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1.
Rev Mal Respir ; 39(6): 534-546, 2022 Jun.
Artigo em Francês | MEDLINE | ID: mdl-35732538

RESUMO

Airway clearance techniques aim to eliminate excess of bronchopulmonary secretions. Common airway clearance methods involve manual techniques or the use of (oscillatory) positive expiratory pressure systems. In some clinical situations, these techniques may be ineffective, and the physiotherapist will require pneumatic instrumental support. Unfortunately, these devices are expensive and burdensome. Moreover, as their utilization requires specialized expertise, they are seldom used by practitioners. This article describes the pneumatic instrumental supports mainly used in France for airway clearance techniques currently available. We explain their key characteristics, how they function, and their basic settings according to different indications.


Assuntos
Oscilação da Parede Torácica , Fibrose Cística , Oscilação da Parede Torácica/métodos , Humanos , Muco , Modalidades de Fisioterapia , Fenômenos Fisiológicos Respiratórios , Terapia Respiratória/métodos
4.
Panminerva Med ; 64(2): 235-243, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32192317

RESUMO

BACKGROUND: Chest physiotherapy is an important tool in the treatment of bronchiectasis. High-frequency chest wall oscillation (HFCWO) is a technique designed to create a global percussion of the lung which moves secretions and probably clears the peripheral bronchial tree. We propose the comparison between an existing device (SmartVest) and a new device (RespIn 11). METHODS: Sixty patients were randomized into three groups: a group was treated with SmartVest, a group with RespIn 11, and a group with pharmacological therapy alone. Primary outcome measures included exacerbations at 3, 6 and 12 months after the end of treatment. Secondary outcome measures were pulmonary function testing, arterial blood gas analysis (ABG), and hematological examinations, cough, dyspnea, health and quality of life scores (Bronchiectasis Health Questionnaire [BHQ], Breathlessness, Cough, and Sputum Scale [BCSS], COPD Assessment Test [CAT], Leicester Cough Questionnaire [LCT]). A five-point Likert Scale was used to evaluate patient's preference. RESULTS: Both patients in the HFCWO groups showed a significant improvement in the tests of dyspnea, cough and health and quality of life score evaluations (BHQ, BCSS, CAT, LCT) compared to the control group, but not in pulmonary function tests and ABG. Only RespIn 11 significantly reduced exacerbations in comparison with the control group. RespIn 11 also had a higher score regarding patients' preference. CONCLUSIONS: The two machines have improved health and quality of life scores in patients with bronchiectasis. RespIn 11 also demonstrated a significant lowering of exacerbations and a better patient acceptance.


Assuntos
Bronquiectasia , Oscilação da Parede Torácica , Bronquiectasia/complicações , Bronquiectasia/terapia , Oscilação da Parede Torácica/métodos , Tosse/complicações , Tosse/terapia , Dispneia/complicações , Dispneia/terapia , Humanos , Qualidade de Vida
5.
Medicine (Baltimore) ; 100(52): e28346, 2021 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-34967366

RESUMO

ABSTRACT: Return of spontaneous circulation (ROSC) from out-of-hospital cardiac arrest (OHCA) is critical for the Emergency Medical Services System. When compared to other developed countries, Taiwan has lower rate of ROSC in OHCA patients.We conducted a retrospective study of cardiac arrest using The Emergency Medical Service Dispatching Center in Northern Taiwan and The Prehospital Care System of New Taipei City Paramedic Service. Patients suffering from nontraumatic OHCA between August of 2019 to February of 2020 were included. We analyzed the cardiopulmonary resuscitation (CPR) quality parameters such as chest compression interruptions, bystander CPR, shockable rhythm, CPR interruption, chest compression fraction (CCF) average, patient transportation in buildings, and adrenaline injection during CPR. Multivariable logistic regression analysis was performed to assess the relationship between potential independent variables and ROSC.In our study, we involved 1265 subjects suffering from nontraumatic OHCA, among which 587 patients met inclusion criteria. We identified that CCF> 0.8, chest compression interruption greater than 3 times, and patient transportation in the building were the most critical factors influencing ROSC. However, patient transportation in a building was identified as a dependent predictor variable (P = .4752).We concluded that CCF > 0.8 and chest compression interruption greater than 3 times were essential factors affecting the CPR ROSC rate. The most significant reason for suboptimal CCF and CPR interruption is patient transportation in a building. Improving the latter point could facilitate high-quality CPR.


