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Hamida El Naser Y, Karayel D. Modeling the effects of external oscillations on mucus clearance in obstructed airways. Biomech Model Mechanobiol 2024; 23:335-348. [PMID: 37861917 DOI: 10.1007/s10237-023-01778-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023]
Abstract
Various therapeutic methods are employed to facilitate the clearance of secretions accumulated in the respiratory tracts of individuals with lower respiratory tract disorders. High-frequency chest wall oscillation (HFCWO) device, designed to apply variable amplitude and frequency vibrations to the individuals' chests, stands out among these therapies. In this study, the effectiveness of this treatment method was investigated numerically using computational fluid dynamics (CFD) on the generated mucus-obstructed bronchial geometry. The conducted analyses compared the effects of vibrations acting in the axial, radial, and tangential directions on the clearance of mucus, which exhibits non-Newtonian flow behavior with shear-thinning properties. Simultaneously, the effects of changes in vibration amplitude and frequency, pressure differentials, fluid properties, and ciliary movements on the flow were separately examined and interpreted. The findings demonstrate that ciliary movements are insufficient in mucus-accumulated airways, applied vibrations enhance mucus clearance, and potential improvements in flow are quite sensitive to boundary conditions.
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Affiliation(s)
- Yusuf Hamida El Naser
- Mechatronics Engineering, Faculty of Technology, Sakarya University of Applied Sciences, Sakarya, Turkey.
| | - Durmuş Karayel
- Mechatronics Engineering, Faculty of Technology, Sakarya University of Applied Sciences, Sakarya, Turkey.
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2
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Duprez F, Crombin M, Daubechies I, Devries N, Durant V, El Khalil M, Audag N. [Update on manual bronchial clearance techniques (adults and adolescents)]. Rev Mal Respir 2024; 41:43-50. [PMID: 38057240 DOI: 10.1016/j.rmr.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 12/08/2023]
Abstract
In adults and teenagers, airway clearance physiotherapy techniques (ACPT) are various and numerous. However, they for still awaiting scientific validation. Among ACPTs, Slow Expiration with the Glottis Opened in the Lateral Posture (ELTGOL), Autogenic Drainage (DA), and Active Cycling Breathing Technique (ACBT) present a Grade B level of evidence with weak recommendations. Even though these maneuvers are widely applied, precise description of chest physiotherapy (CP) is largely absent from the scientific literature; it is difficult to standardize its implementation and reproduce the results; scientific validation and faithful execution of the techniques are consequently problematic. In this paper, the authors aim to depict each of the three CP techniques as precisely as possible; with this in mind, graphic modeling of the different respiratory exercises is presented in such a way that they can be easily learned, applied and reproduced by physiotherapists.
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Affiliation(s)
- F Duprez
- Unité de recherche et d'innovation Condorcet-Epicura (URICE), hôpital Epicura, 63, rue de Mons, 7301 Tournai-Hornu, Belgique; Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique.
| | - M Crombin
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - I Daubechies
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - N Devries
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - V Durant
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - M El Khalil
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - N Audag
- Service de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc. Bruxelles, Belgique; Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et dermatologie, groupe de recherche en kinésithérapie respiratoire, université catholique de Louvain, Bruxelles, Belgique
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3
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Dhochak N, Kabra SK. Transition Care in Cystic Fibrosis. Indian J Pediatr 2023; 90:1223-1226. [PMID: 37129754 DOI: 10.1007/s12098-023-04571-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 05/03/2023]
Abstract
Cystic fibrosis (CF) is a chronic childhood illness with gradually improving survival and significant burden of disease during adult life. Transition of CF care from pediatric to an adult based multidisciplinary team is a complex process and careful coordination with a transition key worker is necessary for successful transition without adverse outcome. Transition is associated with a key change in CF management with shift from family-centred care to self-reliance and independence on part of the patient. Readiness and skills of self-managed care play central part in successful transition. Resource materials for transition are available online for different countries for improved readiness and smooth transition. Situation is worse in resource-limited settings as facilities of fully functional adult multidisciplinary care for CF is not readily available.
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Affiliation(s)
- Nitin Dhochak
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Reshia FAA, Salameh B, Alsadaan N, Alqahtani M, Ayed A, Kassabry MF, Abo Seada AI. Enhancing pulmonary function and arterial blood gas readings through immediate chest physiotherapy among extubated patients in ICU. J Int Med Res 2023; 51:3000605231208600. [PMID: 37929809 PMCID: PMC10683574 DOI: 10.1177/03000605231208600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE To examine the effect of immediate chest physiotherapy (ICPT) on pulmonary function and arterial blood gases among extubated patients. METHOD This prospective study enrolled patients aged 20-60 years who had been intubated for 48 h. They were randomly assigned to either a control or study group. The study group received ICPT by trained critical care nurses and physiotherapists, which included early mobilization, breathing exercises and airway clearance. The control group received standard nursing chest care (positioning, oral and endotracheal suctioning) without ICPT. Researchers evaluated participants using pulmonary function tests, arterial blood gas tests and mechanical ventilation parameters. RESULTS The study enrolled 70 patients. There were no significant differences in the sociodemographic characteristics and medical data before intubation between the two groups except for preparatory education. After extubation, the vital capacity was significantly higher in the study group compared with the control group. There were also significant differences between the two groups in other lung function tests and arterial blood gas tests. After extubation, the total lung capacity, functional residual capacity and residual volume were significantly higher in the study group compared with the control group. CONCLUSION The use of ICPT improved both pulmonary function and arterial blood gases.
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Affiliation(s)
- Fadia Ahmed Abdelkader Reshia
- Department of Medical and Surgical Nursing, College of Nursing, Jouf University, Sakaka, Saudi Arabia
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Basma Salameh
- Department of Nursing, Arab American University, Jenin, Palestine
| | - Nourah Alsadaan
- Department of Nursing Administration and Education, College of Nursing, Jouf University, Sakaka, Saudi Arabia
| | - Mohammed Alqahtani
- Department of Nursing, College of Applied Medical Sciences, King Faisal University, Alahsa, Saudi Arabia
| | - Ahmad Ayed
- Department of Nursing, Arab American University, Jenin, Palestine
| | | | - Asmaa Ibrahem Abo Seada
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt
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Nambi G, Alghadier M, Ebrahim EE, Eltayeb MM, Aldhafian OR, Mohamed SHP, Khanam H, Kashoo FZ, Albarakati AJA, Abdelbasset WK. Role of virtual reality distraction technique to improve chest burns with acute respiratory distress syndrome (ARDS) following smoke inhalation in middle-aged adults - A randomized controlled study. Burns 2023; 49:1643-1653. [PMID: 37270393 DOI: 10.1016/j.burns.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Burns of the chest region constitute a common burn and develops skin contractures around the thorax region. Inhalation of toxic gases and chemical irritants during the fire leads to Acute Respiratory Distress Syndrome (ARDS). Breathing exercises are painful but are needed to help counteract contractures and increase lung capacity. These patients are usually in pain and extremely anxious about chest physiotherapy. Virtual reality distraction is one such technique that is gaining immense popularity when compared to other pain distraction techniques. However, studies examining the efficacy of the virtual reality distraction technique in this population are lacking. OBJECTIVES To find and compare the effects of the virtual reality distraction technique as a pain alleviation tool for reducing pain during chest physiotherapy in chest burns patients with ARDS in middle-aged adults. METHODS A randomized controlled study was conducted at the physiotherapy department between 1st Sep 2020 and 30th Dec 2022. The eligible sixty subjects were randomized into two groups: The virtual reality distraction group (n = 30) received virtual reality distraction technique and the control group (n = 30) received progressive relaxation technique before chest physiotherapy as a pain distraction technique. All the participants received chest physiotherapy as a common treatment (treatment as usual). Primary (Visual Analogue Scale - VAS) and secondary (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow (PEF), residual volume (RV), functional residual capacity (FRC), total lung capacity (TLC), RV/TLC, and diffusing capacity for carbon monoxide of the lungs (DLCO) outcome measures were measured at baseline, after four weeks, eight weeks and at six months follow up. The effects between the two groups were analyzed using the independent t-test and chi-square test. The intra-group effect was analyzed with a repeated measure ANOVA test. RESULTS Baseline demographic characters and study variables show homogenous distribution between the groups (p > 0.05). Four weeks following two different training protocols virtual reality distraction group shows more significant changes in pain intensity, FVC, FEV1, FEV1/FVC, PEF, RV, FRC, TLC, RV/TLC, and DLCO (p = 0.001) but not in RV (p = 0.541). The similar improvements were noted in the 8 weeks and 6 months follow up. CONCLUSION The reports of the study concluded that virtual reality distraction is an effective and useful technique in reducing pain and increasing lung capacity in chest burn patient with ARDS following smoke inhalation in community-dwelling middle-aged adults. In the virtual reality distraction group, the patients reported significantly less pain and clinically meaningful changes in pulmonary functions as compared to the control group (physiotherapy + relaxation).
