Division of Critical Care Medicine, Clínicas Hospital Brazil
|
|
- Bartholomew Doyle
- 6 years ago
- Views:
Transcription
1 Naue et al: Increased pressure support during vibrations in intensive care Increasing pressure support does not enhance secretion clearance if applied during manual chest wall vibration in intubated patients: a randomised trial Wagner da Silva Naue, Ana Carolina Texeira da Silva, Adriana Meira Güntzel, Robledo Leal Condessa, Roselaine Pinheiro de Oliveira and Silvia Regina Rios Vieira Division of Critical Care Medicine, Clínicas Hospital Brazil Questions: What is the effect of increasing pressure support during the application of manual chest wall compression with vibrations for secretion clearance in intubated patients in intensive care? Design: A randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants: 66 patients receiving mechanical ventilation for greater than 48 hours. Intervention: All participants were positioned supine in bed with the backrest elevated 30 degrees. The experimental group received manual chest wall compression with vibrations during which their pressure support ventilation was increased by 10 cmh 2 O over its existing level. The control group received manual chest wall compression with vibrations but no adjustment of the ventilator settings. Both groups then received airway suction. Outcome measures: The primary outcome was the weight of the aspirate. Secondary outcomes were pulmonary and haemodynamic measures and oxygenation. Results: Although both treatments increased the weight of the aspirate compared to baseline, the addition of increased pressure support during manual chest wall compression with vibrations did not significantly increase the clearance of secretions, mean betweengroup difference in weight of the aspirate 0.4g, 95% CI 0.5 to 1.4. Although several other measures also improved in one or both groups with treatment, there were no significant differences between the groups for any of the secondary outcomes. Conclusion: Although increasing pressure support has previously been shown to increase secretion clearance in intubated patients, the current study did not show any benefits when it was added to chest wall compression with vibrations. Trial registration: NCT Journal of Physiotherapy : Physiotherapy, Chest wall compression, Mechanical ventilation, Hyperinflation, Randomised controlled trial Introduction Most patients in intensive care receive invasive ventilatory support, which typically relieves their work of breathing and improves their gas exchange. However, intubation for mechanical ventilation also has deleterious effects on mucus transport by ciliary mechanisms and by cough (Gosselink et al 2008, McCarren et al 2006). This can lead to the stasis of secretions in the airways, which can cause bronchial obstruction (Amato et al 2007). If bronchial obstruction in an airway is not reversed, the more distal airways will remain unventilated and become atelectatic. This may worsen hypoxia. Furthermore, the accumulation of bronchial secretions favours the multiplication of microorganisms in unventilated areas and subsequent development of pneumonia (Bhowmik et al 2009, Ntoumenopoulos et al 2002). Some physiotherapy techniques are intended to reverse these deleterious sequelae of intubation and bronchial obstruction by combating the accumulation of mucus. One such technique is manual chest wall compression with vibrations. This technique is achieved by a sustained isometric contraction of the physiotherapist s upper limbs, with an oscillating compressive force on the patient s thorax during expiration. It aims to facilitate the transport of mucus from peripheral to central airways, thereby facilitating clearance by aspiration with a suction catheter (Frownfelter 2004, McCarren et al 2006). Techniques that increase inspiratory tidal volume and therefore expiratory flow rates, such as hyperinflation via adjustment of the settings on a mechanical ventilator, may also help to mobilise secretions. One rationale for this is that such an intervention may increase ventilation to non-ventilated airways and thereby facilitate the cough mechanism, aiding the transport of mucus from peripheral to central airways (Lemes et al 2009, Savian et al 2006). Hyperinflation can be achieved using the mechanical ventilator by increasing pressure support. For example, Lemes and colleagues (2009) achieved significant increases in tidal volume by increasing pressure support to provide a peak airway pressure of 40 cmh 2 O. In randomised trials, this technique of ventilator hyperinflation increased the static compliance (Berney and Denehy 2002) and the amount of secretions obtained (Lemes 2007). This study is designed to compare the effectiveness of chest wall compression and vibration with and without a concurrent 10 cmh 2 O increase in inspiratory pressure support above the existing level via adjustment of the ventilator settings. Journal of Physiotherapy 2011 Vol. 57 Australian Physiotherapy Association
2 Research Patients screened for participation (n = 1304) Excluded (n = 1238) haemodynamically unstable or not initiating breaths (n = 1237) lack of consent (n = 1) Randomised (n = 66) (n = 34) (n = 32) Baseline Measured secretions obtained with aspiration, pulmonary mechanics, haemodynamics and oxygenation (n = 34) (n = 32) Lost to follow-up (n = 0) Experimental Group usual care manual chest vibrations with increased pressure support aspiration of airway Control Group usual care manual chest vibrations aspiration of airway Lost to follow-up (n = 0) 6 hours Measured secretions obtained with aspiration, pulmonary mechanics, haemodynamics and oxygenation (n = 34) (n = 32) Design and flow of participants through the trial. Characteristics of participants. Therefore, the research questions of this study were: 1. In patients receiving mechanical ventilation in intensive care, does the addition of an increase in pressure support during manual chest wall compression and vibration increase the amount of secretions obtained? 2. Does it improve peak inspiratory pressure, tidal volume and dynamic compliance? 3. Does it have adverse haemodynamic effects? Method Design A randomised trial with assessor blinding of the primary outcome, concealed allocation and intention-to-treat analysis was undertaken at the Clínicas Hospital in Porto Alegre, Brazil, between May 2008 and May Participants were recruited from the Intensive Care Unit. To achieve concealed allocation, each random allocation was concealed in an opaque envelope until a patient s eligibility to participate was confirmed. Outcomes were measured immediately after the intervention. Characteristic Randomised (n = 66) Exp (n = 34) Con (n = 32) Gender, n male (%) 15 (44) 13 (41) Age (yr), mean (SD) 64 (15) 65 (19) APACHE II, mean (SD) 26 (7) 23 (7) Time ventilated (d), mean (SD) 8 8 (6) Pathology, n (%) COPD 7 (21) 5 (16) Bronchopneumonia 9 (26) 16 (50) Heart failure 6 (18) 3 (9) Stroke 8 (24) 2 (6) Septicaemia 14 (41) 12 (38) Other 18 (53) 17 (53) APACHE II = Acute Physiology and Chronic Health Evaluation, COPD = Chronic obstructive pulmonary disease, Other = immunosuppressed, acquired immune deficiency syndrome, neoplasm Journal of Physiotherapy 2011 Vol. 57 Australian Physiotherapy Association 2011
