Prophylactic respiratory physiotherapy after cardiac surgery

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Prophylactic respiratory physiotherapy after cardiac surgery"

Transcription

1 Prophylactic respiratory physiotherapy after cardiac surgery Patrick Pasquina; Martin R Tramèr, MD, D. Phil; Bernhard Walder, MD Divisions of Surgical Intensive Care (Mr Pasquina) and Anaesthesia (Drs Tramèr and Walder), Department APSIC (Anaesthesia, Pharmacology & Surgical Intensive Care), Geneva University Hospitals, Geneva, Switzerland It is well established that pulmonary function deteriorates in patients after cardiac surgery and that these patients are prone to pulmonary complications. Postoperative pulmonary complications increase hospital morbidity, prolong hospital stay and contribute to additional healthcare costs. 1 For improved understanding of the potential benefit of prophylactic respiratory physiotherapy after cardiac surgery, four issues need to be addressed. First, what is the impact of cardiac surgery on pulmonary function? Second, what are the mechanisms of pulmonary changes after cardiac surgery? Third, what postoperative pulmonary complications are relevant to the patients? And fourth, can respiratory physiotherapy prevent patientrelevant pulmonary complications after cardiac surgery? 1. what is the impact of cardiac surgery on pulmonary function? 1.1. Pulmonary function tests Patients after cardiac surgery have a marked reduction in vital capacity and forced expiratory volume in one second. On the second postoperative day, when impairment of pulmonary function tests is maximal, vital capacity and forced expiratory volume in one second are about 30% only of preoperative values. 2,3 At the eighth postoperative day, pulmonary function is still about 70% compared with preoperative values. 2 Thus, at hospital discharge, most patients have not yet returned to normal daily activity and their quality of life may still be reduced Radiographic changes Radiographic pulmonary abnormalities vary in function of the type of cardiac surgery; they are more frequent on the left side of the chest radiograph. 4 For instance, left-sided pulmonary alterations were reported in 88% of patients undergoing left internal mammary artery grafting or left pleurotomy (73% atelectasis, 11% infiltrates, 55% effusions). 4 After saphenous vein grafting or valvular surgery, left-sided alterations were observed in 68% of the patients (54% atelectasis, 3% infiltrates, 35% effusions). 4 No data are available on the duration of these radiographic changes Changes of partial pressure of arterial oxygen After cardiac surgery, partial pressure of arterial oxygen (PaO2) is decreased. The impairment in oxygen exchange is most pronounced on the second postoperative day and is still 997

2 present on the eighth day. 2,5 Therefore, supplementation of oxygen is highly recommended during the postoperative period, particularly during night time. 2. What are the Mechanims of Pulmonary changes after cardiac surgery? Many pulmonary complications seem to be related to disruption of the normal activity of the respiratory muscles, disruption that begins with the induction of anaesthesia and that continues into the postoperative period. Different mechanisms impair the function of respiratory muscles after cardiac surgery. 2.1 Anaesthetics Anaesthetics affect the central regulation of breathing, changing the neural drive to respiratory muscles such as the diaphragm. They reduce the efficiency of the muscles activity inducing hypoventilation and subsequent atelectasis. The effect of anaesthetics may persist into the early postoperative period. 2.2 Phrenic nerve dysfunction Diaphragmatic impairment with atelectasis due to phrenic nerve dysfunction is a well recognised complication of heart surgery. Although several factors have been implicated in this dysfunction, most cases are either due to cold injury or direct damage to the nerve. This nerve dysfunction may persist for many days. 2.3 Chest wall deformation During surgery, the deformation of the chest wall alters the underlying lung, decreasing functional residual capacity and producing atelectases in dependent lungs regions. These intraoperative changes may continue to persist in the postoperative period Surgical trauma Surgical trauma generates multiple impairment of postoperative ventilatory function: disruption of respiratory muscles through incisions, postoperative pain with voluntary limitation of respiratory muscle use, and stimulation of the central nervous system with reflex inhibition of the phrenic and other nerves that are innervating respiratory muscles. These mechanisms lead to a decrease in functional residual and vital capacity for many days, and to atelectases. In an animal study, atelectasis was shown to promote bacterial growth in the lung related to reduced function of alveolar macrophage and reduced functional surfactant, explaining potentially the occurrence of pneumonia What postoperative pulmonary complications are relevant to the patients? A large variety of postoperative pulmonary complications have been reported in clinical studies. However, a few only are clinically relevant, and for most, there are several definitions. 998 Patrick Pasquina, Martin R. Tramèr, D. Phil, Bernhard Walder