Assuntos
Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência/métodos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Adolescente , Oscilação da Parede Torácica , Criança , Auxiliares de Emergência , Feminino , Humanos , Masculino , Parada Cardíaca Extra-Hospitalar/terapia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Taiwan
6.
BMC Pulm Med ; 21(1): 326, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666748

RESUMO

BACKGROUND: Handheld oscillating positive expiratory pressure (OPEP) devices have been a mainstay of treatment for patients with hypersecretory conditions such as cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) since the 1970s. Current devices are reusable and require regular cleaning and disinfection to prevent harbouring potentially pathogenic organisms. Adherence to cleaning regimens for respiratory devices is often poor and in response to this, a prototype disposable OPEP device-the 'UL-OPEP' (University of Limerick-Oscillating Positive Expiratory Pressure device)-was developed to mitigate the risk of contamination by pathogens. The device was previously evaluated successfully in a group of paediatric CF patients. The aim of the current study was to initially evaluate the safety of the prototype in patients with COPD over a period of 1 month to ensure no adverse events, negative impacts on lung function, exercise tolerance, or quality of life. Data on user experience of the device were also collected during post-study follow-up. METHODS: A sample of 50 volunteer participants were recruited from pulmonary rehabilitation clinics within the local hospital network. The patients were clinically stable, productive, and not current or previous users of OPEP devices. Participants were invited to use a prototype disposable OPEP device daily for a period of 1 month. Pre- and post-study lung function was assessed with standard spirometry, and exercise tolerance with the 6-min-walk-test (6MWT). Quality of life was assessed using the St. George's Respiratory Questionnaire (SGRQ), and user experience of the prototype device evaluated using a post-study questionnaire. RESULTS: 24 Participants completed the study: 9 were female. Overall median age was 67.5 years, range 53-85 years. Lung function, 6-min walk test, and SGRQ scores showed no significant change post-study. User feedback was positive overall. CONCLUSIONS: The results indicate that the UL-OPEP is safe to use in patients with COPD. No adverse events were recorded during the study or in the follow-up period of 2 weeks. The device did not negatively impact patients' lung function, exercise tolerance, or quality of life during short term use (1 month), and usability feedback received was generally positive. Larger, longer duration studies will be required to evaluate efficacy. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).


Assuntos
Oscilação da Parede Torácica/instrumentação , Oscilação da Parede Torácica/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Espirometria/instrumentação , Espirometria/métodos , Idoso , Idoso de 80 Anos ou mais , Oscilação da Parede Torácica/psicologia , Equipamentos Descartáveis , Feminino , Volume Expiratório Forçado , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Projetos Piloto , Espirometria/psicologia , Inquéritos e Questionários
8.
BMC Pulm Med ; 21(1): 158, 2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980186

RESUMO

BACKGROUND: Oscillating Positive Expiratory Pressure (OPEP) devices are important adjuncts to airway clearance therapy in patients with cystic fibrosis (CF). Current devices are typically reusable and require daily, or often more frequent, cleaning to prevent risk of infection by acting as reservoirs of potentially pathogenic organisms. In response, a daily disposable OPEP device, the UL-OPEP, was developed to mitigate the risk of contamination and eliminate the burdensome need for cleaning devices. METHODS: A convenience sample of 36 participants, all current OPEP device users, was recruited from a paediatric CF service. For one month, participants replaced their current OPEP device with a novel daily disposable device. Assessment included pre- and post-intervention lung function by spirometry, as well as Lung Clearance Index. Quality of life was assessed using the Cystic Fibrosis Questionnaire - Revised, while user experience was evaluated with a post-study survey. RESULTS: 31 participants completed the study: 18 males; median age 10 years, range 4-16 years. Lung function (mean difference ± SD, %FEV1 = 1.69 ± 11.93; %FVC = 0.58 ± 10.04; FEV1: FVC = 0.01 ± 0.09), LCI (mean difference ± SD, 0.08 ± 1.13), six-minute walk test, and CFQ-R were unchanged post-intervention. Participant-reported experiences of the device were predominantly positive. CONCLUSIONS: The disposable OPEP device maintained patients' lung function during short term use (≤ 1 month), and was the subject of positive feedback regarding functionality while reducing the risk of airway contamination associated with ineffective cleaning. REGISTRATION: The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).


