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1.
Cochrane Database Syst Rev ; 2019(11)2019 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-31774149

RESUMO

BACKGROUND: Chest physiotherapy is widely prescribed to assist the clearance of airway secretions in people with cystic fibrosis (CF). Positive expiratory pressure (PEP) devices provide back pressure to the airways during expiration. This may improve clearance by building up gas behind mucus via collateral ventilation and by temporarily increasing functional residual capacity. The developers of the PEP technique recommend using PEP with a mask in order to avoid air leaks via the upper airways and mouth. In addition, increasing forced residual capacity (FRC) has not been demonstrated using mouthpiece PEP. Given the widespread use of PEP devices, there is a need to determine the evidence for their effect. This is an update of a previously published review. OBJECTIVES: To determine the effectiveness and acceptability of PEP devices compared to other forms of physiotherapy as a means of improving mucus clearance and other outcomes in people with CF. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. The electronic database CINAHL was also searched from 1982 to 2017. Most recent search of the Group's CF Trials Register: 20 February 2019. SELECTION CRITERIA: Randomised controlled studies in which PEP was compared with any other form of physiotherapy in people with CF. This included, postural drainage and percussion (PDPV), active cycle of breathing techniques (ACBT), oscillating PEP devices, thoracic oscillating devices, bilevel positive airway pressure (BiPaP) and exercise. DATA COLLECTION AND ANALYSIS: Three authors independently applied the inclusion and exclusion criteria to publications, assessed the risk of bias of the included studies and assessed the quality of the evidence using the GRADE recommendations. MAIN RESULTS: A total of 28 studies (involving 788 children and adults) were included in the review; 18 studies involving 296 participants were cross-over in design. Data were not published in sufficient detail in most of these studies to perform any meta-analysis. In 22 of the 28 studies the PEP technique was performed using a mask, in three of the studies a mouthpiece was used with nose clips and in three studies it was unclear whether a mask or mouthpiece was used. These studies compared PEP to ACBT, autogenic drainage (AD), oral oscillating PEP devices, high-frequency chest wall oscillation (HFCWO) and BiPaP and exercise. Forced expiratory volume in one second was the review's primary outcome and the most frequently reported outcome in the studies (24 studies, 716 participants). Single interventions or series of treatments that continued for up to three months demonstrated little or no difference in effect between PEP and other methods of airway clearance on this outcome (low- to moderate-quality evidence). However, long-term studies had equivocal or conflicting results regarding the effect on this outcome (low- to moderate-quality evidence). A second primary outcome was the number of respiratory exacerbations. There was a lower exacerbation rate in participants using PEP compared to other techniques when used with a mask for at least one year (five studies, 232 participants; moderate- to high-quality evidence). In one of the included studies which used PEP with a mouthpiece, it was reported (personal communication) that there was no difference in the number of respiratory exacerbations (66 participants, low-quality evidence). Participant preference was reported in 10 studies; and in all studies with an intervention period of at least one month, this was in favour of PEP. The results for the remaining outcome measures (including our third primary outcome of mucus clearance) were not examined or reported in sufficient detail to provide any high-quality evidence; only very low- to moderate-quality evidence was available for other outcomes. There was limited evidence reported on adverse events; these were measured in five studies, two of which found no events. In a study where infants performing either PEP or PDPV experienced some gastro-oesophageal reflux , this was more severe in the PDPV group (26 infants, low-quality evidence). In PEP versus oscillating PEP, adverse events were only reported in the flutter group (five participants complained of dizziness, which improved after further instructions on device use was provided) (22 participants, low-quality evidence). In PEP versus HFCWO, from one long-term high-quality study (107 participants) there was little or no difference in terms of number of adverse events; however, those in the PEP group had fewer adverse events related to the lower airways when compared to HFCWO (high-certainty evidence). Many studies had a risk of bias as they did not report how the randomisation sequence was either generated or concealed. Most studies reported the number of dropouts and also reported on all planned outcome measures. AUTHORS' CONCLUSIONS: The evidence provided by this review is of variable quality, but suggests that all techniques and devices described may have a place in the clinical treatment of people with CF. Following meta-analyses of the effects of PEP versus other airway clearance techniques on lung function and patient preference, this Cochrane Review demonstrated that there was high-quality evidence that showed a significant reduction in pulmonary exacerbations when PEP using a mask was compared with HFCWO. It is important to note that airway clearance techniques should be individualised throughout life according to developmental stages, patient preferences, pulmonary symptoms and lung function. This also applies as conditions vary between baseline function and pulmonary exacerbations.


