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Pediatrics and Neonatology Jul 2022Respiratory distress syndrome (RDS) is the major cause of respiratory failure in preterm infants due to immature lung development and surfactant deficiency. Although the... (Review)
Review
Respiratory distress syndrome (RDS) is the major cause of respiratory failure in preterm infants due to immature lung development and surfactant deficiency. Although the concepts and methods of managing respiratory problems in neonates have changed continuously, determining appropriate respiratory treatment with minimal ventilation-induced lung injury and complications is crucially important. This review summarizes neonatal respiratory therapy's advances and available strategies (i.e., exogenous surfactant therapy, noninvasive ventilation, and different ventilation modes), focusing on RDS management.
Topics: Humans; Infant; Infant, Newborn; Infant, Premature; Interactive Ventilatory Support; Noninvasive Ventilation; Respiratory Distress Syndrome, Newborn; Surface-Active Agents
PubMed: 35382987
DOI: 10.1016/j.pedneo.2022.02.002 -
Revue Des Maladies Respiratoires Jun 2022Congestion of the upper (URT) and lower respiratory tracts (LRT) is a common symptom in several acute and chronic respiratory diseases that occur in childhood. To... (Review)
Review
Congestion of the upper (URT) and lower respiratory tracts (LRT) is a common symptom in several acute and chronic respiratory diseases that occur in childhood. To eliminate these secretions, airway clearance techniques (ACT) directed to the URT and LRT are frequently prescribed. The rationale for the application of these techniques is the same as in adults, but they need to be adapted to be transposed to children. The physiotherapist will be able to choose among a wide range of techniques, of which the most adequate will depend not only on the age of the child and the indication, but also on the basis of his preferences or habits, as well as those of the child. Upper airway clearance, including nasal irrigation, is now recommended for acute and chronic rhinosinusitis in children. It is also one of the symptomatic treatments recommended for infants with acute bronchiolitis. For LRT clearance, several indications, such as cystic fibrosis, primary ciliary dyskinesia and neuromuscular disease, are now widely advocated. Conversely, other indications, such as for infants with acute viral bronchiolitis, are highly controversial. Thoughtful application of these techniques is lacking in robust and precise tools to objectively assess the presence of bronchial congestion, and to treat it accordingly. Similarly, no precise and reliable evaluation of the effectiveness of these ACTs is available to date. This review is designed to explore the ACTs used by physiotherapists, to provide an overview of their current indications, and to consider complementary approaches.
Topics: Adult; Child; Cystic Fibrosis; Humans; Infant; Neuromuscular Diseases; Physical Therapy Modalities; Respiration Disorders; Respiratory Therapy
PubMed: 35738979
DOI: 10.1016/j.rmr.2022.05.001 -
Medizinische Klinik, Intensivmedizin... Nov 2021Weaning from invasive mechanical ventilation is challenging for the ICU team in terms of shortening time of ventilation via endotracheal tube in order to improve the...
Weaning from invasive mechanical ventilation is challenging for the ICU team in terms of shortening time of ventilation via endotracheal tube in order to improve the patient's prognosis by early extubation. Thereby prolonged mechanical ventilation (> 14 days), which is associated with risk of tracheotomy and prolonged weaning, shall be avoided. This article will give an overview about weaning categories, causes for weaning failure and strategies to overcome this problem. In the last part we will cover concepts in the process of prolonged weaning including discharge management with invasive mechanical ventilation.
Topics: Airway Extubation; Humans; Noninvasive Ventilation; Respiration, Artificial; Tracheostomy; Ventilator Weaning
PubMed: 34586430
DOI: 10.1007/s00063-021-00858-5 -
Anesthesiology Feb 2021Acute Respiratory Distress Syndrome (ARDS) is defined as the rapid onset of non-cardiogenic pulmonary edema resulting in respiratory failure and hypoxemia. Efforts over... (Review)
Review
Acute Respiratory Distress Syndrome (ARDS) is defined as the rapid onset of non-cardiogenic pulmonary edema resulting in respiratory failure and hypoxemia. Efforts over the past 25 years, such as those of the ARDS and Prevention and Early Treatment of Acute Lung Injury (PETAL) Networks, have demonstrated a praiseworthy collaboration to further optimize the management of ARDS. However, improvements have been only moderate and ARDS remains a leading cause of mortality in the perioperative and critical care setting. Recently, the significant morbidity and mortality of ARDS have been emphasized by its high incidence in Coronavirus Disease 2019 (COVID-19) patients. A major hurdle to reducing ARDS mortality is that current treatment is limited to preventive measures – such as the use of lung-protective ventilation. Therapeutic approaches targeting the underlying inflammatory lung disease are areas of intensive research, but have not been clinically implemented. Nevertheless, basic science and clinical research efforts that are aimed at identifying novel treatment approaches and further improving outcomes for ARDS are ongoing. Here, we review evidence-based management approaches for ARDS, while highlighting those being investigated or heavily utilized in ARDS associated with COVID-19.