3 3.1 Pneumonia Pneumonia is clearly an outcome that makes a difference to the patient. However, unfortunately, there are different definitions of postoperative pneumonia. Some authors have used the Centre for Disease Control (CDC) criteria involving various combinations of clinical, radiographic, and laboratory signs of infection. And a few authors only have tried to confirm the diagnosis with more invasive interventions, as for instance broncho-alveolar lavage to obtain specimens from the lower respiratory tract for culture and gram stains. 6,8 Despite differences in definitions, there is evidence that pneumonia is the most frequent cause of nosocomial infection after cardiac surgery. The incidence varies between 3% and 6% (with a peak after eight days), 7,8 and mortality reaches 20%. 6 Patients with nosocomial pneumonia have prolonged hospital stays, need additional investigations, treatments and care, and report on increased levels of discomfort. 1,6 3.2 Respiratory failure As with postoperative pneumonia, there are different definitions of postoperative respiratory failure. After cardiac surgery, respiratory failure has often been defined as the need for mechanical ventilatory support for longer than 72 hours. Using this definition of respiratory failure, the incidence was reported to be about 5%; reasons were most often extra-pulmonary, and mortality was 24%. 9 Respiratory failure after cardiac surgery has also been defined as the need for readmission to the intensive care unit related to partial or global respiratory insufficiency. Using this definition, the incidence of respiratory failure was about 2%, it was most often due to nosocomial pneumonia or the patient s inability to clear secretions, and mortality was 15%. 10 Finally, respiratory failure after cardiac surgery has been defined as the presence of an acute respiratory distress syndrome (ARDS). Using this definition, the incidence of was about 1%, and mortality was 15% to 50%. 11, Postoperative pulmonary complications The term postoperative pulmonary complications has often been used in studies that investigated postoperative pulmonary outcomes. However, that endpoint is an amalgamation of several symptoms, and a clear and universally accepted definition is lacking. Almost always that endpoint includes definite or suspected pneumonia and atelectasis (which is often not defined). Sometimes, respiratory failure, acute bronchitis, unexplained fever, excessive bronchial secretions, abnormal breathing sounds, productive cough, need of antibiotics, or hypoxemia is added. 13 This large variety in definitions is most likely responsible for the observed variability in the incidence of postoperative pulmonary complications in patients who do not receive additional care. For instance, in randomised studies testing the impact of respiratory physiotherapy after upper abdominal surgery, the incidence of postoperative pulmonary complications in patients who did not receive any physiotherapy was ranging from 0% to almost 50%. 13,14 The clinical relevance of this composite endpoint remains uncertainty. It has been claimed that composite outcomes are appropriate only when the all symptoms are well defined, when they are of equal importance and occur with similar frequencies, and when the active intervention leads to a comparable relative risk reduction of all components. 15 This is clearly not the case with postoperative pulmonary complications. 999

4 There is an argument to disregard the composite endpoint postoperative pulmonary complications in this context, and to consider more clearly defined outcomes only, such as pneumonia or respiratory failure. 4. Can respiratory physiotherapy prevent pulmonary complications after cardiac surgery? There is an assumption that prophylactic respiratory physiotherapy after cardiac surgery may reduce the decrease in functional residual capacity and thus prevent pulmonary complications. Westerdhal et al. used computed tomography to show that in patients after cardiac surgery maximum inspirations recruited collapsed lung tissue. 17 However, there were no data on the function of the recruited lung tissue, on duration of this potentially improved function, and on reduced pulmonary complications. Many other methods of prophylactic respiratory physiotherapy have been used for the prevention of pulmonary complications after cardiac surgery: deep breathing exercises with directed cough, incentive spirometry, continuous positive airway pressure, or intermittent positive pressure breathing. However, respiratory physiotherapy is labour-intensive and costly, and some patients may suffer from specific, intervention-related adverse effects. To justify the routine use of prophylactic respiratory physiotherapy after cardiac surgery, we need to be confident that the efficacy is worthwhile and that patient-relevant pulmonary complications and length of hospital stay are reduced. We have performed a systematic review of full reports of randomised trials testing the efficacy of prophylactic respiratory physiotherapy in patients undergoing cardiac surgery. 18 Trials had to compare any technique of prophylactic respiratory physiotherapy (active intervention) with no intervention (inactive control) or with another method of respiratory physiotherapy (active control). Trials had to report on pulmonary outcomes during an observation period of at least two days. Since there is no gold standard intervention in this setting, we assumed that the most valid study design to establish the relative efficacy of respiratory physiotherapy was a randomised comparison between an active intervention and a no intervention control. We analysed data from 18 trials (1,457 patients) that were published between 1978 and They tested different regimens of physical therapy (13 trials), incentive spirometry (8), continuous positive airway pressure (CPAP) (5), and intermittent positive pressure breathing (3). Four trials only had a no intervention control; none of those showed any significant benefit with physiotherapy. Across all trials and interventions, the average incidence of atelectasis was 15% to 98%, of pneumonia was 0% to 20%, of partial pressure of arterial oxygen per inspired oxygen fraction was 212 mmhg to 329 mmhg, of vital capacity was 37% to 72% of preoperative values, and of forced expiratory volume in one second was 34% to 72% of preoperative values. None of the tested physiotherapies showed superiority for any endpoint. However, there reports of gastric distension, nausea, intolerance of face mask, oxygen desaturation, and tachycardia during physiotherapy sessions. We concluded that the usefulness of prophylactic respiratory physiotherapy after cardiac surgery remained unproved. 18 The doubtful efficacy of prophylactic respiratory physiotherapy after cardiac surgery was recently reinforced by Brasher et al. 19 They tested a physioherapy program with or without deep breathing exercises after cardiac surgery and reported that additional deep breathing exercises had no effect on patient-relevant pulmonary complications but prolonged therapists labour time. 19 Interestingly, all patients in that study were mobilised early after surgery which may explain the reduced incidence of pulmonary complications Patrick Pasquina, Martin R. Tramèr, D. Phil, Bernhard Walder

5 5. Where do we go from here? The research agenda Since the efficacy of prophylactic respiratory physiotherapy after cardiac surgery remains unproven, the research agenda needs to be clear. One option would be to abandon physiotherapy in this setting and to safe money. However, millions of patients are concerned, and it may therefore be justified to reinforce clinical research to define with more confidence the usefulness (or the uselessness) of respiratory physiotherapy to prevent patient-relevant pulmonary complications. For instance, an interesting alternative concept may be to try to strengthen and to improve the endurance of inspiratory muscles through a preoperative physiotherapy program. Weiner et al. observed that the decrease of pulmonary function tests in patients after cardiac surgery may be prevented by preoperative inspiratory muscle training, starting four weeks before surgery. 20 Obviously, this concept is costly if used in all patients that are scheduled for cardiac surgery. However, it may prove to be cost-effective in patients at particular risk for postoperative pulmonary complications, for instance, those with chronic pulmonary diseases. To avoid methodological pitfalls in future clinical studies, some issues need to be addressed that have been identified through our systematic review Experimental intervention Patients in the intervention group should be treated with highly standardised and valid respiratory physiotherapy methods. Techniques should be identical, of similar duration, and delivered in a standardised manner by trained physiotherapists Control intervention Since a gold standard intervention has not been defined yet and a no intervention control group is ethically acceptable in this setting, future trials should randomise patients to an experimental physiotherapy group and a no intervention control group Sample size Trials should be of reasonable size to overcome random variations, and to identify with confidence small but clinically relevant benefits and rare adverse effects Control of co-interventions Co-interventions such as analgesia or mobilisation should be strictly controlled. In a large randomised trial, the risk of attrition bias will become negligible Methods of assessment Clinically relevant endpoints should be evaluated using standardised and validated methods of assessment. When ever feasible, assessment should be done by observers who are 1001