Assuntos
Fibrose Cística/terapia , Respiração com Pressão Positiva/métodos , Terapia Respiratória/métodos , Fibrose Cística/complicações , Drenagem Postural/métodos , Volume Expiratório Forçado , Humanos , Depuração Mucociliar , Muco/metabolismo , Modalidades de Fisioterapia , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Medicine (Baltimore) ; 97(41): e12752, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30313081

RESUMO

The study aims to evaluate the clinical efficacy of bilateral costotransverse debridement, transpedicular fixation, fusion, and local continuous chemotherapy in 20 patients of contiguous multisegmental thoracic spinal tuberculosis (CMTSTB). We analyzed 20 patients with contiguous thoracic spinal tuberculosis (TB) who underwent surgery via bilateral costotransverse debridement, fusion, posterior instrumentation, and postural drainage with local continuous chemotherapy. The clinical outcomes were evaluated in terms of kyphotic angle, bone fusion, neurologic status, erythrocyte sedimentation rate (ESR), and intraoperative and postoperative complications. All of the patients (8M/12F), averaged 45.8 ±â€Š15.6 years old. The mean duration of postoperative follow-up was 30.7 ±â€Š4.0 months. There was no recurrent TB infection. The values of ESR returned to normal levels at final follow-up. All patients got bony fusion within 8.1 ±â€Š2.3 months after surgery. The average preoperative Cobb angle was 39.9°â€Š±â€Š8.6°, correcting to 9.8°â€Š±â€Š2.3° postoperatively and 10.8°â€Š±â€Š2.3° at the last follow-up. All patients with neurological deficit had dramatic improvement at the final follow-up. Our results showed that bilateral costotransverse surgery and local continuous chemotherapy are feasible and effective procedures in the treatment of CMTSTB. The approach can provide radical debridement, rebuild spinal stability, and cure TB.


Assuntos
Antituberculosos/administração & dosagem , Desbridamento/métodos , Drenagem Postural/métodos , Fusão Vertebral/métodos , Tuberculose da Coluna Vertebral/terapia , Adulto , Idoso , Sedimentação Sanguínea , Terapia Combinada , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto Jovem
3.
Medicine (Baltimore) ; 97(31): e11631, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30075543

RESUMO

BACKGROUND: To compare the clinical values of bronchoscopic sputum suction and general sputum suction in respiratory failure patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with sequential invasive-noninvasive mechanical ventilation at the pulmonary infection control (PIC) window (period of lower sputum production, with thinner viscosity and lighter color, and alleviated clinical signs of infection). METHODS: Patients with AECOPD-induced respiratory failure received orotracheal intubation mechanical ventilation and were randomly divided into bronchoscopic sputum suction group or general sputum suction group, and who were then treated with sequential invasive-noninvasive mechanical ventilation at PIC window (both groups). Baseline data, postoperative blood gas conditions, and postoperative clinical parameters of the patients such as appearance of PIC window, time of invasive ventilation, total time of ventilation, hospital stay, weaning success rate, reintubation rate, ventilator-associated pneumonia (VAP) incidence, and fatality rate were measured to compare the effect of 2 different ways of sputum suction. RESULTS: There was no significant difference in baseline characteristics, postoperative blood gas conditions, between 2 groups (all P > .05). Nevertheless, the bronchoscopic sputum suction group showed earlier appearance of PIC window, shorter time of invasive ventilation, total time of ventilation and hospital stay, lower reintubation rate, VAP incidence and fatality rate, and higher weaning success rate than the general sputum suction group (all P < .05). CONCLUSION: Bronchoscopic sputum suction combined with sequential invasive-noninvasive mechanical ventilation at PIC window showed clinical effects in treating respiratory failure patients with AECOPD.


Assuntos
Broncoscopia/métodos , Drenagem Postural/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/terapia , Sucção/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Insuficiência Respiratória/etiologia , Escarro , Resultado do Tratamento , Ventiladores Mecânicos
4.
Urology ; 116: 47-54, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29545046

RESUMO

OBJECTIVE: To investigate the effectiveness of modified mechanical percussion for eliminating upper urinary tract stone fragments after extracorporeal shock wave lithotripsy. MATERIALS AND METHODS: We assigned patients aged 18-60 years with upper urinary tract calculi to the modified mechanical percussion (trial) or observation (control) group. Kidney-ureter-bladder radiography and ultrasound were used for diagnostic evaluation. The primary outcome was the stone-expulsion rate (SER) at 6 hours. The first stone-expulsion time, the SER at 3, 12, and 24 hours, the stone-free rate, additional interventions, and adverse events (AEs) were recorded. RESULTS: A total of 120 patients underwent randomization: 60 for each group. The mean first stone-expulsion time in the trial and control groups was 6.75 and 13.58 hours, respectively (P = .001). The SERs at 3, 6, and 12 hours in the trial group were 51.8%, 75.4%, and 76.8%, respectively, which were higher than the control group (all P <.05). Among patients who expelled fragments within 6 hours, the stone-free rates were improved at 1 week (P = .002) and at 2 weeks (P = .000). Patients needed fewer additional interventions in the trial group (P = .035). AEs occurred in 42.9% (24 of 56) and 67.9% (38 of 56) of the patients in the trial and control groups, respectively (P = .008). Age, gender, stone size and location, and SER at 24 hours did not differ significantly among the groups. CONCLUSION: Modified mechanical percussion significantly improved SERs and accelerated stone passage after shock wave lithotripsy, resulting in a stone-free status with a lower risk of AEs and reduced need for additional interventions.


