Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study.

AIM: Ventilator-associated pneumonia (VAP) is the most common intensive care unit (ICU)-acquired infection. The current study aimed to assess the efficacy of mechanical insufflation-exsufflation (MI-E) in preventing VAP in critically ill patients. MATERIALS AND METHODS: This retrospective cohort study was conducted at the ICU of Chiba University Hospital between January 2014 and September 2017. The inclusion criteria were patients who required invasive mechanical ventilation ≥48 hours and those who underwent rehabilitation, including chest physical therapy (CPT). In 2015, the study institution started the use of MI-E in patients with impaired cough reflex. From January to December 2014, patients undergoing CPT were classified under the historical control group, and those who received treatment using MI-E from January 2015 to September 2017 were included in the intervention group. The patients received treatment using MI-E via the endotracheal or tracheostomy tube, with insufflation-exsufflation pressure of 15-40 cm H2O. The treatment frequency was one to three sessions daily, and a physical therapist who is experienced in using MI-E facilitated the treatment. RESULTS: From January 2015 to September 2017, 11 patients received treatment using MI-E. Of the 169 patients screened in 2014, 19 underwent CPT. The incidence of VAP was significantly different between the CPT and MI-E groups (84.2% [16/19] vs 26.4% [3/11], p = 0.011). After adjusting for covariates, a multivariate logistic regression analysis was performed, and results showed that the covariates were not associated with the incidence of VAP. CONCLUSION: This retrospective cohort study suggests that the use of MI-E in critically ill patients is independently associated with a reduced incidence of VAP. CLINICAL SIGNIFICANCE: Assessing the efficacy of MI-E to prevent VAP. HOW TO CITE THIS ARTICLE: Kuroiwa R, Tateishi Y, Oshima T, Inagaki T, Furukawa S, Takemura R, et al. Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study. Indian J Crit Care Med 2021;25(1):62-66.

[Impact of Chest Physical Therapy on Length of Stay and Medical Expenditures for Patients With Pulmonary Infection].

BACKGROUND: Sputum retention increases significantly the risk of repetitive respiratory tract infections, which may result in dyspnea and lung injury. Chest physical therapy is the most commonly used method to assist patients to expel sputum. This intervention promotes sputum clearance and prevents airway obstruction, thereby reducing the risk of lung infection. PURPOSE: The purpose of this study was to investigate the impact of chest physical therapy on the length of hospitalization and the medical expenditures of patients with pulmonary infection. METHODS: A retrospective-correlation study was used. Data were collected from 2013 to 2017 in the medical ward of a medical center located in southern Taiwan. The annual differences in the length of stay, medical expenditures, and readmission rates for patients with pulmonary infection after chest physical therapy were analyzed. RESULTS: A total of 707 patients with pulmonary infection were recruited and enrolled as participants. The mean age of the participants was 75.4 (± 13.8) years. The results showed that length of stay (F = 6.66, p < .001) and medical expenditures (F = 5.34, p < .001) were both significantly lower after chest physical therapy and that the corresponding readmission rates had decreased significantly, from 6.9% in 2013 to 1.7% in 2017 (x2 = 5.84, p = .016). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: After conducting a yearly comparison, the results of this study indicate that administering chest physical therapy may be an effective strategy for reducing the length of stay, readmission rates, and medical expenditures of patients with pulmonary infection. The findings of this study may serve as a reference for the clinical implementation of chest physical therapy in patients with pulmonary infection.

Incentive spirometry combined with expiratory positive airway pressure improves asthma control and quality of life in asthma: a randomised controlled trial.

OBJECTIVES: The use of the incentive spirometer (IS) and expiratory positive airway pressure (EPAP) provides several benefits in patients with respiratory disorders. However, the effects of the use of these devices coupled (IS + EPAP) are still unknown in asthmatic patients. The aim of this study was to evaluate the effect of IS associated with EPAP on exercise tolerance (six-minute walk test - 6MWT), lung function (by spirometry), asthma control (Asthma Control Questionnaire - ACQ) and quality of life (Asthma Quality of Life Questionnaire - AQLQ) in patients with severe asthma. METHODS: Patients were randomised into two groups: IS + EPAP (n = 8) and control (n = 6). The IS + EPAP group performed breathing exercises at home, twice daily for 20 min, over a period of 5 weeks. RESULTS: There was no significant difference in spirometric variables and in the distance walked in the 6MWT in both groups. However, the IS + EPAP group showed an improvement in asthma control (p = 0.002) and quality of life (p = 0.02). CONCLUSIONS: These findings demonstrate that the IS + EPAP protocol, when performed at home, provides an improvement in asthma control and quality of life for patients with severe asthma when evaluated by ACQ and AQLQ, respectively.

