Perceived burden of respiratory physiotherapy in people with cystic fibrosis taking elexacaftor-tezacaftor-ivacaftor combination: a 1-year observational study.

BACKGROUND: To limit the progression of disease, people with cystic fibrosis (pwCF) perform daily respiratory physiotherapy, which is perceived as the most burdensome routine in managing their condition. The elexacaftor-tezacaftor-ivacaftor (ETI) combination has changed respiratory management. OBJECTIVE: To investigate how the perceived treatment burden changed in 1 year of treatment with ETI. DESIGN: Prospective observational study. METHODS: Ad hoc questionnaires for the pwCF and for the caregivers of pwCF < 18 years were administered before the initiation of ETI therapy and then at 6-12 months. The Cystic Fibrosis Questionnaire-Revised (CFQ-R) and the Sinonasal Outcome Test (SNOT-22) were administered to explore disease-related symptoms and social limitations. The International Physical Activity Questionnaire was used to determine levels of physical activity. Mixed-effect models were fitted to explore whether the time engaged in respiratory physiotherapy changed during 1 year. RESULTS: The study included 47/184 pwCF aged 21.4 (5.7) years, who completed 1 year of ETI therapy. At 6 months, time on aerosol therapy was decreased by 2.5 (95% CI -32.9 to 27.8) min/day, time on airway clearance therapies (ACTs) was decreased by 8.8 (95% CI -25.9 to 8.3) min/day, and time for cleaning and disinfecting respiratory equipment was decreased by 10.6 (95% CI -26.5 to 5.3) min/day. At 1 year, gains in time saved were nearly 15 min/day on average. At 1 year, 5/47 (10.6%) pwCF reported that they had discontinued positive expiratory pressure mask. CONCLUSION: PwCF on ETI may note less time engaged in their daily respiratory physiotherapy routine. Nonetheless, aerosol therapy, ACTs and maintaining respiratory equipment were still perceived as time-consuming daily activities.

Understanding the challenges of respiratory physiotherapy in individuals with cystic fibrosis using triple therapy: a one-year study.In order to slow down the progression of their disease, people with cystic fibrosis typically do daily respiratory physiotherapy, which they find to be the most challenging part of managing their condition. The elexacaftor-tezacaftor-ivacaftor combination has changed how they manage their respiratory health. We wanted to see how the perceived difficulty of the treatment changed over one year of using elexacaftor-tezacaftor-ivacaftor. We gave questionnaires to people with cystic fibrosis and to their caregivers before they started the triple therapy and again at 6-12 months. We also used two international questionnaires to learn about symptoms and social limitations related to the disease. The International Physical Activity Questionnaire helped us understand their physical activity levels. We used statistical models to see if the time spent on respiratory physiotherapy changed over the year. Our study involved 47 individuals with cystic fibrosis, with an average age of 21 years, who completed one year of elexacaftor-tezacaftor-ivacaftor therapy. After 6 months, time spent on aerosol therapy decreased by 2.5 minutes per day, time on airway clearance therapies decreased by 8.8 minutes per day, and time for cleaning respiratory equipment decreased by 10.6 minutes per day. By the end of the year, they were saving almost 15 minutes per day on average. At one year, 5 out of 47 said they had stopped using the positive expiratory pressure mask. People with cystic fibrosis using elexacaftor-tezacaftor-ivacaftor may find that they spend less time on their daily respiratory physiotherapy routine. However, activities like aerosol therapy, airway clearance therapies, and maintaining respiratory equipment were still seen as time-consuming.

Intensive Care Management of an Adult Patient With Rare Chilaiditi Syndrome Presenting as Abdominal Breathing: A Case Report.