Assuntos
Cálculos Renais/terapia , Litotripsia , Percussão/métodos , Cálculos Ureterais/terapia , Adulto , Drenagem Postural , Desenho de Equipamento , Feminino , Humanos , Litotripsia/efeitos adversos , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Tamanho da Partícula , Posicionamento do Paciente , Estudos Prospectivos , Vibração , Adulto Jovem
5.
Rev Mal Respir ; 35(5): 495-520, 2018 May.
Artigo em Francês | MEDLINE | ID: mdl-27086120

RESUMO

BACKGROUND: The aim of this systematic literature review was to grade the levels of evidence of the most widely used manual airway clearance techniques. METHODS: A literature search was conducted over the period 1995-2014 from the Medline, PEDro, ScienceDirect, Cochrane Library, REEDOC and kinedoc databases, with the following keywords: "postural drainage", "manual vibrations", "manual chest percussion", "directed cough", "increased expiratory flow", "ELTGOL", "autogenic drainage" and "active cycle of breathing technique". RESULTS: Two-hundred and fifty-six articles were identified. After removing duplicates and reading the titles and abstracts, 63 articles were selected, including 9 systematic reviews. This work highlights the lack of useful scientific data and the difficulty of determining levels of evidence for manual airway clearance techniques. Techniques were assessed principally with patients with sputum production (cystic fibrosis, DDB, COPD, etc.). It also shows the limited pertinence of outcome measures to quantify congestion and hence the efficacy of airway clearance techniques. CONCLUSION: The 1994 consensus conference summary table classifying airway clearance techniques according to physical mechanism provides an interesting tool for assessment, grouping together techniques having identical mechanisms of action. From the findings of the present systematic review, it appears that only ELTGOL, autogenic drainage and ACBT present levels of evidence "B". All other techniques have lower levels of evidence. LEVEL OF EVIDENCE: II.


Assuntos
Drenagem Postural/métodos , Pneumopatias/terapia , Manipulações Musculoesqueléticas/métodos , Terapia Respiratória/métodos , Adolescente , Adulto , Fibrose Cística/terapia , Humanos , Fenômenos Fisiológicos Respiratórios
6.
Aust Crit Care ; 31(4): 191-196, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-28662942

RESUMO

INTRODUCTION/AIMS: To describe the processes of care for secretion clearance in adult, intubated and mechanically ventilated patients in Australian and New Zealand Intensive Care Units (ICUs). METHODS/RESULTS: A prospective, cross-sectional study was conducted through the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) Point Prevalence Program. Forty-seven ICUs collected data from 230 patients intubated and ventilated on the study day. Secretion clearance techniques beyond standard suctioning were used in 84/230 (37%) of patients during the study period. Chest wall vibration 34/84 (40%), manual lung hyperinflation 24/84 (29%), chest wall percussion 20/84 (24%), postural drainage/patient positioning 17/84 (20%) and other techniques including mobilisation 15/84 (18%), were the most common secretion clearance techniques employed. On average (SD), patients received airway suctioning 8.8 (5.0) times during the 24-h study period. Mucus plugging events were infrequent (2.7%). The additional secretion clearance techniques were provided by physiotherapy staff in 24/47 (51%) ICUs and by both nursing and physiotherapy staff in the remaining 23/47 (49%) ICUs. CONCLUSION: One-third of intubated and ventilated patients received additional secretion clearance techniques. Mucus plugging events were infrequent with these additional secretion clearance approaches. Prospective studies must examine additional secretion clearance practices, prevalence of mucus plugging episodes and impact on patient outcomes.


Assuntos
Unidades de Terapia Intensiva , Muco , Modalidades de Fisioterapia , Escarro , Auscultação/métodos , Austrália , Oscilação da Parede Torácica/métodos , Cuidados Críticos/métodos , Estudos Transversais , Drenagem Postural/métodos , Feminino , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Posicionamento do Paciente , Estudos Prospectivos , Respiração Artificial , Sucção/métodos
7.
J Biol Regul Homeost Agents ; 31(4): 971-976, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29254301

RESUMO

To analyze the nursing effect on the respiratory function of thoracotomy patients, sixty thoracotomy hospitalized patients were studied. The subjects were divided into a normal group (A) and an observation group (B). The patients in group A received routine nursing only, while those in group B received chest physiotherapy as well as routine nursing. Afterwards, the respiratory function indicators of the two groups were compared and a data analysis was performed. The results showed that the partial pressure of oxygen (PO2) value of the patients in group B was greater than that of the patients in group A while the partial pressure of carbon dioxide (PCO2) value in group B was smaller than that in group A, and there was a significant difference between the two groups (p less than 0.05). The vital capacity under normal circumstances and forced breathing of group B were greater than that of group A and the difference was statistically significant (p less than 0.05). The incidence of complications (atelectasis, respiratory infections, pleural effusion) was statistically significant between the two groups (p less than 0.05). The degree of autonomic respiratory dysfunction in group B was lower than that in group A, and there was a significant difference (p less than 0.05), suggesting that the respiratory function in patients receiving chest physiotherapy improved significantly.