Effects of pre-transplant chest physical therapy on spirometric values and respiratory muscle strength in patients waiting for allogeneic hematopoietic stem cell transplantation: a randomized controlled trial.

Introduction: Many noninfectious pulmonary complications occur immediately within the first few weeks after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study aimed to evaluate the efficacy of chest physical therapy (CPT) performed during the pre-transplant period in terms of spirometric values and respiratory muscle strength (RMS) in patients waiting for allo-HSCT. Material and methods: Fifty patients aged 40 to 55 years who were scheduled for allo-HSCT were randomly allocated into two equal-sized groups, a CPT group and a control group. The CPT group (n = 25) received CPT in addition to routine medical treatment, while the control group (n = 25) received routine medical treatment only. Patients in both groups received standard physical therapy during the inpatient waiting period. Interventions were conducted daily for 3 weeks before allo-HSCT. Pulmonary function (FEV1, FVC, and FEV1/FVC) was measured by spirometry, and RMS was measured by a respiratory pressure meter. A baseline assessment was done 3 weeks before allo-HSCT (T0), then at the end of treatment immediately before allo-HSCT (T1) and the last assessment at 3 weeks after allo-HSCT (T2) for all measured variables. Results: In comparing the two groups at T1 and T2, the mean spirometric values and RMS, maximal inspiratory pressure, and maximal expiratory pressure were all improved significantly in the CPT group in comparison with the control group (p < 0.05). Conclusions: Adding a 3-week CPT intervention to the pre-transplant rehabilitation program seems to be effective and safe for allo-HSCT recipients, as it improves pre-transplant pulmonary function and respiratory muscle strength and prevents their post-transplant decrease.

Six-minute walk test and factors affecting exercise capacity in children with cystic fibrosis.

PURPOSE: This study aimed to compare the result of the six-minute walk test (6MWT) in patients with cystic fibrosis (CF) aged < 20 years old and individuals without CF. METHODS: In this cross-sectional study, 50 children and adolescents with CF and 20 children and adolescents without CF underwent the 6MWT. Vital signs before and immediately after the 6MWT and six-minute walk distance (6MWD) were evaluated. RESULTS: The mean change in heart rate, percentage of peripheral oxygen saturation (SpO2%), systolic blood pressure, respiratory rate, and dyspnea severity during the 6MWT was significantly higher in patients with CF. In the case group, 6MWD was associated with regular chest physical therapy (CPT) and forced expiratory volume (FEV)> 80%. Patients with CF receiving regular CPT or mechanical vibration and with FEV in the first second > 80% showed better physical capacity during the 6MWT (smaller Sp02% decline and lower dyspnea perception). CONCLUSION: Children and adolescents with CF have lower physical capacity compared to individuals without CF. CPT and mechanical vibration could be used to increase physical capacity in this population.

Hand-assisted sputum excretion can effectively reduce postoperative pulmonary complications of esophageal cancer.

BACKGROUND: This study explores whether postoperative hand-assisted expectoration can reduce postoperative pulmonary complications (PPCs) in patients with esophageal cancer. METHODS: A retrospective analysis was performed on 543 patients undergoing radical esophageal cancer (EC) surgery in our hospital from October 2018 to August 2019, 156 of whom received postoperative handassisted sputum excretion (pulmonary rehabilitation, PR) and 387 of whom who did not receive postoperative hand-assisted sputum excretion (no pulmonary rehabilitation, NPR). Because the clinical characteristics of the two groups were not balanced, we used propensity score matching (PSM) to account for the variable factors of age, gender, body mass index (BMI), chronic respiratory comorbidity, smoking index, operation time, operation method, pathological stage. The main observation index used was PPCs. RESULTS: Among these 543 patients, 365 were male (67.2%), while 178 were female (32.8%). The age ranged from 30 to 82 years, with an average of 63.6±7.5 years old. In all, 342 patients (63%) underwent video-assisted thoracic surgery (VATS) surgery, while 201 patients (37%) underwent thoracotomy. Furthermore, 72 patients in the PR group received preoperative rehabilitation training and postoperative hand-assisted sputum excretion (combination pulmonary rehabilitation, CPR), while 87 patients only received postoperative hand-assisted sputum excretion (postoperative pulmonary rehabilitation, PPR). The patients in the PR group and the NPR group were uneven in terms of clinical characteristics, and we performed PSM as a result. After matching, PPC incidence in patients in the PR group was lower than that in the NPR group (P<0.05). CONCLUSIONS: Our results show that hand-assisted sputum excretion after EC surgery can reduce PPCs.