Assuntos
Oscilação da Parede Torácica/métodos , Fibrose Cística/terapia , Pulmão/fisiopatologia , Respiração com Pressão Positiva/métodos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Fibrose Cística/fisiopatologia , Feminino , Volume Expiratório Forçado , Humanos , Pulmão/patologia , Masculino , Depuração Mucociliar , Modalidades de Fisioterapia , Qualidade de Vida
9.
Respir Care ; 66(5): 862-877, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33563794

RESUMO

BACKGROUND: Breathing exercises with positive expiratory pressure (PEP) and oscillating PEP are common treatments for patients with respiratory impairments. There are several trials evaluating the clinical effects of a variety of commercially available and self-made devices. There is a lack of evaluation concerning technical aspects and construction of the devices. The aims of this review were to describe and compare technical aspects of devices and equipment used for PEP and oscillating PEP as a basis for clinical decisions regarding prescriptions. METHODS: In this systematic review, we included trials evaluating different technical aspects of devices and equipment for PEP and oscillating PEP until June 2019. The literature search was performed in PubMed, CINAHL, Cochrane Library, Embase and PEDro. RESULTS: The literature search resulted in 812 studies, which, after being read by 2 independent reviewers, were reduced to 21 trials that matched the inclusion criteria. The achieved PEP is dependent on the given resistance or achieved expiratory flow through the devices and their separate parts. Oscillation frequency in oscillating PEP devices affects the pressure and oscillation amplitude and flow. For some devices, the device's position also has an impact on the outcome. There are similarities and differences among all of the devices, and the equipment components are not interchangeable without changing the achieved PEP levels. CONCLUSIONS: Many devices are available to provide PEP and oscillating PEP treatment. These devices differ substantially in design as well as in performance. When using PEP devices, it is important to understand how all parts of the devices affect outcomes. An increased understanding of how PEP is produced for the spontaneously breathing patient is important to achieve desired treatment effects.


Assuntos
Oscilação da Parede Torácica , Exercícios Respiratórios , Expiração , Humanos , Modalidades de Fisioterapia , Respiração
10.
Clin Cardiol ; 44(4): 531-536, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33590902

RESUMO

BACKGROUND: Chest physiotherapy (CPT) is a non-pharmacological therapy to facilitate airway secretion removal. There have been concerns about potential electromagnetic interference (EMI) and lead integrity problems during the use of vibrating CPT devices in patients with cardiac implantable electronic devices (CIEDs). HYPOTHESIS: Two CPT devices can be used safely in patients with CIED. METHODS: Volunteer patients with CIED underwent device interrogation to check lead integrity and device function before and after application of CPT devices. Mechanical lung vibrator and high-frequency chest wall oscillation (HFCWO) vests were used while monitoring surface electrocardiograms and intra-cardiac electrograms. RESULTS: We prospectively enrolled 46 patients with CIEDs (25 pacemakers, 15 implantable cardioverter-defibrillators, and six cardiac resynchronization therapy-defibrillators). There was no noise detection or EMI during CPT in any patient. None of the patients showed clinically significant changes in lead integrity parameters. HFCWO inappropriately accelerated the pacing rate up to the maximal programmed value in five patients with pacemakers and two with cardiac resynchronization therapy-defibrillators. CONCLUSION: CPT may be safely applied to patients with CIED without compromising lead integrity or device function, except for unwanted increase in pacing rate caused by misdetection of chest wall vibration as patients' activity while using HFCWO. Deactivation of the accelerometer-based activity sensor may be needed when HFCWO is planned for CPT.