Assuntos
Exercícios Respiratórios/métodos , Drenagem Postural/métodos , Enfermagem em Pós-Anestésico/métodos , Enfermagem em Reabilitação/métodos , Toracotomia/reabilitação , Adulto , Feminino , Humanos , Masculino , Massagem/métodos , Pessoa de Meia-Idade , Derrame Pleural/etiologia , Derrame Pleural/prevenção & controle , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/prevenção & controle , Respiração , Testes de Função Respiratória , Infecções Respiratórias/etiologia , Infecções Respiratórias/prevenção & controle , Toracotomia/efeitos adversos
8.
J Med Case Rep ; 11(1): 278, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28964265

RESUMO

BACKGROUND: Cystic fibrosis is an autosomal recessive disorder characterized by chronic progressive multisystem involvement. AH1N1 virus infections caused classic influenza symptoms in the majority of cystic fibrosis patients while others experienced severe outcomes. CASE PRESENTATION: We report a case of late incidental cystic fibrosis diagnosis in a young Caucasian man suffering from respiratory failure following infection due to AH1N1 influenza virus. The patient was admitted to our department with fever, cough, and dyspnea at rest unresponsive to antibiotics CONCLUSIONS: Late diagnosis of cystic fibrosis in uncommon. This report highlights the importance of early cystic fibrosis diagnosis to minimize risk of occurrence of potential life-threatening complications.


Assuntos
Fibrose Cística/complicações , Fibrose Cística/diagnóstico , Diagnóstico Tardio , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/complicações , Influenza Humana/virologia , Pneumonia/complicações , Antibacterianos/administração & dosagem , Ceftazidima/administração & dosagem , Colistina/administração & dosagem , Fibrose Cística/reabilitação , Fibrose Cística/terapia , Drenagem Postural , Testes Genéticos , Humanos , Achados Incidentais , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/tratamento farmacológico , Masculino , Meropeném , Pneumonia/diagnóstico por imagem , Pneumonia/tratamento farmacológico , Pneumonia/virologia , Encaminhamento e Consulta , Suor , Tienamicinas/administração & dosagem , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
Cochrane Database Syst Rev ; 10: CD009595, 2017 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-28984368

RESUMO

BACKGROUND: Autogenic drainage is an airway clearance technique that was developed by Jean Chevaillier in 1967. The technique is characterised by breathing control using expiratory airflow to mobilise secretions from smaller to larger airways. Secretions are cleared independently by adjusting the depth and speed of respiration in a sequence of controlled breathing techniques during exhalation. The technique requires training, concentration and effort from the individual. It is important to systematically review the evidence demonstrating that autogenic drainage is an effective intervention for people with cystic fibrosis. OBJECTIVES: To compare the clinical effectiveness of autogenic drainage in people with cystic fibrosis with other physiotherapy airway clearance techniques. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews, as well as two trials registers (31 August 2017).Dtae of most recent search of the Cochrane Cystic Fibrosis Trials Register: 25 September 2017. SELECTION CRITERIA: We identified randomised and quasi-randomised controlled studies comparing autogenic drainage to another airway clearance technique or no therapy in people with cystic fibrosis for at least two treatment sessions. DATA COLLECTION AND ANALYSIS: Data extraction and assessments of risk of bias were independently performed by two authors. The authors assessed the quality of the evidence using the GRADE system. The authors contacted two investigators for further information pertinent to their published studies. MAIN RESULTS: Searches retrieved 35 references to 21 individual studies, of which seven (n = 208) were eligible for inclusion. One study was of parallel design with the remaining six being cross-over in design; participant numbers ranged from 17 to 75. The total study duration varied between four days and two years. The age of participants ranged between seven and 63 years with a wide range of disease severity reported. Six studies enrolled participants who were clinically stable, whilst participants in one study had been hospitalised with an infective exacerbation. All studies compared autogenic drainage to one (or more) other recognised airway clearance technique. Exercise is commonly used as an alternative therapy by people with cystic fibrosis; however, there were no studies identified comparing exercise with autogenic drainage.The quality of the evidence was generally low or very low. The main reasons for downgrading the level of evidence were the frequent use of a cross-over design, outcome reporting bias and the inability to blind participants.The review's primary outcome, forced expiratory volume in one second, was the most common outcome measured and was reported by all seven studies; only three studies reported on quality of life (also a primary outcome of the review). One study reported on adverse events and described a decrease in oxygen saturation levels whilst performing active cycle of breathing techniques, but not with autogenic drainage. Six of the seven included studies measured forced vital capacity and three of the studies used mid peak expiratory flow (per cent predicted) as an outcome. Six studies reported sputum weight. Less commonly used outcomes included oxygen saturation levels, personal preference, hospital admissions or intravenous antibiotics. There were no statistically significant differences found between any of the techniques used with respect to the outcomes measured except when autogenic drainage was described as being the preferred technique of the participants in one study over postural drainage and percussion. AUTHORS' CONCLUSIONS: Autogenic drainage is a challenging technique that requires commitment from the individual. As such, this intervention merits systematic review to ensure its effectiveness for people with cystic fibrosis. From the studies assessed, autogenic drainage was not found to be superior to any other form of airway clearance technique. Larger studies are required to better evaluate autogenic drainage in comparison to other airway clearance techniques in view of the relatively small number of participants in this review and the complex study designs. The studies recruited a range of participants and were not powered to assess non-inferiority. The varied length and design of the studies made the analysis of pooled data challenging.


