Comparison of lung expansion techniques on thoracoabdominal mechanics and incidence of pulmonary complications after upper abdominal surgery: a randomized and controlled trial.

OBJECTIVE: Lung expansion techniques (LETs) are widely used to prevent postoperative pulmonary complications (PPCs). However, the effects of each of these techniques on thoracoabdominal mechanics and PPC incidence after abdominal surgery remain unclear. The objective of this study was to compare the effects of LET on pulmonary volumes, respiratory muscle activation, and PPC incidence after major, elective upper abdominal surgery. METHODS: This randomized controlled trial enrolled 137 patients who were randomly assigned into four groups: control (n = 35), flow incentive spirometry (n = 33), deep breathing (n = 35), and volume incentive spirometry (n = 34). Each intervention was performed tid during 5 consecutive days. Subsequently, PPCs (pneumonia, atelectasis, or severe hypoxemia) were analyzed by a blinded assessor until hospital discharge. Lung volumes (optoelectronic plethysmography) and inspiratory muscular activation (surface electromyography) were assessed before and 3 days after surgery. Intention-to-treat analysis was performed. RESULTS: Before surgery, all groups were homogenous for age, sex, BMI, lung function, and thoracoabdominal mechanics. After surgery, no difference was observed in the lung volumes and inspiratory muscular activation during the lung expansion technique (P > .05). The PPC incidence was higher in the deep breathing group (P < .05). Higher American Society of Anesthesiologists scores and surgery duration were the only predictors of PPC (n = 14, 11.2%). CONCLUSIONS: LETs do not modify the changes on thoracoabdominal mechanics or prevent PPCs after abdominal surgery. The indiscriminate use of LETs should not be routinely prescribed to prevent PPCs; however, more studies are required to confirm our results and to change the standard practice. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01993602; URL: www.clinicaltrials.gov.

Evaluation of a multimedia online tool for teaching bronchial hygiene to physical therapy students.

BACKGROUND: Advances in information technology have been widely used in teaching health care professionals. The use of multimedia resources may be important for clinical learning and we are not aware of previous reports using such technology in respiratory physical therapy education. OBJECTIVES: Our approach was to evaluate a conventional bronchial hygiene techniques (BHTs) course with an interactive online environment, including multimedia resources. METHODS: Previous developed audiovisual support material comprised: physiology, physiopathology and BHTs, accessible to students through the Internet in conjunction with BHTs classes. Two groups of students were compared and both attended regular classes: the on-line group (n=8) received access to online resources, while the control group (n=8) received conventional written material. Student's performance was evaluated before and after the course. RESULTS: A preliminary test (score 0 to 10) was applied before the beginning of the course, showing that the initial knowledge of both groups was comparable [online, 6.75 (SD=0.88) vs. control, 6.125 (SD=1.35); p>0.05]. Two weeks after the end of the course, a second test showed that the online group performed significantly better than the control group [respectively, 7.75 (SD=1.28) vs. 5.93 (SD=0.72); p>0.05]. CONCLUSIONS: The use of a multimedia online resource had a positive impact on student's learning in respiratory therapy field in which instrumental and manual resources are often used and can be explored using this technology.

Evaluation of a multimedia online tool for teaching bronchial hygiene to physical therapy students / Avaliação de um recurso multimídia para ensino de higiene brônquica para estudantes de fisioterapia

BACKGROUND: Advances in information technology have been widely used in teaching health care professionals. The use of multimedia resources may be important for clinical learning and we are not aware of previous reports using such technology in respiratory physical therapy education. Objectives: Our approach was to evaluate a conventional bronchial hygiene techniques (BHTs) course with an interactive online environment, including multimedia resources. METHODS: Previous developed audiovisual support material comprised: physiology, physiopathology and BHTs, accessible to students through the Internet in conjunction with BHTs classes. Two groups of students were compared and both attended regular classes: the on-line group (n=8) received access to online resources, while the control group (n=8) received conventional written material. Student's performance was evaluated before and after the course. RESULTS: A preliminary test (score 0 to 10) was applied before the beginning of the course, showing that the initial knowledge of both groups was comparable [online, 6.75 (SD=0.88) vs. control, 6.125 (SD=1.35); p>0.05]. Two weeks after the end of the course, a second test showed that the online group performed significantly better than the control group [respectively, 7.75 (SD=1.28) vs. 5.93 (SD=0.72); p>0.05]. CONCLUSIONS: The use of a multimedia online resource had a positive impact on student's learning in respiratory therapy field in which instrumental and manual resources are often used and can be explored using this technology.

CONTEXTUALIZAÇÃO: As novas tecnologias da informação têm sido amplamente utilizadas no ensino em saúde. O uso de recursos multimídia pode ser importante para o aprendizado clínico, no entanto não há descrição na literatura da aplicação e relevância desses recursos para o ensino de fisioterapia respiratória. OBJETIVOS: Avaliar o impacto de um recurso didático multimídia no ensino de manobras de higiene brônquica (MHB). MÉTODOS: O material didático multimídia previamente elaborado foi dividido em três módulos: "princípios fisiológicos", "fisiopatologia" e "MHB", disponibilizado em diversos formatos (páginas on-line, apostila e recursos audiovisuais) e inserido em um ambiente colaborativo de aprendizagem na internet, compondo um curso sobre MHB. Foram comparados dois grupos de estudantes que tiveram aulas presenciais convencionais sobre MHB. Durante o curso, um grupo (on-line, n=8) teve acesso ao recurso multimídia, enquanto o outro (controle, n=8) teve acesso ao material teórico convencional (textos e apostilas). O desempenho dos estudantes foi avaliado por dois testes (escore de 0 a 10) realizados antes e após o curso. RESULTADOS: Nossos resultados mostram que o desempenho dos dois grupos foi similar no primeiro teste (on-line, 6,75 (±0,88) vs. controle, 6,125 (±1,35); p>0,05). Duas semanas após o fim do curso, um segundo teste mostrou que o grupo on-line teve um desempenho melhor que o controle (respectivamente, 7,75 (±1,28) vs. 5,93 (±0,72); p<0,05). CONCLUSÕES: O uso de um recurso multimídia on-line teve um impacto positivo no aprendizado de estudantes de fisioterapia respiratória, área na qual os recursos instrumentais e manuais são frequentemente utilizados e podem ser explorados no contexto deste tipo de tecnologia.