Chilaiditi syndrome (CS) is an uncommon case of the asymptomatic radiographic finding of an intestinal loop between the liver and the diaphragm. The most crucial phases in the diagnosis process are a thorough physical examination and precise imaging, particularly in challenging disorders such as CS. The presence of free air under the right hemidiaphragm in this syndrome, the diagnosis of which is based on radiographic imaging, might direct the start of treatment without the need for surgical intervention. An 86-year-old man, with asthma and chronic obstructive pulmonary disease (COPD) was checked out in our hospital's emergency department (ED) after experiencing nausea and vomiting. Having abdominal breathing while the patient was in an internal medicine department owing to a urinary tract infection (UTI) and acute kidney injury (AKI), he was moved to the intensive care unit (ICU). The patient was treated with respiratory physiotherapy, inhaler bronchodilator treatment, antibiotic therapy, enema, and laxatives. Medical imaging is the primary diagnostic tool for CS, guided by the symptoms. In patients like this elderly patient who was taken to ICU from internal medicine due to acute respiratory failure and abdominal breathing, when free air is detected in the subdiaphragmatic region, control should be provided with computed tomography (CT), and non-invasive mechanical ventilation should be applied.

Physiotherapy Interventions in Lung Cancer Patients: A Systematic Review.

BACKGROUND: Lung cancer is a very common disease and leads to a series of sequelae such as reduced lung capacity or reduced functional capacity in patients, which are associated not only with the disease itself, but also with medical treatment. Thus, physiotherapeutic interventions are needed to improve quality of life and reduce these symptoms. OBJECTIVES: To find out the effects of physiotherapy on functional capacity, lung capacity, dyspnea, pain, and quality of life in lung cancer patients. METHODS: A systematic review was carried out in five databases. Randomized clinical trials published between 2019-2023 were selected, in which the physiotherapeutic treatment was physical exercise and/or respiratory physiotherapy. RESULTS: Nine articles were included, in which the total sample consisted of 635 lung cancer patients. When combined, respiratory physiotherapy and physical exercise improved functional capacity and lung capacity (p < 0.05). Dyspnea also improved, but less significance was shown in the included studies. CONCLUSIONS: Multimodal physiotherapy interventions may offer benefits for some lung cancer patients, but the extent and nature of these benefits may vary depending on the intervention applied. Therefore, it would be of great interest to carry out further scientific research to support this conclusion.

[Respiratory physiotherapy in private practice: Interest and prescription modalities]. / Kinésithérapie respiratoire libérale : intérêts et modalités de prescription.

INTRODUCTION: Respiratory diseases represent a major public health issue and impact both quality of life and life expectancy of the patients. STATE OF ART: Several interventions used in respiratory physiotherapy have been shown to reduce dyspnoea, improve quality of life and reduce hospitalisation in many respiratory diseases. However, respiratory physiotherapy remains poorly known to the medical community and may be under-prescribed. PERSPECTIVES: In order to improve the interdisciplinarity around the patient with respiratory impairment, we describe the interests and prescription modalities of liberal respiratory physiotherapy. In the context of respiratory physiotherapy acts, the precision of drafting prescription directly conditions the means implemented by the physiotherapist regarding care provided to the patient. CONCLUSION: The increased knowledge of prescribers, both concerning the prescription methods and the precise content of the rehabilitation sessions is one of the keys to their success.

Early Respiratory Physiotherapy versus an Individualized Postural Care Program for Reducing Mechanical Ventilation in Preterm Infants: A Randomised Controlled Trial.

BACKGROUND: Tactile stimulation manoeuvres stimulate spontaneous breathing in preterm newborns. The aim of this study is to evaluate the effect of early respiratory physiotherapy on the need for mechanical ventilation during the first week of life in preterm infants with respiratory failure. METHODS: This is a monocentric, randomised controlled trial. Preterm infants (gestational age ≤ 30 weeks) not intubated in the delivery room and requiring non-invasive respiratory support at birth were eligible for the study. The intervention group received early respiratory physiotherapy, while the control group received only a daily physiotherapy program (i.e., modifying the infant's posture in accordance with the patient's needs). RESULTS: between October 2019 and March 2021, 133 preterm infants were studied, 68 infants in the study group and 65 in routine care. The study group showed a reduction in the need for mechanical ventilation (not statistically significant) and a statistically significant reduction in hemodynamically significant patent ductus arteriosus with respect to the control group (19/68 (28%) vs. 35/65 (54%), respectively, p = 0.03). CONCLUSIONS: early respiratory physiotherapy in preterm infants requiring non-invasive respiratory support at birth is safe and has proven to be protective against haemodynamically significant PDA.

