-
Respiration; International Review of... 2021Currently, consensus on the effectiveness of incentive spirometry (IS) following cardiac, thoracic, and upper abdominal surgery has been based on randomized controlled... (Meta-Analysis)
Meta-Analysis
Use of Incentive Spirometry in Adults following Cardiac, Thoracic, and Upper Abdominal Surgery to Prevent Post-Operative Pulmonary Complications: A Systematic Review and Meta-Analysis.
BACKGROUND
Currently, consensus on the effectiveness of incentive spirometry (IS) following cardiac, thoracic, and upper abdominal surgery has been based on randomized controlled trials (RCTs) and systematic reviews of lower methodological quality. To improve the quality of the research and to account for the effects of IS following thoracic surgery, in addition to cardiac and upper abdominal surgery, we performed a meta-analysis with thorough application of the Grading of Recommendations Assessment, Development and Evaluation scoring system and extensive reference to the Cochrane Handbook for Systematic Reviews of Interventions.
OBJECTIVE
The objective of this study was to determine, with rigorous methodology, whether IS for adult patients (18 years of age or older) undergoing cardiac, thoracic, or upper abdominal surgery significantly reduces30-day post-operative pulmonary complications (PPCs), 30-day mortality, and length of hospital stay (LHS) when compared to other rehabilitation strategies.
METHODS
The literature was searched using Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Web of Science for RCTs between the databases' inception and March 2019. A random-effect model was selected to calculate risk ratios (RRs) with 95% confidence intervals (CIs).
RESULTS
Thirty-one RCTs involving 3,776 adults undergoing cardiac, thoracic, or upper abdominal surgery were included. By comparing the use of IS to other chest rehabilitation strategies, we found that IS alone did not significantly reduce 30-day PPCs (RR = 1.00, 95% CI: 0.88-1.13) or 30-day mortality (RR = 0.73, 95% CI: 0.42-1.25). Likewise, there was no difference in LHS (mean difference = -0.17,95% CI: -0.65 to 0.30) between IS and the other rehabilitation strategies. None of the included trials significantly impacted the sensitivity analysis and publication bias was not detected.
CONCLUSIONS
This meta-analysis showed that IS alone likely results in little to no reduction in the number of adult patients with PPCs, in mortality, or in the LHS, following cardiac, thoracic, and upper abdominal surgery.
Topics: Abdomen; Adolescent; Adult; Humans; Length of Stay; Motivation; Postoperative Complications; Respiratory Therapy; Spirometry
PubMed: 34274935
DOI: 10.1159/000517012 -
Chest May 2023Common, operational definitions are crucial to assess interventions and outcomes related to pediatric mechanical ventilation. These definitions can reduce unnecessary...
BACKGROUND
Common, operational definitions are crucial to assess interventions and outcomes related to pediatric mechanical ventilation. These definitions can reduce unnecessary variability among research and quality improvement efforts, to ensure findings are generalizable, and can be pooled to establish best practices.
RESEARCH QUESTION
Can we establish operational definitions for key elements related to pediatric ventilator liberation using a combination of detailed literature review and consensus-based approaches?
STUDY DESIGN AND METHODS
A panel of 26 international experts in pediatric ventilator liberation, two methodologists, and two librarians conducted systematic reviews on eight topic areas related to pediatric ventilator liberation. Through a series of virtual meetings, we established draft definitions that were voted upon using an anonymous web-based process. Definitions were revised by incorporating extracted data gathered during the systematic review and discussed in another consensus meeting. A second round of voting was conducted to confirm the final definitions.
RESULTS
In eight topic areas identified by the experts, 16 preliminary definitions were established. Based on initial discussion and the first round of voting, modifications were suggested for 11 of the 16 definitions. There was significant variability in how these items were defined in the literature reviewed. The final round of voting achieved ≥ 80% agreement for all 16 definitions in the following areas: what constitutes respiratory support (invasive mechanical ventilation and noninvasive respiratory support), liberation and failed attempts to liberate from invasive mechanical ventilation, liberation from respiratory support, duration of noninvasive respiratory support, total duration of invasive mechanical ventilation, spontaneous breathing trials, extubation readiness testing, 28 ventilator-free days, and planned vs rescue use of post-extubation noninvasive respiratory support.
INTERPRETATION
We propose that these consensus-based definitions for elements of pediatric ventilator liberation, informed by evidence, be used for future quality improvement initiatives and research studies to improve generalizability and facilitate comparison.
Topics: Humans; Child; Respiration, Artificial; Ventilator Weaning; Ventilators, Mechanical; Research Design; Airway Extubation
PubMed: 36563873
DOI: 10.1016/j.chest.2022.12.010 -
European Journal of Physical and... Oct 2020Patients with chronic obstructive pulmonary disease (COPD) often suffer from expectoration. To address this problem, active cycle of breathing techniques (ACBT) can be...
INTRODUCTION
Patients with chronic obstructive pulmonary disease (COPD) often suffer from expectoration. To address this problem, active cycle of breathing techniques (ACBT) can be applied. However, the effects of ACBT on COPD patients have shown mixed results. Therefore, we investigated the effectiveness of ACBT in patients with COPD by conducting a systematic review of the literature.
EVIDENCE ACQUISITION
Seven electronic databases (PubMed, Web of Science, Embase, CINAHL, China National Knowledge Infrastructure [CNKI], Chinese Biomedical Literature [CBM], and Wanfang Database) were carefully searched from August 17 to 19, 2019.