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Affiliation(s)
- Gopal Nambi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia.
| | - Mshari Alghadier
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Elturabi Elsayed Ebrahim
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Mudathir Mohamedahmed Eltayeb
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Osama R Aldhafian
- Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
| | | | - Humaira Khanam
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Faizan Z Kashoo
- Department of Physical therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Alaa Jameel A Albarakati
- Department of Surgery, College of Medicine, Umm Al-Qura University, Al-Qunfudah Branch, Makkah, Saudi Arabia
| | - Walid Kamal Abdelbasset
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Rodrigues-Gomes RM, Lage Cendón L, Martínez Rolán R, Gelabert-González M. Respiratory physiotherapy as a tool to allow and optimize lung donation. Respir Med Case Rep 2023; 46:101917. [PMID: 37860584 PMCID: PMC10582771 DOI: 10.1016/j.rmcr.2023.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/18/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Lung donation is complex and sometimes the secretion retention makes it impossible. We report a case of a patient that was screened as potential lung donor with PaO2/FiO2 ratio below range. As in viable patients, the respiratory physiotherapist applied a ventilator-based group of techniques with removal of huge amount of secretions and consequent increase in the PaO2/FiO2 ratio that allowed the inclusion of the patient as potentially lung donor. The protocol was applied until the extraction day, with successful extraction and transplantation. We believe that respiratory physiotherapy could have a potential role in increasing lung viability.
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Affiliation(s)
- Ricardo Miguel Rodrigues-Gomes
- Facultade Medicina, Universidade de Santiago de Compostela, Santiago Compostela, Spain
- Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Rosa Martínez Rolán
- Facultade Medicina, Universidade de Santiago de Compostela, Santiago Compostela, Spain
- Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Miguel Gelabert-González
- Facultade Medicina, Universidade de Santiago de Compostela, Santiago Compostela, Spain
- Centro Hospitalario Santiago de Compostela, Santiago de Compostela, Spain
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Raywood E, Shannon H, Filipow N, Tanriver G, Stanojevic S, Kapoor K, Douglas H, O'Connor R, Murray N, Black B, Main E. Quantity and quality of airway clearance in children and young people with cystic fibrosis. J Cyst Fibros 2023; 22:344-351. [PMID: 36210322 DOI: 10.1016/j.jcf.2022.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/27/2022] [Accepted: 09/19/2022] [Indexed: 05/01/2023]
Abstract
Children and young people with CF (CYPwCF) get advice about using positive expiratory pressure (PEP) or oscillating PEP (OPEP) devices to clear sticky mucus from their lungs. However, little is known about the quantity (number of treatments, breaths, or sets) or quality (breath pressures and lengths) of these daily airway clearance techniques (ACTs) undertaken at home. This study used electronic pressure sensors to record real time breath-by-breath data from 145 CYPwCF (6-16y) during routine ACTs over 2 months. ACT quantity and quality were benchmarked against individual prescriptions and accepted recommendations for device use. In total 742,084 breaths from 9,081 treatments were recorded. Individual CYPwCF maintained consistent patterns of ACT quantity and quality over time. Overall, 60% of CYPwCF did at least half their prescribed treatments, while 27% did fewer than a quarter. About 77% of pre-teens did the right number of daily treatments compared with only 56% of teenagers. CYPwCF usually did the right number of breaths. ACT quality (recommended breath length and pressure) varied between participants and depended on device. Breath pressures, lengths and pressure-length relationships were significantly different between ACT devices. PEP devices encouraged longer breaths with lower pressures, while OPEP devices encouraged shorter breaths with higher pressures. More breaths per treatment were within advised ranges for both pressure and length using PEP (30-31%) than OPEP devices (1-3%). Objective measures of quantity and quality may help to optimise ACT device selection and support CYPwCF to do regular effective ACTs.
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Affiliation(s)
- Emma Raywood
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Harriet Shannon
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Nicole Filipow
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Gizem Tanriver
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sanja Stanojevic
- Community Health and Epidemiology, Dalhousie University Halifax, Canada
| | - Kunal Kapoor
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Helen Douglas
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK; Paediatric Cystic Fibrosis Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Rachel O'Connor
- Paediatric Cystic Fibrosis Centre, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Nicky Murray
- Paediatric Cystic Fibrosis Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Bridget Black
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Eleanor Main
- Physiotherapy, UCL Great Ormond Street Institute of Child Health, London, UK.
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Garofalo E, Rovida S, Cammarota G, Biamonte E, Troisi L, Cosenza L, Pelaia C, Navalesi P, Longhini F, Bruni A. Benefits of secretion clearance with high frequency percussive ventilation in tracheostomized critically ill patients: a pilot study. J Clin Monit Comput 2023; 37:911-918. [PMID: 36607533 PMCID: PMC10175357 DOI: 10.1007/s10877-022-00970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
Clearance of secretions remains a challenge in ventilated patients. Despite high-frequency percussive ventilation (HFPV) showing benefits in patients with cystic fibrosis and neuromuscular disorders, very little is known about its effects on other patient categories. Therefore, we designed a physiological pilot study investigating the effects on lung aeration and gas exchange of short HFPV cycles in tracheostomized patients undergoing mechanical ventilation. Electrical impedance tomography (EIT) was recorded at baseline (T0) by a belt wrapped around the patient's chest, followed by the HFPV cycle lasting 10 min. EIT data was collected again after the HFPV cycle (T1) as well as after 1 h (T2) and 3 h (T3) from T0. Variation from baseline of end-expiratory lung impedance (∆EELI), tidal variation (TIV) and global inhomogeneity index (GI) were computed. Arterial blood was also taken for gas analysis. HFPV cycle significantly improved the ∆EELI at T1, T2 and T3 when compared to baseline (p < 0.05 for all comparisons). The ratio between arterial partial pressure and inspired fraction of oxygen (PaO2/FiO2) also increased after the treatment (p < 0.001 for all comparison) whereas TIV (p = 0.132) and GI (p = 0.114) remained unchanged. Short cycles of HFPV superimposed to mechanical ventilation promoted alveolar recruitment, as suggested by improved ∆EELI, and improved oxygenation in tracheostomized patients with high load of secretion.Trial Registration Prospectively registered on www.clinicaltrials.gov (NCT05200507; dated 6th January 2022).
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Affiliation(s)
- Eugenio Garofalo
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Serena Rovida
- Department of Intensive Care Medicine, St George's University Hospital, London, UK
| | - Gianmaria Cammarota
- Department of Anaesthesia and Intensive Care Medicine, University of Perugia, Perugia, Italy
| | - Eugenio Biamonte
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Letizia Troisi
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Leonardo Cosenza
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Corrado Pelaia
- Pulmonary Medicine Unit, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Paolo Navalesi
- Anaesthesia and Intensive Care, Department of Medicine-DIMED, Padua Hospital, University of Padua, Padua, Italy
| | - Federico Longhini
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy. .,Intensive Care Unit, Department of Medical and Surgical Sciences, Mater Domini University Hospital, Magna Graecia University, Viale Europa, 88100, Catanzaro, Italy.
| | - Andrea Bruni
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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Bokov P, Gerardin M, Brialix G, Da Costa Noble E, Juif R, Foucher AV, Le Clainche L, Houdouin V, Mauroy B, Delclaux C. Beneficial short-term effect of autogenic drainage on peripheral resistance in childhood cystic fibrosis disease. BMC Pulm Med 2022; 22:241. [PMID: 35729620 PMCID: PMC9210656 DOI: 10.1186/s12890-022-02039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Airway clearance techniques are supposed to be a necessary adjunct for the enhancement of impaired peripheral clearance in cystic fibrosis (CF). The objective was to assess the effect of one physiotherapy session (autogenic drainage: AD) on mucus clearance (sputum wet weight) and impulse oscillometry system (IOS) indices, including those obtained from extended Resistance-Inertance-Compliance (eRIC) modelling, considering the degree of bronchial congestion. Methods Thirty children with CF (median age: 12.7 years) in a stable condition prospectively underwent IOS measurements at baseline and after AD. They were divided in two groups: with (visual analog scale of bronchial congestion by the physiotherapist ≥ 5/10) and without (scale < 5/10) bronchial congestion. Paired-comparison of the effects of AD on airway resistance measurements was done with Wilcoxon test. Results The congestion scale correlated with the wet weight of sputum production during the session (Pearson test: p < 0.0001, R = 0.66). Ten children had bronchial congestion and 20 were without congestion. In the whole group, R5–20 Hz significantly decreased after AD (P = 0.049), which was related to a decrease in the children with congestion (P = 0.025), whereas it was not significantly modified in the children without congestion (P = 0.327). The eRIC model allowed the calculation of the peripheral resistance of the respiratory system, which also decreased in the children with congestion (P = 0.037), however, not modified in the children without congestion (P = 0.390). Conclusion One session of autogenic drainage has the ability to decrease peripheral resistance obtained from IOS measurements, more specifically in children with CF with moderate to severe bronchial congestion. Trial registration ClinicalTrials.gov Identifier: NCT04094441.
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Affiliation(s)
- Plamen Bokov
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Université de Paris, Hôpital Robert Debré, AP-HP, 48, boulevard Sérurier, 75019, Paris, France
| | - Michèle Gerardin
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Géraldine Brialix
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Emmanuelle Da Costa Noble
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Romain Juif
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Antonia Vital Foucher
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Laurence Le Clainche
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Véronique Houdouin
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Benjamin Mauroy
- Laboratoire JA Dieudonné, CNRS, Université Nice Côte d'Azur, 06108, Nice, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Université de Paris, Hôpital Robert Debré, AP-HP, 48, boulevard Sérurier, 75019, Paris, France.
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10
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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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Poncin W, Lebret M, Maerckx G. [Pneumatic instrumental airway clearance techniques: Description, settings and indications]. Rev Mal Respir 2022:S0761-8425(22)00174-7. [PMID: 35732538 DOI: 10.1016/j.rmr.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 04/10/2022] [Indexed: 11/20/2022]
Abstract
Airway clearance techniques aim to eliminate excess of bronchopulmonary secretions. Common airway clearance methods involve manual techniques or the use of (oscillatory) positive expiratory pressure systems. In some clinical situations, these techniques may be ineffective, and the physiotherapist will require pneumatic instrumental support. Unfortunately, these devices are expensive and burdensome. Moreover, as their utilization requires specialized expertise, they are seldom used by practitioners. This article describes the pneumatic instrumental supports mainly used in France for airway clearance techniques currently available. We explain their key characteristics, how they function, and their basic settings according to different indications.