Fibrosis quística: epidemiología, clínica, diagnóstico y tratamiento / Cystic fibrosis: Epidemiology, clinical manifestations, diagnosis and treatment

La fibrosis quística es una enfermedad genética y multisistémica. La principal comorbilidad en la edad adulta es la afectación respiratoria, con la presencia de bronquiectasias, infección bronquial crónica y obstrucción al flujo aéreo. Hasta hace una década los tratamientos estaban dirigidos a favorecer el drenaje de secreciones, reducir las exacerbaciones respiratorias, controlar la infección bronquial crónica y enlentecer el deterioro funcional, pero con la llegada de los moduladores del gen cystic fibrosis transmembrane conductance regulator (CFTR) el paradigma de la fibrosis quística se ha modificado. Este novedoso tratamiento da un paso más frente al tratamiento de esta enfermedad, es capaz de mejorar la producción de proteína CFTR defectuosa y aumentar su expresión en la superficie celular, para así conseguir un mejor funcionamiento del intercambio iónico fluidificando las secreciones respiratorias y reduciendo la obstrucción al flujo aéreo. Además, en la actualidad hay diferentes líneas de investigación orientadas a corregir el defecto genético causante de la fibrosis quística (AU)

Cystic fibrosis is a genetic and multisystemic disease. The main comorbidity in adulthood is respiratory involvement, with the presence of bronchiectasis, chronic bronchial infection and airflow obstruction. Until a decade ago, treatments were aimed at favoring secretion drainage, reducing respiratory exacerbations, controlling chronic bronchial infection and slowing functional deterioration, but with the advent of cystic fibrosis transmembrane conductance regulator (CFTR) modulators, the cystic fibrosis paradigm has changed. This novel treatment goes a step further in the management of this disease, it is able to improve the production of defective CFTR protein and increase its expression on the cell surface, thus achieving a better functioning of ion exchange, fluidizing respiratory secretions and reducing airflow obstruction. In addition, there are currently different lines of research aimed at correcting the genetic defect that causes cystic fibrosis (AU)

Respiratory physiotherapy as a tool to allow and optimize lung donation.

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.

Cystic fibrosis: Epidemiology, clinical manifestations, diagnosis and treatment. / Fibrosis quística: epidemiología, clínica, diagnóstico y tratamiento.

Cystic fibrosis is a genetic and multisystemic disease. The main comorbidity in adulthood is respiratory involvement, with the presence of bronchiectasis, chronic bronchial infection and airflow obstruction. Until a decade ago, treatments were aimed at favoring secretion drainage, reducing respiratory exacerbations, controlling chronic bronchial infection and slowing functional deterioration, but with the advent of cystic fibrosis transmembrane conductance regulator (CFTR) modulators, the cystic fibrosis paradigm has changed. This novel treatment goes a step further in the management of this disease, it is able to improve the production of defective CFTR protein and increase its expression on the cell surface, thus achieving a better functioning of ion exchange, fluidizing respiratory secretions and reducing airflow obstruction. In addition, there are currently different lines of research aimed at correcting the genetic defect that causes cystic fibrosis.

Fisioterapia respiratoria en sujetos adultos cursando internación por neumonía adquirida en la comunidad. Revisión bibliográfica / Respiratory physiotherapy in adult subjects hospitalized for community-acquired pneumonia. Literature review

Introducción: La neumonía adquirida en la comunidad (NAC) es una infección respiratoria en la cual es frecuente observar la indicación de fisioterapia respiratoria (FR). Sin embargo, en la actualidad las recomendaciones respecto a su uso en NAC son controvertidas, no existiendo evidencia que respalde su uso y permita conocer su real alcance. Objetivos: Revisar la evidencia respecto al impacto de la FR en pacientes adultos que cursan internación por NAC. Resultados: 5 estudios cumplieron los criterios de inclusión de esta revisión. Las maniobras de FR incluyeron ejercicios respiratorios, drenaje postural, percusión, vibración, espirometría incentivada, resistencia espiratoria, asistencia torácica durante movimientos respiratorios, tos dirigida y presión positiva intermitente. En los estudios incluidos la FR no disminuyó la mortalidad ni mejoró los valores espirométricos en los pacientes con NAC, así como tampoco los días hasta la curación ni la estadía hospitalaria. Respecto a los costos, el uso de FR en pacientes con NAC presentó un incremento significativo de los mismos. Conclusión: No hay evidencia que respalde el uso de manera rutinaria de FR en los pacientes adultos con NAC. Consideramos que se requieren de futuras investigaciones que permitan conocer el impacto de la FR en pacientes adultos con NAC, así como establecer consensos respecto a su indicación, selección de maniobras, estandarización de técnicas, tiempos y dosificación.

