Value of Peak Expiratory Flow Rate in Evaluating Cough Ability in Patients Undergoing Lung Surgery

Impact of inspiratory muscle training on aspiration symptoms in patients with dysphagia following ischemic stroke

OBJECTIVE

To investigate the impact of inspiratory muscle training on lung function and swallowing function in patients with dysphagia-induced aspiration following ischemic stroke and to evaluate the effectiveness of inspiratory muscle training on aspiration symptoms.

METHODS

Fifty-eight inpatients with dysphagia-induced aspiration following ischemic stroke were selected and randomly divided into a control group (n = 29, conventional swallowing therapy) and a treatment group (n = 29, conventional swallowing therapy plus inspiratory muscle training). Both groups received conventional swallowing function training, including oral sensory training, oral motor training, airway safety protection training, and neuromuscular electrical stimulation therapy for 10-20 min per session, twice daily for 2 weeks. The treatment group additionally received inspiratory muscle resistance training using the POWERbreathe device for 20 min per session, twice daily for 2 weeks. Swallowing function was assessed using the Penetration-Aspiration Scale (PAS), Functional Dysphagia Scale (FDS), and Functional Oral Intake Scale (FOIS) based on the videofluoroscopic swallowing study (VFSS) before and after treatment. Lung function, including maximal peak expiratory flow rate (PEF) and forced vital capacity (FVC), was evaluated using the Miraclink X-SCRIBE cardiac stress testing system.

RESULTS

Before treatment, there were no significant differences in FOIS, FDS, and PAS scores between the two groups (P > 0.05), while post-treatment, both groups showed significant improvements in these indicators (P < 0.05), with the treatment group showing more significant improvements than the control group (P < 0.05). Further, before treatment, there were no significant differences in FVC and PEF scores between the two groups (P > 0.05), whereas post-treatment, the treatment group showed significant improvements in these indicators (P < 0.05) and the control group showed no significant changes (P > 0.05). The treatment group also showed more significant improvements than the control group (P < 0.05). Finally, a correlation analysis revealed a significant linear relationship between FVC and PEF in the post-treatment PAS in the treatment group (P < 0.05).

CONCLUSION

Inspiratory muscle training can improve lung function in patients with dysphagia following ischemic stroke, as it develops swallowing function more effectively than conventional swallowing function training alone. Moreover, inspiratory muscle training is effective in treating aspiration caused by dysphagia, with enhancements in aspiration related to improved lung function.

Assessments and exercises of cough strength in critically ill patients: a literature review

Background and Objective

Airway clearance is essential for maintaining patency in critically ill patients and relies on the mucociliary escalator, expiratory flow, and cough strength. A weak cough significantly increases the risk of therapy failure in patients receiving noninvasive ventilation (NIV) or high-flow nasal cannula (HFNC). This review aims to summarize current practices for assessing and exercising cough strength in critically ill patients.

Methods

A comprehensive literature search was conducted in PubMed, Embase, and ScienceDirect using specific keywords related to cough assessment and exercises. A total of 281 articles on cough assessment and 1,407 on cough exercises were identified, with 26 and 73 studies included in the review, respectively.

Key Content and Findings

By collecting literature related to cough efficacy, this narrative review describes methods for assessing cough ability and strategies for improving it. The assessment methods for cough ability include quantitative, semi-quantitative, and qualitative evaluations, each targeting different populations and having its own advantages and disadvantages. For patients whose cough ability has diminished, it is essential to implement cough training. Cough exercises focus on increasing inhaled volume, enhancing expiratory flow, and utilizing oscillation techniques to improve cough effectiveness. Choosing the appropriate training method for the patients can lead to significantly better outcomes.

Conclusions

Weak cough in critically ill patients correlates with increased risks of extubation failure and prolonged hospitalization. Employing appropriate assessment methods and individualized cough exercises is critical for improving patient outcomes in the intensive care unit (ICU) setting. Further research is needed to optimize training methods and enhance patient cooperation.