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12
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Rodrigues-Gomes RM, Martí JD, Rolán RM, Gelabert-González M. Rapid chest compression effects on intracranial pressure in patients with acute cerebral injury. Trials 2022; 23:312. [PMID: 35428364 PMCID: PMC9012060 DOI: 10.1186/s13063-022-06189-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with acute brain injury often require invasive mechanical ventilation, increasing the risk of developing complications such as respiratory secretions retention. Rapid chest compression is a manual chest physiotherapy technique that aims to improve clearance of secretions in these patients. However, the rapid chest compression technique has been suggested to be associated with increased intracranial pressure in patients with acute brain injury. The aim of this work is to elucidate the effects of the technique on intracranial pressure in mechanically ventilated patients with acute brain injury. Furthermore, the effects of the technique in different volumes and flows recorded by the ventilator and the relationship between the pressure applied in the intervention group and the different variables will also be studied. METHODS Randomized clinical trial, double-blinded. Patients with acute brain injury on invasive mechanical ventilation > 48 h will be included and randomized in two groups. In the control group, a technique of passive hallux mobilization will be applied, and in the intervention group, it will be performed using the rapid chest compression technique. Intracranial pressure (main variable) will be collected with an intracranial pressure monitoring system placed at the lateral ventricles (Integra Camino). DISCUSSION The safety of chest physiotherapy techniques in patients at risk of intracranial hyperpressure is still uncertain. The aim of this study is to identify if the rapid manual chest compression technique is safe in ventilated patients with acute brain injury. TRIAL REGISTRATION NCT03609866 . Registered on 08/01/2018.
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13
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O'Sullivan KJ, Power V, Linnane B, McGrath D, Fogarty H, Ryan M, White R, Noonan C, Mulloy E, O'Sullivan LW, Dunne CP. An initial evaluation of the safety of a disposable oscillating positive expiratory pressure device in patients with chronic obstructive pulmonary disease: a sort-term pilot study. BMC Pulm Med 2021; 21:326. [PMID: 34666748 PMCID: PMC8524222 DOI: 10.1186/s12890-021-01689-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background Handheld oscillating positive expiratory pressure (OPEP) devices have been a mainstay of treatment for patients with hypersecretory conditions such as cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) since the 1970s. Current devices are reusable and require regular cleaning and disinfection to prevent harbouring potentially pathogenic organisms. Adherence to cleaning regimens for respiratory devices is often poor and in response to this, a prototype disposable OPEP device—the ‘UL-OPEP’ (University of Limerick—Oscillating Positive Expiratory Pressure device)—was developed to mitigate the risk of contamination by pathogens. The device was previously evaluated successfully in a group of paediatric CF patients. The aim of the current study was to initially evaluate the safety of the prototype in patients with COPD over a period of 1 month to ensure no adverse events, negative impacts on lung function, exercise tolerance, or quality of life. Data on user experience of the device were also collected during post-study follow-up. Methods A sample of 50 volunteer participants were recruited from pulmonary rehabilitation clinics within the local hospital network. The patients were clinically stable, productive, and not current or previous users of OPEP devices. Participants were invited to use a prototype disposable OPEP device daily for a period of 1 month. Pre- and post-study lung function was assessed with standard spirometry, and exercise tolerance with the 6-min-walk-test (6MWT). Quality of life was assessed using the St. George’s Respiratory Questionnaire (SGRQ), and user experience of the prototype device evaluated using a post-study questionnaire. Results 24 Participants completed the study: 9 were female. Overall median age was 67.5 years, range 53–85 years. Lung function, 6-min walk test, and SGRQ scores showed no significant change post-study. User feedback was positive overall. Conclusions The results indicate that the UL-OPEP is safe to use in patients with COPD. No adverse events were recorded during the study or in the follow-up period of 2 weeks. The device did not negatively impact patients’ lung function, exercise tolerance, or quality of life during short term use (1 month), and usability feedback received was generally positive. Larger, longer duration studies will be required to evaluate efficacy. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).
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Affiliation(s)
- Kevin J O'Sullivan
- Rapid Innovation Unit - Confirm Centre for Smart Manufacturing, School of Design and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Valerie Power
- Rapid Innovation Unit - Confirm Centre for Smart Manufacturing, School of Design and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Barry Linnane
- Centre for Interventions in Infection, Inflammation and Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland.,University Hospital Limerick, Dooradoyle, Limerick, Ireland.,National Children's Research Centre, Crumlin, Dublin 12, Ireland.,Paediatric Cystic Fibrosis Department, University Hospital Limerick (UHL), Limerick, Ireland
| | - Deirdre McGrath
- Centre for Interventions in Infection, Inflammation and Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland.,University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Hilda Fogarty
- Centre for Interventions in Infection, Inflammation and Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Rebecca White
- University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | | | | | - Leonard W O'Sullivan
- Rapid Innovation Unit - Confirm Centre for Smart Manufacturing, School of Design and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Colum P Dunne
- Centre for Interventions in Infection, Inflammation and Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland.
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14
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Güngör S, Gencer-Atalay K, Bahar-Özdemir Y, Keniş-Coşkun Ö, Karadağ-Saygı E. The clinical effects of combining postural exercises with chest physiotherapy in cystic fibrosis: A single-blind, randomized-controlled trial. Turk J Phys Med Rehabil 2021; 67:91-8. [PMID: 33948549 DOI: 10.5606/tftrd.2021.5214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/25/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives
This study aims to investigate the effects of postural exercises as an adjunct to chest physiotherapy program on respiratory function, exercise tolerance, quality of life (QoL), and postural stability in patients with cystic fibrosis (CF).
Patients and methods
In this single-blind, randomized-controlled trial, 19 pediatric CF patients (11 males, 8 females; mean age: 9.36 years; range, 6 to 14 years) were randomly allocated to chest physiotherapy and postural exercise program (Group 1, n=10) or chest physiotherapy program alone (Group 2, n=9) between March 2017 and October 2017. Respiratory functions were assessed with pulmonary function tests, whereas exercise tolerance with the Modified Shuttle Test (MST), quality of life with the Cystic Fibrosis Questionnaire-Revised Child Version (CFQR), and postural stability with the Limits of Stability Test (LOS). All tests were performed before treatment and six weeks, three months, and six months after treatment.
Results
Respiratory functions were improved in both groups; however, these changes were not statistically significant. The MST increased after treatment in both groups (p<0.001 and p=0.003 respectively), without a significant difference between the groups. Emotional function and treatment difficulties subdomains in CFQR were significantly increased only in the group with postural exercises (p<0.05).
Conclusion
The postural exercise program in addition to chest physiotherapy in pediatric CF patients whose postural changes were not taken place did not cause significant changes in respiratory function, exercise tolerance, and postural stability; however, it affected the emotional state well and improved the compliance with the treatment.
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15
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Battaglini D, Robba C, Caiffa S, Ball L, Brunetti I, Loconte M, Giacobbe DR, Vena A, Patroniti N, Bassetti M, Torres A, Rocco PR, Pelosi P. Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19. Respir Physiol Neurobiol 2020; 282:103529. [PMID: 32818606 PMCID: PMC7430249 DOI: 10.1016/j.resp.2020.103529] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 02/08/2023]
Abstract
In late 2019, an outbreak of a novel human coronavirus causing respiratory disease was identified in Wuhan, China. The virus spread rapidly worldwide, reaching pandemic status. Chest computed tomography scans of patients with coronavirus disease-2019 (COVID-19) have revealed different stages of respiratory involvement, with extremely variable lung presentations, which require individualized ventilatory strategies in those who become critically ill. Chest physiotherapy has proven to be effective for improving long-term respiratory physical function among ICU survivors. The ARIR recently reported the role of chest physiotherapy in the acute phase of COVID-19, pointing out limitation of some procedures due to the limited experience with this disease in the ICU setting. Evidence on the efficacy of chest physiotherapy in COVID-19 is still lacking. In this line, the current review discusses the important role of chest physiotherapy in critically ill mechanically ventilated patients with COVID-19, around the weaning process, and how it can be safely applied with careful organization, including the training of healthcare staff and the appropriate use of personal protective equipment to minimize the risk of viral exposure.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Medicine, University of Barcelona (UB), Barcelona, Spain.
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Salvatore Caiffa
- Intensive Care Respiratory Physiotherapy, Rehabilitation and Functional Education, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Iole Brunetti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Maurizio Loconte
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Antonio Vena
- Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Nicolò Patroniti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antoni Torres
- Department of Medicine, University of Barcelona (UB), Barcelona, Spain; Division of Animal Experimentation, Department of Pulmonology, Hospital Clinic, Barcelona, Spain; Centro de investigacion en red de enfermedades respiratorias (CIBERES), Madrid, Spain; Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Patricia Rm Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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16
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Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, Pandit U, Shetye JV, Diwate A, Damke U, Ravindra S, Patil P, Nagarwala RM, Gaikwad P, Agarwal S, Madan K, Jacob P, Surendran PJ, Swaminathan N. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020; 24:905-913. [PMID: 33281313 PMCID: PMC7689134 DOI: 10.5005/jp-journals-10071-23564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND With the Wuhan pandemic spread to India, more than lakhs of population were affected with COVID-19 with varying severities. Physiotherapists participated as frontline workers to contribute to management of patients in COVID-19 in reducing morbidity of these patients and aiding them to road to recovery. With infrastructure and patient characteristics different from the West and lack of adequate evidence to existing practices, there was a need to formulate a national consensus. MATERIALS AND METHODS Recommendations were formulated with a systematic literature search and feedback of physiotherapist experiences. Expert consensus was obtained using a modified Delphi method. RESULTS The intraclass coefficient of agreement between the experts was 0.994, significant at p < 0.001. CONCLUSION This document offers physiotherapy evidence-based consensus and recommendation to planning physiotherapy workforce, assessment, chest physiotherapy, early mobilization, preparation for discharge planning, and safety for patients and therapist in acutec are COVID 19 setup of India. The recommendations have been integrated in the algorithm and are intended to use by all physiotherapists and other stakeholders in management of patients with COVID-19 in acute care settings. HOW TO CITE THIS ARTICLE Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, et al. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020;24(10):905-913.