Assuntos
Oscilação da Parede Torácica , Desfibriladores Implantáveis , Marca-Passo Artificial , Desfibriladores Implantáveis/efeitos adversos , Eletrônica , Humanos , Pulmão
11.
Medicine (Baltimore) ; 100(6): e24666, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578597

RESUMO

BACKGROUND: Cardiopulmonary resuscitation (CPR) performance depends on individual ability and training. Well-trained or professional rescuers can maintain high-quality CPR for longer than laypeople. This study aimed to examine the effects of reducing resting intervals on CPR performance, physiological parameters, and hemodynamic parameters during prolonged CPR in well-trained providers. METHODS: The study enrolled 90 volunteers from the paramedic students of our institution. They were randomly divided into 3 groups: 2 minutes, 1 minute 45 seconds, and 1 minute 30 seconds rest groups. Each participant performed 5 cycles of chest compression only CPR (2 min/cycle) with different resting intervals according to grouping. CPR quality, physiological variations, and hemodynamic variations were measured for each cycle and compared across the groups. RESULTS: Of the 90 volunteers, 79 well-trained providers were finally included. The variation of the average chest compression depth across the 5 cycles showed significant differences between the 3 groups: from cycle 1 to 2: 1.2 (3.1) mm, -0.8 (2.0) mm, and -2.0 (3.0) mm in the 2 minutes, 1 minute 45 seconds, and 1 minute 30 seconds groups, respectively (P < .001); from cycle 1 to 3: 0.0 (3.0) mm, -0.7 (3.2) mm, and -2.6 (3.9) mm, respectively (P = .030). However, all 3 groups maintained the recommended rate and chest compression depth for all 5 cycles. Physiological and hemodynamic parameters showed no significant differences between the groups. CONCLUSIONS: Well-trained providers were able to maintain high-quality CPR despite reducing rest intervals. Adjusting the rest interval may help maintain overall CPR quality in special situations or where layperson rescuers are involved.


Assuntos
Reanimação Cardiopulmonar/educação , Hemodinâmica/fisiologia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Descanso/fisiologia , Pessoal Técnico de Saúde/educação , Pessoal Técnico de Saúde/estatística & dados numéricos , Reanimação Cardiopulmonar/estatística & dados numéricos , Oscilação da Parede Torácica/estatística & dados numéricos , Oscilação da Parede Torácica/tendências , Auxiliares de Emergência/educação , Auxiliares de Emergência/estatística & dados numéricos , Fadiga , Feminino , Humanos , Masculino , Fenômenos Fisiológicos/fisiologia , Estudos Prospectivos , Treinamento por Simulação/métodos , Estudantes , Fatores de Tempo , Adulto Jovem
12.
Rehabilitacion (Madr) ; 55(1): 30-37, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-32660842

RESUMO

INTRODUCTION: Chest physiotherapy is an essential part of the treatment of respiratory diseases with increased respiratory secretion and ineffective cough. To date, there have been no studies on the effect of high frequency chest wall oscillatory (HFCWO) therapy on respiratory muscle strength, ventilation and gas exchange. The aim of this study was therefore to assess these three factors in healthy participants. METHODS: Respiratory muscle strength was measured before and immediately after HFCWO therapy in 25 healthy participants. During the treatment, we continuously measured ventilation parameters, gas exchange, oxygen saturation and heart rate. All participants underwent HFCWO sessions twice (with 24hours difference) with the same procedure. Symptoms during the session and discomfort were measured with the visual analog scale (VAS). RESULTS: HFCWO therapy produced a change in breathing pattern with increased ventilation associated with altered gas exchange. Heart rate also increased, with no changes in oxygenation. There was no effect, either beneficial or deleterious, on the strength of respiratory muscles. Up to 20% of participants reported substantial discomfort (VAS≥5/10) during the session. CONCLUSIONS: This study shows that, during the application of HFCWO therapy in healthy participants, ventilation and heart rate increased. However, there were undesirable effects on gas exchange with a high degree of intolerance among volunteers, with no effects on respiratory muscle strength.