Assuntos
Fibrose Cística/terapia , Drenagem Postural/métodos , Adolescente , Adulto , Idoso , Criança , Expiração , Volume Expiratório Forçado , Humanos , Pessoa de Meia-Idade , Muco/metabolismo , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia Respiratória/métodos
10.
Respir Care ; 62(10): 1291-1297, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28634173

RESUMO

BACKGROUND: Airway clearance techniques are a vital part of routine care for patients with bronchiectasis. There is no clear superior modality. The Flutter combines oscillations (6-20 Hz) and positive expiratory pressure; the Lung Flute combines positive expiratory pressure and low frequency acoustic waves (18-22 Hz), to augment clearance. This project aimed to compare these devices. METHODS: This was a randomized crossover study of adult subjects with stable non-cystic fibrosis bronchiectasis (expectorating > 25 mL/d). Subjects attended 2 separate out-patient visits, 1 week apart, and completed a supervised sputum clearance regime and Lickert scale (8 questions regarding subjects' perception of the experience using each device). Total sputum expectorated during supervised intervention (T1) and after 30 min from the end of T1 (T2) was recorded as wet sputum weight. Total wet sputum weight desiccated in a microwave (10 min at 300 watts), allowed measurement of total dry sputum weight. Data were compared using paired t test. RESULTS: We recruited 40 subjects with a mean ± SD age of 63 ± 16 y. Overall, there was no significant difference in wet sputum weight (Flutter, 5.78 ± 6.47 g; Lung Flute, 5.75 ± 0.22 g) and dry sputum weight (Flutter, 0.40 ± 0.86 g; Lung Flute, 0.22 ± 0.21 g). At T1, wet sputum weight was higher for the Flutter (5.10 ± 6.26 g) compared with the Lung Flute (3.74 ± 3.44 g) (P = .038). At T2, wet sputum weight was higher for the Lung Flute (2.02 ± 3.01 g) compared with the Flutter (0.68 ± 0.75 g) (P = .001). Subjects perceived the Flutter as being significantly better at clearing secretions (P = .01), easy to understand (P = .03), and simple to use (P = .01) compared with the Lung Flute. CONCLUSIONS: Both devices were well-tolerated and successfully augmented secretion clearance. Most subjects preferred the Flutter because of increased speed of secretion clearance, and greater ease of use.


Assuntos
Bronquiectasia/terapia , Drenagem Postural/instrumentação , Escarro , Idoso , Bronquiectasia/etiologia , Estudos Cross-Over , Drenagem Postural/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Resultado do Tratamento
11.
Respir Care ; 62(6): 826-848, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28546380

RESUMO

Children with progressive neuromuscular weakness undergo a stereotypical progression of respiratory involvement, beginning with impaired airway clearance and progressing to nocturnal and then diurnal ventilatory failure. This review examines issues related to airway clearance and mucus mobilization, sleep problems, and use of assisted ventilation in children with neuromuscular diseases. Interventions for each of these problems have been created or adapted for the pediatric population. The use of airway clearance therapies and assisted ventilation have improved survival of children with neuromuscular weakness. Questions regarding the best time to introduce some therapies, the therapeutic utility of certain interventions, and the cost-effectiveness of various treatments demand further investigation. Studies that assess the potential to improve quality of life and reduce hospitalizations and frequency of lower-respiratory tract infections will help clinicians to decide which techniques are best suited for use in children. As children with neuromuscular disease survive longer, coordinated programs for transitioning these patients to adult care must be developed to enhance their quality of life.


Assuntos
Manuseio das Vias Aéreas/métodos , Doenças Neuromusculares/complicações , Insuficiência Respiratória/terapia , Criança , Drenagem Postural/métodos , Humanos , Respiração Artificial/métodos , Insuficiência Respiratória/etiologia
12.
Med Teach ; 39(8): 836-843, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28539065

RESUMO

OBJECTIVE: The objective of this study is to compare the effectiveness of a "cartoon-style" handout with a "traditional-style" handout in a self-study assignment for preclinical medical students. METHODS: Third-year medical students (n = 93) at the Faculty of Medicine Ramathibodi Hospital, Mahidol University, took a pre-learning assessment of their knowledge of intercostal chest drainage. They were then randomly allocated to receive either a "cartoon-style" or a "traditional-style" handout on the same topic. After studying these over a 2-week period, students completed a post-learning assessment and estimated their levels of reading completion. RESULTS: Of the 79 participants completing the post-learning test, those in the cartoon-style group achieved a score 13.8% higher than the traditional-style group (p = 0.018). A higher proportion of students in the cartoon-style group reported reading ≥75% of the handout content (70.7% versus 42.1%). In post-hoc analyses, students whose cumulative grade point averages (GPA) from previous academic assessments were in the middle and lower range achieved higher scores with the cartoon-style handout than with the traditional one. In the lower-GPA group, the use of a cartoon-style handout was independently associated with a higher score. CONCLUSIONS: Students given a cartoon-style handout reported reading more of the material and achieved higher post-learning test scores than students given a traditional handout.


