medical optimization, physical training, nutritional counseling, and psychological support. The analysis of the prehabilitation program implementation in an ERAS protocol should undergo further research in order to test the efficacy on surgical outcome and recovery after surgery.
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An SK, Shin WS. Effect of air stacking training on pulmonary function, respiratory strength and peak cough flow in persons with cervical spinal cord injury. ACTA ACUST UNITED AC 2018. [DOI: 10.14474/ptrs.2018.7.4.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sang-Kyun An
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea
| | - Won-Seob Shin
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon, Republic of Korea
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Kim K, Jang DM, Park JY, Yoo H, Kim HS, Choi WJ. Changes of diaphragmatic excursion and lung compliance during major laparoscopic pelvic surgery: A prospective observational study. PLoS One 2018; 13:e0207841. [PMID: 30496318 PMCID: PMC6264802 DOI: 10.1371/journal.pone.0207841] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 11/07/2018] [Indexed: 11/18/2022] Open
Abstract
Major laparoscopic pelvic surgery requires steep Trendelenburg position with pneumoperitoneum for a long time. We investigated the effect of Trendelenburg position with pneumoperitoneum on diaphragmatic excursion and lung compliance during major laparoscopic pelvic surgery using M-mode sonography. Twenty patients undergoing elective pelviscopic radical hysterectomy were included in this study. Diaphragmatic excursion was measured at the following time points; after sedation, after intubation, 90 minutes after Trendelenburg position with pneumoperitoneum, and after operation with recovery of muscle relaxation. And lung compliance was measured using anesthetic machine under general anesthesia; after the intubation, 90 minutes after Trendelenburg position with pneumoperitoneum and after operation with recovery of muscle relaxation. In order to detect postoperative pulmonary complication, postoperative chest radiography was checked. Static lung compliance, dynamic lung compliance and diaphragmatic excursion were decreased during operation (P < 0.001, respectively). At the end of the operation with recovery of muscle relaxation, reduced diaphragmatic movement was not recovered as its excursion after sedation (P < 0.001). In conclusion, lung compliance was decreased following transiently decreased diaphragmatic excursion during major laparoscopic pelvic surgery.
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Affiliation(s)
- Kyungmi Kim
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Dong-Min Jang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Yeon Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hwanhee Yoo
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Soon Kim
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Woo-Jong Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Aydemir Ö, Aslan FE, Karabacak Ü, Akdaş Ö. The Effect of Exaggerated Lithotomy Position on Shoulder Pain after Laparoscopic Cholecystectomy. Pain Manag Nurs 2018; 19:663-670. [PMID: 29934129 DOI: 10.1016/j.pmn.2018.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/05/2018] [Accepted: 04/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The exaggerated lithotomy position with the expertise of nurses can be successful solution for the patients who have the postoperative shoulder pain after laparoscopic cholecystectomy. AIMS This study aimed to determine the effect of applying an exaggerated lithotomy positions to patients who had laparoscopic cholecystectomy to relieve shoulder pain. The study was conducted on nonrandomized groups and made as a semiexperimental study with a pretest/post-test control group design. Design, Settings, and Subjects/Participants: The study was conducted on 102 patients who had elective laparoscopic cholecystectomy and agreed to participate in this study after they met the inclusion-exclusion criteria in the general surgery clinic of a training and research hospital in Istanbul between December 12, 2012, and June 30, 2013. METHODS The pain levels (10 minutes before and after positioning) and peripheral oxygen saturation (SPO2) levels (1 minute, 5 minutes, and 10 minutes before and after positioning-total 6 times) of the patients were measured using a visual analog scale and pulse oximetry, respectively. The pain levels and the analgesic (pethidine hydrochloride and diclofenac sodium) usage of the patients in both the experimental and the control group were compared. RESULTS The exaggerated lithotomy position appreciably lowered the shoulder pain of the patients in the experimental group (t = 12.663; p = .000 < .001). It also increased peripheral saturation levels of the patients more rapidly compared with those in the control group receiving analgesics (t = 17.693; p = .000 < .005). In addition, it decreased the need to use additional analgesics and opioids (t = 2.14; p = .037). CONCLUSIONS In this study the exaggerated lithotomy position was found to be fast and effective for relieving shoulder pain after laparoscopic cholecystectomy, decreased the need to use additional analgesics and opioids, and, in conjunction with pain control, also contributed to improvements in respiratory functions.
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Affiliation(s)
- Özgül Aydemir
- Istanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
| | | | - Ükke Karabacak
- School of Nursing, Acıbadem University, Istanbul, Turkey
| | - Özlem Akdaş
- Palliative Care Service, Department of Anesthesiology and Reanimation, Uşak Public Hospital, Uşak, Turkey
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Use of thoracic ultrasound by physiotherapists: a scoping review of the literature. Physiotherapy 2018; 104:367-375. [PMID: 29958691 DOI: 10.1016/j.physio.2018.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Use of diagnostic thoracic ultrasound (TUS) in medical professions to examine the pleura, lung parenchyma and diaphragm is gaining in popularity, however the ways in which physiotherapists are using TUS is unclear. OBJECTIVE The aim of this scoping review is to gain an understanding of the emerging evidence base surrounding physiotherapy use of TUS to inform research and clinical practice. DATA SOURCES A systematic search was conducted of the following databases: Cochrane, EPPI centre, PROSPERO, Medline, CINAHL, AMED, EMBASE, HMIC, and BNI. STUDY SELECTION Inclusion criteria: primary research reporting the use of diagnostic TUS; a physiotherapist as part of the study design or as the chief investigator; published in English. SYNTHESIS METHODS Data regarding demographics, design, type of conditions and anatomical structures investigated and profession leading the TUS of included papers were compiled in a tabular format. RESULTS Of the 26 included papers, nine studied healthy participants, four studied COPD and four studied critical care patients. Most papers (n=23) involved scanning the diaphragm. In eight studies the physiotherapist operated the TUS. LIMITATIONS The paper selection process was performed by one author; with no cross-checking by another individual. CONCLUSION Use of TUS by physiotherapists is an emerging area in both diaphragm and lung diagnostics. A wide range of patient populations may benefit from physiotherapists using TUS. Papers in this review are heterogeneous making any generalisability difficult but does show its potential for varied uses. TUS is an innovative skill in the hands of physiotherapists, but more research is needed.
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