6 unaware of treatment allocation. The observation period should expand until hospital discharge Relevant endpoints Studies should concentrate on the reporting of clinically relevant, well defined endpoints. Surrogate endpoints that do not have a direct impact on outcome (for instance oxygen saturation) should be avoided. Length of stay (in the intensive care unit, in the hospital) has important implications for costs; these data should be reported Patient selection If control patients who do not receive prophylactic respiratory physiotherapy, do not develop pulmonary complications, physiotherapy has no scope to improve this outcome. Thus, pulmonary high-risk patients need to be included in future trials, although, then, applicability of trial results will be of limited value. Risk scores may enable investigators to stratify patients into those who are most likely to profit from prophylactic respiratory physiotherapy. Based on data from cohort studies, and using multivariate analyses, a variety of risk factors have been identified. 9 As an alternative, a multifactorial risk index for predicting postoperative respiratory failure or pneumonia in patients undergoing major non-cardiac surgery, may be used. 21,22 6. Conclusions A variety of intra-operative mechanisms lead to pulmonary modifications and subsequent complications. It has been hypothesised that prophylactic respiratory physiotherapy may reduce those. However, evidence is lacking on the benefit of prophylactic respiratory physiotherapy for the prevention of pulmonary complications after cardiac surgery. Indeed, based on a recently published systematic review of randomised trials, prophylactic physiotherapy after cardiac surgery cannot be recommended for all patients. Nevertheless, in patients undergoing cardiac surgery, regular postoperative pulmonary evaluation remains essentially to detect patient-relevant pulmonary complications, and to initiate adequate care that may include therapeutic respiratory physiotherapy. 7. References 1. Lawrence VA, Hilsenbeck SG, Mulrow CD, et al. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. J Gen Intern Med 1995;10: Pasquina P, Merlani P, Granier JM, et al. Continuous positive airway pressure versus noninvasive pressure support ventilation to treat atelectasis after cardiac surgery. Anesth Analg 2004;99: Ferdinande PG, Beets G, Michels A, et al. Pulmonary function tests after different techniques for coronary artery bypass surgery. Saphenous vein versus single versus double internal mammary artery grafts. Intensive Care Med 1988;14: Jain U, Rao TL, Kumar P, et al. Radiographic pulmonary abnormalities after different types of cardiac surgery. J Cardiothorac Vasc Anesth 1991;5: Patrick Pasquina, Martin R. Tramèr, D. Phil, Bernhard Walder

7 5. Singh NP, Vargas FS, Cukier A, et al. Arterial blood gases after coronary artery bypass surgery. Chest 1992;102: Kollef MH, Sharpless L, Vlasnik J, et al. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest 1997;112: Leal-Noval SR, Marquez-Vacaro JA, Garcia-Curiel A, et al. Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med 2000;28: Carrel TP, Eisinger E, Vogt M, et al. Pneumonia after cardiac surgery is predictable by tracheal aspirates but cannot be prevented by prolonged antibiotic prophylaxis. Ann Thorac Surg 2001;72: Canver CC, Chanda J. Intraoperative and postoperative risk factors for respiratory failure after coronary bypass. Ann Thorac Surg 2003;75: Bardell T, Legare JF, Buth KJ, et al. ICU readmission after cardiac surgery. Eur J Cardiothorac Surg 2003;23: Messent M, Sullivan K, Keogh BF, et al. Adult respiratory distress syndrome following cardiopulmonary bypass: incidence and prediction. Anaesthesia 1992;47: Milot J, Perron J, Lacasse Y, et al. Incidence and predictors of ARDS after cardiac surgery. Chest 2001;119: Celli BR, Rodriguez KS, Snider GL. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis 1984;130: Lotz P, Heise U, Schaffer J, et al. The effect of intraoperative PEEP ventilation and postoperative CPAP breathing on postoperative lung function following upper abdominal surgery. Anaesthesist 1984;33: Montori VM, Permanyer-Miralda G, Ferreira-Gonzalez I, et al. Validity of composite end points in clinical trials. BMJ 2005;330: Van Kaam AH, Lachmann RA, Herting E, et al. Reducing atelectasis attenuates bacterial growth and translocation in experimental pneumonia. Am J Respir Crit Care Med 2004;169: Westerdahl E, Lindmark B, Eriksson T, et al. The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery. Scand Cardiovasc J 2003;37: Pasquina P, Tramèr MR, Walder B. : systematic review. BMJ 2003;327: Brasher PA, McClelland KH, Denehy L, et al. Does removal of deep breathing exercises from a physiotherapy program including pre-operative education and early mobilisation after cardiac surgery alter patient outcomes? Aust J Physiother 2003;49: Weiner P, Zeidan F, Zamir D, et al. Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg 1998;22: Arozullah AM, Daley J, Henderson WG, et al. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg 2000;232: Arozullah AM, Khuri SF, Henderson WG, et al. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med 2001;135:

PRE-OPERATIVE INCENTIVE SPIROMETRY; EFFECTIVENESS TO IMPROVE POST-OPERATIVE OXYGENATION IN PATIENTS UNDERGOING CABG SURGERY

PRE-OPERATIVE INCENTIVE SPIROMETRY; EFFECTIVENESS TO IMPROVE POST-OPERATIVE OXYGENATION IN PATIENTS UNDERGOING CABG SURGERY The Professional Medical Journal DOI: 10.17957/TPMJ/16.3579 ORIGINAL PROF-3579 PRE-OPERATIVE INCENTIVE SPIROMETRY; EFFECTIVENESS TO IMPROVE POST-OPERATIVE OXYGENATION IN PATIENTS UNDERGOING CABG SURGERY

More information

Perioperative Pulmonary Management. Objectives

Perioperative Pulmonary Management. Objectives Citywide Resident Perioperative Medical Consult Conference Perioperative Pulmonary Management Frank Jacono, MD May 5, 2017 Objectives Definition of post-operative pulmonary complications (PPC) Risk factors

More information

What is the next best step?