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Affiliation(s)
- Mariya P Jiandani
- Physiotherapy School and Centre, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Bela Agarwal
- Department of Physiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Gaurang Baxi
- Department of Physiotherapy, Dr. DY Patil College of Physiotherapy, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India
| | - Sudeep Kale
- Department of Cardiorespiratory Physiotherapy, Terna Physiotherapy College, Navi Mumbai, Maharashtra, India
| | - Titiksha Pol
- Department of Physiotherapy, DY Patil University, School of Physiotherapy, Navi Mumbai, Maharashtra, India
| | - Anjali Bhise
- Department of Physiotherapy, Government Physiotherapy College and Spine Institute, Civil Hospital, Ahmedabad, Gujarat, India
| | - Unnati Pandit
- Department of Physiotherapy, DY Patil University, School of Physiotherapy, Navi Mumbai, Maharashtra, India
| | - Jaimala V Shetye
- Physiotherapy School and Centre, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Abhijit Diwate
- Department of Physiotherapy, Dr. Vithalrao Vikhe Patil Foundations College of Physiotherapy, Ahmednagar, Maharashtra, India
| | - Umanjali Damke
- Physiotherapy School and Center, Government Medical College, Nagpur, Maharashtra, India
| | - Savita Ravindra
- COO-Centre for Rehabilitation, M.S. Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - Prajakta Patil
- Department of Cardiorespiratory Physiotherapy, Smt. Kashibai Navale College of Physiotherapy, Pune, Maharashtra, India
| | - Raziya M Nagarwala
- Cardiovascular and Respiratory Physiotherapy Department, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
| | - Pratibha Gaikwad
- Department of Physiotherapy, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | | | - Kushal Madan
- Department of Cardiology, Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Prasobh Jacob
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Praveen J Surendran
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Narasimman Swaminathan
- Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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17
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Andersson-Marforio S, Lundkvist Josenby A, Ekvall Hansson E, Hansen C. The effect of physiotherapy including frequent changes of body position and stimulation to physical activity for infants hospitalised with acute airway infections. Study protocol for a randomised controlled trial. Trials 2020; 21:803. [PMID: 32958026 PMCID: PMC7504844 DOI: 10.1186/s13063-020-04681-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background Every year, many infants are infected with the respiratory syncytial virus (RSV) or other agents and need hospitalisation due to bronchiolitis. The disease causes much suffering and high costs. Thus, it is important that the treatment methods are both effective and cost-efficient. The use of different physiotherapy treatment methods is debated, and not all methods are evaluated scientifically. The clinical praxis in Sweden that includes frequent changes of body position and stimulation to physical activity has not previously been evaluated. The aim of this clinical study is to evaluate this praxis. Methods This study is a clinical two-centre individually randomised controlled trial (RCT) with three parallel groups. The participants will be randomly assigned to an individualised physiotherapy intervention, a non-individualised intervention, or a control group. All three groups will receive the standard care at the ward, and the two intervention groups will receive additional treatment, including different movements of the body. The primary outcome measure is a clinical index based on determinants for hospitalisation. Baseline assessments will be compared with the assessments after 24 h. The secondary outcome measures include vital signs, the parents’ observations, time spent at the hospital ward, and referrals to an intensive care unit. We also want see if there is any immediate effect of the first intervention, after 20 min. Discussion This study will add knowledge about the effect of two physiotherapy interventions that are commonly in use in Swedish hospitals for infants with bronchiolitis or other acute lower respiratory tract infections. Trial registration ClinicalTrials.gov NCT03575091. Registered July 2, 2018—retrospectively registered.
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Affiliation(s)
| | - Annika Lundkvist Josenby
- Department of Health Sciences, Lund University, Margaretavägen 1B, S-22240, Lund, Sweden.,Children's Hospital, Skåne University Hospital, S-22185, Lund, Sweden
| | - Eva Ekvall Hansson
- Department of Health Sciences, Lund University, Margaretavägen 1B, S-22240, Lund, Sweden
| | - Christine Hansen
- Children's Hospital, Skåne University Hospital, S-22185, Lund, Sweden
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18
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Longhini F, Bruni A, Garofalo E, Ronco C, Gusmano A, Cammarota G, Pasin L, Frigerio P, Chiumello D, Navalesi P. Chest physiotherapy improves lung aeration in hypersecretive critically ill patients: a pilot randomized physiological study. Crit Care 2020; 24:479. [PMID: 32746877 PMCID: PMC7396943 DOI: 10.1186/s13054-020-03198-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
Abstract
Background Besides airway suctioning, patients undergoing invasive mechanical ventilation (iMV) benefit of different combinations of chest physiotherapy techniques, to improve mucus removal. To date, little is known about the clearance effects of oscillating devices on patients with acute respiratory failure undergoing iMV. This study aimed to assess (1) the effects of high-frequency chest wall oscillation (HFCWO) on lung aeration and ventilation distribution, as assessed by electrical impedance tomography (EIT), and (2) the effect of the association of HFCWO with recruitment manoeuvres (RM). Methods Sixty critically ill patients, 30 classified as normosecretive and 30 as hypersecretive, who received ≥ 48 h of iMV, underwent HFCWO; patients from both subgroups were randomized to receive RM or not, according to two separated randomization sequences. We therefore obtained four arms of 15 patients each. After baseline record (T0), HFCWO was applied for 10 min. At the end of the treatment (T1) or after 1 (T2) and 3 h (T3), EIT data were recorded. At the beginning of each step, closed tracheobronchial suctioning was performed. In the RM subgroup, tracheobronchial suctioning was followed by application of 30 cmH2O to the patient’s airway for 30 s. At each step, we assessed the change in end-expiratory lung impedance (ΔEELI) and in tidal impedance variation (ΔTIV), and the center of gravity (COG) through EIT. We also analysed arterial blood gases (ABGs). Results ΔTIV and COG did not differ between normosecretive and hypersecretive patients. Compared to T0, ΔEELI significantly increased in hypersecretive patients at T2 and T3, irrespective of the RM; on the contrary, no differences were observed in normosecretive patients. No differences of ABGs were recorded. Conclusions In hypersecretive patients, HFCWO significantly improved aeration of the dorsal lung region, without affecting ABGs. The application of RM did not provide any further improvements. Trial registration Prospectively registered at the Australian New Zealand Clinical Trial Registry (www.anzctr.org.au; number of registration: ACTRN12615001257550; date of registration: 17th November 2015).
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Affiliation(s)
- Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Chiara Ronco
- Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy
| | - Andrea Gusmano
- Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy
| | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care, "Maggiore della carità" University Hospital, Novara, Italy
| | - Laura Pasin
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | | | - Davide Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.,Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy
| | - Paolo Navalesi
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy. .,Dipartimento di Medicina-DIMED, Università degli Studi di Padova, Via Giustiniani, 2 -, 35128, Padova, Italy.
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19
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McAlinden B, Kuys S, Schibler A, Hough JL. Chest physiotherapy improves regional lung volume in ventilated children. Crit Care 2020; 24:440. [PMID: 32677990 PMCID: PMC7364137 DOI: 10.1186/s13054-020-03156-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/05/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Bronagh McAlinden
- School of Allied Health, Australian Catholic University, Banyo, QLD, 4014, Australia.,Mater Health, South Brisbane, 4101, Australia
| | - Suzanne Kuys
- School of Allied Health, Australian Catholic University, Banyo, QLD, 4014, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Children's Health Research Centre - The University of Queensland, South Brisbane, 4101, Australia
| | - Judith L Hough
- School of Allied Health, Australian Catholic University, Banyo, QLD, 4014, Australia. .,Mater Health, South Brisbane, 4101, Australia. .,Paediatric Critical Care Research Group, Children's Health Research Centre - The University of Queensland, South Brisbane, 4101, Australia.
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20
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Balañá Corberó A, Admetlló Papiol M, Sancho Muñoz A, Kallouchi M, Badenes D, Rodríguez DA, Martínez-Llorens J. [Effects of high frequency chest wall oscillatory (HFCWO) therapy on gas exchange and ventilation in healthy participants]. Rehabilitacion (Madr) 2020; 55:30-37. [PMID: 32660842 DOI: 10.1016/j.rh.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Chest physiotherapy is an essential part of the treatment of respiratory diseases with increased respiratory secretion and ineffective cough. To date, there have been no studies on the effect of high frequency chest wall oscillatory (HFCWO) therapy on respiratory muscle strength, ventilation and gas exchange. The aim of this study was therefore to assess these three factors in healthy participants. METHODS Respiratory muscle strength was measured before and immediately after HFCWO therapy in 25 healthy participants. During the treatment, we continuously measured ventilation parameters, gas exchange, oxygen saturation and heart rate. All participants underwent HFCWO sessions twice (with 24hours difference) with the same procedure. Symptoms during the session and discomfort were measured with the visual analog scale (VAS). RESULTS HFCWO therapy produced a change in breathing pattern with increased ventilation associated with altered gas exchange. Heart rate also increased, with no changes in oxygenation. There was no effect, either beneficial or deleterious, on the strength of respiratory muscles. Up to 20% of participants reported substantial discomfort (VAS≥5/10) during the session. CONCLUSIONS This study shows that, during the application of HFCWO therapy in healthy participants, ventilation and heart rate increased. However, there were undesirable effects on gas exchange with a high degree of intolerance among volunteers, with no effects on respiratory muscle strength.
