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Audag N, Dubus JC, Combret Y. [Respiratory physiotherapy in pediatric practice]. Rev Mal Respir 2022; 39:547-560. [PMID: 35738979 DOI: 10.1016/j.rmr.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/03/2022] [Indexed: 01/11/2023]
Abstract
Congestion of the upper (URT) and lower respiratory tracts (LRT) is a common symptom in several acute and chronic respiratory diseases that occur in childhood. To eliminate these secretions, airway clearance techniques (ACT) directed to the URT and LRT are frequently prescribed. The rationale for the application of these techniques is the same as in adults, but they need to be adapted to be transposed to children. The physiotherapist will be able to choose among a wide range of techniques, of which the most adequate will depend not only on the age of the child and the indication, but also on the basis of his preferences or habits, as well as those of the child. Upper airway clearance, including nasal irrigation, is now recommended for acute and chronic rhinosinusitis in children. It is also one of the symptomatic treatments recommended for infants with acute bronchiolitis. For LRT clearance, several indications, such as cystic fibrosis, primary ciliary dyskinesia and neuromuscular disease, are now widely advocated. Conversely, other indications, such as for infants with acute viral bronchiolitis, are highly controversial. Thoughtful application of these techniques is lacking in robust and precise tools to objectively assess the presence of bronchial congestion, and to treat it accordingly. Similarly, no precise and reliable evaluation of the effectiveness of these ACTs is available to date. This review is designed to explore the ACTs used by physiotherapists, to provide an overview of their current indications, and to consider complementary approaches.
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Affiliation(s)
- N Audag
- Institut de recherche expérimentale et clinique, pôle de pneumologie, ORL & dermatologie, groupe recherche en kinésithérapie respiratoire, université Catholique de Louvain, Bruxelles, Belgique; Secteur de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc, avenue Hippocrate 10, Bruxelles 1200, Belgique.
| | - J-C Dubus
- Service de médecine infantile et pneumologie pédiatrique, CHU Timone-Enfants, Marseille, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU Méditerranée-infection, Marseille, France
| | - Y Combret
- Secteur de kinésithérapie, Groupe Hospitalier du Havre, 76600 Le Havre, France
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2
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Perin C, Mazzucchelli M, Piscitelli D, Braghetto G, Meroni R, Cornaggia CM, Cerri CG. Feasibility of a standardized protocol for respiratory training with intermitted positive pressure breathing ventilator application in dysphonia and dysarthria. Eur J Phys Rehabil Med 2022; 58:218-224. [PMID: 34652084 PMCID: PMC9980488 DOI: 10.23736/s1973-9087.21.06946-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Brain damage can affect several functions related to speech production leading to dysphonia and dysarthria. Most rehabilitation treatments focus on articulation training rather than on pneumophonic coordination and respiratory muscle strength. Respiratory training using an intermitted positive pressure breathing (IPPB) ventilator can be used for this last purpose; no agreement on a standard protocol has been reached to date. AIM To evaluate the feasibility and the effectiveness of a standardized incremental protocol of respiratory training using IPPB to treat dysphonia and dysarthria. DESIGN Case series study. SETTING Neuropsychological Rehabilitation Unit in an Italian Neurorehabilitation Division. POPULATION Thirty-two subjects with dysphonia and dysarthria resulting from neurological lesion. METHODS Participants were assessed using clinical evaluation scales (GIRBAS scale of dysphonia, Robertson dysarthria profile), respiratory function test, and arterial blood gas analysis in air. The evaluations were performed at baseline and after 20 sessions of respiratory training with IPPB. The protocol provided a default increment of ventilator parameters. All subjects also underwent a standard speech and language therapy treatment. A satisfaction survey to assess acceptability and the Goal Attainment Scale were applied. RESULTS All participants fulfilled the protocol. No complications or discomfort were reported. Subjects' satisfaction at survey was 97.7%. After respiratory training, all respiratory function parameters increased, but only maximal voluntary ventilation (MVV), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were statistically significant (P<0.05). Clinical evaluation scales significantly improved (P<0.05). Correlation between respiratory function parameters and clinical evaluation scales showed a moderate correlation between MVV, MEP, MIP, and Robertson dysarthria profile (P<0.01). A weak correlation was found between MIP, MVV, and GIRBAS scale (P<0.05). CONCLUSIONS Our protocol showed to be practical and well-tolerated. After respiratory training, MVV, MIP and MEP improved in significantly. Clinical scale scores improved in all participants. CLINICAL REHABILITATION IMPACT Respiratory training using IPPB ventilator can be useful in implementing speech and language treatments in subjects with dysphonia and dysarthria linked to brain injury.