Introduction: Community-acquired pneumonia (CAP) is a respiratory infection in which the indication for respiratory physiotherapy (RF) is frequently observed. However, currently the recommendations regarding its use in CAP are controversial, and there is no evidence to support its use and allow us to know its real scope. Objectives: To review the evidence regarding the impact of RF in adult patients who are hospitalized for CAP. Results: 5 studies met the inclusion criteria of this review. RF maneuvers included breathing exercises, postural drainage, percussion, vibration, incentive spirometry, expiratory resistance, chest support during respiratory movements, directed cough, and intermittent positive pressure. In the included studies, RF did not reduce mortality or improve spirometric values in patients with CAP, nor did it improve days to cure or hospital stay. Regarding costs, the use of RF in patients with CAP presented a significant increase in costs. Conclusion: There is no evidence to support the routine use of RF in adult patients with CAP. We believe that future research is required to determine the impact of RF in adult patients with CAP, as well as to establish consensus regarding its indication, selection of maneuvers, standardization of techniques, times, and dosage.

Fisioterapia respiratoria en sujetos adultos cursando internación por neumonía adquirida en la comunidad. Revisión bibliográfica

Introducción: La neumonía adquirida en la comunidad (NAC) es una infección respiratoria en la cual es frecuente observar la indicación de fisioterapia respiratoria (FR). Sin embargo, en la actualidad las recomendaciones respecto a su uso en NAC son controvertidas, no existiendo evidencia que respalde su uso y permita conocer su real alcance. Objetivos: Revisar la evidencia respecto al impacto de la FR en pacientes adultos que cursan internación por NAC. Resultados: 5 estudios cumplieron los criterios de inclusión de esta revisión. Las maniobras de FR incluyeron ejercicios respiratorios, drenaje postural, percusión, vibración, espirometría incentivada, resistencia espiratoria, asistencia torácica durante movimientos respiratorios, tos dirigida y presión positiva intermitente. En los estudios incluidos la FR no disminuyó la mortalidad ni mejoró los valores espirométricos en los pacientes con NAC, así como tampoco los días hasta la curación ni la estadía hospitalaria. Respecto a los costos, el uso de FR en pacientes con NAC presentó un incremento significativo de los mismos. Conclusión: No hay evidencia que respalde el uso de manera rutinaria de FR en los pacientes adultos con NAC. Consideramos que se requieren de futuras investigaciones que permitan conocer el impacto de la FR en pacientes adultos con NAC, así como establecer consensos respecto a su indicación, selección de maniobras, estandarización de técnicas, tiempos y dosificación.

Introduction: Community-acquired pneumonia (CAP) is a respiratory infection in which the indication for respiratory physiotherapy (RF) is frequently observed. However, currently the recommendations regarding its use in CAP are controversial, and there is no evidence to support its use and allow us to know its real scope. Objectives: To review the evidence regarding the impact of RF in adult patients who are hospitalized for CAP. Results: 5 studies met the inclusion criteria of this review. RF maneuvers included breathing exercises, postural drainage, percussion, vibration, incentive spirometry, expiratory resistance, chest support during respiratory movements, directed cough, and intermittent positive pressure. In the included studies, RF did not reduce mortality or improve spirometric values in patients with CAP, nor did it improve days to cure or hospital stay. Regarding costs, the use of RF in patients with CAP presented a significant increase in costs. Conclusion: There is no evidence to support the routine use of RF in adult patients with CAP. We believe that future research is required to determine the impact of RF in adult patients with CAP, as well as to establish consensus regarding its indication, selection of maneuvers, standardization of techniques, times, and dosage.

Online Education Improves Confidence in Mechanical Insufflation-Exsufflation.