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Affiliation(s)
- A Balañá Corberó
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España.
| | - M Admetlló Papiol
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España
| | - A Sancho Muñoz
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España
| | - M Kallouchi
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España
| | - D Badenes
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España
| | - D A Rodríguez
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España; CEXS, Universitat Pompeu Fabra, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), ISC III, Madrid, España
| | - J Martínez-Llorens
- Servei de Pneumologia - URMAR, Hospital del Mar - IMIM, Parc de Salut Mar, Barcelona, España; CEXS, Universitat Pompeu Fabra, Barcelona, España
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21
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Kubo T, Osuka A, Kabata D, Kimura M, Tabira K, Ogura H. Chest physical therapy reduces pneumonia following inhalation injury. Burns 2021; 47:198-205. [PMID: 32711901 DOI: 10.1016/j.burns.2020.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to clarify the efficacy of chest physiotherapy (CPT) in patients with inhalation injury in the acute phase. PATIENTS AND METHODS This was a single-institution retrospective study of patients with inhalation injury admitted to the Chukyo Hospital Burn Center from April 2004 to March 2014 who required endotracheal intubation for respiratory care. The patients were divided into two groups: the CPT group and the conventional physical therapy group. We compared the two groups according to the incidence of pneumonia, length of ICU/hospital stay, and level of activities of daily living at discharge. To match subject backgrounds, we conducted a propensity score matching analysis, and using a Cox regression analysis, we evaluated the effect of CPT on the first pneumonia event. RESULTS Of 271 patients admitted to the burn center, 139 patients were included. The incidence of pneumonia in the CPT group was significantly lower and these patients required fewer days until they could sit on the edge of the bed compared with the conventional physical therapy group. In a Cox regression model, the hazard ratio for the first incidence of pneumonia in the CPT group vs. the conventional therapy group was 0.27 (95% confidence interval: 0.13-0.54, P = 0.0002) after propensity score matching. CONCLUSIONS CPT reduces the incidence of pneumonia and facilitates patient mobilization following inhalation injury.
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22
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Kawaguchi A, Bernier G, Lacroix J, El Salti S, Cheng MP, Lee TC, Khwaja K, Jouvet P. Comparison of two methods to clear the airways of critically ill children and adults with COVID-19 infection: a structured summary of a study protocol for a pilot randomized controlled trial. Trials 2020; 21:610. [PMID: 32620174 PMCID: PMC7332538 DOI: 10.1186/s13063-020-04533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives As there is no treatment for COVID-19 with a proven mortality benefit at this moment in the pandemic, supportive management including mechanical ventilation is the core management in an intensive care unit (ICU). It is a challenge to provide consistent care in this situation, highly demanding and leading to potential staff shortages in ICU. We need to reduce unnecessary exposure of healthcare workers to the virus. This study aims to examine the impact of care using a non-invasive oscillating device (NIOD) for chest physiotherapy in the care of mechanically ventilated patients with COVID-19. In particular, we aim to explore if a NIOD performed by non-specialized personnel is not inferior to the standard chest physiotherapy (CPT) undertaken by physiotherapists caring for patients with COVID-19. Trial design A pilot multicenter prospective crossover noninferiority randomized controlled trial. Participants All mechanically ventilated patients with COVID-19 admitted to one of the two ICUs, and CPT ordered by the responsible physician. The participants will be recruited from two intensive care units in Canadian Academic Hospitals (one pediatric and one adult ICU). Intervention and comparator We will implement NIOD and CPT alternatingly for 3 h apart over 3 h. We will apply a pragmatic design, so that other procedures including hypertonic saline nebulization, intermittent positive pressure ventilation, suctioning (e.g., oral or nasal), or changing the ventilator settings or modality (i.e., increasing positive end-expiratory pressure or changing the nasal mask to total face continuous positive airway pressure) can be provided at the direction of bedside intensivists in charge. Main outcomes The primary outcome measurement is the oxygenation level before and after the procedure (SpO2/FiO2 ratio). For cases with invasive ventilation (i.e., the use of an endotracheal tube to deliver positive pressure) and non-invasive ventilation, we will also document expiratory tidal volume, vital signs, and any related complications such as vomiting, hypoxemia, or unexpected extubation. We will collect the data before, 10 min after, and 30 min after the procedure. Randomization The order of the procedures (i.e., NIOD or CPT) will be randomly allocated using manual generated random numbers for each case. Randomization will be carried out by the independent research assistant in the study coordinating center by using opaque sealed envelopes, assigning an equal number of cases to each intervention arm. Stratification will be applied for age (> 18 years or ≤ 18 years of age) and the study sites. Blinding (masking) No blinding will be performed. Numbers to be randomized (sample size) We estimate the necessary sample size as 25 for each arm (total 50 cases), with a power of 0.90 and an alpha of 0.05, with a non-inferiority design. Trial status The protocol version number 1 was approved on 27 March 2020. Currently, recruitment has not yet started, with the start scheduled by the mid-June 2020 and the end anticipated by December 2020. Trial registration ClinicalTrials.gov NCT04361435. Registered on 28 April 2020 Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional File 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.
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Affiliation(s)
- Atsushi Kawaguchi
- Department of Pediatrics, University of Montreal, CHU Sainte-Justine, 3175 Chemin de Côte Sainte Catherine, Quebec, QB, H3T 1C5, Canada.,Department of Pediatrics, Children's Hospital Eastern Ontario, University of Ottawa, Ottawa, Canada
| | | | - Jacques Lacroix
- Department of Pediatrics, University of Montreal, CHU Sainte-Justine, 3175 Chemin de Côte Sainte Catherine, Quebec, QB, H3T 1C5, Canada
| | - Saly El Salti
- Department of Pediatrics, University of Montreal, CHU Sainte-Justine, 3175 Chemin de Côte Sainte Catherine, Quebec, QB, H3T 1C5, Canada
| | - Matthew P Cheng
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Quebec, Canada.,McGill Interdisciplinary Initiative in Infection and Immunity, Quebec, Canada
| | - Todd C Lee
- McGill Interdisciplinary Initiative in Infection and Immunity, Quebec, Canada.,Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Quebec, Canada
| | - Kosar Khwaja
- Réseau de Recherche en Santé Respiratoire du Québec, Quebec, Canada
| | - Philippe Jouvet
- Department of Pediatrics, University of Montreal, CHU Sainte-Justine, 3175 Chemin de Côte Sainte Catherine, Quebec, QB, H3T 1C5, Canada.
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23
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Sereearuno T, Rittayamai N, Lawansil S, Thirapatarapong W. Effectiveness of a chest physiotherapy care map in hospitalized patients. Heart Lung 2020; 49:616-621. [PMID: 32340869 DOI: 10.1016/j.hrtlng.2020.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Conventional chest physiotherapy (chest PT) has been widely used to facilitate airway clearance. However, conventional chest PT is time consuming, unnecessary prescriptions result in heavier workloads for therapists. Therefore, judicious prescription of chest PT is important. PURPOSE To develop a chest physiotherapy care-map and evaluate its efficacy. METHOD Seventy-eight hospitalized patients who were consulted for chest PT were enrolled and consecutively allocated into two groups of 39 patients. Group I and II was enrolled before and after the implementation of the chest PT map, respectively. RESULT After the care-map was implemented, the chest PT prescription rate decreased from 56.4% to 33.3%, (p = 0.040). The duration of conventional chest PT trended to lower but not reaching significance from 4.5 (1-28) to 4 (2-9) days, (p = 0.582). The mean cost of chest PT was reduced by 38.2% (p = 0.019). CONCLUSION Chest PT care-map is an effective tool to reduce unnecessary chest PT prescriptions, lower costs, and more effectively allocate therapist time.
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Affiliation(s)
- T Sereearuno
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - S Lawansil
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - W Thirapatarapong
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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24
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Winck JC, Ambrosino N. COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems. Pulmonology 2020; 26:213-220. [PMID: 32362507 PMCID: PMC7183996 DOI: 10.1016/j.pulmoe.2020.04.013] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/08/2023] Open
Abstract
Background and aim The war against Covid-19 is far from won. This narrative review attempts to describe some problems with the management of Covid-19 induced acute respiratory failure (ARF) by pulmonologists. Methods We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and reviewed the references of retrieved articles for additional studies. The search was limited to the terms: Covid-19 AND: acute respiratory distress syndrome (ARDS), SARS, MERS, non invasive ventilation (NIV), high flow nasal cannula (HFNC), pronation (PP), health care workers (HCW). Results Protection of Health care workers should be paramount, so full Personal Protective Equipment and Negative pressure rooms are warranted. HFNC alone or with PP could be offered for mild cases (PaO2/FiO2 between 200–300); NIV alone or with PP may work in moderate cases (PaO2/FiO2 between 100–200). Rotation and coupled (HFNC/NIV) strategy can be beneficial. A window of opportunity of 1–2 h is advised. If PaO2/FIO2 significantly increases, Respiratory Rate decreases with a relatively low Exhaled Tidal Volume, the non-invasive strategy could be working and intubation delayed. Conclusion Although there is a role for non-invasive respiratory therapies in the context of COVID-19 ARF, more research is still needed to define the balance of benefits and risks to patients and HCW. Indirectly, non invasive respiratory therapies may be of particular benefit in reducing the risks to healthcare workers by obviating the need for intubation, a potentially highly infectious procedure.
