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Abstract
Thoracotomy is a major cause of respiratory impairment, increasing the risk of postoperative pulmonary complications (PPC). Systems assessing ribcage kinematics may detect changes in chest expansion following thoracotomy and may thus aid in the development of patient-tailored chest physiotherapy. Hence, we aimed to identify studies assessing changes in chest wall movement following thoracotomy using objective measures. The Cochrane library, MEDLINE, EMBASE, Scopus and Web of Science databases were searched to find relevant articles providing an objective assessment of chest wall movement following thoracotomy. Methodological quality of included studies concerning chest wall movement following thoracotomy was assessed by use of QUADAS-2 tool. A total of 12 articles were included for the assessment of chest wall changes following thoracotomy using objective measures. Four studies measured changes in the cross-sectional area of the ribcage and abdomen using the respiratory inductive plethysmography (RIP), 1 study computed the chest wall compliance by monitoring the intra-pleural pressure, 3 studies measured changes in chest circumference with a simple tape measure and 4 articles performed a compartmental analysis of the chest wall volume by means of an optoelectronic plethysmography (OEP). There was no delay in the collection of data of the index test and reference standard, resulting in a low risk of bias for the flow and timing domain. Across all studies, participants underwent the same reference standard, resulting in a low risk of verification bias. Several objective measures were able to detect changes in chest wall displacement following thoracotomy and differed in the practical use and invasive nature. OEP allows a compartmental analysis of the chest wall volume. Hence, this system allows to assess chest wall movement changes following thoracotomy and the impact of different types of surgical approach. Furthermore, it could aid in the development of tailored physiotherapy.
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Affiliation(s)
- Karina Tukanova
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Enrica Papi
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Bioengineering, Imperial College London, London, UK
| | - Sara Jamel
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
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Oswald N, Jalal Z, Kadiri S, Naidu B. Changes in chest wall motion with removal of Nuss bar in repaired pectus excavatum - a cohort study. J Cardiothorac Surg 2019; 14:4. [PMID: 30621729 PMCID: PMC6325662 DOI: 10.1186/s13019-018-0827-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 11/16/2018] [Accepted: 12/26/2018] [Indexed: 11/25/2022] Open
Abstract
Background The effects of the Nuss procedure on chest wall motion and spirometry have previously been described; we aimed to describe the effects of removal of the Nuss bar. Methods We studied 9 patients just prior to and 6 weeks after Nuss bar removal. Regional chest volume changes, synchrony of respiratory movement and spirometry were recorded using optoelectronic plethysmography (OEP) and compared. Recordings were performed at rest and exercise during cycle ergometry. Results There were small but statistically significant changes in tidal volumes of the diaphragmatic ribcage compartment during exercise (+ 48 ml, p = 0.038, Cohen’s d = 0.12) and percentage contribution of the diaphragmatic ribcage to total tidal volumes at rest (+ 2.7 percentage points, p = 0.038, Cohen’s d = 0.12). Synchrony of respiratory movements at rest and during exercise was unchanged following Nuss bar removal. There were no significant changes in spirometry and exercise capacity. Conclusions The effects of Nuss bar removal on diaphragmatic ribcage motion are detectable but small and unlikely to be of clinical significance. No change in exercise capacity should be expected after Nuss bar removal. Trial registration Registered at ClinicalTrials.gov, identifier NCT02958683, registered 5th August 2016, first patient enrolled July 2016, retrospectively registered.
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Affiliation(s)
- Nicola Oswald
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Centre for Translational Inflammation Research, University of Birmingham Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Zara Jalal
- Department of Thoracic Research, Heartlands Hospital, Birmingham, B9 5SS, UK
| | - Salma Kadiri
- Department of Thoracic Research, Heartlands Hospital, Birmingham, B9 5SS, UK
| | - Babu Naidu
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Centre for Translational Inflammation Research, University of Birmingham Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Elshafie G, Kumar P, Motamedi-Fakhr S, Iles R, Wilson RC, Naidu B. Measuring changes in chest wall motion after lung resection using structured light plethysmography: a feasibility study. Interact Cardiovasc Thorac Surg 2016; 23:544-7. [PMID: 27316661 DOI: 10.1093/icvts/ivw185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 12/30/2015] [Accepted: 04/29/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We describe the use of structured light plethysmography (SLP)-a novel, non-contact, light-based technique for measuring tidal breathing-among a cohort of patients undergoing lung resection. In this feasibility study, we examined whether changes in chest wall motion or in asynchrony between regions of the thoraco-abdominal wall could be identified after surgery. METHODS Fifteen patients underwent wedge resection (n = 8) or lobectomy (n = 7). All patients underwent two SLP assessments (before surgery and on Day 1 post-surgery). Each assessment captured data during 5 min of quiet (tidal) breathing. RESULTS When data were averaged across all patients, motion on the operated side of the thorax was significantly reduced after surgery (mean change from presurgery ± standard deviation: -14.7 ± 16.5%, P = 0.01), while motion on the non-operated side increased (15.9 ± 18.5%, P = 0.01). Thoraco-abdominal asynchrony also increased (mean change ± standard deviation: 43.4 ± 55.1%, P = 0.01), but no significant difference was observed in right-left hemi-thoracic asynchrony (163.7 ± 230.3%, P = 0.08). When analysed by resection type, lobectomy was associated with reduced and increased motion on the operated and non-operated side, respectively, and with an increase in both right-left hemi-thoracic and thoraco-abdominal asynchrony. No significant changes in motion or asynchrony were identified in patients who underwent wedge resection. CONCLUSIONS SLP was able to detect changes in chest wall motion and asynchrony after thoracic surgery. Changes in this small group of patients were consistent with the side of the incision and were most apparent in patients undergoing lobectomy.