Assuntos
Oscilação da Parede Torácica , Parede Torácica , Voluntários Saudáveis , Humanos , Pulmão , Respiração
13.
Burns ; 47(1): 198-205, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32711901

RESUMO

PURPOSE: The purpose of this study was to clarify the efficacy of chest physiotherapy (CPT) in patients with inhalation injury in the acute phase. PATIENTS AND METHODS: This was a single-institution retrospective study of patients with inhalation injury admitted to the Chukyo Hospital Burn Center from April 2004 to March 2014 who required endotracheal intubation for respiratory care. The patients were divided into two groups: the CPT group and the conventional physical therapy group. We compared the two groups according to the incidence of pneumonia, length of ICU/hospital stay, and level of activities of daily living at discharge. To match subject backgrounds, we conducted a propensity score matching analysis, and using a Cox regression analysis, we evaluated the effect of CPT on the first pneumonia event. RESULTS: Of 271 patients admitted to the burn center, 139 patients were included. The incidence of pneumonia in the CPT group was significantly lower and these patients required fewer days until they could sit on the edge of the bed compared with the conventional physical therapy group. In a Cox regression model, the hazard ratio for the first incidence of pneumonia in the CPT group vs. the conventional therapy group was 0.27 (95% confidence interval: 0.13-0.54, P = 0.0002) after propensity score matching. CONCLUSIONS: CPT reduces the incidence of pneumonia and facilitates patient mobilization following inhalation injury.


Assuntos
Oscilação da Parede Torácica/normas , Pneumonia/prevenção & controle , Lesão por Inalação de Fumaça/complicações , APACHE , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Unidades de Queimados/organização & administração , Unidades de Queimados/estatística & dados numéricos , Oscilação da Parede Torácica/métodos , Oscilação da Parede Torácica/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/terapia , Estudos Retrospectivos , Lesão por Inalação de Fumaça/epidemiologia
15.
J Burn Care Res ; 42(2): 300-304, 2021 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-32860696

RESUMO

Smoke inhalation results in bronchospasm of the trachea, increasing secretion of mucus, casts formation, and improvement of blood flow of the airway. High frequency chest wall oscillation is a common modality used for clearing mucus secretion in patients suffering from hypersecretion of thick mucus and used also to help cough clearance. This study aimed to detect the effect of high frequency chest wall oscillation in improving pulmonary function in burn patients suffering from smoke inhalation. Sixty smoke inhalation injury patients were randomly distributed into two groups of equal size. Group A: received high frequency chest wall oscillation and conventional chest physical therapy (breathing exercises, early ambulation, and cough training) thrice per week for 8 weeks. Group B: received traditional chest physical therapy (breathing exercises, early ambulation, and cough training) thrice per week for 8 weeks. Pulmonary function test (forced vital capacity, forced expiratory volume in the first second and peak expiratory flow rate) was measured at enrollment and after 8 weeks by using spirometer. Pulmonary function increased significantly posttreatment when compared with that pretreatment in groups A and B (P > .001). Also, they increased significantly in group A compared with that of group B posttreatment (P > .05). High-frequency chest wall oscillation have an impact on improving pulmonary function and should be handled to be a part of the pulmonary rehabilitation plan for smoke inhalation injury patients.


Assuntos
Queimaduras/terapia , Oscilação da Parede Torácica/métodos , Consumo de Oxigênio/fisiologia , Lesão por Inalação de Fumaça/terapia , Adulto , Queimaduras/complicações , Seguimentos , Humanos , Masculino , Testes de Função Respiratória , Lesão por Inalação de Fumaça/etiologia , Volume de Ventilação Pulmonar , Resultado do Tratamento
16.
Am J Emerg Med ; 44: 235-240, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32307296