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Affiliation(s)
- Cecilia Perin
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy
| | - Miryam Mazzucchelli
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy - .,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Giacomo Braghetto
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy
| | - Roberto Meroni
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy.,Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - Cesare M Cornaggia
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy
| | - Cesare G Cerri
- School of Medicine and Surgery, University of Milan - Bicocca, Monza, Monza e Brianza, Italy.,Istituti Clinici Zucchi, Carate Brianza, Monza e Brianza, Italy
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3
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Wu MF, Wang TY, Chen DS, Hsiao HF, Hu HC, Chung FT, Lin TY, Lin SM. The effects of mechanical insufflation-exsufflation on lung function and complications in cardiac surgery patients: a pilot study. J Cardiothorac Surg 2021; 16:350. [PMID: 34886881 PMCID: PMC8662824 DOI: 10.1186/s13019-021-01738-x] [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: 12/19/2020] [Accepted: 11/07/2021] [Indexed: 12/04/2022] Open
Abstract
Background Postoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy. Methods This retrospective study included 51 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two types of positive pressure devices, MI-E (n = 21) or IPPB (n = 30). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups. Results Subjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.4 ± 4.74% vs. 46.0 ± 3.70%, p = 0.042), forced expiratory volume in one second (62.4 ± 5.23% vs. 46.8 ± 3.83%, p = 0.017), and peak flow rate (67.1 ± 5.53 L vs. 55.7 ± 4.44 L p = 0.111). However, the incidence of chest pain was higher in the MI-E group (n = 13, 61.9%) than in the IPPB group (n = 4, 16.7%; odds ratio, 0.123, 95% confidence interval, 0.03–0.45; p = 0.002). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups. Conclusion Both IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with better-preserved pulmonary function and higher incidence of chest pain. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01738-x.
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Affiliation(s)
- Meng-Fang Wu
- Department of Respiratory Therapy, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Tsai-Yu Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd, Taipei, Taiwan
| | - Da-Shen Chen
- Department of Respiratory Therapy, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Hsiu-Fong Hsiao
- Department of Respiratory Therapy, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Han-Chuang Hu
- Department of Respiratory Therapy, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd, Taipei, Taiwan
| | - Fu-Tsai Chung
- Department of Respiratory Therapy, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd, Taipei, Taiwan
| | - Ting-Yu Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd, Taipei, Taiwan
| | - Shu-Min Lin
- Department of Respiratory Therapy, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan. .,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, 199 Tun-Hwa N. Rd, Taipei, Taiwan.
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4
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Nielsen Jeschke K, Bonnesen B, Hansen EF, Jensen JUS, Lapperre TS, Weinreich UM, Hilberg O. Guideline for the management of COVID-19 patients during hospital admission in a non-intensive care setting. Eur Clin Respir J 2020; 7:1761677. [PMID: 33224450 PMCID: PMC7655082 DOI: 10.1080/20018525.2020.1761677] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has presented health-care systems worldwide with novel challenges and experiences and evidence is emerging during the pandemic. Patients requiring hospitalization frequently suffer from respiratory failure of different severities. Aim The aim of this guideline is the treatment of patients with SARS CoV-2 (COVID-19) in hospital; in particular, it addresses the treatment of respiratory failure treated in general Internal Medical- and Pulmonary Medical wards. Results Elderly patients and patients with chronic disease are particularly vulnerable to COVID-19. Target oxygen saturation should be between 92% and 96% in patients without chronic lung diseases. Treatment with >5 L oxygen/min should be in close collaboration with intensive care colleagues and >15 l/min preferably in intensive care units. High-flow nasal canula (HFNC) and long-term Continuous Positive Airway Pressure (CPAP) are recommended for patients not responding to conventional oxygen therapy. Non-invasive ventilation (NIV) is only recommended for selected patients, such as those with a ceiling of treatment or patients presenting with hypercapnic failure. With the use of humidification protective equipment as FFP2-3 masks should be used. Nebulized medication should be avoided, and spacers should be used instead. Conclusion Respiratory failure is frequently the cause of hospitalization in patients with COVID-19 and should be monitored closely.