Topics: Adrenal Cortex Hormones; COVID-19; Extracorporeal Membrane Oxygenation; Humans; Oxygen Inhalation Therapy; Prone Position; Respiration, Artificial; Respiratory Distress Syndrome; Respiratory Therapy
PubMed: 33016981
DOI: 10.1097/ALN.0000000000003571 -
Respiratory Medicine May 2020Bronchiectasis is a complex, chronic respiratory condition, characterized by frequent cough and exertional dyspnea due to a range of conditions that include inherited... (Review)
Review
Bronchiectasis is a complex, chronic respiratory condition, characterized by frequent cough and exertional dyspnea due to a range of conditions that include inherited mucociliary defects, inhalational airway injury, immunodeficiency states and prior respiratory infections. For years, bronchiectasis was classified as either being caused by cystic fibrosis or non-cystic fibrosis. Non-cystic fibrosis bronchiectasis, once considered an orphan disease, is more prevalent worldwide in part due to greater availability of chest computed tomographic imaging. Identification of the cause of non-cystic fibrosis bronchiectasis with the use of chest imaging, laboratory testing, and microbiologic assessment of airway secretions can lead to initiation of specific therapies aimed at slowing disease progression. Nonpharmacologic therapies such as airway clearance techniques and pulmonary rehabilitation improve patient symptoms. Inhaled corticosteroids should not be routinely prescribed unless concomitant asthma or COPD is present. Inhaled antibiotics prescribed to individuals with >3 exacerbations per year are well tolerated, reduce airway bacteria load and may reduce the frequency of exacerbations. Likewise, chronic macrolide therapy reduces the frequency of exacerbations. Medical therapies for cystic fibrosis bronchiectasis may not be effective in treatment of non-cystic fibrosis bronchiectasis.
Topics: Administration, Inhalation; Anti-Bacterial Agents; Bronchiectasis; Cystic Fibrosis; Disease Progression; Humans; Rare Diseases; Respiratory System; Respiratory Therapy; Respiratory Tract Infections; Tomography, X-Ray Computed
PubMed: 32250872
DOI: 10.1016/j.rmed.2020.105940 -
Thorax Jul 2019The CIRO Academy in Horn (the Netherlands) organised a 2-day meeting to present and discuss the studies published in 2017 pertaining to key priority areas of respiratory... (Review)
Review
The CIRO Academy in Horn (the Netherlands) organised a 2-day meeting to present and discuss the studies published in 2017 pertaining to key priority areas of respiratory and critical care medicine. This review summarises studies focussing on pulmonary rehabilitation and exercise training, physical activity, chronic respiratory failure and palliative respiratory care published in 2017.
Topics: Exercise; Exercise Therapy; Home Care Services, Hospital-Based; Humans; Lung Diseases, Interstitial; Nutrition Therapy; Oxygen Inhalation Therapy; Palliative Care; Pulmonary Disease, Chronic Obstructive; Respiratory Insufficiency; Respiratory Therapy
PubMed: 30872364
DOI: 10.1136/thoraxjnl-2018-212044 -
Respiratory Care Jul 2021Evidence-based medicine is the integration of individual clinical expertise with the best available research and the patient's values and expectations. The efficient... (Review)
Review
Evidence-based medicine is the integration of individual clinical expertise with the best available research and the patient's values and expectations. The efficient approach to finding the best evidence is to identify systematic reviews or evidence-based clinical practice guidelines. Respiratory therapies that are supported by evidence include lung-protective ventilation and noninvasive ventilation for individuals with COPD. Evidence does not support postoperative incentive spirometry or intermittent mandatory ventilation. The principles of evidence-based medicine are a valuable approach to respiratory care practice.