BACKGROUND: Mechanical insufflation-exsufflation (MI-E) is a cough augmentation technique used to support people with an ineffective cough. MI-E can be complex due to the number of different pressure, flow, and temporal setting adjustments needed to optimize cough efficacy. Many clinicians identify inadequate training, limited experience, and low confidence as barriers to MI-E use. The purpose of this study was to determine if an online education course could improve confidence and competence in the delivery of MI-E. METHODS: An e-mail invitation to participate was disseminated to physiotherapists with a caseload that involved airway clearance for adults. The exclusion criteria were self-reported confidence and clinical expertise in MI-E. The education was created by physiotherapists with extensive experience in the provision of MI-E. The education material reviewed theoretical and practical components and was designed to take 6 h to complete. Physiotherapists were randomized to either the intervention group, who had 3 weeks of access to the education or the control group who received no intervention. Respondents in both groups completed a baseline and a post-intervention questionnaire by using visual analog scales, 0 to 10, with the primary outcomes being confidence in the prescription and confidence in the application of MI-E. Ten multiple-choice questions that covered key components of MI-E fundamentals were also completed at baseline and post-intervention. RESULTS: The intervention group had a significant improvement in the visual analog scale after the education period with a between-group difference of mean 3.6 (95% CI 4.5 to 2.7) for prescription confidence and mean 2.9 (95% CI 3.9 to 1.9) for application confidence. There was also an improvement in the multiple-choice questions with a between-group difference of mean 3.2 (95% CI 4.3 to 2). CONCLUSIONS: Access to an evidence-based online education course improved confidence in the prescription and application of MI-E, and may be a valuable tool for training clinicians in the application of MI-E.

Técnicas Instrumentales en Kinesiología Respiratoria: Principios y Orientación para la Práctica Clínica / Instrumental respiratory physiotherapy: principles and guidance for clinical practice

Introducción. La kinesiología respiratoria cuenta con una amplia variedad de estrategias terapéuticas para el tratamiento de pacientes con disfunción respiratoria, entre las cuales se pueden mencionar las técnicas instrumentales. En la actualidad, existe una amplia variedad de ellas, la gran mayoría frecuentemente utilizadas en la práctica clínica. No obstante, la literatura que respalda su uso es heterogénea al igual que sus protocolos de aplicación. El objetivo de esta revisión es describir las técnicas kinesiológicas instrumentales más utilizadas en la práctica clínica teniendo como base una propuesta de clasificación. Se incluyen los siguientes dispositivos: Threshold PEP, Mascarilla PiPEP, TheraPEP, Flutter, Acapella, RC-Cornet, chaleco oscilatorio/compresivo torácico de alta frecuencia, ventilación percusiva intrapulmonar e incentivador volumétrico y flujométrico. Estas se describen de acuerdo a sus características principales, principios fisiológicos, protocolos de aplicación y evidencia disponible en la literatura.

Background. Respiratory physiotherapy has various therapeutic strategies for treating patients with respiratory dysfunction, including mechanical devices. Currently, a wide variety of these devices exist, and many are frequently used in clinical practice. However, the literature supporting their use is heterogeneous, as well as their application protocols. This paper aims to provide an overview of the most used devices in respiratory physiotherapy at clinical practice based on a proposed classification. The following devices were included: Threshold PEP, PiPEP mask, TheraPEP, Flutter, Acapella, RC-Cornet, High frequency chest wall compression/oscillation, Intrapulmonary Percussive Ventilation, flow and volume spirometer. They were described according to their main characteristics, physiological mechanisms, application protocols and evidence from literature.

[Hyperventilation syndrome, definition, diagnostic and therapy]. / Le syndrome d'hyperventilation, définition, diagnostic et thérapeutique.

Hyperventilation syndrome (HVS) is a frequent disorder of which the etiology is unclear. Diagnosis is based on the ruling out of organic disease and, more positively, on results of the Nijmegen questionnaire, reproduction of symptoms during the hyperventilation provocation test (HPVT), and detected hypocapnia. Treatment is based on targeted respiratory physiotherapy consisting in voluntary hypoventilation and instructions to the patient on regular respiratory exercise over an appreciable period of time. Additional research is needed to evaluate the validity of current investigative tools leading to the diagnosis of hyperventilation syndrome and to appraise the efficacy of current respiratory physiotherapy methods.