Assuntos
Drenagem Postural/métodos , Educação de Graduação em Medicina/métodos , Avaliação Educacional/métodos , Aprendizagem , Estudantes de Medicina , Humanos , Músculos Intercostais
13.
Respir Care ; 62(7): 920-927, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28424226

RESUMO

BACKGROUND: Objective measures of adherence to high-frequency chest wall compression (HFCWC), a form of airway clearance therapy for patients with cystic fibrosis, are lacking. We used a novel electronic monitoring device integrated into an HFCWC vest to measure adherence compared with self-reported adherence. We determined factors that influenced adherence and how adherence correlated with baseline pulmonary function and pulmonary exacerbations. METHODS: Data were collected by direct measurement of date, time of day, and duration of HFCWC use to determine the number of daily treatments and daily duration of treatments. Chart review provided prescribed airway clearance therapy treatment and demographic and clinical information. Subject and caregiver report of the daily number of airway clearance therapy treatments was obtained by telephone interviews. Analysis used 2-sample and paired t test, analysis of variance, and linear regression. RESULTS: Average adherence was 69%. Adherence was highest in children (82%, P = .02) and those receiving assistance with treatment (82%, P < .001). Subjects overestimated therapy duration from a mean ± SD of 127 ± 169% by adults to 19.2 ± 26.3% by parents or guardians of children. Average adherence decreased with increasing prescribed therapy time (P = .02). Average daily therapy time and adherence had significant positive associations with baseline FEV1 percent of predicted (P = .02 and P = .02, respectively) and negative associations with pulmonary exacerbations during the pre-study period and at baseline (P = .044 and P = .02, respectively). CONCLUSIONS: Greater adherence to HFCWC measured directly by a novel recorder was associated with better baseline pulmonary function and fewer exacerbations in the pre-study and baseline period. Adherence decreased with age and prescribed therapy time and increased with therapy assistance. Self-report overestimation is large and thus not an accurate measure of adherence.


Assuntos
Oscilação da Parede Torácica/estatística & dados numéricos , Fibrose Cística/terapia , Drenagem Postural/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Terapia Respiratória/estatística & dados numéricos , Adolescente , Oscilação da Parede Torácica/métodos , Oscilação da Parede Torácica/psicologia , Criança , Fibrose Cística/fisiopatologia , Fibrose Cística/psicologia , Progressão da Doença , Drenagem Postural/métodos , Drenagem Postural/psicologia , Feminino , Volume Expiratório Forçado , Humanos , Pulmão/fisiopatologia , Masculino , Monitorização Ambulatorial/estatística & dados numéricos , Pacientes Ambulatoriais/psicologia , Pacientes Ambulatoriais/estatística & dados numéricos , Cooperação do Paciente/psicologia , Terapia Respiratória/métodos , Terapia Respiratória/psicologia , Resultado do Tratamento , Adulto Jovem
14.
JAAPA ; 30(5): 23-27, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28441669

RESUMO

Cystic fibrosis (CF) affects more than 30,000 people in the United States and 80,000 people worldwide. This life-threatening genetic disorder causes a buildup of thick, viscous mucus secretions in various organ systems, most commonly the gastrointestinal, pulmonary, and genitourinary systems. This article reviews the clinical manifestations, diagnosis, and monitoring of patients with CF as well as guidelines for management and emerging pharmacologic treatments.


Assuntos
Fibrose Cística/fisiopatologia , Fibrose Cística/terapia , Drenagem Postural/métodos , Respiração , Terapia Respiratória/métodos , Cloretos/análise , Fibrose Cística/diagnóstico , Humanos , Recém-Nascido , Triagem Neonatal/métodos , Prognóstico , Sudorese/fisiologia
15.
Eur Respir Rev ; 26(143)2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28223396

RESUMO

This review describes a framework for providing a personalised approach to selecting the most appropriate airway clearance technique (ACT) for each patient. It is based on a synthesis of the physiological evidence that supports the modulation of ventilation and expiratory airflow as a means of assisting airway clearance. Possession of a strong understanding of the physiological basis for ACTs will enable clinicians to decide which ACT best aligns with the individual patient's pathology in diseases with anatomical bronchiectasis and mucus hypersecretion.The physiological underpinning of postural drainage is that by placing a patient in various positions, gravity enhances mobilisation of secretions. Newer ACTs are based on two other physiological premises: the ability to ventilate behind obstructed regions of the lung and the capacity to achieve the minimum expiratory airflow bias necessary to mobilise secretions. After reviewing each ACT to determine if it utilises both ventilation and expiratory flow, these physiological concepts are assessed against the clinical evidence to provide a mechanism for the effectiveness of each ACT. This article provides the clinical rationale necessary to determine the most appropriate ACT for each patient, thereby improving care.