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Affiliation(s)
- J C Winck
- Faculdade de Medicina da Universidade do Porto, Portugal.
| | - N Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Istituto di Montescano, Italy
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25
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Wang MY, Pan L, Hu XJ. Chest physiotherapy for the prevention of ventilator-associated pneumonia: A meta-analysis. Am J Infect Control 2019; 47:755-60. [PMID: 30642672 DOI: 10.1016/j.ajic.2018.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in mechanically ventilated patients. We undertook a meta-analysis to evaluate the efficacy of chest physiotherapy (CPT) for the prevention of VAP. METHODS A systematic literature search of PubMed and Embase databases were searched up until November 25, 2018 for published studies of mechanically ventilated patients comparing CPT with controls and reporting on the occurrence of VAP. Two authors independently selected studies and abstracted data on study quality and outcomes. We pooled data using random-effects models. RESULTS A total of 6 randomized (n = 704) controlled trials were identified. CPT did not significantly reduce the incidence of VAP (risk ratio = 1.02; 95% confidence interval, 0.82-1.26; P = .87), but reduced hospital mortality (risk ratio = 0.68; 95% confidence interval, 0.48-0.95; P = .02). No significant differences were observed regarding intensive care unit mortality, length of intensive care unit stay, and duration of mechanical ventilation. CONCLUSIONS CPT may not significantly reduce the incidence of VAP and alter other important clinical outcomes in adult patients receiving mechanical ventilation. However, the results should be interpreted cautiously owing to the heterogeneity and the limited trials. Further large-scale, well-designed randomized controlled trials are needed.
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26
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Powner J, Nesmith A, Kirkpatrick DP, Nichols JK, Bermingham B, Solomon GM. Employment of an algorithm of care including chest physiotherapy results in reduced hospitalizations and stability of lung function in bronchiectasis. BMC Pulm Med 2019; 19:82. [PMID: 31023284 PMCID: PMC6485142 DOI: 10.1186/s12890-019-0844-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/02/2019] [Indexed: 12/14/2022] Open
Abstract
Background There is a paucity of data on long term clinical effects of high frequency chest wall oscillation (HFCWO) in the Bronchiectasis population. Other therapies such as nebulized mucolytics and long term antibiotics have proven benefit on quality of life and exacerbation rate. In this study a treatment algorithm that included HFCWO as a component was initiated to see what the long term effects of the proposed algorithm were on lung function, antibiotic use, and exacerbation rates. Methods This was an observational comparative retrospective cohort study from database of patients with Bronchiectasis. Patients with > 2 exacerbations and significant symptom burden were enrolled to receive a treatment algorithm. The algorithm included: nebulized bronchodilators, mucolytics (hypertonic saline (3–7%) or n-acetylcysteine) inhaled daily or twice daily, thrice weekly macrolide therapy when appropriate, and high frequency chest wall oscillation (HFCWO) therapy (daily to twice daily per issued protocol) Outcomes from the cohort were analyzed for the subsequent twelve months after initiation to observe longitudinal lung function and clinical outcomes. Chart review was then done to obtain data the year prior to the start of the algorithm in this same cohort of patients. Results Sixty-five patients received the Smart Vest® HFCWO system and were enrolled into the algorithm for treatment during the study period. Of the sixty-five patients, forty-three were eligible due to adequate 1-year baseline and follow up data at the time of the study initiation. The mean FEV1 remained stable at 1-year post enrollment (1.85 ± 0.60 L pre vs 1.89 ± 0.60 L post, p = NS) and the number of exacerbations requiring hospitalization was reduced (1.3 ± 1.0 pre vs. 0.46 ± 0.81 hospitalizations, post initiation, p < 0.0001). Antibiotic use overall was also reduced (2.5 ± 0.86 courses/year pre vs 2.1 ± 0.92 courses per year post initiation, p < 0.0001). Conclusion Standardized care for Bronchiectasis involving an algorithm for Mucociliary clearance that centers on initiation of HFCWO may help to reduce lung function decline, need for oral antibiotics, and reduced hospitalization rate.
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Affiliation(s)
- Jordan Powner
- University of Alabama at Birmingham Department of Medicine, Birmingham, AL, USA
| | - Andrew Nesmith
- University of Alabama at Birmingham Department of Medicine, Birmingham, AL, USA
| | | | | | - Brent Bermingham
- University of Alabama at Birmingham Department of Medicine, Birmingham, AL, USA
| | - George M Solomon
- University of Alabama at Birmingham Department of Medicine, Birmingham, AL, USA. .,Gregory Fleming James Cystic Fibrosis Research Center, 1900 University Blvd THT 422, Birmingham, AL, 35294, USA.
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27
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Rotolo N, Cattoni M, D'Andria M, Cavanna L, Patrizio G, Imperatori A, Nicolini A. Comparison of an expiratory flow accelerator device versus positive expiratory pressure for tracheobronchial airway clearance after lung cancer lobectomy: a preliminary study. Physiotherapy 2019; 110:34-41. [PMID: 33563372 DOI: 10.1016/j.physio.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE A new type of device has recently been introduced in chest physiotherapy as an aid to tracheo-bronchial airway clearance: expiratory flow accelerator (EFA). It promotes mucus clearance without generating any pressure gradient, allowing patients to breathe at tidal volume against no resistance. DESIGN Pilot randomized controlled study. SETTING Tertiary hospital. PARTICIPANTS Fifty adult patients who underwent lung cancer lobectomy were randomized to undergo chest physiotherapy with EFA (n=26) or PEP (n=24). INTERVENTIONS EFA; PEP bottle. MAIN OUTCOMES Incidence of postoperative pulmonary complications (PPC) and length of stay. SECONDARY OUTCOMES trends in inspiratory capacity, respiratory rate, oxygen saturation, and dyspnoea. Patients rated user-friendliness of the two devices on a 5-point Likert scale. RESULTS A slightly different incidence of PPCs was observed between the EFA and PEP group. Nevertheless, the length of stay was similar in the two groups. No substantial differences were seen in trends of inspiratory capacity, respiratory rate, oxygen saturation, dyspnoea between the two groups. Patient-reported user-friendliness of the two devices did not differ significantly, although the use of the EFA device appeared less strenuous. CONCLUSIONS Results of this pilot study point to the use of EFA as an alternative treatment option rather than as a replacement for the PEP bottle in chest physiotherapy following lung cancer lobectomy. EFA may be preferable for weaker patients and/or with airway leakages in whom PEP has limited indications. Further investigation in a larger sample is required to statistically confirm the findings. Clinical Trial Registration Number ChiCTR-ONC-17013255.
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Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Michele D'Andria
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Laura Cavanna
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Giorgia Patrizio
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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28
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Gomes GR, Donadio MVF. Effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis. Arch Pediatr 2018; 25:394-398. [PMID: 30064712 DOI: 10.1016/j.arcped.2018.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 05/16/2018] [Accepted: 06/24/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis (AVB). METHODS A literature review was done searching the Pubmed, LILACS, PEDro, and Scielo databases. The following key words were used: bronchiolitis, physiotherapy, techniques, physical therapy, and chest physiotherapy. Both controlled and uncontrolled clinical trials, without limits as to date, were selected. RESULTS Fifteen articles were included and the use of different techniques of respiratory physiotherapy showed positive results in eight studies. Most (11) were controlled clinical trials, and only two had a double-blind design. Of the 14 studies with a control group, in six this group was submitted to nasopharyngeal aspiration. The most widely used techniques were manual vibration and postural drainage (eight studies), and then tapping/percussion (seven studied). The maneuvers considered as current, e.g., prolonged slow expiration, expiratory flow acceleration, and rhinopharyngeal retrograde clearance, were used in four, four, and two studies, respectively. CONCLUSIONS The use of respiratory physiotherapy in children with AVB remains controversial. The heterogeneity of techniques evaluated in the studies limits the interpretation of efficacy, although its use was considered safe. Recent findings indicating a reduction in the length of the hospital stay remain to be confirmed.
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Affiliation(s)
- G R Gomes
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - M V F Donadio
- Centro Infant, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
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29
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Egan AM, Clain JM, Escalante P. Non-antimicrobial airway management of non-cystic fibrosis bronchiectasis. J Clin Tuberc Other Mycobact Dis 2018; 10:24-8. [PMID: 31720381 DOI: 10.1016/j.jctube.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 11/24/2022] Open
Abstract
Bronchiectasis are often encountered in clinical practice, and are characterized by abnormal airway dilatation and distortion associated with impaired mucociliary clearance and mucous plugging, which are frequently associated with recurrent infections. Numerous etiologies can underlie the development of bronchiectasis, but the most important distinction in research and clinical practice is between bronchiectasis due to cystic fibrosis (CF) and bronchiectasis due to all other reasons (non-CF bronchiectasis). The causes of non-CF bronchiectasis are varied and often unclear. Patients disease severity and phenotypes of non-CF bronchiectasis also varied, which can influence disease trajectory, frequency of exacerbations and mortality. This article reviews the published evidence and suggests interventions to enhance airways clearance in patients with non-CF bronchiectasis, which are key components of an individualized therapeutic program in order to achieve symptomatic relief and prevention of exacerbations and functional decline.