3 Naue et al: Increased pressure support during vibrations in intensive care Mean (SD) for outcomes for each group, mean (SD) difference within groups, and mean (95% CI) difference between groups. Groups Difference within groups Difference between groups Pre Post Post minus Pre Post minus Pre Exp (n = 34) Aspirate weight (g) 2.6 (3.0) Peak (cmh 2 O) 20.9 (4.2) Tidal volume (ml) 465 (88) Cdyn (ml/cmh 2 O) 32 (9) Heart rate (bpm) 92 (21) Resp rate (br/min) (6) MAP (mmhg) 91 (18) SpO 2 (%) 96.9 (2.5) Con (n = 32) 1.3 (1.2) 21.8 (3.4) 5 (119) 36 (11) 91 (19) (17) 97.6 (2.8) Exp (n = 34) 3.5 (3.8) 21.2 (4.5) 521 (120) 35 (10) 96 (20) 93 (20) 96.9 (3.1) Con (n = 32) 1.7 (1.6) 21.7 (3.5) 555 (145) 38 (13) 96 (18) (6) 91 (14) 97.2 (3.3) Exp Con Exp minus Con 0.9 (2.1) 0.3 (0.9) 56 (69) 3 4 (10) 0 (6) 2 (12) 0.0 (2.0) 0.5 (1.5) 0.2 (1.7) 33 (101) 2 (9) 6 (9) 2 3 (12) 0.4 (1.9) 0.4 ( 0.5 to 1.4) 0.5 ( 0.2 to 1.1) ( 20 to 65) 1 ( 3 to 4) 1 ( 6 to 3) 2 ( 4 to 1) 1 ( 7 to 5) 0.4 ( 0.6 to 1.4) Shaded row = primary outcome, bpm = beats per minute, br = breaths, Cdyn = Dynamic compliance of the respiratory system, Resp = respiratory, MAP = mean arterial pressure, SpO 2 % = percentage saturation of oxyhaemoglobin estimated by pulse oximetry Participants Patients who were intubated and had received mechanical ventilation for at least 48 hr in the Intensive Care Unit and who were initiating spontaneous breaths were eligible to participate. Exclusion criteria were: ventilator associated pneumonia, positive end-expiratory pressure greater than 10 cmh 2 O, haemodynamic instability (defined as mean arterial pressure less than 60 cmh 2 O), contraindications to an increase in the applied inspiratory pressure (eg, pneumothorax, undrained haemothorax, subcutaneous emphysema), osteoporosis, peak airway pressure greater than 40 cmh 2 O, neurosurgery, and a relative who was unwilling to consent to the patient s participation. Intervention All participants received usual medical and nursing care while in the Intensive Care Unit. This included position changes second hourly, aspiration of the airway as needed, chest wall vibrations with compression twice a day. Clinical data including gender, age, baseline Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, comorbidities, start and end dates of mechanical ventilation, presence or absence of ventilator-associated pneumonia, type of ventilator and mode of ventilation were recorded at baseline. After randomisation, all participants were positioned supine in bed with the bedhead elevated 30 deg. In this position, their airway was aspirated once with a 12-gauge suction catheter with a vacuum pressure of 40 cmh 2 O. Two hours later, haemodynamic and pulmonary measures were recorded. The participants artificial airway was then aspirated 3 times with an open suction system, for 12 sec, at intervals of 30 sec, with the same catheter and vacuum pressure. The aspirate was collected in a vial and stored for weighing. Haemodynamic and ventilator measures were recorded 1 min later. These were the baseline measures. Approximately six hours later, all participants were again positioned in supine with the bedhead elevated 30 deg and had their airway aspirated once, as described above. Two hours later, haemodynamic and pulmonary measures were recorded. Experimental group participants then received manual chest wall compression with vibrations for 5 min to each hemithorax by a physiotherapist. During the application of these manual techniques, the ventilator settings were altered so that inspiratory pressure support increased by 10 cmh 2 O above the existing level. Control group participants received the same regimen of compression with vibration of the chest wall, but without any change in their ventilator settings. In all participants, the airway was then aspirated 3 times with an open suction system, for 12 sec, at intervals of 30 sec, again with the same catheter and vacuum pressure. The aspirate was collected in a vial and stored for weighing. The haemodynamic and pulmonary measures were recorded 1 min later. Outcome measures The secretions obtained with each aspiration were collected and stored in a collection flask and weighed on an electronic scale by an investigator blinded to whether the sample was from the experimental or control group. The pulmonary measures recorded were: peak inspiratory pressure, endexpiratory pressure, and tidal volume, each measured via the mechanical ventilator. Dynamic compliance was calculated as the tidal volume divided by the difference between the peak inspiratory pressure and the endexpiratory pressure. The haemodynamic measures recorded were: heart rate, respiratory rate, mean arterial pressure, and oxyhaemoglobin saturation measured by peripheral pulse oximetry. Journal of Physiotherapy 2011 Vol. 57 Australian Physiotherapy Association
4 Research Data analysis The minimal important difference in secretions aspirated with a single treatment has not yet been established. We therefore nominated 0.7 g as the between-group difference we sought to identify. Assuming a SD of 1 g, 68 participants (34 per group) would provide 80% power, at the 2-sided 5% significance level, to detect a 0.7 g difference between the experimental and control groups as statistically significant. Continuous data were summarised as means and standard deviations and categorical data were summarised as frequencies and percentages. Normal distribution of the data was confirmed with the Kolmogorov-Smirnov test. Between-group differences in change from baseline were analysed using unpaired t-tests. Mean differences (95% CI) between groups are presented. Within-group changes were analysed using a paired samples t test. Chi-squared or Fischer s exact test were used for categorical variables. Data were analysed by intention to treat. Results through the trial Recruitment and data collection were carried out between May 2008 and May During the study period, 1304 patients were screened for eligibility. Sixty-six met the eligibility criteria and were randomised: 34 in the experimental group and 32 in the control group. The flow of participants through the trial and the reasons for the exclusion of some participants are illustrated in Figure 1. Baseline characteristics of the participants were similar between the allocated groups (Table 1). Interventions to the experimental group were provided by the Intensive Care Unit physiotherapist, who had seven years of clinical experience, including four years in intensive care. The Intensive Care Unit of the Clínicas Hospital in Porto Alegre, Brazil, was the only centre to recruit and test patients in the trial. The Intensive Care Unit has 25 adult medical-surgical beds and a throughput of 1117 patients per year. All randomised participants completed the trial, including both interventions as randomly allocated and all outcome measures. No participant in either group had adverse haemodynamic or ventilatory changes during