Assuntos
Drenagem Postural/métodos , Pneumopatias/terapia , Pulmão/fisiopatologia , Depuração Mucociliar , Medicina de Precisão/métodos , Animais , Drenagem Postural/efeitos adversos , Humanos , Pulmão/metabolismo , Pneumopatias/diagnóstico , Pneumopatias/fisiopatologia , Posicionamento do Paciente , Seleção de Pacientes , Pico do Fluxo Expiratório , Ventilação Pulmonar , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Respiração Artificial , Resultado do Tratamento
16.
Respir Care ; 62(5): 524-531, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28223466

RESUMO

BACKGROUND: Lung clearance index (LCI), a measure of ventilation inhomogeneity derived from a multiple-breath washout test, is a promising tool for assessing airway function in patients with non-cystic fibrosis bronchiectasis. However, it is unknown whether ventilation inhomogeneity could improve after successful elimination of excessive secretions within bronchiectasis. The objective of this work was to assess the short-term effects of lung secretion clearance using the autogenic drainage technique on standard lung function tests and LCI in subjects with non-cystic fibrosis bronchiectasis. METHODS: Nitrogen-based multiple-breath washout, spirometry, and body plethysmography tests were performed 30 min before autogenic drainage in adults with stable non-cystic fibrosis bronchiectasis. The autogenic drainage session was followed by a 5-min break, after which the tests were repeated in the same order. Sputum expectorated during autogenic drainage was quantified as dry weight and correlated with change between post- and pre-measurements (Δ). Paired t test or Wilcoxon signed-rank tests were used to compare pre- and post-autogenic drainage measurement outcomes. A P value of ≤.05 was considered as statistically significant. RESULTS: Twenty-four subjects were studied (18 females, median age [range]: 65 [21-81] y). Mean ± SD LCI significantly improved after autogenic drainage (10.88 ± 2.62 vs 10.53 ± 2.35, P = .042). However, only 20% of subjects with mucus hyperproduction during autogenic drainage had a ΔLCI that exceeded measurement variability. The percent of predicted slow vital capacity (SVC%) also slightly improved (88.7 ± 19.3% vs 90 ± 19.1%, P = .02). ΔLCI was inversely related to dry sputum weight (r = -.48, P = .02) and ΔSVC% (r = -.64, P = .001). ΔSVC% also correlated with dry sputum weight (r = 0.46, P = .02). CONCLUSIONS: In adults with non-cystic fibrosis bronchiectasis and mucus hypersecretion, autogenic drainage improved ventilation inhomogeneity. LCI change may be the result of the maximum recruited lung volume and the amount of cleared mucus secretion. (ClinicalTrials.gov registration NCT02411981.).


Assuntos
Bronquiectasia/terapia , Drenagem Postural/métodos , Ventilação Pulmonar/fisiologia , Terapia Respiratória/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bronquiectasia/fisiopatologia , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Muco/metabolismo , Estudos Prospectivos , Testes de Função Respiratória , Espirometria , Escarro/metabolismo , Resultado do Tratamento , Capacidade Vital/fisiologia , Adulto Jovem
17.
Rev Pneumol Clin ; 72(5): 305-309, 2016 Oct.
Artigo em Francês | MEDLINE | ID: mdl-27567981

RESUMO

The patients suffering of trachea bronchial dyskinesia in a context of trachea bronchomalacia present an important decrease of the expiratory flow during the Forced Expiration Techniques, and during the cough, returning difficult mucus clearance. The use of CPAP for these patients as a pneumatic prothesis can bring a considerable help during the chest physiotherapy techniques, avoiding the tracheobronchial collapse. The objectivation of the efficiency of this technique through a clinical case, its ease of application and control, allows us to propose the attempt of this additive help when the indication and the contraindications are clearly defined.


Assuntos
Assistência Ambulatorial/métodos , Pressão Positiva Contínua nas Vias Aéreas , Depuração Mucociliar/fisiologia , Traqueobroncomalácia/terapia , Drenagem Postural/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Muco , Modalidades de Fisioterapia , Traqueobroncomalácia/fisiopatologia
18.
Cochrane Database Syst Rev ; 7: CD007862, 2016 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-27378490

