Physiospot CardioRespiratory

Pulmonary Effects of Noninvasive Ventilation Combined with the Recruitment Maneuver after Cardiac Surgery

Serdar Celebi, Özge Köner, Ferdi Menda, O uz Omay, lhan Günay, Kaya Suzer, and Nahit Cakar

The authors evaluated the pulmonary effects of non-invasive ventilation (NIV) with or without a recruitment manoeuvre (RM) in a group of patients following coronary artery bypass graft surgery. Patients excluded were those with pre-existing pulmonary disease, age > 65 years, ejection fraction < 40%, BMI > 30Kg/M2 and current smokers. The study sample was divided into 4 groups; RM, RM and NIV, NIV and a control group.

NIV together with RM was associated with better oxygenation during and after mechanical ventilation while NIV either alone or together with RM showed better early pulmonary function tests and lower atelectasis scores when compared to the control group. However there was no difference between the groups in terms of; duration of mechanical ventilation, length of ICU or hospital stay.NIV combined with RM is recommended to prevent postoperative atelectasis and hypoxaemia, but lacks justification as a routine intervention as it would seem not to reduce length of ICU or hospital stay in the above sample of patients.

Anaesthesia and Analgesia 2008; 107: 614 – 619

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Early intensive care unit mobility therapy in the treatment of acute respiratory failure.

Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, Penley L, Howard A, Dixon L, Leach S, Small R, Hite RD, Haponik E.

This study included 330 (divided into two groups, usual care and mobility protocol) medical intensive care unit patients with acute respiratory failure requiring mechanical ventilation on admission. An intensive care unit Mobility Team (critical care nurse, nursing assistant, physical therapist) initiated a mobility protocol within 48 hrs of mechanical ventilation. Protocol patients were out of bed earlier (5 vs. 11 days), had therapy initiated more frequently in the intensive care unit (91% vs. 13%), and had similar low complication rates compared with Usual Care. In addition protocol patients had shorter intensive care unit length of stay (5.5 vs. 6.9 days); hospital length of stay (11.2 vs. 14.5 days).

There were no untoward events during an intensive care unit Mobility session and no cost difference. The authors concluded that a Mobility Team using a mobility protocol initiated earlier physical therapy that was feasible, safe, did not increase costs and was associated with decreased intensive care unit and hospital length of stay in survivors who received physical therapy during intensive care unit treatment compared with patients who received usual care.

Critical Care Medicine 2008; 36 (8): 2238 – 2243

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Detecting oxygen desaturation in patients with COPD: Incremental versus endurance shuttle walking

C.J. Sandland, M.D.L. Morgan, S.J. Singh

This study compared the relative desaturation between the incremental shuttle walking test and the constant speed walking test and response to ambulatory oxygen to detect the relative oxygen desaturation in patients with chronic obstructive pulmonary disease.  Outcome measures were recorded following a 7-week pulmonary rehabilitation programme.  The results showed that incremental and endurance walking provokes significant desaturation and that there is a short-term benefit of oxygen versus air in enhancing exercise performance and there was no significant difference in the level of desaturation between tests.

The incremental shuttle walking test is a suitable exercise test that can be used to evaluate desaturation and is practically more realistic.

Respiratory Medicine, 2008, 102(8), 1148-1152

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Improvement in health status following bronchopulmonary hygiene physical therapy in patients with bronchiectasis

Kugathasan Mutalithas, Gillian Watkin, Briony Willig, Andrew Wardlaw, Ian D. Pavord, Surinder S. Birring

This study evaluates the impact of Bronchopulmonary hygiene physical therapy on health-related quality of life in patients with non-cystic fibrosis bronchiectasis.  All of the 53 patients with bronchiectasis complained of cough as the major symptom and cough-related health status was reduced at baseline. After treatment there were significant improvements in cough symptoms and cough-related health status.

Bronchopulmonary hygiene physical therapy can lead to a significant improvement in cough-related quality of life.

Respiratory Medicine, 2008, 102(8), 1140-1144

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Home-based exercise increases exercise capacity but not quality of life in people with chronic heart failure: a systematic review

Chien CL, Lee CM, Wu YW, Chen TA, Wu YT.

The authors did a systematic review of the literature to determine if home-based exercise was safe and effective in improving exercise capacity and quality of life in people with chronic heart failure. Studies included for analysis were those with adult participants with chronic heart failure (based on clinical presentation or left ventricular ejection fraction), who participated in home based aerobic exercises with or without resistance exercises.

Of the studies included for analysis the majority of participants had clinically stable (NYHA class II or III) heart failure, with ejection fractions ≤ 40%. Exercise was at low to moderate intensity 40 – 70% of maximum heart rate. These studies showed a significant benefit to exercise capacity, but did not demonstrate an improved quality of life. Hospitalisations were not adversely affected suggesting that home based exercise is safe.

Australian Journal of Physiotherapy 2008; 54: 87 - 93

Position affects distribution of ventilation in the lungs of older people: an experimental study

Krieg S., Alison J.A., McCarren B., Cowell S.

Ten healthy adults older than 65 years were assessed for the effect of sitting and right side lying on the distribution of ventilation during tidal volume breathing. In sitting 9% more ventilation went to the right lung while the cranial – caudal distribution was greatest in the middle region followed by the basal region with least distribution to the apical region. In right side lying ventilation to the right lung was 32% more than to the left lung. The cranial-caudal distribution in this position was once again most distribution to the middle region, followed by the basal region and least to the apical region.

Clinical relevance: It is possible in the older adult that closing volume affects distribution of ventilation to the most gravity dependant regions of the lung which may mean modifying positions when basal regions are being treated.

Australian Journal of Physiotherapy 2007; 53: 179 – 184

Efficacy of clinical guideline implementation to improve the appropriateness of chest physiotherapy prescription among inpatients with community-acquired pneumonia.

Guessous I, Cornuz J, Stoianov R, Burnand B, Fitting JW, Yersin B, Lamy O

The purpose of this study was to measure and compare the efficacy of two modalities of chest physiotherapy (CP) guideline implementation on the appropriateness of CP prescription among patients hospitalised for community-acquired pneumonia (CAP). The CP prescription rate and duration was measured in all consecutive admitted CAP inpatients during three consecutive one-year time periods: (1) before any guideline implementation; (2) after a passive implementation by medical grand rounds and guideline diffusion through mailing; (3) after adding a one-page reminder in the CAP patient's medical chart highlighting our recommendations.

Both passive and active implementation of guidelines appear to improve the appropriateness of CP prescription among inpatients with CAP without impairing their outcomes. Restricting CP use to patients who benefit from this treatment might be an opportunity to decrease CAP medical cost and workload.

Respiratory Medicine, 2008 Jul 9, online article ahead of print

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Relationship between Expiratory Activity of the Lateral Abdominal Muscle and Exercise Tolerance in Chronic Obstructive Pulmonary Disease

Hideo Kaneko, Hitoshi Maruyama and Hironori Sato

The purpose of this study was to investigate the relationship between the expiratory activity of the lateral abdominal muscle during quiet breathing and exercise tolerance in COPD patients. The expiratory activity of the lateral abdominal muscle and exercise tolerance were measured in 15 COPD and 15 healthy subjects. Expiratory activity was higher in COPD patients than in healthy subjects, and a moderate significant negative correlation was found between expiratory activity and the distance walked. However, there was no significant correlation between expiratory activity and exercise tolerance.

The results indicate that exercise intolerance may be more important factors than airflow limitation in expiratory muscle activity during quiet breathing in advanced COPD patients.

Journal of Physical Therapy Science, 2008, 20(2), 147-151

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