the intervention to such an extent that they necessitated cessation of the intervention. Effect of intervention Group data for all outcomes for the experimental and control interventions are presented in Table 2, while individual data are presented in Table 3 (see eaddenda for Table 3). The weight of the aspirate was significantly greater after physiotherapy in the experimental group, compared to baseline. However, the control group also showed a small increase and overall the difference in effect between the experimental and control groups was not statistically significant, mean difference 0.4g (95% CI 0.5 to 1.4). After the interventions, peak airway pressure did not significantly differ between the experimental and control groups. Tidal volume was significantly greater after physiotherapy in the experimental group, compared to baseline. However, the control group also showed a small increase and overall the difference in effect between the experimental and control groups was not statistically significant, mean difference ml (95% CI 20 to 65). Similarly, dynamic compliance improved significantly after physiotherapy in the experimental group, but the change was not significantly greater than in the control group, mean difference 1 cmh 2 O (95% CI 3 to 4). Heart rate increased significantly in both groups from baseline, but the between-group difference in this change was not statistically significant. The changes in respiratory rate were clinically unimportant, with no statistically significant difference between the groups in the change during the intervention, mean difference 2 breaths per minute (95% CI 4 to 1). The changes in mean arterial pressure and oxyhaemoglobin saturation were also not statistically significantly different between the experimental and control groups. Discussion Several authors have described the use of hyperinflation to prevent lung collapse, re-expand atelectatic areas, increase oxygenation, improve lung compliance and facilitate the movement of secretions from the small to the larger central airways (Denehy 1999, Savian et al 2006, Singer et al 1994). These effects appear to occur due to an increase in the tidal volume generated by the hyperinflation that further expands the normal alveoli through the interdependence mechanism, which also re-expands collapsed alveoli (Stiller 2000). Lemes and colleagues (2009) provided data to support this using a randomised crossover trial. A ventilator-induced increase in pressure support improved the volume of secretions aspirated and the static compliance of the respiratory system. Although the difference in the intervention arms in both the Lemes study and the current study was the use of ventilator-induced hyperinflation, the other interventions applied to both groups differed. In the Lemes study, positioning was the only other intervention. In the current study, both groups received positioning and chest wall compression with vibrations. Thus, while Lemes and colleagues (2009) found that ventilator hyperinflation improved the amount of secretions aspirated above the effect of positioning alone, the current study found it did not significantly improve the amount of secretions above the effect of positioning and chest wall vibrations with compression. This result may have been influenced by the difference in the average baseline sputum production of the two groups, which was relatively large. The current study used chest wall vibrations with compression in both groups and therefore can only examine its effect as uncontrolled data. Notwithstanding this, both groups increased the amount of secretions aspirated after the interventions, with the within-group change being statistically significant in the experimental group. Unoki and colleagues (2005) also examined the effect of manual chest wall compression in a randomised crossover trial. Chest wall compression had a modest and statistically nonsignificant effect on the volume of secretions aspirated. Even with uncontrolled data, it is valuable to see the effect of chest wall compression with vibration isolated from the effects of other techniques. Most other studies of chest wall compression have included it with techniques such as postural drainage and percussion. Ntoumenopolous and colleagues (2002) and Vieira and colleagues (2009) have 24 Journal of Physiotherapy 2011 Vol. 57 Australian Physiotherapy Association 2011
5 Naue et al: Increased pressure support during vibrations in intensive care shown that a combination of physiotherapy techniques can reduce the risk of ventilator associated pneumonia in mechanically ventilated patients in intensive care. However, Patman and colleagues (2008) found that physiotherapy did not prevent, or hasten recovery from, ventilator-associated pneumonia in patients with acquired brain injury. While this is valuable information that can be applied clinically, authors such as Hess (2007) have commented that the effects of the individual techniques in these complex physiotherapy interventions are indistinguishable, and therefore the current study and others that allow the effect of individual techniques to be separated from the overall physiotherapy regimen can help advance our understanding of which techniques are effective. The increase in peak inspiratory tidal volume caused by hyperinflation may improve expiratory flow rates and therefore assist in shifting secretions from smaller airways to the larger central airways, thereby reducing the resistance in the airways and leading to an increase in tidal volume (Choi and Jones 2005, Santos 2010). Although there was a significant within-group improvement in tidal volume in the group that received ventilator-induced hyperinflation, this was not significantly greater than the improvement in the control group in the current study. Berney and Denehy (2002) demonstrated a significant increase in lung compliance after hyperinflation in a randomised crossover trial. Savian and colleagues (2006) later published similar results, attributing the increase in pulmonary compliance to improved distribution of ventilation and the subsequent recruitment of collapsed lung units. Although the within-group improvement in lung compliance in the experimental group was statistically significant, this was not significantly greater than the improvement in the control group in the current study. One limitation of this study was the sample size. Although formal power calculations were performed a priori and a desirable sample size was recruited, some outcomes still have confidence intervals that include the possibility of clinically worthwhile effects particularly in the beneficial direction. Therefore, ventilator-induced hyperinflation should be investigated further. Another limitation is that only one outcome albeit the primary outcome was assessed by a blinded investigator. Also, there were baseline differences in some groups that were large enough to have possibly influenced the final outcomes to a clinically meaningful degree. In summary, although the addition of ventilator-induced hyperinflation appears to have an effect on the amount of