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Affiliation(s)
- Ghazi Elshafie
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK School of Clinical and Experimental Medicine, The Medical School, University of Birmingham, Birmingham, UK
| | - Prem Kumar
- School of Clinical and Experimental Medicine, The Medical School, University of Birmingham, Birmingham, UK
| | | | - Richard Iles
- PneumaCare Ltd, Prospect House, Ely, Cambridgeshire, UK Evelina London Children's Hospital, London, UK
| | | | - Babu Naidu
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK School of Clinical and Experimental Medicine, The Medical School, University of Birmingham, Birmingham, UK
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Lowanichkiattikul C, Dhanachai M, Sitathanee C, Khachonkham S, Khaothong P. Impact of chest wall motion caused by respiration in adjuvant radiotherapy for postoperative breast cancer patients. Springerplus 2016; 5:144. [PMID: 27026841 PMCID: PMC4764603 DOI: 10.1186/s40064-016-1831-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 12/07/2015] [Accepted: 02/15/2016] [Indexed: 12/29/2022]
Abstract
To determine the chest wall movement of each patient during deep inspiratory breath hold (DIBH) and expiratory breath hold (EBH) in postoperative breast cancer patients. Postoperative breast cancer patients who underwent CT simulation for 3D radiotherapy treatment planning during December 2012 to November 2013 were included. Before scanning the radio-opaque wire was placed on the surface for breast and chest wall visualization on CT images, then the patient underwent three phases of CT scanning (free breathing, DIBH, and EBH, respectively). The distances of chest wall motion at five reference points were calculated using the treatment planning system. 38 breast cancer patients who underwent surgery were included. Median age was 48.5 (28–85) years. Median BMI was 23.4 (16.6–38.3) kg/m2. Median lung volume was 3160.5 (1830.8–4754.0) cm3. Median Haller index was 2.43 (1.92–3.56). Median chest wall movement was wider in anteroposterior (A–P, 4.2–5.4 mm) than superoinferior (S–I, 2.5–2.6 mm) and mediolateral (M–L, 0.6–1.1 mm) dimension in all five measured points. There was no significant effect of the type of surgery, BMI, lung volume, and the Haller index on the distances of chest wall movement. Additional margins of 7, 5, and 2 mm to the A–P, S–I, and M–L dimension should adequately cover the extreme chest wall movement in 95 % of the patients. This study showed that the maximal movement of the chest wall during DIBH and EBH was greatest in the A–P axis followed by the S–I axis, while the M–L axis was minimally affected by respiration.
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Affiliation(s)
- C Lowanichkiattikul
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama Road VI, Rachathevi, Bangkok, 10400 Thailand
| | - M Dhanachai
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama Road VI, Rachathevi, Bangkok, 10400 Thailand
| | - C Sitathanee
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama Road VI, Rachathevi, Bangkok, 10400 Thailand
| | - S Khachonkham
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama Road VI, Rachathevi, Bangkok, 10400 Thailand
| | - P Khaothong
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama Road VI, Rachathevi, Bangkok, 10400 Thailand
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Abstract
Assessing chest wall motion is a basic and vital component in managing the child with respiratory problems, whether these are due to pathology in the lungs, airways, chest wall or muscles. Since the 1960s, clinical assessment has been supplemented with an ever-growing range of technological options for measuring chest wall motion, each with unique advantages and disadvantages. Measurements of chest wall motion can be used to: (1) Assess respiratory airflow and volume change, as a non-invasive alternative to measurement at the airway opening, (2) Monitor breathing over long periods of time, to identify apnoea and other types of sleep-disordered breathing, (3)Identify and quantify patterns of abnormal chest wall movement, whether between ribcage and abdominal components (thoracoabdominal asynchrony) or between different regions of the ribcage (eg in scoliosis and pectus excavatum). Measuring chest wall motion allows us to do things which simply cannot be done by more mainstream respiratory function techniques measuring flow at the airway opening: it allows respiratory airflow to be measured when it would otherwise be impossible, and it tells us how the different parts of the chest wall (eg ribcage vs abdomen, right vs left) are moving in order to generate that airflow. The basis of the different techniques available to assess and measure chest wall motion will be reviewed and compared, and their relevance to paediatric respiratory practice assessed.
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Affiliation(s)
- Paul Seddon
- Consultant Respiratory Paediatrician, Royal Alexandra Children's Hospital, Eastern Road, Brighton BN2 5BE, United Kingdom.
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