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30
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Grammatopoulou E, Charmpas TN, Strati EG, Nikolaos T, Evagelodimou A, Vlassia Belimpasaki, Skordilis EK. The scope of physiotherapy services provided in public ICUs in Greece: A pilot study. Physiother Theory Pract 2017; 33:138-146. [PMID: 28075178 DOI: 10.1080/09593985.2016.1266718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the present study was to determine the scope of physiotherapy services provided in Greek ICUs in Athens. A cross-sectional study was conducted with two postal questionnaires administered separately, one for ICU directors and one for ICU physiotherapists. Responses were received from 19 ICU directors and 103 physiotherapists employed in all the adult public mixed medical and surgical ICUs across Athens. The response rate for the survey completion was 100% for ICU directors and 68.7% for physiotherapists. The results showed a 1:50 to 1:12 range in the ratio of physiotherapists to ICU beds. Among the 19 ICUs, 15 (78.9%) employed physiotherapists on a rotational basis, while four (21.0%) retained them exclusively. On weekdays, all surveyed ICUs were covered by physiotherapists in the morning and 10/19 (52.6%) during the afternoon. On weekends, 12/19 (63.2%) of the surveyed ICUs reported physiotherapy care during the morning and 4/19 (21.0%) during both morning and afternoon. All 103 physiotherapists conducted airway clearance techniques and progressive mobilization, 92/103 (89.3%) were involved in extubating patients, 102/103 (99.0%) in passive and active range of motion exercises, and 61/103 (59.2%) in walking. In conclusion, all Greek ICUs in Athens surveyed had physiotherapy cover. The physiotherapists working in these ICUs in Athens were involved in respiratory care and mobilization.
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Affiliation(s)
- Eirini Grammatopoulou
- a Department of Physiotherapy , Technological and Educational Institution-TEI of Athens , Athens , Greece
| | - Theodoros N Charmpas
- a Department of Physiotherapy , Technological and Educational Institution-TEI of Athens , Athens , Greece
| | - Eftychia G Strati
- a Department of Physiotherapy , Technological and Educational Institution-TEI of Athens , Athens , Greece
| | - Tsamis Nikolaos
- a Department of Physiotherapy , Technological and Educational Institution-TEI of Athens , Athens , Greece
| | - Afroditi Evagelodimou
- a Department of Physiotherapy , Technological and Educational Institution-TEI of Athens , Athens , Greece
| | | | - Emmanouil K Skordilis
- c School of Physical Education and Sport Sciences , National and Kapodistrian University of Athens , Athens , Greece
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Reychler G, Jacques L, Arnold D, Scheers I, Smets F, Sokal E, Stephenne X. [Influence of chest physiotherapy on gastro-œsophageal reflux in children]. Rev Mal Respir 2015; 32:493-9. [PMID: 25725980 DOI: 10.1016/j.rmr.2015.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 12/24/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Chest physiotherapy is regularly prescribed for children, particularly in cystic fibrosis. Gastro-oesophageal reflux is common in this disease and is associated with certain chest physiotherapy manoeuvres. AIM OF THE STUDY To evaluate the influence of two chest physiotherapy techniques on gastro-oesophageal reflux in children. MATERIAL AND METHOD Twenty-nine children were investigated by routine pHmetry. During the examination, they performed two chest physiotherapy manoeuvres in a seated position for 10 minutes each with a 5 minutes rest between them. The two manoeuvres used were a slow expiration technique (ELPr) and positive expiratory pressure (PEP). It was a prospective study and the order of manoeuvres was randomised. The pH traces were analysed blindly when all the studies had been completed. RESULTS In the sample, 21% of children had gastro-oesophageal reflux during the physiotherapy session. No relationship was found between reflux during physiotherapy and pathological reflux (P=0.411) nor the physiotherapy technique used (P=0.219). CONCLUSION The use of these two chest physiotherapy techniques in children in a seated position can produce gastro-oesophageal reflux.
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Guimarães FS, Lopes AJ, Moço VJR, Cavalcanti de Souza F, Silveira de Menezes SL. Eltgol acutelly improves airway clearance and reduces static pulmonary volumes in adult cystic fibrosis patients. J Phys Ther Sci 2014; 26:813-6. [PMID: 25013273 PMCID: PMC4085198 DOI: 10.1589/jpts.26.813] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/07/2014] [Indexed: 12/04/2022] Open
Abstract
Chest physical therapy techniques are essential in order to reduce the frequency of
recurrent pulmonary infections that progressively affect lung function in cystic fibrosis
patients. Recently, ELTGOL (L’Expiration Lente Totale Glotte Ouverte en décubitus Latéral)
emerged as an inexpensive and easy to perform therapeutic option. The aim of this study
was to compare the acute effects of ELTGOL and the Flutter valve in stable adult patients
with cystic fibrosis. [Subjects and Methods] This was a randomized, crossover study with a
sample of cystic fibrosis outpatients. The subjects underwent two protocols (Flutter Valve
and ELTGOL interventions, referred to as ELTGOL and FLUTTER) in a randomized order with a
one-week washout interval between them. The main outcomes were pulmonary function
variables and expectorated sputum dry weight. [Results] ELTGOL cleared 0.34 g more of
secretions than FLUTTER (95% CI 0.11 to 0.57). When comparing the physiological effects of
ELTGOL and FLUTTER, the first was superior in improving airway resistance (−0.51
cmH2O/L/s; 95% CI −0.88 to −0.14) and airway conductance (0.016
L/s/cmH2O; 95% CI 0.008 to 0.023). [Conclusion] ELTGOL promoted higher
secretion removal and improvement in airway resistance and conductance than the Flutter
valve. These techniques were equivalent in reducing the pulmonary hyperinflation and air
trapping in cystic fibrosis patients.
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Affiliation(s)
- Fernando Silva Guimarães
- Rehabilitation Science Graduate Program, Augusto Motta University Centre (UNISUAM), Brazil ; Physical Therapy Department, Federal University of Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Rehabilitation Science Graduate Program, Augusto Motta University Centre (UNISUAM), Brazil ; Laboratory of Respiratory Physiology, University of the State of Rio de Janeiro, Brazil
| | | | | | - Sara Lúcia Silveira de Menezes
- Rehabilitation Science Graduate Program, Augusto Motta University Centre (UNISUAM), Brazil ; Physical Therapy Department, Federal University of Rio de Janeiro, Brazil
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Castro-Rodriguez JA, Silva R, Tapia P, Salinas P, Tellez A, Leisewitz T, Sanchez I. Chest physiotherapy is not clinically indicated for infants receiving outpatient care for acute wheezing episodes. Acta Paediatr 2014; 103:518-23. [PMID: 24571395 DOI: 10.1111/apa.12578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 01/15/2014] [Accepted: 01/24/2014] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the effectiveness of chest physiotherapy (CPT), which provides slow and long expiratory flow and assisted cough techniques, in infants receiving outpatient care for acute wheezing episodes. METHODS Forty-eight infants with moderate acute wheezing episodes were randomised to receive either salbutamol MDI with CPT (n = 25) or without CPT (n = 23). The clinical score and SpO2 levels were recorded, before and after treatment, in a blinded design. The primary outcome was discharge after the first hour of treatment: clinical score ≤5/12 and SpO2 ≥ 93%. Secondary outcomes were the number of admissions to hospital after the second hour, use of oral corticosteroid bursts and admissions to hospital on day seven. RESULTS There were no differences between children with and without CPT in discharge rate (92% vs. 87%), clinical score (median [IQR]: 2.8 [2.2-3.3] vs. 3.4 [2.8-4.1]) and SpO2 = (96.4 [95.7-97.1] vs. 96.0 [94.9-96.5]) after the first hour of treatment or in the number of hospital admissions after the second hour. No differences were observed at days seven and 28 following treatment. CONCLUSION There was no evidence of clinical benefits from these specific CPT techniques for infants receiving outpatient care for acute wheezing episodes.
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Affiliation(s)
- Jose A. Castro-Rodriguez
- Department of Paediatrics; School of Medicine; Pontificia Universidad Catolica de Chile; Santiago Chile
- Department of Family Medicine; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Rodrigo Silva
- Department of Family Medicine; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Patricio Tapia
- CESFAM Juan Pablo II; School of Medicine; Pontificia Universidad Catolica de Chile; Santiago Chile
| | - Pamela Salinas
- CESFAM Juan Pablo II; School of Medicine; Pontificia Universidad Catolica de Chile; Santiago Chile
| | - Alvaro Tellez
- Department of Family Medicine; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Thomas Leisewitz
- Department of Family Medicine; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Ignacio Sanchez
- Department of Paediatrics; School of Medicine; Pontificia Universidad Catolica de Chile; Santiago Chile
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Chokshi T, Alaparthi GK, Krishnan S, Vaishali K, Zulfeequer CP. Practice patterns of physiotherapists in neonatal intensive care units: A national survey. Indian J Crit Care Med 2014; 17:359-66. [PMID: 24501488 PMCID: PMC3902571 DOI: 10.4103/0972-5229.123448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine practice pattern of physiotherapists in the neonatal intensive care units (ICUs) in India with regards to cardiopulmonary and neuromuscular physiotherapy. MATERIALS AND METHODS A cross-sectional survey was conducted across India, in which 285 questionnaires were sent via e-mail to physiotherapists working in neonatal intensive care units. RESULTS A total of 139 completed questionnaires were returned with a response rate of 48.7%, with a majority of responses from Karnataka, Maharashtra and Gujarat. More than 90% of physiotherapists performed chest physiotherapy in neonatal ICUs. Chest physiotherapy assessment predominantly focused on vital parameter assessment (86%) and in treatment predominantly focused on percussion (74.1%), vibration (75.5%), chest manipulation (73.3%), postural drainage (67.6%) and suction (65.4%). In neuromuscular physiotherapy more than 60% of physiotherapists used positioning, and parent education, whereas more than 45% focused on passive range of motion exercise and therapeutic handling. CONCLUSION The practice pattern of physiotherapists for neonates in neonatal intensive care units involves both chest physiotherapy as well neuromuscular physiotherapy. Chest physiotherapy assessment focused mainly on vital parameter assessment (heart rate, respiratory rate and partial pressure of oxygen saturation SpO2). Treatment focused on airway clearance techniques including percussion, vibration, postural drainage and airway suction. In neuromuscular physiotherapy most physiotherapists focused on parent education and passive range of motion exercise, therapeutic handling, as well as positioning.