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Affiliation(s)
| | - Barbara Bonnesen
- Department of Internal Medicine, Respiratory Medicine Section, Herlev-Gentofte Hospital, Hellerup, Denmark
| | | | - Jens-Ulrik Stæhr Jensen
- Department of Internal Medicine, Respiratory Medicine Section, Herlev-Gentofte Hospital, Hellerup, Denmark
| | | | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital and the Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Ole Hilberg
- Department of Medicine, Vejle Hospital, Vejle, Denmark
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Blattner CN, Santos RSD, Dias FS, Dias AS, Mestriner RG, Vieira SRR. Acute bag-valve breathing maneuvers plus manual chest compression is safe during stable septic shock: a randomized clinical trial. Rev Bras Ter Intensiva 2017; 29:14-22. [PMID: 28444068 PMCID: PMC5385981 DOI: 10.5935/0103-507x.20170004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/03/2016] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the effects of bag-valve breathing maneuvers combined with
standard manual chest compression techniques on safety, hemodynamics and
oxygenation in stable septic shock patients. Design A parallel, assessor-blinded, randomized trial of two groups. A
computer-generated list of random numbers was prepared by an independent
researcher to allocate treatments. Setting The Intensive Care Unit at Hospital São Lucas,
Pontifícia Universidade Católica do Rio Grande do
Sul. Participants Fifty-two subjects were assessed for eligibility, and 32 were included. All
included subjects (n = 32) received the allocated intervention (n = 19 for
the Experimental Group and n = 13 for the Control Group). Intervention Twenty minutes of bag-valve breathing maneuvers combined with manual chest
compression techniques (Experimental Group) or chest compression, as
routinely used at our intensive care unit (Control Group). Follow-up was
performed immediately after and at 30 minutes after the intervention. Main outcome measure Mean artery pressure. Results All included subjects completed the trial (N = 32). We found no relevant
effects on mean artery pressure (p = 0.17), heart rate (p = 0.50) or mean
pulmonary artery pressure (p = 0.89) after adjusting for subject age and
weight. Both groups were identical regarding oxygen consumption after the
data adjustment (p = 0.84). Peripheral oxygen saturation tended to increase
over time in both groups (p = 0.05), and there was no significant
association between cardiac output and venous oxygen saturation (p = 0.813).
No clinical deterioration was observed. Conclusion A single session of bag-valve breathing maneuvers combined with manual chest
compression is hemodynamically safe for stable septic-shocked subjects over
the short-term.
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Affiliation(s)
- Clarissa Netto Blattner
- Faculdade de Enfermagem, Nutrição e Fisioterapia, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | | | - Fernando Suparregui Dias
- Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Unidade de Terapia Intensiva, Hospital Pompeia - Caxias do Sul (RS), Brasil
| | - Alexandre Simões Dias
- Departamento de Fisioterapia, Hospital das Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Régis Gemerasca Mestriner
- Faculdade de Enfermagem, Nutrição e Fisioterapia, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Silvia Regina Rios Vieira
- Unidade de Terapia Intensiva, Hospital das Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
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6
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Polastri M, Martin-Suarez S, Alfonsi J, Savini C. Intermittent positive pressure breathing in the cardiac surgery setting: A review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.12.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose: To review the role of intermittent positive pressure breathing in the cardiac surgery setting. Methods: This review was conducted by searching seven major databases. A search string was built using the key words ‘intermittent positive pressure breathing’, and ‘cardiac surgery’ matched with the Boolean operator AND. Filters were selected for the publication dates January 2006 to January 2016. In each database, the search was conducted in the fields of the article title, abstract and keywords. Results: In total, seven citations that fulfilled the inclusion criteria were included in the final review. There was consensus among the authors regarding the inspiratory pressure values at which intermittent positive pressure breathing should be administered (15–30 cm H2O). The duration of treatment ranged between 15–30 minutes divided into one to three daily sessions, or was carried out considering the number of respirations. With regard to the treatment of pulmonary atelectasis, intermittent positive pressure breathing was shown to be effective after coronary artery bypass grafting, and it was the most cited postoperative intervention used to treat either pulmonary atelectasis and oxygen impairment, in cardiac surgery patients. Conclusions: The findings of this review seem to confirm that intermittent positive pressure breathing is still currently being used postoperatively in the cardiac surgery setting to treat surgery-related pulmonary complications.