Objective Versus Self-Reported Adherence to Airway Clearance Therapy in Cystic Fibrosis.

BACKGROUND: Historically, studies of adherence to airway clearance therapy in cystic fibrosis (CF) have relied on self-reporting. We compared self-reported airway clearance therapy adherence to actual usage data from home high-frequency chest wall compressions (HFCWC) vests and identified factors associated with overestimation of adherence in self-reports. METHODS: Pediatric patients who perform airway clearance therapy with a HFCWC vest were eligible to participate. Objective adherence data were obtained from the HFCWC device, which records cumulative utilization time. Two readings at least 5 weeks apart were collected. Objective adherence was recorded as a ratio of mean-to-prescribed daily use (%). Self-reported adherence data were collected with a caregiver survey at enrollment. Adherence rates were categorized as low (< 35% of prescribed), moderate (36-79% of prescribed), and high (≥ 80% of prescribed). An overestimation was present when self-reported adherence was at least one category higher than objective adherence. RESULTS: In the final sample (N = 110), mean adherence by usage data was 61%. Only 35% of subjects (n = 38) were highly adherent, and 28% (n = 31) were low adherent. In contrast, 65% of subjects (n = 72) reported high adherence and only 8% (n = 9) reported low adherence (P < .001). Nearly half of self-reports (46%) overestimated adherence. In a multiple regression analysis, overestimation was associated with multiple airway clearance therapy locations (odds ratio 7.13, 95% CI 1.16-43.72, P = .034) and prescribed daily use ≥ 60 min (odds ratio 3.85, 95% CI 1.08-13.76, P < .038). Among subjects with prescribed daily airway clearance therapy ≥ 60 min, the odds of overestimating adherence increased 3-fold (odds ratio 3.04, 95% CI 1.17-7.87, P = .02) in a lower-income (< $50,000/y) environment. CONCLUSIONS: Self-reports overestimated actual adherence to airway clearance therapy, and the overestimation increased with treatment occurring in multiple households and prescribed therapy duration. Among participants with prescribed airway clearance therapy ≥ 60 min, overestimation increased with lower income. Objective measures of adherence are needed, particularly for lower-income children and those receiving treatments in multiple locations.

A pilot study on the non-invasive management of tracheobronchial secretions in tracheostomised patients.

INTRODUCTION/OBJECTIVES: The aim of our study was to assess the safety, efficacy and feasibility of an Expiratory Flow Accelerator (EFA) device, Free Aspire, in reducing the need for daily suctions in tracheostomised (TCS) patients. METHODS: Twenty-five patients (13 males, 12 females, aged 69.88 ± 9.06 years) were investigated. The number of superficial/deep suctions, shallows, arterial blood gas (ABG) analysis, perception of mucus encumbrance (Visual Numeric Scale, VNS) and adverse event were recorded for five days. On the first two days (T1-T2), suctioning was performed as usual, on the following three days (T3, T4, T5), patients were treated also with Free Aspire (20 min, 3 times a day). RESULTS/CONCLUSION: The use of the non-invasive device was associated with a decrease of total number of aspirations from T2 to T5 (8.48 ± 2.62 vs 4.48 ± 3.08, P = 0.0003). Total number of daily aspirations decreased over the five days (8.68 ± 3.64 vs 4.48 ± 3.08, P = 0.0009). Deep aspirations decreased from T1 to T5 (6.16 ± 3.53 vs 1.80 ± 1.50, P = 0.0001). ABG data confirmed that no significant side effects occurred. VNS score decreased from 7.03 ± 1.42 at T1 to 4.05 ± 1.80 at T5 (P < 0.0001). These data suggest that EFA may be useful for managing secretions in TCS patients, as it can reduce the number of daily suctions, particularly the deep ones, and may improve the perception of mucus encumbrance, without side effects. More studies are needed to confirm these data and to understand in which categories of TCS patients this device can be introduced.