What is the next best step? Noninvasive Ventilation William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center What is the next best step? 65 year old female

More information

Respiratory Physiotherapy To Prevent Pulmonary Complications After Abdominal Surgery*

Respiratory Physiotherapy To Prevent Pulmonary Complications After Abdominal Surgery* CHEST Special Feature Respiratory Physiotherapy To Prevent Pulmonary Complications After Abdominal Surgery* A Systematic Review Patrick Pasquina; Martin R. Tramèr, MD, DPhil; Jean-Max Granier; and Bernhard

More information

IJPHY ABSTRACT. Int J Physiother. Vol 3(1), , February (2016) ISSN: ORIGINAL ARTICLE /ijphy/2016/v3i1/88929

IJPHY ABSTRACT. Int J Physiother. Vol 3(1), , February (2016) ISSN: ORIGINAL ARTICLE /ijphy/2016/v3i1/88929 Int J Physiother. Vol 3(1), 140-146, February (2016) ISSN: 2348-8336 ORIGINAL ARTICLE IJPHY ABSTRACT COMPARATIVE STUDY ON THE IMMEDIATE EFFECTS OF DEEP BREATHING EXERCISES WITH PEP DEVICE VERSES IN- CENTIVE

More information

Sample Case Study. The patient was a 77-year-old female who arrived to the emergency room on

Sample Case Study. The patient was a 77-year-old female who arrived to the emergency room on Sample Case Study The patient was a 77-year-old female who arrived to the emergency room on February 25 th with a chief complaint of shortness of breath and a deteriorating pulmonary status along with

More information

Recent Advances in Respiratory Medicine

Recent Advances in Respiratory Medicine Recent Advances in Respiratory Medicine Dr. R KUMAR Pulmonologist Non Invasive Ventilation (NIV) NIV Noninvasive ventilation (NIV) refers to the administration of ventilatory support without using an invasive

More information

INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4

INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4 INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4 RESPIRATORY FAILURE Acute respiratory failure is defined by hypoxemia with or without hypercapnia. It is one

More information

Over the last several years various national and

Over the last several years various national and Recommendations for the Management of COPD* Gary T. Ferguson, MD, FCCP Three sets of guidelines for the management of COPD that are widely recognized (from the European Respiratory Society [ERS], American

More information

The use of proning in the management of Acute Respiratory Distress Syndrome

The use of proning in the management of Acute Respiratory Distress Syndrome Case 3 The use of proning in the management of Acute Respiratory Distress Syndrome Clinical Problem This expanded case summary has been chosen to explore the rationale and evidence behind the use of proning

More information

Respiratory Physiology

Respiratory Physiology Respiratory Physiology Dr. Aida Korish Associate Prof. Physiology KSU The main goal of respiration is to 1-Provide oxygen to tissues 2- Remove CO2 from the body. Respiratory system consists of: Passages

More information

Transfusion & Mortality. Philippe Van der Linden MD, PhD

Transfusion & Mortality. Philippe Van der Linden MD, PhD Transfusion & Mortality Philippe Van der Linden MD, PhD Conflict of Interest Disclosure In the past 5 years, I have received honoraria or travel support for consulting or lecturing from the following companies:

More information

Identification and Treatment of the Patient with Sleep Related Hypoventilation

Identification and Treatment of the Patient with Sleep Related Hypoventilation Identification and Treatment of the Patient with Sleep Related Hypoventilation Hillary Loomis-King, MD Pulmonary and Critical Care of NW MI Munson Sleep Disorders Center X Conflict of Interest Disclosures

More information

Does the Use of Positive End Expiratory Pressure (PEEP) During Surgery Decrease Respiratory Complications Twenty-Four Hours Post Operative?

Does the Use of Positive End Expiratory Pressure (PEEP) During Surgery Decrease Respiratory Complications Twenty-Four Hours Post Operative? Rhode Island College Digital Commons @ RIC Master's Theses, Dissertations, Graduate Research and Major Papers Overview Master's Theses, Dissertations, Graduate Research and Major Papers 2016 Does the Use

More information

Noninvasive Mechanical Ventilation in Children ศ.พญ.อร ณวรรณ พฤทธ พ นธ หน วยโรคระบบหายใจเด ก ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร โรงพยาบาลรามาธ บด

Noninvasive Mechanical Ventilation in Children ศ.พญ.อร ณวรรณ พฤทธ พ นธ หน วยโรคระบบหายใจเด ก ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร โรงพยาบาลรามาธ บด Noninvasive Mechanical Ventilation in Children ศ.พญ.อร ณวรรณ พฤทธ พ นธ หน วยโรคระบบหายใจเด ก ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร โรงพยาบาลรามาธ บด Noninvasive Mechanical Ventilation Provide support without

More information

OSA and COPD: What happens when the two OVERLAP?

OSA and COPD: What happens when the two OVERLAP? 2011 ISRC Seminar 1 COPD OSA OSA and COPD: What happens when the two OVERLAP? Overlap Syndrome 1 OSA and COPD: What happens when the two OVERLAP? ResMed 10 JAN Global leaders in sleep and respiratory medicine

More information

1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation.