RESUMO

BACKGROUND: People with cystic fibrosis experience chronic airway infections as a result of mucus build up within the lungs. Repeated infections often cause lung damage and disease. Airway clearance therapies aim to improve mucus clearance, increase sputum production, and improve airway function. The active cycle of breathing technique (also known as ACBT) is an airway clearance method that uses a cycle of techniques to loosen airway secretions including breathing control, thoracic expansion exercises, and the forced expiration technique. This is an update of a previously published review. OBJECTIVES: To compare the clinical effectiveness of the active cycle of breathing technique with other airway clearance therapies in cystic fibrosis. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of last search: 25 April 2016. SELECTION CRITERIA: Randomised or quasi-randomised controlled clinical studies, including cross-over studies, comparing the active cycle of breathing technique with other airway clearance therapies in cystic fibrosis. DATA COLLECTION AND ANALYSIS: Two review authors independently screened each article, abstracted data and assessed the risk of bias of each study. MAIN RESULTS: Our search identified 62 studies, of which 19 (440 participants) met the inclusion criteria. Five randomised controlled studies (192 participants) were included in the meta-analysis; three were of cross-over design. The 14 remaining studies were cross-over studies with inadequate reports for complete assessment. The study size ranged from seven to 65 participants. The age of the participants ranged from six to 63 years (mean age 22.33 years). In 13 studies, follow up lasted a single day. However, there were two long-term randomised controlled studies with follow up of one to three years. Most of the studies did not report on key quality items, and therefore, have an unclear risk of bias in terms of random sequence generation, allocation concealment, and outcome assessor blinding. Due to the nature of the intervention, none of the studies blinded participants or the personnel applying the interventions. However, most of the studies reported on all planned outcomes, had adequate follow up, assessed compliance, and used an intention-to-treat analysis.Included studies compared the active cycle of breathing technique with autogenic drainage, airway oscillating devices, high frequency chest compression devices, conventional chest physiotherapy, and positive expiratory pressure. Preference of technique varied: more participants preferred autogenic drainage over the active cycle of breathing technique; more preferred the active cycle of breathing technique over airway oscillating devices; and more were comfortable with the active cycle of breathing technique versus high frequency chest compression. No significant difference was seen in quality of life, sputum weight, exercise tolerance, lung function, or oxygen saturation between the active cycle of breathing technique and autogenic drainage or between the active cycle of breathing technique and airway oscillating devices. There was no significant difference in lung function and the number of pulmonary exacerbations between the active cycle of breathing technique alone or in conjunction with conventional chest physiotherapy. All other outcomes were either not measured or had insufficient data for analysis. AUTHORS' CONCLUSIONS: There is insufficient evidence to support or reject the use of the active cycle of breathing technique over any other airway clearance therapy. Five studies, with data from eight different comparators, found that the active cycle of breathing technique was comparable with other therapies in outcomes such as participant preference, quality of life, exercise tolerance, lung function, sputum weight, oxygen saturation, and number of pulmonary exacerbations. Longer-term studies are needed to more adequately assess the effects of the active cycle of breathing technique on outcomes important for people with cystic fibrosis such as quality of life and preference.


Assuntos
Fibrose Cística/terapia , Terapia Respiratória/métodos , Oscilação da Parede Torácica/métodos , Fibrose Cística/complicações , Drenagem Postural/métodos , Ventilação de Alta Frequência/instrumentação , Humanos , Preferência do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
J Wound Ostomy Continence Nurs ; 43(5): 551-3, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27347771

RESUMO

BACKGROUND: Skin damage under various drainage tubes and parenteral access lines occurs frequently in pediatric patients. Our team sought an alternative to the use of gauze or foam for prevention and management of peritubular skin damage. CASES: We used a moisture wicking fabric in select patients in a tertiary children's hospital in Northern California. The fabric was placed under tracheostomy ties and around gastrostomy tubes and Penrose drains. CONCLUSION: The moisture wicking fabric was effective in absorbing moisture and maintaining skin integrity. This new approach has been incorporated into our facility policy.


Assuntos
Curativos Oclusivos/normas , Paracentese/efeitos adversos , Úlcera Cutânea/prevenção & controle , California , Criança , Pré-Escolar , Drenagem Postural/efeitos adversos , Drenagem Postural/enfermagem , Gastrostomia/efeitos adversos , Gastrostomia/instrumentação , Hospitais Pediátricos/organização & administração , Humanos , Lactente , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/enfermagem , Curativos Oclusivos/microbiologia , Paracentese/instrumentação , Úlcera Cutânea/fisiopatologia
20.
J Bodyw Mov Ther ; 20(2): 356-63, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27210854

RESUMO

OBJECTIVE: The aim of this study was to evaluate the influence of manual percussion during three different positions of postural drainage (PD) on lung volumes and metabolic status. METHODS: Twenty six healthy volunteers (13 women and 13 men), with a mean age of 20.15 ± 1.17 years, participated. They were randomized into three standard positions of PD (upper, middle, or lower lobes) and given manual percussion at a frequency of 240 times per minute for 5 min. Lung volumes, including tidal volume (TV), inspiratory reserve volume (IRV), expiratory reserve volume (ERV) and vital capacity (VC); and metabolic status, such as oxygen consumption (VO2), carbon dioxide (VCO2), respiratory rate (RR), and minute ventilation (VE) were evaluated. RESULTS: The lung volumes showed no statistical difference in VC or IRV from percussion during PD in all positions, except for the lower lobe, where increased TV and decreased ERV were found when compared to PD alone. Furthermore, percussion during PD of the upper and middle lobes did not affect RR or VE, when compared to PD alone. In addition, percussion during PD of the middle and lower lobes increased VO2 and VCO2 significantly, when compared to PD alone, but it did not influence PD of the upper lobe. CONCLUSION: This study indicated that up to 5 min of manual percussion on PD of the upper and middle lobes is safe mostly for lung volumes, RR, and VE, but it should be given with care in PD conditions of the lower lobe.


Assuntos
Drenagem Postural/métodos , Pulmão/fisiologia , Percussão/métodos , Modalidades de Fisioterapia , Feminino , Voluntários Saudáveis , Hemodinâmica/fisiologia , Humanos , Medidas de Volume Pulmonar , Masculino , Consumo de Oxigênio/fisiologia , Respiração , Adulto Jovem
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