Topics: Evidence-Based Medicine; Humans; Physical Therapy Modalities; Respiration, Artificial; Respiratory Therapy
PubMed: 33824175
DOI: 10.4187/respcare.08950 -
Heart & Lung : the Journal of Critical... 2022Active cycle breathing technique (ACBT), which includes cycle of breathing control, thoracic expansion exercises and forced expiratory technique (FET), appears to have... (Review)
Review
BACKGROUND
Active cycle breathing technique (ACBT), which includes cycle of breathing control, thoracic expansion exercises and forced expiratory technique (FET), appears to have beneficial effects in patients with a variety of respiratory diseases. This systematic review provides an update on the new related studies, expanding the evidence base through the last 12 years and specifically evaluating the effectiveness of ACBT on pulmonary function-related outcome variables in patients with chronic respiratory diseases.
METHODS
MEDLINE/Pubmed, PEDro, and Cochrane Library for Randomized Controlled Trials were searched between September 2008 and December 2021, in continuance of a previous systematic review, to identify randomized clinical trials and/or crossover studies comparing ACBT to other respiratory treatment techniques in patients with chronic obstructive pulmonary diseases, cystic fibrosis, or bronchiectasis.
RESULTS
Eleven studies were included and the quality of most of them was moderate to good. The outcomes most frequently assessed were forced expiratory volume in 1 s (FEV), sputum wet weight, forced vital capacity (FVC), and peak expiratory flow rate. Secondary outcomes were quality of life and dyspnea. Various comparators were identified and most of them assessed the ACBT as an effective method in comparison with other respiratory treatment modalities. Most studies revealed that ACBT/FET had at least an equally beneficial short-term effect on sputum wet weight, FEV and FVC compared to other treatment methods.
CONCLUSION
The results of this updating review reinforced the data of a previous systematic review regarding the beneficial impact of ACBT for the short-term improvement in respiratory tract secretions clearance and pulmonary function. ACBT is effective in increasing the expectorated sputum volume, in reducing viscoelasticity of the secretion and in relieving symptoms such as dyspnea.
Topics: Bronchiectasis; Drainage, Postural; Humans; Quality of Life; Respiratory Therapy; Sputum
PubMed: 35235877
DOI: 10.1016/j.hrtlng.2022.02.006 -
European Respiratory Review : An... Dec 2020Respiratory physiotherapists have a key role within the integrated care continuum of patients with respiratory diseases. The current narrative review highlights the... (Review)
Review
Respiratory physiotherapists have a key role within the integrated care continuum of patients with respiratory diseases. The current narrative review highlights the profession's diversity, summarises the current evidence and practice, and addresses future research directions in respiratory physiotherapy. Herein, we describe an overview of the areas that respiratory physiotherapists can act in the integrated care of patients with respiratory diseases based on the Harmonised Education in Respiratory Medicine for European Specialists syllabus. In addition, we highlight areas in which further evidence needs to be gathered to confirm the effectiveness of respiratory therapy techniques. Where appropriate, we made recommendations for clinical practice based on current international guidelines.
Topics: Forecasting; Humans; Physical Therapists; Physical Therapy Modalities; Respiratory Therapy
PubMed: 33328280
DOI: 10.1183/16000617.0264-2020 -
Respirology (Carlton, Vic.) Mar 2019This paper aims to provide physiological rationale for airway clearance, mucoactive therapy and pulmonary rehabilitation (PR) (or exercise interventions) in... (Review)
Review
This paper aims to provide physiological rationale for airway clearance, mucoactive therapy and pulmonary rehabilitation (PR) (or exercise interventions) in bronchiectasis. There is increasing emphasis on the role of airway clearance techniques (ACT) in the management of bronchiectasis. No single ACT has currently shown superior effect over another. Given the large range of different techniques available, consideration of the physiological effects underpinning a technique including expiratory flow, ventilation and oscillation, is essential to effectively personalize ACT. Key clinical trials of mucoactives in bronchiectasis are underway and will provide clarity on the role of these agents in the management of patients with bronchiectasis. Prescription of mucoactive therapies should be done in conjunction with ACT and therefore the mechanism of action of mucoactive drugs and their timing with ACT should be taken into consideration. PR and/or exercise training are recommended in all current bronchiectasis guidelines. There is a clear physiological rationale that muscle weakness and physical inactivity may play a role in disease progression as well as impacting health-related quality of life, frequency of pulmonary exacerbations and ability to mobilize sputum. However, there are residual unanswered questions surrounding the delivery and accessibility to PR. This review summarizes the physiological principles and supporting evidence for airway clearance, mucoactive medication and PR, which are key components in the management of bronchiectasis.
Topics: Breathing Exercises; Bronchiectasis; Disease Progression; Exercise Therapy; Expectorants; Humans; Mucociliary Clearance; Quality of Life; Respiratory Therapy; Sputum
PubMed: 30650472
DOI: 10.1111/resp.13459