RESUMO

BACKGROUND: The application of appropriate personal protective equipment for respiratory protection to health care workers is a cornerstone for providing safe healthcare in emergency departments. We investigated the protective effect and usefulness of loose-fitting powered air-purifying respirators (PAPRs) during chest compression. METHODS: This was a single-center simulation study performed from May 2019 to July 2019 in a tertiary hospital. We measured the concentrations of ambient aerosol and particles inside the loose-fitting PAPR during chest compression, and this ratio was set as the simulated workplace protecting factor (SWPF). According to the National Institute for Occupational Safety and Health regulations, the assigned protection factor (APF) of loose-fitting PAPRs is 25. Thus, the loose-fitting PAPRs were assumed to have a protective effect when the SWPF were ≥ 250 (APF × 10). We measured the SWPF of PAPR in real time during chest compression and also investigated the problems encountered during its use. RESULTS: Ninety-one participants (median age 29 [interquartile range (IQR): 26-32] years; 74% female) completed the simulation. None of the participants failed with SWPF below 250 during three sessions of chest compression. The median (IQR) values of SWPF at three cycles were 17,063 (10,145-26,373), 15,683 (9477-32,394), and 16,960 (7695-27,279). There was no disconnection of equipment or mechanical failures during chest compression. In addition, most participants (83%) replied that they rarely or never experienced difficulty in verbal communication and felt that the loose-fitting PAPR was comfortable. CONCLUSIONS: The loose-fitting PAPRs provided sufficient respiratory protection without disturbances during chest compression.


Assuntos
Oscilação da Parede Torácica , Medicina de Emergência/educação , Serviço Hospitalar de Emergência , Controle de Infecções/métodos , Exposição Ocupacional/prevenção & controle , Dispositivos de Proteção Respiratória/normas , Adulto , Aerossóis/análise , Poluentes Ocupacionais do Ar/análise , Feminino , Humanos , Masculino , National Institute for Occupational Safety and Health, U.S. , Estados Unidos
17.
Respir Care ; 66(3): 425-433, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33144386

RESUMO

BACKGROUND: No studies have investigated the use and safety of high-frequency chest wall compression (HFCWC) for non-hospitalized infants with acute viral bronchiolitis (AVB). The aim of the present study was to evaluate the immediate effects and safety of HFCWC as compared to airway clearance techniques in children with AVB. METHODS: In this randomized clinical trial in non-hospitalized infants (0-12 months old) with mild to moderate AVB, children were randomized into 2 groups: airway clearance techniques (20 min of prolonged slow expiration and provoked cough) or HFCWC (15 min). A single session was performed and children were evaluated at baseline and at 10 min and 20 min after treatments. Outcomes measures were the Wang severity score, [Formula: see text], sputum wet-weight, and the presence of adverse events. RESULTS: A total of 91 infant subjects, mean age 7.9 ± 2.6 months, were included. Significant (P = .004) between-group differences were found in the Wang score, which was 0.28 points lower in the airway clearance techniques group. There was a greater increase of infants classified as normal and a greater decrease of those classified as mild according to the Wang score when airway clearance techniques were used compared to the use of HFCWC (P = .009). The sputum wet-weight was lower in subjects treated with the airway clearance techniques (P < .001). Although [Formula: see text]improved in both groups, no differences were found between them. There was also no difference for adverse events, and the majority of children did not present any adverse events after 20 min. CONCLUSIONS: The use of HFCWC induced similar clinical effects as airway clearance techniques and was safe for non-hospitalized infants with AVB. Both techniques reduced respiratory symptoms and acutely improved [Formula: see text]. (ClinicalTrials.gov: NCT03835936.).