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Affiliation(s)
- Massimiliano Polastri
- Physiotherapist, Physical Medicine and Rehabilitation, University Hospital Saint Orsola-Malpighi, Bologna, Italy
| | - Sofia Martin-Suarez
- Cardiac surgeon, Department of Cardiac-Thoracic and Vascular Diseases, Cardiac Surgery, University Hospital Saint Orsola-Malpighi, Bologna, Italy
| | - Jacopo Alfonsi
- Cardiac surgeon, Department of Cardiac-Thoracic and Vascular Diseases, Cardiac Surgery, University Hospital Saint Orsola-Malpighi, Bologna, Italy
| | - Carlo Savini
- Cardiac surgeon, Department of Cardiac-Thoracic and Vascular Diseases, Cardiac Surgery, University Hospital Saint Orsola-Malpighi, Bologna, Italy
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7
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Pulmonary Protection Strategies in Cardiac Surgery: Are We Making Any Progress? OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:416235. [PMID: 26576223 PMCID: PMC4630421 DOI: 10.1155/2015/416235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/12/2015] [Indexed: 01/19/2023]
Abstract
Pulmonary dysfunction is a common complication of cardiac surgery. The mechanisms involved in the development of pulmonary dysfunction are multifactorial and can be related to the activation of inflammatory and oxidative stress pathways. Clinical manifestation varies from mild atelectasis to severe respiratory failure. Managing pulmonary dysfunction postcardiac surgery is a multistep process that starts before surgery and continues during both the operative and postoperative phases. Different pulmonary protection strategies have evolved over the years; however, the wide acceptance and clinical application of such techniques remain hindered by the poor level of evidence or the sample size of the studies. A better understanding of available modalities and/or combinations can result in the development of customised strategies for the different cohorts of patients with the potential to hence maximise patients and institutes benefits.
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8
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Beck MC, Piccin CF, Oliveira LCAD, Scapini F, Coser Neto RF, Silva AMVD. Obstructive sleep apnea: acute effects of CPAP on polyssonographic variables. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.002.ao02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction The use of non-invasive ventilation in the form of continuous positive airway pressure (CPAP) is among the main therapeutic options for patients with obstructive sleep apnea (OSA). Yet the effects of CPAP obtained on the first night of use are underreported. Objective To evaluate the acute effects of CPAP on polysomnographic variables in patients with OSA. Materials and methods This study is a case series with 31 patients (55.8 ± 11.4 years; 22 men) in the initial phase of CPAP treatment. The subjects were evaluated by means of polysomnography with and without CPAP (10.2 ± 3.1 cmH2O) and without CPAP, on different days, by means of the following variables: sleep stages 1, 2 and 3 (N1, N2 and N3), rapid eye movement (REM) sleep, apnea and hypopnea index (AHI), AHI in REM sleep (AHIREM) and the micro-arousal index (MAI). Results The use of CPAP resulted in a reduction of N2 (p < 0.001), AHI (p < 0.001), AHIREM (p < 0.001) and MAI (p = 0.001). There was an increase in N3 (p = 0.006) and REM sleep (p < 0.001) during the night with use of CPAP. Conclusion This study demonstrated that, from the first night of use by patients with OSA, CPAP promotes greater balance between sleep phases, and improves sleep quality. These results should be presented to patients and their families in order to encourage greater adherence in the initial phase of treatment with CPAP.