sputum aspirated and the compliance of the respiratory system over the effect of positioning alone (Lemes et al 2009), the current study did not show similar benefits when increased pressure support was added to positioning and chest wall compression with vibration. eaddenda: Available at JoP.physiotherapy.asn.au Table 3. Ethics: The Clínicas Hospital Ethics Committee(s) approved this study (number 07504). All participants gave informed consent before data collection began. Support: This study was supported by the Fundo de Incentivo a Pesquisa e Eventos (FIPE) Research and Event Inventive Fund. Acknowledgements: The authors are grateful to the patients, nurses, and officers of the Division of Critical Care Medicine of Clínicas Hospital for their assistance in the conduct of this work. Competing interests: None declared. Correspondence: Wagner da Silva Naue, Department: Division of Critical Care Medicine, Clínicas Hospital / Rio Grande do Sul Federal University, Ramiro Barcelos, Porto Alegre / RS, Brazil. wnaue@hcpa.ufrgs.br References Amato MB, Carvalho CR, Isola A, Vieira S, Rotman V, Moock M, et al (2007) [Mechanical ventilation in Acute Lung Injury Jornal Brasiliero de Pneumologia 33 Suppl 2S: S Berney S, Denehy L (2002) A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and ventilated intensive care patients. Physiotherapy Research International 7: Bhowmik A, Chahal K, Austin G, Chakravorty I (2009) Improving mucociliary clearance in chronic obstructive pulmonary disease. Respiratory Medicine 103: Choi JS, Jones AY (2005) Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia. Australian Journal of Physiotherapy 51: Denehy L (1999) The use of manual hyperinflation in airway clearance. European Respiratory Journal 14: Frownfelter DD, Dean E (2004) Fisioterapia Cardiopulmonar Principios e Práticas (3 edn). Reivinter. Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al (2008) Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Medicine 34: Hess DR (2007) Airway clearance: physiology, pharmacology, techniques, and practice. Respiratory Care 52: Lemes DA, Zin WA, Guimarães FS (2009) Hyperinflation using pressure support ventilation improves secretion clearance and respiratory mechanics in ventilated patients with pulmonary infection: a randomised crossover trial. Australian Journal of Physiotherapy 55: Lemes DA, Guimarães FS (2007) O uso da hipeinsuflação como recurso fisioterapêutico em unidade de terapia intensiva (The use of hyperinflation as a physical therapy resource in intensive care unit). Revista Brasileira de Terapia Intensiva 19: 1 5. McCarren B, Alison JA, Herbert RD (2006) Manual vibration increases expiratory flow rate via increased intrapleural pressure in healthy adults: an experimental study. Australian Journal of Physiotherapy 52: Ntoumenopoulos G, Presneill JJ, McElholum M, Cade JF (2002) Chest physiotherapy for the prevention of ventilatorassociated pneumonia. Intensive Care Medicine 28: Patman S, Jenkins S, Stiller K (2008) Physiotherapy does not prevent, or hasten recovery from, ventilator-associated pneumonia in patients with acquired brain injury. Intensive Care Medicine 35: Pisi G, Chetta A (2009) Airway clearance therapy in cystic fibrosis patients. Acta Biomedica 80: Journal of Physiotherapy 2011 Vol. 57 Australian Physiotherapy Association
6 Research Santos LJ (2010) Efeitos da manobra de hiperinsuflação manual associada à pressão positiva expiratória final em pacientes submetidos à cirurgia de revascularização miocárdica Revista Brasileira de Terapia Intensiva : 98. Savian C, Paratz J, Davies A (2006) Comparison of the effectiveness of manual and ventilator hyperinflation at different levels of positive end-expiratory pressure in artificially ventilated and intubated intensive care patients. Heart and Lung 35: Singer M, Vermaat J, Hall G, Latter G, Patel M (1994) Hemodynamic effects of manual hyperinflation in critically ill mechanically ventilated patients. Chest 106: Stiller K (2000) Physiotherapy in intensive care: towards an evidence-based practice. Chest 118: Unoki T, Kawasaki Y, Mizutani T, Fujino Y, Yanagisawa Y, Ishimatsu S, et al (2005) Effects of expiratory rib-cage compression on oxygenation, ventilation, and airwaysecretion removal in patients receiving mechanical ventilation. Respiratory Care 50: Vieira DF (2009) Implantação de Protocolo de Prevenção de Pneumonia Associada à Ventilação Mecânica: Impacto do cuidado não farmacológico. Cochrane Database of Systematic Reviews: 149. Submitting randomised trials to Journal of Physiotherapy Authors are reminded that Journal of Physiotherapy accepts only registered trials. All clinical trials submitted for publication must have been registered in a publicly-accessible trials register. We will accept any register that satisfies the International Committee of Medical Journal Editors requirements (such as The Australian Clinical Trial Registry at or the US trial register at ClinicalTrials.gov). Authors must provide the name and website address of the register and the trial registration number on submission. 26 Journal of Physiotherapy 2011 Vol. 57 Australian Physiotherapy Association 2011
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 informationA survey of the use of ventilator hyperinflation in Australian tertiary intensive care units
A survey of the use of ventilator hyperinflation in Australian tertiary intensive care units Diane M Dennis, Wendy J Jacob and Fiona D Samuel Manual hyperinflation (MHI) or bagging has been used by physiotherapists
More informationDaniela Aires Lemes, Walter Araújo Zin and Fernando Silva Guimarães. Federal University of Rio de Janeiro, Brazil
Lemes et al: Ventilator-induced hyperinflation in intensive care Hyperinflation using pressure support ventilation improves secretion clearance and respiratory mechanics in ventilated patients with pulmonary
More informationPHYSIOTHERAPY IN INTENSIVE CARE: how the evidence has changed since 2000 Kathy Stiller Physiotherapy Department Royal Adelaide Hospital Adelaide South Australia Kathy.Stiller@health.sa.gov.au Aim review
More informationCardiorespiratory Physiotherapy Tutoring Services 2017
VENTILATOR HYPERINFLATION ***This document is intended to be used as an information resource only it is not intended to be used as a policy document/practice guideline. Before incorporating the use of
More informationTHE USE OF MANUAL HYPERINFLATION BY PHYSIOTHERAPISTS IN SOUTH AFRICA DURING THE TREATMENT OF RESPIRATORY COMPROMISED PATIENTS IN INTENSIVE CARE
THE USE OF MANUAL HYPERINFLATION BY PHYSIOTHERAPISTS IN SOUTH AFRICA DURING THE TREATMENT OF RESPIRATORY COMPROMISED PATIENTS IN INTENSIVE CARE Gian Jacobs A research report submitted to the Faculty of
More informationin mmhg) and static lung compliance (in ml/cmh 2
Blattner et al: Early manual hyperinflation after surgery Oxygenation and static compliance is improved immediately after early manual hyperinflation following myocardial revascularisation: a randomised
More informationThe Use of Active Cycle of Breathing Technique (ACBT) In Pulmonary Physiotherapy: A Critical Review of the Literature Lauro G. Villegas Jr.