1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation. Chapter 1: Principles of Mechanical Ventilation TRUE/FALSE 1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation. F

More information

Abstract: Introduction: Sumbla A 1, Rafaqat A 2, Shaukat A 3, Kanwal R 4, Janjua UI 5

Abstract: Introduction: Sumbla A 1, Rafaqat A 2, Shaukat A 3, Kanwal R 4, Janjua UI 5 Effectiveness of Manual Hyperinflation Therapy plus Postural Drainage and Suctioning To Prevent Ventilator Associated Complications Sumbla A 1, Rafaqat A 2, Shaukat A 3, Kanwal R 4, Janjua UI 5 Abstract:

More information

Monash Medical Centre, Melbourne 2 The University of Melbourne

Monash Medical Centre, Melbourne 2 The University of Melbourne Does removal of deep breathing exercises from a physiotherapy program including pre-operative education and early mobilisation after cardiac surgery alter patient outcomes? Phillip A Brasher 1, Kirstin

More information

Respiratory Failure how the respiratory physicians deal with airway emergencies

Respiratory Failure how the respiratory physicians deal with airway emergencies Respiratory Failure how the respiratory physicians deal with airway emergencies Dr Michael Davies MD FRCP Consultant Respiratory Physician Respiratory Support and Sleep Centre Papworth Hospital NHS Foundation

More information

Lung protection in thoracic surgery anaesthesia. Adriaan Myburgh

Lung protection in thoracic surgery anaesthesia. Adriaan Myburgh Lung protection in thoracic surgery anaesthesia Adriaan Myburgh!! UNIVERSITY OF CAPE TOWN Department of Anaesthesia and Perioperative Medicine!!!!!! Introduction ICM 2006 NEJM 2007 Ventilator- associated

More information

Mechanical ventilation in the emergency department

Mechanical ventilation in the emergency department Mechanical ventilation in the emergency department Intubation and mechanical ventilation are often needed in emergency treatment. A ENGELBRECHT, MB ChB, MMed (Fam Med), Dip PEC, DA Head, Emergency Medicine

More information

Proportional Assist Ventilation (PAV) (NAVA) Younes ARRD 1992;145:114. Ventilator output :Triggering, Cycling Control of flow, rise time and pressure

Proportional Assist Ventilation (PAV) (NAVA) Younes ARRD 1992;145:114. Ventilator output :Triggering, Cycling Control of flow, rise time and pressure Conflict of Interest Disclosure Robert M Kacmarek Unconventional Techniques Using Your ICU Ventilator!" 5-5-17 FOCUS Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston,

More information

a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure.

a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure. B. 10 Applied Respiratory Physiology a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure. Intermittent positive pressure ventilation

More information

The MetaNeb System Three therapies. One device. An effective and efficient solution.

The MetaNeb System Three therapies. One device. An effective and efficient solution. The MetaNeb System Three therapies. One device. An effective and efficient solution. Three therapies. One device. An effective and efficient solution. The MetaNeb System is designed to mobilize retained

More information

Surviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview

Surviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview Mechanical Ventilation of Sepsis-Induced ALI/ARDS ARDSnet Mechanical Ventilation Protocol Results: Mortality

More information

INTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2

INTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2 2 Effects of CPAP INTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2 ). The effect on CO 2 is only secondary to the primary process of improvement in lung volume and

More information

Mechanical Ventilation of the Patient with Neuromuscular Disease

Mechanical Ventilation of the Patient with Neuromuscular Disease Mechanical Ventilation of the Patient with Neuromuscular Disease Dean Hess PhD RRT Associate Professor of Anesthesia, Harvard Medical School Assistant Director of Respiratory Care, Massachusetts General

More information

ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate. Carolyn Calfee, MD MAS Mark Eisner, MD MPH

ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate. Carolyn Calfee, MD MAS Mark Eisner, MD MPH ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate Carolyn Calfee, MD MAS Mark Eisner, MD MPH June 3, 2010 Case Presentation Setting: Community hospital, November 2009 29 year old woman with

More information

Management of Acute Exacerbations

Management of Acute Exacerbations 15 Management of Acute Exacerbations Cenk Kirakli Izmir Dr. Suat Seren Chest Diseases and Surgery Training Hospital Turkey 1. Introduction American Thoracic Society (ATS) and European Respiratory Society

More information

Arterial oxygen tension oscillations and cyclical atelectasis in the ventilated pig

Arterial oxygen tension oscillations and cyclical atelectasis in the ventilated pig Arterial oxygen tension oscillations and cyclical atelectasis in the ventilated pig John Cronin Centre for Human and Aerospace Physiological Sciences King s College London john.n.cronin@kcl.ac.uk SAFE

More information

Best of Pulmonary Jennifer R. Hucks, MD University of South Carolina School of Medicine

Best of Pulmonary Jennifer R. Hucks, MD University of South Carolina School of Medicine Best of Pulmonary 2012-2013 Jennifer R. Hucks, MD University of South Carolina School of Medicine Topics ARDS- Berlin Definition Prone Positioning For ARDS Lung Protective Ventilation In Patients Without

More information

APRV: An Update CHLOE STEINSHOUER, MD PULMONARY & SLEEP CONSULTANTS OF KANSAS 04/06/2017

APRV: An Update CHLOE STEINSHOUER, MD PULMONARY & SLEEP CONSULTANTS OF KANSAS 04/06/2017 APRV: An Update CHLOE STEINSHOUER, MD PULMONARY & SLEEP CONSULTANTS OF KANSAS 04/06/2017 Disclosures No conflicts of interest Objectives Attendees will be able to: Define the mechanism of APRV Describe

More information

Early Rehabilitation in the ICU: Do We Still Need Chest Physiotherapy?