Effectiveness of Respiratory Rehabilitation in COVID-19's Post-Acute Phase: A Systematic Review.

BACKGROUND: The COVID-19 pandemic, caused by the new grave and acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), generated an unprecedented danger to public health. This condition may impact survivors' quality of life and includes extensive pulmonary and respiratory outcomes. Respiratory rehabilitation is known for its effects in improving dyspnea, alleviating anxiety and depression, reducing complications, preventing and ameliorating dysfunctions, reducing morbidity, preserving functions and improving subjects' quality of life. For this reason, respiratory rehabilitation may be recommended for this category of patients. OBJECTIVE: Our objective was to evaluate the effectiveness and benefits produced by the adoption of pulmonary rehabilitation (PR) programs in COVID-19's post-acute phase. MATERIAL AND METHODS: A search of relevant publications was conducted using the following electronic databases: PubMed, Scopus, PEDro, and Cochrane Library. A single reviser selected pertinent articles that studied the effects of pulmonary rehabilitation during COVID-19's post-acute phase in improving the respiratory function, physical performance, autonomy and quality of life (QoL). RESULTS: After an initial selection, 18 studies were included in this systematic review, of which 14 concern respiratory rehabilitation delivered in conventional form and 4 concern respiratory rehabilitation provided in telehealth. CONCLUSIONS: Pulmonary rehabilitation combining different types of training-breathing, aerobic, fitness and strength-and not bypassing the neuropsychological aspects revealed itself to be capable of improving pulmonary and muscular functions, general health and quality of life in post-acute COVID-19 patients, besides increasing workout capacity and muscle strength, improving fatigue states and reducing anxiety and depression.

Systemic and Cerebral Effects of Physiotherapy in Mechanically Ventilated Subjects.

BACKGROUND: Physiotherapy may result in better functional outcomes, shorter duration of delirium, and more ventilator-free days. The effects of physiotherapy on different subpopulations of mechanically ventilated patients on respiratory and cerebral function are still unclear. We evaluated the effect of physiotherapy on systemic gas exchange and hemodynamics as well as on cerebral oxygenation and hemodynamics in mechanically ventilated subjects with and without COVID-19 pneumonia. METHODS: This was an observational study in critically ill subjects with and without COVID-19 who underwent protocolized physiotherapy (including respiratory and rehabilitation physiotherapy) and neuromonitoring of cerebral oxygenation and hemodynamics. PaO2 /FIO2 , PaCO2 , hemodynamics (mean arterial pressure [MAP], mm Hg; heart rate, beats/min), and cerebral physiologic parameters (noninvasive intracranial pressure, cerebral perfusion pressure using transcranial Doppler, and cerebral oxygenation using near-infrared spectroscopy) were assessed before (T0) and immediately after physiotherapy (T1). RESULTS: Thirty-one subjects were included (16 with COVID-19 and 15 without COVID-19). Physiotherapy improved PaO2 /FIO2 in the overall population (T1 = 185 [108-259] mm Hg vs T0 = 160 [97-231] mm Hg, P = .02) and in the subjects with COVID-19 (T1 = 119 [89-161] mm Hg vs T0 = 110 [81-154] mm Hg, P = .02) and decreased the PaCO2 in the COVID-19 group only (T1 = 40 [38-44] mm Hg vs T0 = 43 [38-47] mm Hg, P = .03). Physiotherapy did not affect cerebral hemodynamics, whereas increased the arterial oxygen part of hemoglobin both in the overall population (T1 = 3.1% [-1.3 to 4.9] vs T0 = 1.1% [-1.8 to 2.6], P = .007) and in the non-COVID-19 group (T1 = 3.7% [0.5-6.3] vs T0 = 0% [-2.2 to 2.8], P = .02). Heart rate was higher after physiotherapy in the overall population (T1 = 87 [75-96] beats/min vs T0 = 78 [72-92] beats/min, P = .044) and in the COVID-19 group (T1 = 87 [81-98] beats/min vs T0 = 77 [72-91] beats/min, P = .01), whereas MAP increased in the COVID-19 group only (T1 = 87 [82-83] vs T0 = 83 [76-89], P = .030). CONCLUSIONS: Protocolized physiotherapy improved gas exchange in subjects with COVID-19, whereas it improved cerebral oxygenation in non-COVID-19 subjects.