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Affiliation(s)
| | - Chaiane Facco Piccin
- Universidade Federal de Santa Maria, Brazil; Instituto do Sono de Santa Maria, Brazil
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9
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Özkan M, Kırkıl G, Dilektaşlı AG, Söğüt A, Sertoğullarından B, Çetinkaya E, Coşkun F, Ulubay G, Yüksel H, Sezer M, Özbudak Ö, Ulaşlı SS, Arslan S, Kovan T. Summary of Consensus Report on Preoperative Evaluation. Turk Thorac J 2015; 16:43-52. [PMID: 29404077 PMCID: PMC5783046 DOI: 10.5152/ttd.2014.4505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/04/2014] [Indexed: 12/31/2022]
Affiliation(s)
| | - Gamze Kırkıl
- Department of Chest Diseases, Fırat University Faculty of Medicine, Elazığ, Turkey
| | | | - Ayhan Söğüt
- Division of Pediatric Allergy and Immunology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | | | - Erdoğan Çetinkaya
- Department of Chest Diseases, Karabük University Faculty of Medicine, Karabük, Turkey
| | - Funda Coşkun
- Department of Chest Diseases, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Gaye Ulubay
- Department of Chest Diseases, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Hasan Yüksel
- Division of Pediatric Chest Diseases, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Murat Sezer
- Department of Chest Diseases, Bezmialem Vakif University Faculty of Medicine, İstanbul, Turkey
| | - Ömer Özbudak
- Department of Chest Diseases, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Sevinç Sarınç Ulaşlı
- Department of Chest Diseases, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
| | - Sulhattin Arslan
- Department of Chest Diseases, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Tezay Kovan
- Clinic of Chest Diseases, Beyşehir State Hospital, Konya, Turkey
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10
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Optimum Insufflation Capacity and Peak Cough Flow in Neuromuscular Disorders. Ann Am Thorac Soc 2014; 11:1560-8. [DOI: 10.1513/annalsats.201406-264oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Hostyn SV, Johnston C, Braga JAP, Carvalho WBD, Nogueira SC. Fisioterapia respiratória em crianças com doença falciforme e síndrome torácica aguda. REVISTA PAULISTA DE PEDIATRIA 2011. [DOI: 10.1590/s0103-05822011000400029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Realizar uma revisão sistemática da literatura médica para identificar as técnicas de fisioterapia respiratória aplicadas em crianças com doença falciforme e síndrome torácica aguda, bem como descrever seu nível de evidência e recomendação. FONTES DE DADOS: Revisão bibliográfica nos bancos de dados Medline, Lilacs, SciELO e Cochrane no período de 1995 e 2009, com os descritores: "doença falciforme", "síndrome torácica aguda", "fisioterapia", "criança", "inspirometria de incentivo", em português e inglês, excluindo-se os estudos de revisão. Os artigos foram classificados por nível de evidência. SÍNTESE DOS DADOS: Foram encontrados cinco artigos; destes, três utilizaram a inspirometria de incentivo e observaram que ela evita as complicações pulmonares associadas à síndrome torácica aguda (nível de evidência II, II e IV), um deles (evidência II) comparou a inspirometria de incentivo com o dispositivo de pressão expiratória, sem diferenças entre ambos. Um artigo utilizou uma rotina de cuidados, incluindo a inspirometria de incentivo (evidência V), e observou redução do tempo de internação hospitalar e do uso de medicação oral para dor. Outro estudo com a ventilação não invasiva para crianças com desconforto respiratório e com incapacidade de realizar a inspirometria de incentivo relatou melhora da oxigenação e do desconforto respiratório (nível de evidência V). CONCLUSÕES: As técnicas de fisioterapia respiratória com dispositivos de inspirometria de incentivo, de pressão expiratória e a ventilação não invasiva podem ser aplicadas em crianças com doença falciforme e síndrome torácica aguda; o nível de recomendação é C.