The Use of Active Cycle of Breathing Technique (ACBT) In Pulmonary Physiotherapy: A Critical Review of the Literature Lauro G. Villegas Jr., PTRP Keywords: Active Cycle of Breathing Technique (ACBT), Pulmonary
More informationTHE USE OF HYPERINFLATION IN THE MANAGEMENT OF INTUBATED AND VENTILATED ADULT PATIENTS RECOMMENDATIONS
THE USE OF HYPERINFLATION IN THE MANAGEMENT OF INTUBATED AND VENTILATED ADULT PATIENTS RECOMMENDATIONS Recommendation 1 on website Hyperinflation (Ventilator or manual) might be included in the management
More informationMechanically Ventilated Patients: A Randomized Crossover Trial
Expiratory Rib Cage Compression, Secretion Clearance and Respiratory Mechanics in Mechanically Ventilated Patients: A Randomized Crossover Trial Fernando S Guimarães, PT, PhD 1,2 ; Agnaldo J Lopes, MD,
More informationChest physiotherapy in mechanically ventilated patients without pneumonia a narrative review
Review Article Chest physiotherapy in mechanically ventilated patients without pneumonia a narrative review Herbert D. Spapen, Jouke De Regt, Patrick M. Honoré Department of Intensive Care, Universitair
More informationRespiratory and Hemodynamic Effects of Manual Hyperinflation in Mechanically Ventilated Critically Ill Patients
The Internet Journal of Anesthesiology 2009 : Volume 19 Number 2 Respiratory and Hemodynamic Effects of Manual Hyperinflation in Mechanically Ventilated Critically Ill Patients Arzu Genc Ph.D., PT Dokuz
More informationActive Cycle of Breathing Technique
Active Cycle of Breathing Technique Full Title of Guideline: Author (include email and role): Division & Speciality: Version: 3 Ratified by: Scope (Target audience, state if Trust wide): Review date (when
More informationThe objectives of this presentation are to
1 The objectives of this presentation are to 1. Review the mechanics of airway clearance 2. Understand the difference between secretion mobilization and secretion clearance 3. Identify conditions that
More informationORIGINAL ARTICLE. University of Washington, Seattle, USA 3 Professor, College of Nursing, Seoul National University, Seoul, Korea
ORIGINAL ARTICLE Chest Physiotherapy on the Respiratory Mechanics and Elimination of Sputum in Paralyzed and Mechanically Ventilated Patients With Acute Lung Injury: A Pilot Study Minhee Suh 1, RN, PhD,
More informationRespiratory physiotherapy in the critical care unit
Respiratory physiotherapy in the critical care unit Nim Pathmanathan MBChB FRCA Nicola Beaumont BHSc (Hons) Physiotherapy Andrew Gratrix MBChB FCARSCI FRCA FFICM Matrix reference 2C04, 3C00 Key points
More informationResponse of Mechanically Ventilated Respiratory Failure Patients to Respiratory Muscles Training
Med. J. Cairo Univ., Vol. 82, No. 1, March: 19-24, 2014 www.medicaljournalofcairouniversity.net Response of Mechanically Ventilated Respiratory Failure Patients to Respiratory Muscles Training AMANY R.
More informationAPILOT SURVEY OF THE CURRENT SCOPE OF PRACTICE OF SOUTH AFRICAN PHYSIOTHERAPISTS IN INTENSIVE CARE UNITS
P ILOT S TUDY APILOT SURVEY OF THE CURRENT SCOPE OF PRACTICE OF SOUTH AFRICAN PHYSIOTHERAPISTS IN INTENSIVE CARE UNITS ABSTRACT: Objective: A pilot study was conducted to determine the current scope of
More informationNON-INVASIVE VENTILATION. Lijun Ding 23 Jan 2018
NON-INVASIVE VENTILATION Lijun Ding 23 Jan 2018 Learning objectives What is NIV The difference between CPAP and BiPAP The indication of the use of NIV Complication of NIV application Patient monitoring
More informationImmediate Effects of Chest Physiotherapy on Hemodynamic, Metabolic, and Oxidative Stress Parameters in Subjects With Septic Shock
Immediate Effects of Chest Physiotherapy on Hemodynamic, Metabolic, and Oxidative Stress Parameters in Subjects With Septic Shock Rafael S dos Santos MSc, Márcio VF Donadio PhD, Gabriela V da Silva MSc,
More informationAM PM Side-lying Figure 1. Experimental procedure. The study was approved by the Ethics and Human Research Committee at the Austin Hospital. Informed
Head-down tilt and manual hyperinflation enhance sputum clearance in patients who are intubated and ventilated Susan Berney 1, Linda Denehy 2 and Jeff Pretto 3 1 Department of Physiotherapy, Austin Hospital
More informationRespiratory Physio Protocol for Paediatric Patients on BIPAP via a tracheotomy (uncuffed tube)
This is an official Northern Trust policy and should not be edited in any way Respiratory Physio Protocol for Paediatric Patients on BIPAP via a tracheotomy (uncuffed tube) Reference Number: NHSCT/12/547
More informationJennifer R Bishop, Odette J Erskine and Peter G Middleton
Timing of dornase alpha inhalation does not affect the efficacy of an airway clearance regimen in adults with cystic fibrosis: a randomised crossover trial Jennifer R Bishop, Odette J Erskine and Peter
More informationIPPB via the Servo I Guidelines for use in UCH Critical Care.