Noninvasive ventilation and respiratory physical therapy reduce exercise-induced bronchospasm and pulmonary inflammation in children with asthma: randomized clinical trial.

BACKGROUND: Asthma is characterized by hyperresponsiveness of the airways, and exercise-induced bronchospasm (EIB) is a symptom that limits a large proportion of asthmatic patients, especially children. Continuous positive airway pressure (CPAP) leads to a reduction in the reactivity of the airways. The aim of this study was to evaluate the effect of outpatient treatment with CPAP and bilevel pressure combined with respiratory physical therapy for children and adolescents with asthma following bronchial hyperresponsiveness caused by an exercise bronchoprovocation test. METHODS: A randomized, controlled, blind, clinical trial was conducted involving 68 asthmatic children and adolescents aged 4 to 16 years divided into three groups: G1, treated with bilevel pressure (inspiratory positive airway pressure: 12 cm H2O; expiratory positive airway pressure: 8 cm H2O), G2, treated with CPAP (8 cm H2O) and G3, treated with respiratory muscle training (RMT), considered as the control group. All groups were treated at an outpatient clinic and submitted to 10 1-hour sessions, each of which also included respiratory exercises. Evaluations were performed before and after treatment and involved spirometry, an exercise bronchoprovocation test, respiratory pressures, fraction of nitric oxide (FeNO), the Asthma Control Questionnaire (ACQ6) and anthropometric variables. This study received approval from the local ethics committee (certificate number: 1487225/2016) and is registered with ClinicalTrials [ ClinicalTrials.gov identifier: NCT02939625]. RESULTS: A total of 64 patients concluded the protocol; the mean age of the patients was 10 years. All were in the ideal weight range and had adequate height ( z score: -2 to +2). The three groups demonstrated improved asthma control after the treatments, going from partial to complete control. A significant increase in maximal inspiratory pressure occurred in the three groups, with the greatest increase in the RMT group. A reduction in FeNO in the order of 17.4 parts per billion (effect size: 2.43) and a reduction in bronchial responsiveness on the exercise bronchoprovocation test occurred in the bilevel group. An improvement in FeNO on the order of 15.7 parts per billion (effect size: 2.46) and a reduction in bronchial responsiveness occurred in the CPAP group. No changes in lung function or responsiveness occurred in the RMT group. CONCLUSION: Positive pressure and respiratory exercises were effective in reducing pulmonary inflammation, exercise-innduced bronchoespasm (EIB), and increased the clinical control of asthma, as well as RMT, which also resulted in improved clinical control.

Effects of Chest Physical Therapy in Patients with Non-Tuberculous Mycobacteria.

Antibiotic therapy against non-tuberculous mycobacteria (NTM) is prolonged and can be associated with toxicity. We sought to evaluate whether chest physical therapy (PT) was associated with clinical improvement in patients with NTM not receiving anti-mycobacterial pharmacotherapy. A retrospective review of 77 subjects that were followed from June 2006 to September 2014 was performed. Baseline time point was defined as the first positive sputum culture for NTM; symptoms, pulmonary function, and radiology reports were studied. Subjects were followed for up to 24 months and results analyzed at specified time points. Half of the subjects received chest PT at baseline. Cough improved at 12 (p = 0.001) and 24 months (p = 0.003) in the overall cohort when compared with baseline, despite lack of NTM antibiotic treatment. Cough decreased at 6 (p = 0.01), 9 (p = 0.02), 12 (p = 0.02) and 24 months (p = 0.002) in subjects that received chest PT. Sputum production also improved at 24 months in the overall cohort (p = 0.01). There was an increase in the percent change of total lung capacity in subjects that received chest PT (p = 0.005). Select patients with NTM may have clinical improvement with chest PT, without being subjected to prolonged antibiotic therapy. Future studies are warranted to prospectively evaluate outcomes in the setting of non-pharmacologic treatment and aid with the decision of antibiotic initiation.

Short-Term Pulmonary Rehabilitation for a Female Patient with Chronic Scleroderma under a Single-Case Research Design.