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12
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Hyperinflation using pressure support ventilation improves secretion clearance and respiratory mechanics in ventilated patients with pulmonary infection: a randomised crossover trial. ACTA ACUST UNITED AC 2009; 55:249-54. [DOI: 10.1016/s0004-9514(09)70004-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Intermittent Positive-Pressure Breathing Effects in Patients With High Spinal Cord Injury. Arch Phys Med Rehabil 2008; 89:1575-9. [DOI: 10.1016/j.apmr.2007.12.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 10/15/2007] [Accepted: 12/11/2007] [Indexed: 12/13/2022]
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14
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Fauroux B, Guillemot N, Aubertin G, Nathan N, Labit A, Clément A, Lofaso F. Physiologic benefits of mechanical insufflation-exsufflation in children with neuromuscular diseases. Chest 2007; 133:161-8. [PMID: 18071020 DOI: 10.1378/chest.07-1615] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES To analyze the physiologic effects and tolerance of mechanical insufflation-exsufflation (MI-E) by means of mechanical cough assistance (Cough Assist; JH Emerson Company; Cambridge, MA) for children with neuromuscular disease. DESIGN Prospective clinical trial. SETTING Physiology laboratory of a pediatric pulmonary department of a university hospital. PATIENTS Seventeen children with Duchenne muscular dystrophy (n = 4), spinal muscular atrophy (n = 4), or other congenital myopathy (n = 9) who were in a stable state. INTERVENTIONS Pressures of 15, 30, and 40 cm H(2)O were cycled to each patient, with 2 s for insufflation and 3 s for exsufflation. One application consisted of six cycles at each pressure for a total of three applications. MEASUREMENTS AND RESULTS Airway pressure and airflow were measured during every application. Breathing pattern, vital capacity (VC), sniff nasal inspiratory pressure (SNIP), peak expiratory flow (PEF), and respiratory comfort were evaluated at baseline and after each application. The tolerance of the patients was excellent, with a significant increase in the respiratory comfort score in all of the patients (p = 0.02). Expired volume during the MI-E application increased significantly to reach twice the VC at 40 cm H(2)O. Mean and maximal inspiratory and expiratory flows increased in a pressure-dependent manner. Breathing pattern did not change after the MI-E applications and pulse oximetric saturation remained stable within normal values, but the mean end-tidal carbon dioxide pressure decreased significantly. VC did not change, but the mean SNIP and PEF improved significantly after MI-E applications. CONCLUSIONS Our results confirm the good tolerance and physiologic short-term benefit of the MI-E in children with neuromuscular disease who were in a stable state.
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Affiliation(s)
- Brigitte Fauroux
- Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Pediatric Pulmonary Department, Research unit INSERM UMR-S 719, Université Pierre et Marie Curie-Paris 6, 28 Ave du Docteur Arnold Netter, Paris, F-75012 France.
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Trebbia G, Lacombe M, Fermanian C, Falaize L, Lejaille M, Louis A, Devaux C, Raphaël JC, Lofaso F. Cough determinants in patients with neuromuscular disease. Respir Physiol Neurobiol 2005; 146:291-300. [PMID: 15766917 DOI: 10.1016/j.resp.2005.01.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Revised: 01/04/2005] [Accepted: 01/05/2005] [Indexed: 11/19/2022]
Abstract
Neuromuscular disease leads to cough impairment. Cough augmentation can be achieved by mechanical insufflation (MI) or manually assisted coughing (MAC). Many studies have compared these two methods, but few have evaluated them in combination. In 155 neuromuscular patients, we assessed determinants of peak cough flow (PCF) using stepwise correlation. Maximal inspiratory capacity contributed 44% of the variance (p<0.001), expiratory reserve volume 13%, and maximal expiratory pressure 2%. Thus, augmenting inspiration seems crucial. However, parameters dependent on expiratory muscles independently influence PCF. We measured vital capacity and PCF in 10 neuromuscular patients during cough augmentation by MI, MAC, or both. MI or MAC significantly improved VC and PCF (p<0.01) as compared to the basal condition and VC and PCF were higher during MI plus MAC than during MAC or MI alone (p<0.01). In conclusion, combining MAC and MI is useful for improving cough in neuromuscular patients.
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Affiliation(s)
- Grégoire Trebbia
- Medical Intensive Care Unit, Physiology and Function Testing Unit/Technological Innovation Center, AP-HP, 92380 Garches, France
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Klingler W, Lehmann-Horn F, Jurkat-Rott K. Complications of anaesthesia in neuromuscular disorders. Neuromuscul Disord 2005; 15:195-206. [PMID: 15725581 DOI: 10.1016/j.nmd.2004.10.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2004] [Revised: 09/27/2004] [Accepted: 10/09/2004] [Indexed: 12/17/2022]
Abstract
The purpose of this review is to alert non-anaesthesiologists to the various complications from which patients with neuromuscular disorders and those susceptible to malignant hyperthermia can suffer during anaesthesia. The patient's outcome correlates with the quality of consultation between anaesthesiologists, surgeons, neurologists and cardiologists. Special precautions must be taken, since many anaesthetics and muscle relaxants can aggravate the clinical features or trigger life-threatening reactions. Complications frequently occur in these patients, although anaesthetic procedures have become safer by the reduced administration of suxamethonium and the use of total intravenous anaesthesia, new volatile anaesthetics and non-depolarising relaxants. This review provides a synopsis of pre-operative anaesthetic considerations and adverse drug effects on skeletal, cardiac and smooth muscle tissue. It describes the pathogenetic aspects of typical complications and introduces anaesthetic procedures for the various neuromuscular disorders, including regional anaesthesia for patients in whom a restriction of respiratory and/or cardiac function is predicted.