Quantification of changes in lung aeration associated with physiotherapy using lung ultrasound in mechanically ventilated patients: a prospective cohort study.

BACKGROUND: Lung ultrasound (LUS) is a novel and emerging tool for physiotherapists in ICU and may provide a way of monitoring lung aeration change in response to respiratory physiotherapy treatment during a patient's ICU stay. OBJECTIVE: To measure change in the LUS score associated with a respiratory physiotherapy treatment; to determine whether change in LUS score correlates with other physiological measures. DESIGN AND SETTING: A single-centre prospective cohort study was undertaken in a tertiary teaching hospital in Sydney, Australia. PATIENTS: Adult mechanically ventilated patients in ICU with suspicion of atelectasis. MEASUREMENTS: Primary outcome: pre-post difference in LUS score. SECONDARY OUTCOMES: PaO2/FiO2 (PF) ratio, tidal volume (VT), lung auscultation score, driving pressure (DP) and the modified radiological atelectasis score (mRAS) on CXR. RESULTS: 43 patients were included. There was a mean improvement in total LUS score after physiotherapy treatment of - 2.9 (95%CI -4.4, -1.4), and a mean improvement in LUS of the right and left lungs of - 1.6 (-2.5, -0.7) and - 1.3 (-2.5, -0.1) respectively. There was a mean improvement in PF ratio, VT and auscultation score of 10.4 (-11.89, 32.7), 19 (-7.4, 44.5) and - 1.8 (-2.6, -1.0) respectively. There was no improvement in mRAS or DP. There was a weak correlation between change in LUS score compared with change in mRAS score. LIMITATIONS: Limitations included the prospective cohort single site design and the small sample size. CONCLUSIONS: The LUS score can be used to detect changes in lung aeration associated with respiratory physiotherapy treatment for acute lobar atelectasis in mechanically ventilated patients. Australian and New Zealand Clinical Trials Registry Number: ACTRN12619000783123. CONTRIBUTION OF THE PAPER.

Interrater reliability in assigning a lung ultrasound score.

BACKGROUND AND PURPOSE: Lung ultrasound (LUS) for physiotherapists is an emerging bedside tool. The LUS score of aeration presents as a possible means of assessing and monitoring lung aeration associated with respiratory physiotherapy treatments. There are no studies to date that have assessed the interrater reliability (IRR) of physiotherapists assigning the LUS score of aeration. This study assessed the IRR of assigning the LUS score among adult, mechanically ventilated patients in an intensive care unit with a clinical suspicion of acute lobar atelectasis. METHODS: A convenience sample of patients had an LUS performed by a physiotherapist, and images were independently reviewed by two physiotherapists. Each lung zone was assigned an LUS score between 0 and 3 (with 0 being normal aeration and 3 being complete consolidation, presence of effusion, or pneumothorax). IRR was assessed using the kappa statistic. RESULTS: A total of 1032 LUS images were obtained. Assigning of the LUS across all lung zones demonstrated substantial agreement with kappa 0.685 (95% confidence interval: 0.650, 0.720). Right (0.702 [0.653, 0.751]) and left (0.670 [0.619, 0.721]) lung zones also demonstrated substantial agreement. CONCLUSION: We found substantial IRR between physiotherapists in assigning the LUS score in a mechanically ventilated adult population in the intensive care unit. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRATION NUMBER: ACTRN12619000783123.

Comparing the Effect of Respiratory Physiotherapy and Positive End-Expiratory Pressure Changes on Capnography Results in Intensive Care Unit Patients with Ventilator-Associated Pneumonia.