Although previously proposed that chronic scleroderma should be cared for clinically and early rehabilitation should be performed in hospital by a chest physical therapist, little evidence is currently available on its benefits. Therefore, this study demonstrated the benefits of short-term pulmonary rehabilitation during hospitalization in a female patient with chronic scleroderma. The aim of rehabilitation was to improve ventilation and gas exchange by using airway clearance, chest mobilization, and breathing-relearning techniques, including strengthening the respiratory system and the muscles of the limbs by using the BreathMax® device and elastic bands. Gross motor function and activities of daily life were regained by balancing, sitting, and standing practices. Data on minimal chest expansion, high dyspnea, high respiratory rate, and low maximal inspiratory mouth pressure were recorded seven days before rehabilitation or at the baseline period. But there was a clinically significant improvement in dyspnea, chest expansion, maximal inspiratory mouth pressure, and respiratory rate, when compared to baseline data, which were recorded by a chest physical therapist during seven days of rehabilitation. Furthermore, physicians decided to stop using a mechanical ventilator, and improvement in functional capacity was noted. Therefore, in the case of chronic and stable scleroderma, short-term rehabilitation during hospitalization for chest physical therapy possibly shows clinical benefits by improving both pulmonary function and physical performance.

Effects of manual percussion during postural drainage on lung volumes and metabolic status in healthy subjects.

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.

Changes in oxidative stress from tracheal aspirates sampled during chest physical therapy in hospitalized intubated infant patients with pneumonia and secretion retention.

OBJECTIVE: This study aimed to show the changes in oxidative stress and clinical condition from either chest physical therapy (CPT) or CPT with aerosol treatment in infant patients with pneumonia. METHODS: From 52 intubated patients, three groups were composed: groups A, B, and C comprising 21 patients aged 5.3±0.6 months (CPT program), 20 patients aged 5.6±0.7 months (aerosol treatment before CPT program), and eleven patients aged 5.0±0.35 months (control), respectively. CPT was composed of manual percussion and vibration before suction in a specific position for draining secretion and re-expanding collapsed lungs. Groups A and B received three sessions of treatment three times daily for 6 days, when tracheal aspirates were collected for evaluating oxidative stress markers for the thiol group: vitamin E, thiobarbituric acid reactive substances-malondialdehyde, and hyarulonan. Furthermore, lung injury score and oxygenation index (PvO2/FiO2 ratio) were recorded daily. RESULTS: All parameters in group C did not change statistically during study. The thiol group increased significantly in group A after day 4, and increased significantly on days 3 and 6 when compared to day 1 in group B. Vitamin E levels increased significantly on days 3, 5, and 6 in group A, and days 3, 4, and 6 in group B, when compared to day 1. Whereas, the thiobarbituric acid reactive substances-malondialdehyde adduct showed a significant reduction after day 4 in groups A and B, when compared to day 1. Hyarulonan levels showed a significant reduction after day 3 in group A and on day 2 in group B. In addition, lung injury score decreased slightly and nonsignificantly in groups A and B, whereas the oxygenation index increased significantly after day 4 in group A and on day 6 in group B. CONCLUSION: These preliminary results suggest that CPT with or without aerosol treatment possibly reduces oxidative stress and enhances oxygenation status in infant patients.

The application of beside lung ultrasound in emergency-plus protocol for chest physical therapy in patients with severe pneumonia / 中国实用护理杂志

Objective@#To explore the effect of chest physical therapy guided by ultrasound in patients with severe pneumonia.@*Methods@#One hundred patients with mechanical ventilation in the ICU were divided into a control group and a test group according to the occupancy time. The control group was given chest physical therapy according to routine imaging data and pulmonary auscultation. The experimental group was given physical therapy of the chest according to the routine imaging and pulmonary auscultation, also according to the BLUE ultrasound protocol. The mechanical ventilation time, ICU hospitalization time and the drainage capacity of 1 day, 2 days, 4 days, and 7 days after treatment were observed.@*Results@#The mechanical ventilation time was (7.82±1.38) days and ICU hospitalization time were (10.16±1.88) days in the test group. The mechanical ventilation time was (10.14±1.73) days and ICU hospitalization time were (12.78±2.11) days in the control group. There were significant differences between the two groups (t=7.42, 6.56, P<0.05). There was a significant difference in the ability of spontaneous drainage on the 4th and 7th day after treatment between the two groups (Z=-2.47, -2.52, P<0.05). The sputum ability on the first and second day after treatment were not statistically significant between the two groups (P>0.05).@*Conclusions@#Pulmonary ultrasound can continuously monitor lung changes. Nurses can perform targeted nursing treatment on the basis of ultrasound.