Early Rehabilitation in the ICU: Do We Still Need Chest Physiotherapy? Early Rehabilitation in the ICU: Do We Still Need Chest Physiotherapy? Michelle Kho, PT, PhD Assistant Professor, School of Rehabilitation Science, McMaster University Adjunct Assistant Professor, Department

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. This online publication has been corrected. The corrected

More information

Lecture Notes. Chapter 9: Smoke Inhalation Injury and Burns

Lecture Notes. Chapter 9: Smoke Inhalation Injury and Burns Lecture Notes Chapter 9: Smoke Inhalation Injury and Burns Objectives List the factors that influence mortality rate Describe the nature of smoke inhalation and the fire environment Recognize the pulmonary

More information

Awake regional versus general anesthesia in preterms and ex-preterm infants for herniotomy

Awake regional versus general anesthesia in preterms and ex-preterm infants for herniotomy Awake regional versus general anesthesia in preterms and ex-preterm infants for herniotomy Department of Anaesthesia University Children s Hospital Zurich Switzerland Epidemiology Herniotomy needed in

More information

What s New About Proning?

What s New About Proning? 1 What s New About Proning? J. Brady Scott, MSc, RRT-ACCS, AE-C, FAARC Director of Clinical Education and Assistant Professor Department of Cardiopulmonary Sciences Division of Respiratory Care Rush University

More information

ICU Volume 14 - Issue 3 - Autumn Matrix

ICU Volume 14 - Issue 3 - Autumn Matrix ICU Volume 14 - Issue 3 - Autumn 2014 - Matrix Prevention of Perioperative Complications: It Takes a Village to Raise a Child" Authors Yuda Sutherasan, MD Department of Surgical Sciences and Integrated

More information

REPORT OF TRANSFUSION ADVERSE REACTION TO BLOOD CENTERS

REPORT OF TRANSFUSION ADVERSE REACTION TO BLOOD CENTERS REPORT OF TRANSFUSION ADVERSE REACTION TO BLOOD CENTERS INSTRUCTIONS: Send the form to ALL blood centers that provided blood components to this patient. Timely reporting is important, so that, if appropriate,

More information

The Surgical Patient. Objectives:

The Surgical Patient. Objectives: The Surgical Patient Objectives: 1. Discuss the effect of surgery on the body systems. 2. Explain the etiological factors, nursing assessment, and management of potential problems during the postoperative

More information

Anatomy & Physiology 2 Canale. Respiratory System: Exchange of Gases

Anatomy & Physiology 2 Canale. Respiratory System: Exchange of Gases Anatomy & Physiology 2 Canale Respiratory System: Exchange of Gases Why is it so hard to hold your breath for Discuss! : ) a long time? Every year carbon monoxide poisoning kills 500 people and sends another

More information

5. What is the cause of this patient s metabolic acidosis? LACTIC ACIDOSIS SECONDARY TO ANEMIC HYPOXIA (HIGH CO LEVEL)

5. What is the cause of this patient s metabolic acidosis? LACTIC ACIDOSIS SECONDARY TO ANEMIC HYPOXIA (HIGH CO LEVEL) Self-Assessment RSPT 2350: Module F - ABG Analysis 1. You are called to the ER to do an ABG on a 40 year old female who is C/O dyspnea but seems confused and disoriented. The ABG on an FiO 2 of.21 show:

More information

The ability to accurately assess and measure lung

The ability to accurately assess and measure lung A New Oxygenation Index for Reflecting Intrapulmonary Shunting in Patients Undergoing Open-Heart Surgery* Mohamad F. El-Khatib, PhD; and Ghassan W. Jamaleddine, MD Study objectives: To assess the reliability

More information

Haemodynamic and Respiratory Responses to Abdominal Muscle FES A Pilot Study

Haemodynamic and Respiratory Responses to Abdominal Muscle FES A Pilot Study Haemodynamic and Respiratory Responses to Abdominal Muscle FES A Pilot Study H Rischbieth 1 *, J Clark 1, S Donohoe 1, J Strayer 1,2, M Jelbart 1, K Stiller 3, T McDonald 3, R Marshall 1,2. FES Clinic,

More information

Chronic obstructive lung disease. Dr/Rehab F.Gwada

Chronic obstructive lung disease. Dr/Rehab F.Gwada Chronic obstructive lung disease Dr/Rehab F.Gwada Obstructive lung diseases Problem is in the expiratory phase Lung disease Restrictive lung disease Restriction may be with, or within the chest wall Problem

More information

Nasal High Flow Humidification with or without Oxygen for COPD Management. Shereen Bailey, RCP, RRT, NPS

Nasal High Flow Humidification with or without Oxygen for COPD Management. Shereen Bailey, RCP, RRT, NPS Nasal High Flow Humidification with or without Oxygen for COPD Management Shereen Bailey, RCP, RRT, NPS Objectives How it works COPD Management today The role of NHFC Evidence Research/Case Studies Types

More information

CORONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW

CORONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW CONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW 2015 PQRS OPTIONS F MEASURES GROUPS: 2015 PQRS MEASURES IN CONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP: #43 Coronary Artery Bypass Graft (CABG):

More information

Noninvasive ventilation: Selection of patient, interfaces, initiation and weaning

Noninvasive ventilation: Selection of patient, interfaces, initiation and weaning CME article Johnson S, et al: Noninvasive ventilation Noninvasive ventilation: Selection of patient, interfaces, initiation and weaning Saumy Johnson, Ramesh Unnikrishnan * Email: ramesh.unnikrishnan@manipal.edu

More information

PRESSURES DELIVERED BY NASAL HIGH FLOW THERAPY DURING

PRESSURES DELIVERED BY NASAL HIGH FLOW THERAPY DURING PRESSURES DELIVERED BY NASAL HIGH FLOW THERAPY DURING ALL PHASES OF THE RESPIRATORY CYCLE Rachael L. Parke, RN, MHSc (Hons) Cardiothoracic and Vascular Intensive Care Unit Auckland City Hospital Private

More information

RESPIRATORY FAILURE NON INVASIVE VENTILATION TREATMENT

RESPIRATORY FAILURE NON INVASIVE VENTILATION TREATMENT RESPIRATORY FAILURE NON INVASIVE VENTILATION TREATMENT Dr. Dhruva Chaudhry Senior Professor & Chair Pulmonary & Critical Care Medicine PGIMS,UHS Rohtak, Haryana General Secretary (Elect) Indian Society