Lower peak expiratory flow rate is associated with a higher risk of pneumonia in patients with stroke

BACKGROUND

Low peak expiratory flow (PEF) rate is common in patients with stroke. Studies on changes in PEF rates in patients with stroke often have small sample sizes, limiting the generalizability of their findings.

AIM

This study aimed to compare the PEF rates between patients who were post-stroke with or without pneumonia and age- and sex-matched healthy controls and explore the PEF-pneumonia association among stroke survivors.

DESIGN

Prospective observational study.

SETTING

Department of Rehabilitation, the First Affiliated Hospital of Wenzhou Medical University.

POPULATION

Initially, 809 patients with stroke undergoing inpatient rehabilitation were recruited.

METHODS

Data collected included the demographics, stroke history, the presence of dysphagia, and the PEF rates on admission. Logistic regression analysis was conducted to identify the PEF threshold as predictive of pneumonia after adjusting for confounders.

RESULTS

Patients with stroke had a mean PEF rate of 243.89±139.38 L/min, significantly lower than that of the normal control group. The PEF rate was significantly lower in the pneumonia group than in the non-pneumonia group (P<0.001). Within the stroke cohort, the PEF rates were lower than the predicted rates (P<0.001). Older age, lower PEF(%),and dysphagia were associated with a higher pneumonia risk post-stroke per stepwise multivariate logistic regression analysis. Furthermore, the combination of these three significant predictors (PEF(%), swallowing function, and age) yielded an area under the curve of 0.857 .Regarding age, the cut-off point of ≥65.5 years was the optimal level to discriminate the presence of pneumonia among patients with stroke. For PEF%,the cut-off point of <60% was the optimal level to discriminate the presence of pneumonia among patients with stroke. For screening dysphagia, the patients with impaired safety only and those with impaired safety and efficacy faced a higher pneumonia risk.

CONCLUSIONS

Patients with stroke exhibited significantly lower peak expiratory flow rates compared to healthy controls after adjusting for age and sex and when compared to their reference values. Decreased PEF rates were independently associated with pneumonia development during inpatient rehabilitation in post-stroke patients.

CLINICAL REHABILITATION IMPACT

This study suggests that low PEF rates may predict pneumonia and that the prevention of PEF rate decline may prevent pneumonia development.

Effect of Hope Theory combined with active cycle of breathing techniques on pulmonary rehabilitation among COPD patients: A quasi-experiment study

BACKGROUND

Pulmonary rehabilitation plays a positive role in improving exercise tolerance and reducing readmission rates in patients with chronic obstructive pulmonary disease (COPD), while the adherence of pulmonary rehabilitation in COPD patients is still poor. The active cycle of breathing techniques based on the Hope Theory is a method to enhance patients' confidence in overcoming the disease and improve the intrinsic motivation of exercise through symptom improvement such as cough and sputum evacuation ability.

OBJECTIVES

To investigate the effect of Hope Theory education combined with the active cycle of breathing techniques on pulmonary rehabilitation of COPD patients, including exercise adherence, cough and sputum evacuation ability, hope index and exercise self-efficacy.

METHODS

The study assigned 70 COPD patients hospitalized into intervention and control groups to receive the active cycle of breathing techniques based on Hope Theory or routine treatment in order of admission. Data for cough and sputum evacuation ability, hope, exercise confidence were collected at baseline and after the program. Exercise adherence was assessed at the end of 1, 4 and 8 week following discharge.

RESULTS

The actual number of sample consisted of 65 patients divided into intervention (n = 33) and control (n = 32) groups due to severe complications, explicit refusal, disinterest and loss to follow-up. After two weeks of intervention, exercise adherence of the intervention group were better than those of the control group at the end of 4 and 8 week of discharge (P < 0.05). And there was an improvement in cough and sputum evacuation ability, hope and exercise self-efficacy outcomes in the intervention group, with a statistically significant difference between the two groups (P < 0.05).

CONCLUSION

The active cycle of breathing techniques based on Hope Theory education can improve cough and sputum evacuation ability, hope index, exercise self-efficacy, and exercise adherence of COPD patients.