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Affiliation(s)
- Tejas Chokshi
- Department of Physiotherapy, Kasturba Medical College (A constituent Institute of Manipal University), Bejai, Mangalore, Karnataka, India
| | - Gopala Krishna Alaparthi
- Department of Physiotherapy, Kasturba Medical College (A constituent Institute of Manipal University), Bejai, Mangalore, Karnataka, India
| | - Shyam Krishnan
- Department of Physiotherapy, Kasturba Medical College (A constituent Institute of Manipal University), Bejai, Mangalore, Karnataka, India
| | - K Vaishali
- Department of Physiotherapy, Kasturba Medical College (A constituent Institute of Manipal University), Bejai, Mangalore, Karnataka, India
| | - C P Zulfeequer
- Department of Physiotherapy, Kasturba Medical College (A constituent Institute of Manipal University), Bejai, Mangalore, Karnataka, India
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Esguerra-Gonzales A, Ilagan-Honorio M, Kehoe P, Fraschilla S, Lee AJ, Madsen A, Marcarian T, Mayol-Ngo K, Miller PS, Onga J, Rodman B, Ross D, Shameem Z, Nandy K, Toyama J, Sommer S, Tamonang C, Villamor F, Weigt SS, Gawlinski A. Effect of high-frequency chest wall oscillation versus chest physiotherapy on lung function after lung transplant. Appl Nurs Res 2013; 27:59-66. [PMID: 24387872 DOI: 10.1016/j.apnr.2013.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 11/03/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study is to compare the effects of chest physiotherapy (CPT) and high-frequency chest wall oscillation (HFCWO) on lung function in lung transplant recipients. BACKGROUND Chest physiotherapy and HFCWO are routinely used after lung transplant to attenuate dyspnea, increase expiratory flow, and improve secretion clearance. METHODS In a two-group experimental, crossover design with repeated-measures, 45 lung transplant recipients (27 single, 18 bilateral; 64% male; mean age, 57 years) were randomized to receive CPT at 10:00 AM and 2:00 PM followed by HFCWO at 6:00 PM and 10:00 PM (n=22) or vice versa (n=23) on postoperative day 3. Dyspnea (modified Borg score), Spo2/FiO2, and peak expiratory flow (PEF) were measured pre-treatment and post-treatment. Data were analyzed using chi-square tests, t tests, and linear mixed effects models. RESULTS There was no statistically significant treatment effect for dyspnea or PEF in patients who received HFCWO versus CPT. However, there was a significant treatment effect on the Spo2/FiO2 ratio (p<0.0001). CONCLUSIONS Preliminary results suggest that lung function (measured by Spo2/FiO2) improves with HFWCO after lung transplantation. Although dyspnea and PEF did not differ significantly between treatment types, HFCWO may be an effective, feasible alternative to CPT.
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Affiliation(s)
- Angeli Esguerra-Gonzales
- Department of Nursing, Cardiothoracic Intensive Care Unit, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
| | - Monina Ilagan-Honorio
- Department of Nursing, Cardiothoracic Intensive Care Unit, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
| | | | - Stephanie Fraschilla
- Transplant Services, Heart and Lung Transplantation, UCLA Health System, Los Angeles, California.
| | - Ai Jin Lee
- Department of Nursing, Cardiothoracic Intensive Care Unit, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
| | - Ashley Madsen
- Department of Nursing, Cardiothoracic Intensive Care Unit, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
| | - Taline Marcarian
- Department of Nursing, Cardiothoracic Intensive Care Unit, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
| | - Kristina Mayol-Ngo
- Department of Nursing, Cardiothoracic Intensive Care Unit, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
| | | | - Jay Onga
- Transplant Services, Heart and Lung Transplantation, UCLA Health System, Los Angeles, California.
| | - Betty Rodman
- Department of Nursing, Cardiothoracic Intensive Care Unit, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
| | - David Ross
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Zeba Shameem
- Department of Nursing, Cardiothoracic Intensive Care Unit, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
| | - Karabi Nandy
- School of Nursing, UCLA, Los Angeles, California; Department of Biostatistics, School of Public Health, UCLA, Los Angeles, California.
| | - Joy Toyama
- School of Nursing, UCLA, Los Angeles, California; Department of Biostatistics, School of Public Health, UCLA, Los Angeles, California.
| | - Susan Sommer
- Department of Nursing, Cardiothoracic Intensive Care Unit, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
| | - Cheryl Tamonang
- Department of Nursing, Cardiothoracic Intensive Care Unit, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
| | - Filma Villamor
- Department of Nursing, Cardiothoracic Intensive Care Unit, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
| | - S Samuel Weigt
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
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Jingar A, Alaparthi GK, Vaishali K, Krishnan S, Zulfeequer, Unnikrishnan B. Clinical management practices adopted by physiotherapists in India for chronic obstructive pulmonary disease: A national survey. Lung India 2013; 30:131-8. [PMID: 23741094 PMCID: PMC3669553 DOI: 10.4103/0970-2113.110421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Objective: Evidence supports the use of pulmonary rehabilitation in the treatment of chronic obstructive pulmonary disease (COPD) patients both during acute exacerbation and at later stages. It is used in India; but, to date, there has been no study that has investigated the structure of pulmonary rehabilitation programs for COPD patients in India. The recent study aims to determine the current practice patterns of Indian Physiotherapists for COPD patients admitted in Intensive Care Units (ICUs) and wards in terms of assessment and treatment. Materials and Methods: A questionnaire-based survey was conducted across India. Questionnaires were distributed to around 800 physiotherapists via E-mail. Physiotherapists with a Master Degree and a specialization in cardiopulmonary science or a minimum of 1 year of experience in treating cardiopulmonary patients were included. The questionnaires addressed assessment measures and treatment techniques given to COPD patients. Results: A total of 342 completed questionnaires were received, yielding a response rate of 43.8%, with a majority of responses from Karnataka, Maharashtra and Gujarat. The assessment and treatment techniques used were almost similar between ICUs and wards. More than 80% of the responders carried out the assessment of certain respiratory impairments in both ICUs and wards. An objective measure of dyspnea was taken by less than 40% of the responders, with little attention given to functional exercise capacity and health-related quality of life. Eighty-five percent of the responders used Dyspnea-relieving strategies and traditional airway clearance techniques in both ICUs and wards. Eighty-three percent of the responders were giving patients in the wards training for upper and lower extremity. Fifty percent were giving strength training in the wards. Conclusion: Whether patients are admitted in ICUs or Wards, the practice pattern adopted by Physiotherapists to treat them vary very little with respect to certain measures taken. Assessment predominantly focused on respiratory impairment measures, followed by dyspnea-quantifying measures, with little attention given to functional exercise capacity and health-related quality of life measures. Treatment techniques given were concentrated on dyspnea-relieving strategies, airway clearance techniques and upper and lower extremity exercises, with little attention given to strength training.
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Affiliation(s)
- Aripta Jingar
- Department of Physiotherapy, Kasturba Medical College (A constituent institute of Manipal University), Mangalore, India
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Bilan N, Poorshiri B. The role of chest physiotherapy in prevention of postextubation atelectasis in pediatric patients with neuromuscular diseases. Iran J Child Neurol 2013; 7:21-4. [PMID: 24665285 PMCID: PMC3943081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 06/23/2012] [Accepted: 07/15/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There are controversial findings in the literature on the effects of chest physiotherapy on postextubation lung collapse in pediatric age group. Therefore, we aimed to investigate the efficacy of chest physiotherapy in prevention of postextubation atelectasis in pediatric patients. MATERIALS & METHODS In a case-control study from March 2007 to March 2011, two groups of patients (35 patients in each group) susceptible to lung collapse were enrolled in the study. The studied patients had neuromuscular diseases such as spinal muscular atrophy, Guillain-Barre syndrome, critical illness polyneuropathy/myopathy, and cerebral palsy. The patients were randomly divided into two groups (case and control); The case group underwent daily chest physiotherapy through vibrator and chest percussion and the control group was under supervision. In the latter group, the underlying disease was treated and the lung collapse was managed, if occurred. RESULTS The frequency of atelectasis was lower in the case group who received prophylactic chest physiotherapy compared to the control group (16.6% vs. 40%). CONCLUSION Chest physiotherapy as well as appropriate and regular change of position can considerably reduce the rate of pulmonary collapse in pediatric patients.
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Affiliation(s)
- Nemat Bilan
- Professor of Pediatric Pulmonology, Paediatric Health Research Center, Department of Pediatrics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bita Poorshiri
- Resident of Pediatrics, Department of Pediatrics, Tabriz University of Medical Sciences, Tabriz, Iran
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