IPPB via the Servo I Guidelines for use in UCH Critical Care. Version 1.3 Document Control Summary Approved by & date Date of publication Review Date Creator & telephone details Distribution/availability
More informationPhysiotherapy Baseline 2 Side lying Baseline 3 Baseline 1 Side lying Baseline 2 Physiotherapy Baseline 3 Baseline 1 = 10 minutes steady state Baseline
The effect of physiotherapy treatment on oxygen consumption and haemodynamics in patients who are critically ill Susan Berney 1 and Linda Denehy 2 1 The Austin Hospital, Melbourne 2 The University of Melbourne
More informationWeb Appendix 1: Literature search strategy. BTS Acute Hypercapnic Respiratory Failure (AHRF) write-up. Sources to be searched for the guidelines;
Web Appendix 1: Literature search strategy BTS Acute Hypercapnic Respiratory Failure (AHRF) write-up Sources to be searched for the guidelines; Cochrane Database of Systematic Reviews (CDSR) Database of
More informationEarly 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 informationProtocol for performing chest clearance techniques by nursing staff
Protocol for performing chest clearance techniques by nursing staff Rationale The main indications for performing chest clearance techniques (CCT) are to assist in the removal of thick, tenacious secretions
More informationInterventional 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 informationBreathing exercises for chronic obstructive pulmonary disease (Protocol)
Breathing exercises for chronic obstructive pulmonary disease (Protocol) Holland AE, Hill C, McDonald CF This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration
More informationHigh Frequency Chest Wall Oscillation Devices
High Frequency Chest Wall Oscillation Devices Policy Number: Original Effective Date: MM.01.007 07/15/2003 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 12/18/2015 Section: DME
More informationThe effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation
Original Article The effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation Mitra Payami Bousarri 1, Yadolah Shirvani 2, Saeed
More informationCritical Care Therapy and Respiratory Care Section
Critical Care Therapy and Respiratory Care Section Category: Clinical Section: Bronchial Hygiene Title: Chest Physiotherapy Policy #: 01 Revised: 03/00 1.0 DESCRIPTION 1.1 Definition Chest physiotherapy
More informationEndobronchial valve insertion to reduce lung volume in emphysema
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Interventional procedure consultation document Endobronchial valve insertion to reduce lung volume in emphysema Emphysema is a chronic lung disease that
More informationLung Compliance and Arterial Blood Gases Response to Diaphragm Stretch in Intubated Patients
World Journal of Mical Sciences 13 (3): 165-169, 2016 ISSN 1817-3055 IDOSI Publications, 2016 DOI: 10.5829/idosi.wjms.2016.165.169 Lung Compliance and Arterial Blood Gases Response to Diaphragm Stretch
More informationQuickLung Breather Patient Settings
The QuickLung Breather is capable of simulating a spontaneously breathing patient in a variety of modes and patterns. In response to customer requests, we have compiled five common respiratory cases below.
More informationAFCH NEUROMUSCULAR DISORDERS (NMD) PROTOCOL
AFCH NEUROMUSCULAR DISORDERS (NMD) PROTOCOL A. Definition of Therapy: 1. Cough machine: 4 sets of 5 breaths with a goal of I:E pressures approximately the same of 30-40. Inhale time = 1 second, exhale
More informationBenefit of Selective Inspiratory Muscles Training on Respiratory Failure Patients
Available online at www.ijmrhs.com ISSN No: 2319-5886 International Journal of Medical Research & Health Sciences, 2017, 6(5): 49-54 Benefit of Selective Inspiratory Muscles Training on Respiratory Failure
More informationThorax Online First, published on February 14, 2008 as /thx Title page
Thorax Online First, published on February 14, 2008 as 10.1136/thx.2007.088195 Title page Title of the article: Chest physical therapy for children hospitalized with acute pneumonia: a randomized controlled
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Autogenic Drainage versus Acapella for Airway Clearance in Patients with Bronchiectasis: Randomized
More informationEffects of manual hyperinflation in preterm newborns under mechanical ventilation
ORIGINAL ARTICLE Camila Chaves Viana 1, Carla Marques Nicolau 1, Regina Celia Turola Passos Juliani 1, Werther Brunow de Carvalho 2, Vera Lucia Jornada Krebs 1 Effects of manual hyperinflation in preterm
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Cardiorespiratory Response to Chest Physiotherapy in Intensive Respiratory Care Unit Mariya
More informationInspiratory Resistance Decreases Limb Blood Flow in COPD Patients with Heart Failure
ERJ Express. Published on November 14, 2013 as doi: 10.1183/09031936.00166013 Letter to the Editor Inspiratory Resistance Decreases Limb Blood Flow in COPD Patients with Heart Failure Gaspar R. Chiappa
More informationRESPIRATORY REHABILITATION
RESPIRATORY REHABILITATION By: Dr. Fatima Makee AL-Hakak University of kerbala College of nursing CHEST PHYSIOTHERAPY Chest physiotherapy (CPT) includes: 1.Postural drainage. 2.Chest percussion and vibration.
More informationOxygenation. Chapter 45. Re'eda Almashagba 1
Oxygenation Chapter 45 Re'eda Almashagba 1 Respiratory Physiology Structure and function Breathing: inspiration, expiration Lung volumes and capacities Pulmonary circulation Respiratory gas exchange: oxygen,
More informationPulmo Waves Device for respiratory physiotherapy
MADE IN ITALY Pulmo Waves Device for respiratory physiotherapy Respiratory physiotherapy Accumulation of secretions in certain parts of the human respiratory system can take place for different reasons.
More informationThe Effect of the Duration of Pre-Oxygenation before Endotracheal Suction on Hemodynamic Symptoms
Global Journal of Health Science; Vol. 9, No. 2; 2017 ISSN 1916-9736 E-ISSN 1916-9744 Published by Canadian Center of Science and Education The Effect of the Duration of Pre-Oxygenation before Endotracheal
More informationMotor Neurone Disease NICE to manage Management of ineffective cough. Alex Long Specialist NIV/Respiratory physiotherapist June 2016
Motor Neurone Disease NICE to manage Management of ineffective cough Alex Long Specialist NIV/Respiratory physiotherapist June 2016 Content NICE guideline recommendations Respiratory involvement in MND
More informationNebulised hypertonic saline for cystic fibrosis.
Revista: Cochrane Database Syst Rev. 2003;(1):CD001506. Nebulised hypertonic saline for cystic fibrosis. Autor: Wark PA, McDonald V. Source: Department of Respiratory Medicine, John Hunter Hospital, Locked
More informationIPV INTRAPULMONARY PERCUSSIVE VENTILATION IPV 23/03/2013 IPV INTRAPULMONARY PERCUSSIVE VENTILATION
INTRAPULMONARY PERCUSSIVE VENTILATION INTRAPULMONARY PERCUSSIVE VENTILATION FT Vilma Donizetti Valduce Hospital FT Vilma Donizetti Rehabilitation Center Villa Beretta Costa Masnaga, Lecco (I) It s a ventilatory
More informationPrepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor
Mechanical Ventilation Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor 1 Definition Is a supportive therapy to facilitate gas exchange. Most ventilatory support requires an artificial airway.
More informationNIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP)
Introduction NIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP) Noninvasive ventilation (NIV) is a method of delivering oxygen by positive pressure mask that allows for the prevention or postponement of invasive
More informationPROCEDURE - Chest Physiotherapy Chest Physiotherapy Effective: 10/12/94 Revised: 10/31/14 Revised: 04/05/18 Chest Physiotherapy Purpose Policy
PROCEDURE - Page 1 of 10 Purpose Policy Physician's Order Indications Contraindications To standardize the use of chest physiotherapy as a form of therapy using one or more techniques to optimize the effects
More informationTerapias no farmacológicas de aclaramiento de la vía aérea y soporte respiratorio muscular en
Terapias no farmacológicas de aclaramiento de la vía aérea y soporte respiratorio muscular en el paciente ventilado: Estado del arte João Carlos Winck, MD, PhD Coordinator of the Respiratory Medicine Unit
More informationAlternative title: Confessions of a Mucus Enthusiast. Mechanical Insufflation Exsufflation for airway secretion clearance and lung expansion therapy
Mechanical Insufflation Exsufflation for airway secretion clearance and lung expansion therapy Alternative title: Confessions of a Mucus Enthusiast Marty Davig, RRT RCP Philips Respironics Inc. Objectives
More informationRESPIRATORY PHYSIOLOGY Pre-Lab Guide
RESPIRATORY PHYSIOLOGY Pre-Lab Guide NOTE: A very useful Study Guide! This Pre-lab guide takes you through the important concepts that where discussed in the lab videos. There will be some conceptual questions
More informationCHEST PHYSIOTHERAPY IN NICU PURPOSE POLICY STATEMENTS SITE APPLICABILITY PRACTICE LEVEL/COMPETENCIES. The role of chest physiotherapy in the NICU
PURPOSE The role of chest physiotherapy in the NICU POLICY STATEMENTS In principle chest physiotherapy should be limited to those infants considered most likely to benefit with significant respiratory
More informationMechanical 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 informationManual hyperinflation effects on respiratory parameters
PRI 5.3 3rd Proof 15/8/97 11:11 am Page 157 Physiotherapy Research International, 5(3) 157 171, 2000 Whurr Publishers Ltd 157 Manual hyperinflation effects on respiratory parameters SHANE PATMAN Royal
More informationPositive Expiratory pressure (PEP), Acapella and Flutter
Positive Expiratory pressure (PEP), Acapella and Flutter Full Title of Guideline: Author (include email and role): Division & Speciality: Version: 3 Ratified by: Scope (Target audience, state if Trust
More informationCitation for published version (APA): Schans, C. P. V. D. (1991). Physiotherapy and bronchial mucus transport s.n.
University of Groningen Physiotherapy and bronchial mucus transport van der Schans, Cees P. IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from
More informationThe Vigileo monitor by Edwards Lifesciences supports both the FloTrac Sensor for continuous cardiac output and the Edwards PreSep oximetry catheter
1 2 The Vigileo monitor by Edwards Lifesciences supports both the FloTrac Sensor for continuous cardiac output and the Edwards PreSep oximetry catheter for continuous central venous oximetry (ScvO2) 3
More informationVentilatory Effects of Manual Breathing Assist Technique (MBAT) and Shaking in Central Nervous System Disease Sufferers
Original Article Ventilatory Effects of Manual Breathing Assist Technique (MBAT) and Shaking in Central Nervous System Disease Sufferers J. Phys. Ther. Sci. 22: 209 215, 2010 HIDEAKI KURITA, MS, RPT 1,2),
More informationThe Winston Memorial Trust of Australia. Report by - Dr George Ntoumenopoulos 2002/2 Churchill Fellow
The Winston Memorial Trust of Australia Report by - Dr George Ntoumenopoulos 2002/2 Churchill Fellow The Bob and June Prickett Churchill Fellowship to study the effects of chest physiotherapy on mucociliary
More informationHigh Frequency Chest Wall Oscillation Devices
High Frequency Chest Wall Oscillation Devices Policy Number: Original Effective Date: MM.01.007 07/15/2003 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 10/24/2014 Section: DME
More informationREHABILITATION OF PATIENTS MANAGED IN ICU
REHABILITATION OF PATIENTS MANAGED IN ICU RECOMMENDATIONS Safety to mobilize / exercise: on the website Recommendation 1 All critically ill patients nursed in ICU should be screened closely before active
More informationThe 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 informationRecognizing and Correcting Patient-Ventilator Dysynchrony
2019 KRCS Annual State Education Seminar Recognizing and Correcting Patient-Ventilator Dysynchrony Eric Kriner BS,RRT Pulmonary Critical Care Clinical Specialist MedStar Washington Hospital Center Washington,
More informationCarole Wegner RN, MSN And Lori Leiser CRT
Airway Clearance Carole Wegner RN, MSN And Lori Leiser CRT Topics Suctioning and suctioning equipment Medications to facilitate t airway clearance Bronchial hygiene modalities Preparing for suctioning
More informationAnalysis of Three Oscillating Positive Expiratory Pressure Devices During Simulated Breathing
Analysis of Three Oscillating Positive Expiratory Pressure Devices During Simulated Breathing Doug Pursley, MEd, RRT-ACCS, FAARC Introduction Previous studies reporting performance characteristics of Oscillating
More informationPulmonary Rehabilitation in Acute Spinal Cord Injury. Jatuporn Jatutawanit Physical therapist, Physical therapy unit, Prince of songkla university
Pulmonary Rehabilitation in Acute Spinal Cord Injury Jatuporn Jatutawanit Physical therapist, Physical therapy unit, Prince of songkla university Causes of spinal cord injury Traumatic injury Motor vehicle
More informationRespiratory 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 informationChronic 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 informationNeuromuscular diseases (NMDs) include both hereditary and acquired diseases of the peripheral neuromuscular system. They are diseases of the
Neuromuscular diseases (NMDs) include both hereditary and acquired diseases of the peripheral neuromuscular system. They are diseases of the peripheral nerves (neuropathies and anterior horn cell diseases),
More informationClinical Study What Is the Best Pulmonary Physiotherapy Method in ICU?
Canadian Respiratory Journal Volume 2016, Article ID 4752467, 5 pages http://dx.doi.org/10.1155/2016/4752467 Clinical Study What Is the Best Pulmonary Physiotherapy Method in ICU? Ufuk Kuyrukluyildiz,
More informationHandling Common Problems & Pitfalls During. Oxygen desaturation in patients receiving mechanical ventilation ACUTE SEVERE RESPIRATORY FAILURE
Handling Common Problems & Pitfalls During ACUTE SEVERE RESPIRATORY FAILURE Pravit Jetanachai, MD QSNICH Oxygen desaturation in patients receiving mechanical ventilation Causes of oxygen desaturation 1.