Interest of the Leicester Cough Questionnaire in predicting postoperatives complications after lung resection: LCQ-SURGE

Background

Postoperative complications may occur after major lung surgery for non-small cell lung cancer (NSCLC), with a high rate of morbidity and mortality. The main objective of this study was to assess the relevance of preoperative Leicester Cough Questionnaire (LCQ) to predict postoperative complications after major lung resection for any indication.

Methods

This was a retrospective cohort study conducted in the Thoracic Surgery Department of Rouen University Hospital from November 21st, 2022, to June 2nd, 2023. Patients aged ≥18 years who underwent major lung resection for any indications and filled an LCQ self-questionnaire were included.

Results

Seventy-one patients were eligible for our study. One patient was lost to follow-up upon hospital discharge. Nineteen (27.1%) postoperative complications of grade ≥2 according to the Clavien-Dindo classification were observed. The mean LCQ total score was 18.11±2.56. The area under the receiver operating characteristic (ROC) curve for the LCQ result to predict postoperative complications of grade ≥2 within 30 days following the surgical intervention was 0.60 [95% confidence interval (CI): 0.45, 0.75].

Conclusions

This study failed to demonstrate the relevance of a preoperative LCQ to predict postoperative complications after major lung surgery. However, the statistical precision of this study was insufficient to show a moderate predictive performance. Further studies conducted in larger populations are needed.

Factors related to pre-operative cough strength in cardiac surgical patients: a cross-sectional study

BACKGROUND

Pulmonary complications often arise from ineffective coughing, yet limited research exists on the determinants of cough strength in patients undergoing cardiac surgery.

OBJECTIVES

The aim is to explore preoperative cough strength in patients scheduled for cardiac surgery and identify factors associated with diminished cough strength.

METHODS

A cross-sectional study was conducted on 330 adult patients admitted for cardiac surgery at a tertiary Grade A hospital in Jiangsu Province, China between August 2022 and February 2023. Cough strength was assessed using cough peak flow, with values below 270 L/min classified as reduced cough strength. The study adhered to the STROBE guidelines.

RESULTS

The study comprised 228 males (69.1 %) and 102 females (30.9 %), aged 23 to 81 years. Types of cardiac surgery included coronary artery bypass surgery, heart valvuloplasty, or heart valve replacement among others. The mean preoperative cough peak flow was 250.38 ± 119.71 L/min, with 60.3 % of patients exhibiting reduced cough strength. A multiple linear regression analysis identified gender, age, exercise regimen, pulmonary arterial hypertension, left ventricular ejection fraction, inspiratory capacity, and proficiency in coughing techniques as primary factors affecting cough strength.

CONCLUSIONS

Our findings indicate an association between diminished cough strength and factors such as female gender, advanced age, absence of systematic exercise, presence of pulmonary arterial hypertension, lower left ventricular ejection fraction, reduced inspiratory capacity, and inadequate mastery of coughing techniques. Healthcare staff should prioritize regular assessment of cough strength and manage the pertinent factors to enhance preoperative coughing ability.

A Prediction Model for Peak Expiratory Flow Derived From Venous Blood Biomarkers and Clinical Factors in Amyotrophic Lateral Sclerosis

Although peripheral venous blood biomarkers are related to respiratory function in Amyotrophic lateral sclerosis (ALS) patients, there are still few prediction models that predict pulmonary function. This study aimed to investigate the venous blood biomarkers associated with respiratory function in patients with ALS from southwest China and to create prediction models based on those clinical biomarkers using logistic regression. A total of 319 patients with ALS from the retrospective cohort and 97 patients with ALS from the prospective cohort were enrolled in this study. A multivariable prediction model for the correlation between peak expiratory flow (PEF) and hematologic, biochemical laboratory parameters, and clinical factors in patients with ALS was created. Along with female patients, bulbar-onset, lower body mass index (BMI), later age of onset, lower level of creatinine, uric acid, triglyceride, and a higher level of high-density lipoprotein cholesterol (HDL_C) were related to reduced PEF. The area under the receiver operating characteristics (ROC) curve is.802 for the test set and.775 for the validation set. The study constructed a multivariable prediction model for PEF in patients with ALS. The results can be helpful for clinical practice to predict respiratory impairment.