Background: While critically ill patients experience a life-threatening illness, they commonly develop ventilator-associated pneumonia (VAP) which can increase morbidity, mortality, and healthcare costs. The present study aimed to compare the effect of respiratory physiotherapy and increased positive endexpiratory pressure (PEEP) on capnography results. Materials and Methods: This randomized control clinical trial was performed on 80 adult patients with VAP in the intensive care unit (ICU). The patients were randomized to receive either PEEP at 5 cm H2O, followed by a moderate increase in PEEP to 10 cm H2O, or PEEP at 5 cm H2O with respiratory physiotherapy for 15 min. The numerical values were recorded on the capnograph at minutes 1, 5, 10, 15, and 30 in both methods. Data collection instruments included a checklist and MASIMO capnograph. Results: As evidenced by the obtained results, the two methods significantly differed in the excreted pCO2 (partial pressure of carbon dioxide) (P<0.0001). However, the average amount of excreted pCO2 was higher in the respiratory physiotherapy and PEEP intervention (38.151mmHg) in comparison with increasing PEEP alone method (36.184mmHg). Also, PEEP elevation method prolonged the time of the first phase (inhalation time) and the second phase while shortening the third phase (exhalation time) in capnography waves. Conclusion: CO2 excretion in patients with VAP increased after respiratory physiotherapy. Further, physiotherapy demonstrated more acceptable results in CO2 excretion compared with PEEP changes in mechanically ventilated patients.

Post-operative Rehabilitation in Klatskin Tumor: A Rare Case Report.

Cholangiocarcinoma (CCA), commonly referred to as Klatskin tumor (KT), is a rare cancer that develops from the epithelium of the intra- or extrahepatic bile duct. This case outlines the impact of physiotherapy rehabilitation in a post-operative case of a KT in a 58-year-old male who presented with complaints of abdominal pain, nausea, constipation, and difficulty in urinating and reportedly exhibited generalized weakness, weight loss, and dyspnea. Following investigations such as computed tomography (CT) scan, the patient was diagnosed with a KT for which he underwent hepaticojejunostomy and was kept under observation, following which supervised physiotherapy intervention (PI) commenced from post-operative day (POD) 3. The outcome measure was peak expiratory flow rate (PEFR), whereas the intervention involved diaphragmatic breathing exercises (DBEs), thoracic expansion exercises (TEEs), incentive spirometry (IS), range of motion (ROM) exercises, active cycle of breathing technique (ACBT), and ambulation. After two weeks of treatment, there were an improvement in cough frequency and an appreciable change in vital capacity (VC), and a significant increase in PEFR values was observed.

Challenges in physiotherapy of managing respiratory diseases in elderly population.

INTRODUCTION: Lung function is a convincing prognosticator of longevity. With advancing age, there are many irreversible functional and anatomic changes in the body, making elderly susceptible to disease processes. As people age, the respiratory system experiences a number of anatomical, physiological, and immunological changes, predisposing risk of many chronic lung diseases (CLDs). Respiratory tract infections, TB, chronic obstructive pulmonary disease (COPD), and interstitial pulmonary disease are examples of common respiratory diseases (CRDs). The risk factors are mainly smoking, exposure to air pollution both indoors and outdoors, allergies, occupational exposure, poor diet, obesity, inactivity. Between 25 and 80 years the lung function and aerobic capacity each decline by ∼40% limiting physical function and promoting multimorbidity. In elderly, skeletal muscle dysfunction causes age-related multifactorial health disorders such sarcopenia and frailty, a recognised symptom of chronic respiratory disease. METHODS: This perspective article highlights the importance of pulmonary physiotherapy in elderly with chronic lung disease and other chronic respiratory disorders. Common symptoms frequently experienced are dyspnoea, fatigue, decreased exercise tolerance, peripheral muscle dysfunction, and mental disturbances. An individual's symptoms, physical functioning, quality of life (QoL), hospitalisation, and morbidity goals are all addressed by a pulmonary rehabilitation programme (PRP). Pulmonary physiotherapy, an extensive patient-tailored intervention as exercise training, education, and life style modification is prescribed on the basis of a thorough personalised assessment. RESULT: Through pulmonary physiotherapy, the goal is to restore the quality of life of elderly with chronic respiratory diseases and to encourage their long-term adherence to health-improving behaviour. The older patients learn to accept and overcome the reality of their illness rather than sticking to its limits. CONCLUSION: Multidisciplinary approach with a customized and comprehensive program makes the difference between living a fulfilling life and living a life with pulmonary disabilities.