More informationPositive expiratory pressure techniques in respiratory patients: old evidence and new insights
The ERS designates this educational activity for a maximum of 1 CME credit. For information on how to earn CME credits, see page 81, or visit www.ers-education.org/ breathe-cme.htm Positive expiratory
More informationApproach to type 2 Respiratory Failure
Approach to type 2 Respiratory Failure Changing Nature of NIV Not longer just the traditional COPD patients Increasingly Obesity Neuromuscular Pneumonias 3 fold increase in patients with Ph 7.25 and below
More informationCHEST PHYSIOTHERAPY IN MECHANICALLY VENTILATED INFANTS: A NARRATIVE LITERATURE REVIEW
ISSN: 2052-3297 CHEST PHYSIOTHERAPY IN MECHANICALLY VENTILATED INFANTS: A NARRATIVE LITERATURE REVIEW Jemma Scott School of Health Sciences, Robert Gordon University. j.scott6@rgu.ac.uk Fiona Roberts School
More informationTrial protocol - NIVAS Study
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Trial protocol - NIVAS Study METHODS Study oversight The Non-Invasive Ventilation after Abdominal Surgery
More informationObjectives. Health care significance of ARF 9/10/15 TREATMENT OF ACUTE RESPIRATORY FAILURE OF VARIABLE CAUSES: INVASIVE VS. NON- INVASIVE VENTILATION
TREATMENT OF ACUTE RESPIRATORY FAILURE OF VARIABLE CAUSES: INVASIVE VS. NON- INVASIVE VENTILATION Louisa Chika Ikpeama, DNP, CCRN, ACNP-BC Objectives Identify health care significance of acute respiratory
More informationCondensed version.
I m Stu 3 Condensed version smcvicar@uwhealth.org Listen 1. Snoring 2. Gurgling 3. Hoarseness 4. Stridor (inspiratory/expiratory) 5. Wheezing 6. Grunting Listen Crackles Wheezing Stridor Absent Crackles
More informationTest Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo
Instant dowload and all chapters Test Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo https://testbanklab.com/download/test-bank-pilbeams-mechanical-ventilation-physiologicalclinical-applications-6th-edition-cairo/
More informationI Need to Cough Ways to Keep Your Airways Clear
I Need to Cough Ways to Keep Your Airways Clear 2018 Annual Cure SMA Conference Richard Kravitz, MD Duke University School of Medicine Duke University Medical Center Durham, North Carolina Presenters Jane
More informationChapter 10 The Respiratory System
Chapter 10 The Respiratory System Biology 2201 Why do we breathe? Cells carry out the reactions of cellular respiration in order to produce ATP. ATP is used by the cells for energy. All organisms need
More informationRESPIRATORY COMPLICATIONS AFTER SCI
SHEPHERD.ORG RESPIRATORY COMPLICATIONS AFTER SCI NORMA I RIVERA, RRT, RCP RESPIRATORY EDUCATOR SHEPHERD CENTER 2020 Peachtree Road, NW, Atlanta, GA 30309-1465 404-352-2020 DISCLOSURE STATEMENT I have no
More informationWhat 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 informationParamedic Rounds. Pre-Hospital Continuous Positive Airway Pressure (CPAP)
Paramedic Rounds Pre-Hospital Continuous Positive Airway Pressure (CPAP) Morgan Hillier MD Class of 2011 Dr. Mike Peddle Assistant Medical Director SWORBHP Objectives Outline evidence for pre-hospital
More informationSmall Volume Nebulizer Treatment (Hand-Held)
Small Volume Aerosol Treatment Page 1 of 6 Purpose Policy Physician's Order Small Volume Nebulizer Treatment To standardize the delivery of inhalation aerosol drug therapy via small volume (hand-held)
More informationLevine Children s Hospital. at Carolinas Medical Center. Respiratory Care Department
Page 1 of 7 at Carolinas Medical Center 02.04 Pediatric Patient-Centered Respiratory Care Protocol Application of Chest Physical Therapy Created: 1/98 Reviewed: 4/03, 1/05, 6/08 Revised: Purpose: To describe
More informationCorporate Medical Policy
Corporate Medical Policy Oscillatory Devices for the Treatment of Respiratory Conditions File Name: Origination: Last CAP Review: Next CAP Review: Last Review: oscillatory_devices_for_treatment_of_respiratory_conditions
More informationPositive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis (Review)
Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis (Review) Elkins MR, Jones A, van der Schans C This is a reprint of a Cochrane review, prepared and maintained
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
of Cystic Fibrosis and Other Respiratory Disorders Page 1 of 23 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Oscillatory Devices for the Treatment of Cystic Fibrosis
More informationCLINICAL CONSIDERATIONS FOR THE BUNNELL LIFE PULSE HIGH-FREQUENCY JET VENTILATOR
CLINICAL CONSIDERATIONS FOR THE BUNNELL LIFE PULSE HIGH-FREQUENCY JET VENTILATOR 801-467-0800 Phone 800-800-HFJV (4358) Hotline TABLE OF CONTENTS Respiratory Care Considerations..3 Physician Considerations
More informationA repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients
Collings and Cusack BMC Anesthesiology 2015, 15:1 RESEARCH ARTICLE Open Access A repeated measures, randomised cross-over trial, comparing the acute exercise response between passive and active sitting
More informationCystic Fibrosis Complications ANDRES ZIRLINGER, MD STANFORD UNIVERSITY MEDICAL CENTER MARCH 3, 2012
Cystic Fibrosis Complications ANDRES ZIRLINGER, MD STANFORD UNIVERSITY MEDICAL CENTER MARCH 3, 2012 INTRODUCTION PNEUMOTHORAX HEMOPTYSIS RESPIRATORY FAILURE Cystic Fibrosis Autosomal Recessive Genetically
More informationMASTER SYLLABUS
MASTER SYLLABUS 2018-2019 A. Academic Division: Health Science B. Discipline: Respiratory Care C. Course Number and Title: RESP 2490 Practicum IV D. Course Coordinator: Tricia Winters, BBA, RRT, RCP Assistant
More informationCompetency Title: Continuous Positive Airway Pressure
Competency Title: Continuous Positive Airway Pressure Trainee Name: ------------------------------------------------------------- Title: ---------------------------------------------------------------
More informationCOPD Manual Diaphragm Manipulation
COPD Manual Diaphragm Manipulation Journal of Physiotherapy 61 (2015) 182 189 Journal of PHYSIOTHERAPY journal homepage: www.elsevier.com/locate/jphys Research The Manual Diaphragm Release Technique improves
More information