Year in review 2014: airway clearance.

The respiratory therapist has had integrated adjuncts to improve mucus clearance for decades. However, there is a lack of literature describing the impact of these interventions on specific patient populations, resulting in an inability to make recommendations about the use of devices and techniques. The purpose of this article is to review recent literature regarding airway clearance therapies in a manner that is most likely to have interest to the readers of Respiratory Care.

[Chest physical therapy of the distal lung. Mechanical basis of a new paradigm]. / La kinésithérapie respiratoire du poumon profond. Bases mécaniques d'un nouveau paradigme.

Recent medical literature has shown that there has been renewed interest focused on the small airways deep in the lung tissue. Although there is involvement of the distal airways at an early stage in mucus secreting lung diseases, no specific chest physical therapy (CPT) manoeuver has been proposed for small airways clearance. A four-tier classification of CPT has been established with identification of its benefits at each level of a monoalveolar respiratory tract model. The usual expiratory techniques directed towards the upper and middle respiratory tract are not applicable to the small airways and new paradigm is proposed appropriate to their specific mechanical characteristics. This comprises a slow resistive inspiratory manoeuver in the lateral position. Clinical auscultation of the lung is the cornerstone of the validation and follow-up of the technique.

Nonpharmacologic airway clearance techniques in hospitalized patients: a systematic review.

Nonpharmacologic airway clearance techniques are used to reduce the sequelae of obstructive secretions. We systematically reviewed comparative studies of nonpharmacologic interventions that health professionals can employ to achieve mucus clearance in hospitalized or postoperative patients without cystic fibrosis, over the age of 12 months. We searched MEDLINE and other databases from 1990 to 2012 to identify relevant literature. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers also independently extracted data regarding subject and intervention characteristics and outcomes, and assigned overall quality ratings. The 32 studies meeting the review criteria included 24 randomized controlled trials, 7 crossover randomized controlled trials, and one prospective cohort study. Studies were typically small and together included a total of 2,453 subjects (mean 76/study). Studies generally examined chest physical therapy/physiotherapy modalities in postoperative or critically ill subjects or those with COPD. Interventions, comparators, and populations varied considerably across studies, hampering our ability to draw firm conclusions. Interventions, including conventional chest physical therapy/physiotherapy, intrapulmonary percussive ventilation, and positive expiratory pressure, typically provided small benefits in pulmonary function, gas exchange, oxygenation, and need for/duration of ventilation, among other outcomes, but differences between groups were generally small and not significant. Harms of the techniques were not consistently reported, though airway clearance techniques were generally considered safe in studies that did comment on adverse effects. Further research with clearly characterized populations and interventions is needed to understand the potential benefits and harms of these techniques.

Chest physical therapy in acute viral bronchiolitis: an updated review.

We describe the various therapies for infant acute viral bronchiolitis and the contradictory results obtained with chest physical therapy. The treatment target is bronchial obstruction, which is a multifactorial phenomenon that includes edema, bronchoconstriction, and increased mucus production, with a clinical grading defined as severe, moderate, or mild. Chest physical therapy is revisited in its various modalities, according to preliminary scoring of the disease.

Kinesioterapia respiratoria en la bronquiolitis aguda: estrategia terapéutica, bases fisiológicas e impacto clínico / Chest physical therapy in acute bronchiolitis: therapeutic strategies, physiological basis and clinical impact

Acute bronchiolitis (AB) is a common acute respiratory disease that affects children younger than 2 years. The main etiological factor is given by respiratory syncytial virus. The role of chest physical therapy (CPT) in the management of this condition has been studied in recent years with discrepant results because conventional CPT has been designed for use in adult patients, which significantly compromises external validity of the studies that have evaluated the effectiveness of these treatment protocols in infants. In this sense prolonged slow expiration (PSE) arises as a therapeutic alternative, since the physiological purpose of its implementation responds to the mechanism by which the respiratory function deteriorates in this patient´s group. In recent years, successive reports have been published regarding the benefits PSE technique on the clinical course of patients with AB, which have shown that helps to reduce the hyperinflation and improve airway clearance in infant, without triggering dynamic hyperinflation. In the present review were addressed in an integrated manner the most relevant aspects related to bronchial obstruction mechanism in infant, physiological effect and impact of PSE. This report intended to be a contribution to advance the development of future research that will contribute to enrich the knowledge of this discipline.