More information

October Paediatric Respiratory Workbook APCP RESPIRATORY COMMITTEE

October Paediatric Respiratory Workbook APCP RESPIRATORY COMMITTEE October 2017 Paediatric Respiratory Workbook APCP RESPIRATORY COMMITTEE This workbook is designed to introduce to you the difference between paediatric and adult anatomy and physiology. It will also give

More information

Chapter 21. Flail Chest. Mosby items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 21. Flail Chest. Mosby items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 21 Flail Chest 1 Figure 21-1. Flail chest. Double fractures of three or more adjacent ribs produce instability of the chest wall and paradoxical motion of the thorax. Inset, Atelectasis, a common

More information

CHEST VOLUME 117 / NUMBER 4 / APRIL, 2000 Supplement

CHEST VOLUME 117 / NUMBER 4 / APRIL, 2000 Supplement CHEST VOLUME 117 / NUMBER 4 / APRIL, 2000 Supplement Evidence-Based Assessment of Diagnostic Tests for Ventilator- Associated Pneumonia* Executive Summary Ronald F. Grossman, MD, FCCP; and Alan Fein, MD,

More information

Chapter 22. Pulmonary Infections

Chapter 22. Pulmonary Infections Chapter 22 Pulmonary Infections Objectives State the incidence of pneumonia in the United States and its economic impact. Discuss the current classification scheme for pneumonia and be able to define hospital-acquired

More information

Respiratory Complications of Obesity. Diana Wilson, M.D. ACP Educational Session September 16, 2017

Respiratory Complications of Obesity. Diana Wilson, M.D. ACP Educational Session September 16, 2017 Respiratory Complications of Obesity Diana Wilson, M.D. ACP Educational Session September 16, 2017 1 Prevalence of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2011 Prevalence

More information

The ARDS is characterized by increased permeability. Incidence of ARDS in an Adult Population of Northeast Ohio*

The ARDS is characterized by increased permeability. Incidence of ARDS in an Adult Population of Northeast Ohio* Incidence of ARDS in an Adult Population of Northeast Ohio* Alejandro C. Arroliga, MD, FCCP; Ziad W. Ghamra, MD; Alejandro Perez Trepichio, MD; Patricia Perez Trepichio, RRT; John J. Komara Jr., BA, RRT;

More information

PAPER DE LA VNI EN LA RETIRADA DE LA VENTILACIÓ INVASIVA I FRACÀS D EXTUBACIÓ

PAPER DE LA VNI EN LA RETIRADA DE LA VENTILACIÓ INVASIVA I FRACÀS D EXTUBACIÓ PAPER DE LA VNI EN LA RETIRADA DE LA VENTILACIÓ INVASIVA I FRACÀS D EXTUBACIÓ Dr. Miquel Ferrer UVIIR, Servei de Pneumologia, Hospital Clínic, IDIBAPS, CibeRes, Barcelona. E- mail: miferrer@clinic.ub.es

More information

Chronic NIV in heart failure patients: ASV, NIV and CPAP

Chronic NIV in heart failure patients: ASV, NIV and CPAP Chronic NIV in heart failure patients: ASV, NIV and CPAP João C. Winck, Marta Drummond, Miguel Gonçalves and Tiago Pinto Sleep disordered breathing (SDB), including OSA and central sleep apnoea (CSA),

More information

Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation (ECMO) Extracorporeal Membrane Oxygenation (ECMO) Policy Number: Original Effective Date: MM.12.006 05/16/2006 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 01/01/2017 Section: Other/Miscellaneous

More information

Steroids in ARDS: if, when, how much? John Fowler, MD, FACEP Dept. of Emergency Medicine Kent Hospital, İzmir, Türkiye

Steroids in ARDS: if, when, how much? John Fowler, MD, FACEP Dept. of Emergency Medicine Kent Hospital, İzmir, Türkiye Steroids in ARDS: if, when, how much? John Fowler, MD, FACEP Dept. of Emergency Medicine Kent Hospital, İzmir, Türkiye Steroids in ARDS: conclusion Give low-dose steroids if indicated for another problem

More information

Patient-Ventilator Asynchrony: How to fix it

Patient-Ventilator Asynchrony: How to fix it Patient-Ventilator Asynchrony: How to fix it Younsuck Koh, MD, PhD, FCCM Dept. of Pulmonary & CCM Asan Medical Center, Univ. of Ulsan College of Medicine Seoul, Korea 2 Systems Patient-Ventilator Synchrony

More information

Interventional procedures guidance Published: 20 December 2017 nice.org.uk/guidance/ipg600

Interventional procedures guidance Published: 20 December 2017 nice.org.uk/guidance/ipg600 Endobronchial valve insertion to reduce lung volume in emphysema Interventional procedures guidance Published: 20 December 2017 nice.org.uk/guidance/ipg600 Your responsibility This guidance represents

More information

Respiratory Distress During RSV Season

Respiratory Distress During RSV Season Respiratory Distress During RSV Season Carroll King, MD, FAAP Disclosure : Carroll King, MD, FAAP has nothing to disclose. 1 Objectives At the end of this educational activity, participants should be able

More information

Julio F Fiore Jr MSc, Luciana D Chiavegato PhD, Linda Denehy PhD, Denise M Paisani MSc, and Sonia M Faresin PhD

Julio F Fiore Jr MSc, Luciana D Chiavegato PhD, Linda Denehy PhD, Denise M Paisani MSc, and Sonia M Faresin PhD Do Directed Cough Maneuvers Improve Cough Effectiveness in the Early Period After Open Heart Surgery? Effect of Thoracic Support and Maximal Inspiration on Cough Peak Expiratory Flow, Cough Expiratory

More information

New Surveillance Definitions for VAP

New Surveillance Definitions for VAP New Surveillance Definitions for VAP 2012 Critical Care Canada Forum Toronto Dr. John Muscedere Associate Professor of Medicine, Queen s University Kingston, Ontario Presenter Disclosure Dr. J. G. Muscedere

More information

Acute Respiratory Failure. Respiratory Failure. Respiratory Failure. Acute Respiratory Failure. Ventilatory Failure. Type 1 Respiratory Failure

Acute Respiratory Failure. Respiratory Failure. Respiratory Failure. Acute Respiratory Failure. Ventilatory Failure. Type 1 Respiratory Failure Acute Respiratory Failure Physiologic Classification Acute Respiratory Failure Type 1 Hypoxemic Type 2 Ventilatory Type 3 Post-op Type 4 Shock Mechanism Shunt Va Atelectasis Cardiac Output Phil Factor,

More information

Citation for published version (APA): Leur, J. P. V. D. (2005). Clearance of bronchial secretions after major surgery Groningen: s.n.

