Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients.

STUDY DESIGN: Prospective single centre study. OBJECTIVES: Pulmonary rehabilitation focuses on improving the expiratory muscle function in order to increase the reduced cough capacity in patients with cervical spinal cord injuries (SCI). However, an improvement in the inspiratory function is also important for coughing effectively. Therefore, this study was to examine the significance of the inspiratory muscle strength on the cough capacity in the patients with a cervical SCI. SETTING: SCI unit, Yonsei Rehabilitation Hospital, Seoul, Korea. METHODS: The vital capacity (VC), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were measured. Moreover, the unassisted peak cough flow (PCF) and assisted PCF under three conditions were evaluated. RESULTS: All three assisted cough methods showed a significantly higher value than the unassisted method (P < 0.001). The VC correlated with the voluntary cough capacity and the MIP (R = 0.749) correlated more significantly with the VC than the MEP (R = 0.438) (P < 0.01). The MIP showed a higher correlation with both the unassisted PCF and all three assisted PCFs than the MEP (P < 0.001). CONCLUSIONS: The management of the inspiratory muscle strength should be considered in the pulmonary rehabilitation at cervical SCI patients.

Extubation failure: diagnostic value of occlusion pressure (P0.1) and P0.1-derived parameters.

OBJECTIVE: To evaluate the ability of the new, built-in occlusion pressure (P0.1) measurement to predict extubation failure. DESIGN AND SETTING: Prospective observational multicentre study in the ICU of five general hospitals. PATIENTS: Hundred thirty patients on mechanical ventilation longer than 48 h when considered ready for weaning. MEASUREMENTS AND RESULTS: Patients underwent a 30-min spontaneous breathing trial with simultaneous monitoring of occlusion pressure (P0.1) and breathing pattern (f/Vt). Sixteen patients (12%) failed the weaning trial and full ventilatory support was resumed, while 114 tolerated the trial and were extubated. Twenty-one (18%) required reintubation within 48 h. The area under the ROC curve for diagnosing extubation failure was 0.53 for f/Vt, 0.59 for P0.1 and 0.61 for P0.1*f/Vt (p=NS). Accordingly, P0.1*f/Vt more than 100 detected extubation failure with a sensitivity of 0.89, specificity of 0.35, positive predictive value of 0.21 and negative predictive value of 0.94. CONCLUSION: During a first trial of spontaneous breathing on pressure support ventilation (PSV), bedside P0.1 and P0.1*f/Vt are of little help, if any, for predicting extubation failure.

Physical therapy for the acutely ill medical patient.

Chest physical therapy for acutely ill medical patients is a specialty that has evolved in response to patient need and medical progress. With the ability to support the patient's respiratory system mechanically came the requirement to manage acute and chronic lung injuries and their complications. Techniques of evaluation and treatment are discussed. A literature review focusing on treatment techniques for acutely ill patients and the efficacy of these treatments is included.