La bronquiolitis aguda (BA) es una enfermedad respiratoria aguda frecuente que afecta a niños menores de 2 años, siendo su principal agente etiológico el virus respiratorio sincicial. El rol de la kinesioterapia respiratoria(KTR) en el manejo de esta patología ha sido materia de estudio en los últimos años con resultados discrepantes debido a que las técnicas de KTR convencional han sido diseñadas para su aplicación en el paciente adulto, lo que compromete significativamente la validez externa de los estudios que han evaluado la efectividad de estos protocolos terapéuticos en lactantes. En este contexto, surge la técnica de espiración lenta prolongada (ELPr) como alternativa terapéutica, puesto que el sustrato fisiológico de su ejecución responde al mecanismo mediante el cual se deteriora funcionalmente la mecánica ventilatoria en este grupo de pacientes. En los últimos años, se han publicado reportes consecutivos respecto a los beneficios de la técnica de ELPr sobre el curso clínico de los pacientes con BA, donde se ha observado contribuye a reducir la hiperinsuflación y permeabilizar la vía aérea del lactante, sin gatillar hiperinsuflación dinámica; pilares claves en la disfunción respiratoria en estos pacientes. En la presente revisión se abordaron de manera integrada los aspectos más relevantes vinculados a mecanismo de obstrucción bronquial del lactante, efecto fisiológico de la ELPr e impacto cínico de su ejecución. Datos que pretenden ser un aporte para avanzar en el desarrollo de investigaciones futuras que contribuyan a enriquecer el conocimiento de esta disciplina.

Aplicação de um protocolo fisioterapêutico na síndrome de Kartagener: estudo de caso / Application of a protocol on physiotherapeutic Kartagener Syndrome: a case study

A Síndrome Kartagener é uma doença autossômica recessiva rara que se caracteriza por situs inversus e discinesia ciliar, Além disso essa enfermidade pode desencadear sinusite paranasal e bronquiectasia. Desse modo, o objetivo deste estudo foi avaliar a evolução das variáveis ventilatórias, da força muscular respiratória e da capacidade funcional submáxima de uma paciente com 27 anos e diagnóstico clínico de Síndrome de Kartagener, submetida a fisioterapia respiratória. O protocolo fisioterapêutico implementado constou de 10 sessões, duas vezes por semana, por meio de treinamento muscular inspiratório (Threshold IMT®), reeducação diafragmática, manobras de higiene brônquica, exercícios respiratórios e treinamento dinâmico de membros inferiores. As variáveis analisadas antes e após o protocolo foram, pico de fluxo expiratório, pressões respiratórias máximas (PImáx e PEmáx), teste de caminhada de seis minutos (TC6?) e cirtometria toracoabdominal. De acordo com o presente estudo, concluiu-se que houve melhora dos resultados das variáveis analisadas, demonstrando a importância da intervenção fisioterapêutica, podendo auxiliar na diminuição das recidivas do processo infeccioso.

The Kartagener Syndrome is a rare recessive autosomal illness, which is characterized by situs inversus and ciliarydyskinesia, and this can trigger paranasal sinusitis and bronquiectasis. The objective of this study was to evaluate the variables ventilatory, respiratory muscle strength and submaximal functional capacity in patient of 27 years with clinical diagnosis of Kartagener Syndrome submitted a respiratory therapy. The physical therapy protocol implemented consisted of 10 sessions, twice a week, including inspiratory muscle training (Threshold IMT®), diaphragmatic training, bronchial hygiene maneuvers, breathing exercises and dynamic training of the lower limbs. The treatment was performed in the physiotherapy clinic of a university hospital . The variables analyzed before and after the protocol were: peak expiratory flow, maximal respiratory pressures (MIP and MEP), 6-min walk test (6MWT) and thoracoabdominal circumference measurements. According to this study we concluded that there was an improvement of results of variables, demonstrating the importance of physical therapy intervention, it can help in reducing the recurrence of the infectious process.