Assuntos
Bronquiolite Viral , Bronquiolite , Oscilação da Parede Torácica , Bronquiolite Viral/terapia , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Terapia Respiratória , Escarro
19.
Crit Care ; 24(1): 479, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32746877

RESUMO

BACKGROUND: Besides airway suctioning, patients undergoing invasive mechanical ventilation (iMV) benefit of different combinations of chest physiotherapy techniques, to improve mucus removal. To date, little is known about the clearance effects of oscillating devices on patients with acute respiratory failure undergoing iMV. This study aimed to assess (1) the effects of high-frequency chest wall oscillation (HFCWO) on lung aeration and ventilation distribution, as assessed by electrical impedance tomography (EIT), and (2) the effect of the association of HFCWO with recruitment manoeuvres (RM). METHODS: Sixty critically ill patients, 30 classified as normosecretive and 30 as hypersecretive, who received ≥ 48 h of iMV, underwent HFCWO; patients from both subgroups were randomized to receive RM or not, according to two separated randomization sequences. We therefore obtained four arms of 15 patients each. After baseline record (T0), HFCWO was applied for 10 min. At the end of the treatment (T1) or after 1 (T2) and 3 h (T3), EIT data were recorded. At the beginning of each step, closed tracheobronchial suctioning was performed. In the RM subgroup, tracheobronchial suctioning was followed by application of 30 cmH2O to the patient's airway for 30 s. At each step, we assessed the change in end-expiratory lung impedance (ΔEELI) and in tidal impedance variation (ΔTIV), and the center of gravity (COG) through EIT. We also analysed arterial blood gases (ABGs). RESULTS: ΔTIV and COG did not differ between normosecretive and hypersecretive patients. Compared to T0, ΔEELI significantly increased in hypersecretive patients at T2 and T3, irrespective of the RM; on the contrary, no differences were observed in normosecretive patients. No differences of ABGs were recorded. CONCLUSIONS: In hypersecretive patients, HFCWO significantly improved aeration of the dorsal lung region, without affecting ABGs. The application of RM did not provide any further improvements. TRIAL REGISTRATION: Prospectively registered at the Australian New Zealand Clinical Trial Registry ( www.anzctr.org.au ; number of registration: ACTRN12615001257550; date of registration: 17th November 2015).


Assuntos
Oscilação da Parede Torácica , Modalidades de Fisioterapia , Insuficiência Respiratória/terapia , Idoso , Estado Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Respiração Artificial , Insuficiência Respiratória/fisiopatologia , Resultado do Tratamento
20.
Respir Care ; 65(12): 1831-1837, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32636276

RESUMO

BACKGROUND: Airway clearance techniques (ACTs), including high-frequency chest wall oscillation (vest therapy), are important for maintaining lung function for patients with cystic fibrosis, but daily completion of ACTs is time-consuming and cumbersome. Patient adherence is a persistent challenge, and adherence data are largely patient reported, which may reduce accuracy. To provide definitive adherence data, this study utilized a Bluetooth-enabled vest therapy system to remotely collect objective adherence data from a cohort of pediatric subjects. METHODS: Vest usage data were collected over a 12-month period and compared to each subject vest prescription. Because vest prescriptions are multifaceted, we developed metrics to examine adherence to the various facets (eg, daily treatment, treatments per day, treatment duration, frequency settings, and frequency and pressure settings combined) as well as an overall adherence metric. RESULTS: Among the 73 enrolled subjects, 62 (50% male, age range 2-19 y) completed the study. Among adolescent subjects age 13-19 y, average adherence to daily vest therapy (44.0%) was significantly lower than that among subjects 0-6 y old (77.8%) and subjects 7-12 y old (89.5%). As more prescribed therapy components were combined into a single adherence metric, all age groups declined in mean adherence rates, with overall adherence a decreasing function of age. CONCLUSIONS: Employing new technology to remotely collect vest usage data allows for a granular examination of vest therapy adherence. While maintaining high levels of treatment adherence becomes increasingly difficult as children age, we also found substantial reductions in adherence rates among all age groups when more complex aspects of therapy prescriptions, such as frequency and pressure settings, were examined. These data illustrate areas providers and care teams can focus on to improve patient adherence to vest prescriptions.


Assuntos
Fibrose Cística , Adolescente , Adulto , Oscilação da Parede Torácica , Criança , Pré-Escolar , Fibrose Cística/tratamento farmacológico , Feminino , Volume Expiratório Forçado , Objetivos , Humanos , Masculino , Cooperação do Paciente , Adulto Jovem
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