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Affiliation(s)
- Werner Klingler
- Department of Anaesthesiology, Ulm University, Albert-Einstein-Allee 11, 89069 Ulm, Germany
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Pasquina P, Merlani P, Granier JM, Ricou B. Continuous Positive Airway Pressure Versus Noninvasive Pressure Support Ventilation to Treat Atelectasis After Cardiac Surgery. Anesth Analg 2004; 99:1001-1008. [PMID: 15385340 DOI: 10.1213/01.ane.0000130621.11024.97] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Atelectasis is common after cardiac surgery and may result in impaired gas exchange. Continuous positive airway pressure (CPAP) is often used to prevent or treat postoperative atelectasis. We hypothesized that noninvasive pressure support ventilation (NIPSV) by increasing tidal volume could improve the evolution of atelectasis more than CPAP. One-hundred-fifty patients admitted to our surgical intensive care unit (SICU) with a Radiological Atelectasis Score >or=2 after cardiac surgery were randomly assigned to receive either CPAP or NIPSV four times a day for 30 min. Positive end-expiratory pressure was set at 5 cm H(2)O in both groups. In the NIPSV group, pressure support was set to provide a tidal volume of 8-10 mL/kg. At SICU discharge, we observed an improvement of the Radiological Atelectasis Score in 60% of the patients with NIPSV versus 40% of those receiving CPAP (P = 0.02). There was no difference in oxygenation (Pao(2)/fraction of inspired oxygen at SICU discharge: 280 +/- 38 in the CPAP group versus 301 +/- 40 in the NIPSV group), pulmonary function tests, or length of stay. Minor complications, such as gastric distensions, were similar in the two groups. NIPSV was superior to CPAP regarding the improvement of atelectasis based on radiological score but did not confer any additional clinical benefit, raising the question of its usefulness for altering outcome.
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Affiliation(s)
- Patrick Pasquina
- *Respiratory Therapy Unit of the Division of Surgical Intensive Care, †Division of Surgical Intensive Care, Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital, Geneva, Switzerland
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Abstract
OBJECTIVE To assess whether respiratory physiotherapy prevents pulmonary complications after cardiac surgery. DATA SOURCES Searches through Medline, Embase, Cinahl, the Cochrane library, and bibliographies, for randomised trials comparing any type of prophylactic respiratory physiotherapy with another type or no intervention after cardiac surgery, with a follow up of at least two days, and reporting on respiratory outcomes. REVIEW METHODS Investigators assessed trial validity independently. Information on study design, population, interventions, and end points was abstracted by one investigator and checked by the others. RESULTS 18 trials (1457 patients) were identified. Most were of low quality. They tested physical therapy (13 trials), incentive spirometry (eight), continuous positive airway pressure (five), and intermittent positive pressure breathing (three). The maximum follow up was six days. Four trials only had a no intervention control; none showed any significant benefit of physiotherapy. Across all trials and interventions, average values postoperatively were: incidence of atelectasis, 15-98%; incidence of pneumonia, 0-20%; partial pressure of arterial oxygen per inspired oxygen fraction, 212-329 mm Hg; vital capacity, 37-72% of preoperative values; and forced expiratory volume in one second, 34-72%. No intervention showed superiority for any end point. For the most labour intensive intervention, continuous positive airway pressure, the average cost of labour for each patient day was 27 euro (pound 19; 32 dollars). CONCLUSIONS The usefulness of respiratory physiotherapy for the prevention of pulmonary complications after cardiac surgery remains unproved. Large randomised trials are needed with no intervention controls, clinically relevant end points, and reasonable follow up periods.
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Affiliation(s)
- Patrick Pasquina
- Division of Surgical Intensive Care, Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospitals, Switzerland.
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