Citation for published version (APA): Leur, J. P. V. D. (2005). Clearance of bronchial secretions after major surgery Groningen: s.n. University of Groningen Clearance of bronchial secretions after major surgery Leur, Johannes Peter van de IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish

More information

Phases of Respiration. Chapter 18: The Respiratory System. Structures of the Respiratory System. Structures of the Respiratory System

Phases of Respiration. Chapter 18: The Respiratory System. Structures of the Respiratory System. Structures of the Respiratory System Phases of Respiration Chapter 18: The Respiratory System Respiration Process of obtaining oxygen from environment and delivering it to cells Phases of Respiration 1. Pulmonary ventilation between air and

More information

A New Look at Managing Chronic Obstructive Pulmonary Disease (COPD): NIV Therapy

A New Look at Managing Chronic Obstructive Pulmonary Disease (COPD): NIV Therapy A New Look at Managing Chronic Obstructive Pulmonary Disease (COPD): NIV Therapy 1 ResMed 2013 Global leaders in sleep and respiratory medicine COPD Market Size Over 12M people in the US diagnosed with

More information

SWISS SOCIETY OF NEONATOLOGY. Supercarbia in an infant with meconium aspiration syndrome

SWISS SOCIETY OF NEONATOLOGY. Supercarbia in an infant with meconium aspiration syndrome SWISS SOCIETY OF NEONATOLOGY Supercarbia in an infant with meconium aspiration syndrome January 2006 2 Wilhelm C, Frey B, Department of Intensive Care and Neonatology, University Children s Hospital Zurich,

More information

COMMISSION ON ACCREDITATION FOR RESPIRATORY CARE TMC DETAILED CONTENT OUTLINE COMPARISON

COMMISSION ON ACCREDITATION FOR RESPIRATORY CARE TMC DETAILED CONTENT OUTLINE COMPARISON A. Evaluate Data in the Patient Record I. PATIENT DATA EVALUATION AND RECOMMENDATIONS 1. Patient history e.g., admission data orders medications progress notes DNR status / advance directives social history

More information

HEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION

HEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION HEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION David Jay Weber, M.D., M.P.H. Professor of Medicine, Pediatrics, & Epidemiology Associate Chief Medical Officer, UNC Health Care Medical

More information

The Vest Airway Clearance System, Model 205 Breathe a Little Easier.

The Vest Airway Clearance System, Model 205 Breathe a Little Easier. The Vest Airway Clearance System, Model 205 Breathe a Little Easier. How does The Vest Airway Clearance System work? Through High Frequency Chest Wall Oscillation technology, The Vest Airway Clearance

More information

Breathe a Little Easier. The Vest Airway Clearance System, Model 205

Breathe a Little Easier. The Vest Airway Clearance System, Model 205 Breathe a Little Easier. The Vest Airway Clearance System, Model 205 How does The Vest Airway Clearance System work? Through High Frequency Chest Wall Oscillation technology, The Vest Airway Clearance

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE SCOPE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE 1 Guideline title SCOPE Bronchiolitis: diagnosis and management of bronchiolitis in children. 1.1 Short title Bronchiolitis in children 2 The remit The

More information

Acute Respiratory Failure. Presented by Omar AL-Rawajfah, RN, PhD

Acute Respiratory Failure. Presented by Omar AL-Rawajfah, RN, PhD Acute Respiratory Failure Presented by Omar AL-Rawajfah, RN, PhD Lecture Outlines Etiology and Pathophysiology Classification Assessment Collaborative Management ۲ Etiology and Pathophysiology Acute respiratory

More information

The Berlin Definition: Does it fix anything?

The Berlin Definition: Does it fix anything? The Berlin Definition: Does it fix anything? Gordon D. Rubenfeld, MD MSc Professor of Medicine, University of Toronto Chief, Program in Trauma, Emergency, and Critical Care Sunnybrook Health Sciences Centre

More information

Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation (ECMO) Extracorporeal Membrane Oxygenation (ECMO) Policy Number: Original Effective Date: MM.12.006 05/16/2006 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 11/01/2014 Section: Other/Miscellaneous

More information

Chapter 10 Respiratory System J00-J99. Presented by: Jesicca Andrews

Chapter 10 Respiratory System J00-J99. Presented by: Jesicca Andrews Chapter 10 Respiratory System J00-J99 Presented by: Jesicca Andrews 1 Respiratory System 2 Respiratory Infections A respiratory infection cannot be assumed from a laboratory report alone; physician concurrence

More information

Chronic Obstructive Pulmonary Disease (COPD) Clinical Guideline

Chronic Obstructive Pulmonary Disease (COPD) Clinical Guideline Chronic Obstructive Pulmonary Disease (COPD) Clinical These clinical guidelines are designed to assist clinicians by providing an analytical framework for the evaluation and treatment of patients. They

More information

Restrictive Pulmonary Diseases

Restrictive Pulmonary Diseases Restrictive Pulmonary Diseases Causes: Acute alveolo-capillary sysfunction Interstitial disease Pleural disorders Chest wall disorders Neuromuscular disease Resistance Pathophysiology Reduced compliance

More information