EVIDENCE SYNTHESIS
The search yielded 2224 records, and ultimately only eight articles were selected for analysis. A total of 390 patients were included in the eight studies. The intervention program is a comparison of ACBT with non-ACBT. For COPD patients, ACBT was more effective in sputum production and cough efficiency. Compared with usual care, ACBT may improve lung function, blood gas analysis, and other parameters.
CONCLUSIONS
Our systematic review found that ACBT can effectively improve the sputum production and cough efficiency in patients with COPD. However, there was no definite conclusion on the effectiveness of ACBT on lung function, blood gas analysis and other aspects. More research and quantitative analyses are needed to confirm the effectiveness of ACBT on other aspects of COPD patient.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Respiratory Therapy
PubMed: 32397703
DOI: 10.23736/S1973-9087.20.06144-4 -
Pneumologie (Stuttgart, Germany) Sep 2019
Topics: Humans; Noninvasive Ventilation; Practice Guidelines as Topic; Respiration, Artificial; Respiratory Insufficiency
PubMed: 31533176
DOI: 10.1055/a-0760-7092 -
Jornal Brasileiro de Pneumologia :... Feb 2021
Topics: COVID-19; Humans; Respiratory Therapy; Telemedicine
PubMed: 33656096
DOI: 10.36416/1806-3756/e20210034 -
Respiratory Care Dec 2021In order to determine, document, and communicate the value of respiratory therapists performing respiratory care procedures, the respiratory care profession needs to...
In order to determine, document, and communicate the value of respiratory therapists performing respiratory care procedures, the respiratory care profession needs to position itself to capture and report both time and value standards that can be applied in allocating respiratory care resources. To do this, we propose a new metric called value-efficiency. If we wish to use value-efficiency as a metric to justify respiratory care activities and support labor budgets, there are three key considerations: (1) What value does respiratory care add to the health care organization? (2) Are the interventions provided necessary and of clinical value? (3) What is the value of the respiratory therapist in the delivery of these services? Significant challenges are facing the respiratory care profession and a focus on value-efficiency is a direction the profession must pursue. This approach is a practical response to the increasing demands of payers, administrators, consultants, and patients.
Topics: Allied Health Personnel; Humans; Respiratory Therapy
PubMed: 34521760
DOI: 10.4187/respcare.09100 -
Journal of Ethnopharmacology Dec 2021Inhalations with thermal waters are an old therapeutic method used in the therapy of respiratory diseases as a treatment of choice showing a long-lasting outcome with no... (Review)
Review
ETHNOPHARMACOLOGICAL RELEVANCE
Inhalations with thermal waters are an old therapeutic method used in the therapy of respiratory diseases as a treatment of choice showing a long-lasting outcome with no side effects. Paradoxically, there is little well-established research on their mechanisms of action.
AIM OF THE STUDY
The aim of this paper is therefore to summarize the influence of inhalatory treatment with thermal waters on the main symptoms and features of respiratory disorders including allergy-like symptoms, inflammation, oxidant-anti-oxidant balance, cellular influx, disturbed mucus secretions, recurrent infections, pulmonary and nasal function and quality of life. A short history of inhalations is also presented.
MATERIALS AND METHODS
The present paper is a sum-up of research articles on the use of inhalations with thermal waters in respiratory disorders.
RESULTS
According to the herein presented literature, the use of thermal water inhalations is beneficial for almost all manifestations of respiratory diseases. The mode of their action remains still unclear; however, it seems that the most important one relies on the restoration of proper defense mechanisms of the organism.
CONCLUSIONS
Inhalations with thermal waters alleviate symptoms of respiratory diseases. They also improve the quality of life of the patients and seem to be a good add-on therapy in the treatment of disorders of the respiratory system.
Topics: Administration, Inhalation; Animals; Bacterial Infections; Balneology; History, 19th Century; History, Ancient; History, Medieval; Hot Springs; Humans; Inflammation; Leukocyte Disorders; Mucus; Respiratory Mucosa; Respiratory Therapy; Respiratory Tract Diseases; Virus Diseases; Water
PubMed: 34371115
DOI: 10.1016/j.jep.2021.114505 -
Jornal Brasileiro de Pneumologia :... Sep 2020
Topics: Physical Therapy Modalities; Respiratory Mechanics; Respiratory Therapy
PubMed: 32901692
DOI: 10.36416/1806-3756/e20200443 -
Respiratory Care Jun 2017CPAP and noninvasive ventilation (NIV) offer an alternative to intubation and mechanical ventilation in the treatment of acute and chronic respiratory disorders commonly... (Review)
Review
CPAP and noninvasive ventilation (NIV) offer an alternative to intubation and mechanical ventilation in the treatment of acute and chronic respiratory disorders commonly encountered in infants and children. There are many distinct challenges associated with the application, management, and safety of CPAP and NIV in the pediatric population. This review attempts to identify indications, contraindications, management strategies, and safety measures associated with the application of CPAP or NIV delivery in children. More recently, high-flow nasal cannula (HFNC) has emerged as an alternative to CPAP and NIV. Evidence related to the use of CPAP, NIV, and HFNC is included in this review.
Topics: Child; Continuous Positive Airway Pressure; Humans; Infant; Noninvasive Ventilation; Respiration Disorders
PubMed: 28546373
DOI: 10.4187/respcare.05244 -
Respiratory Care Aug 2019A respiratory therapy consult service (RTCS) may reduce misallocation of treatments. Misallocation consists of over-ordering (ie, therapy not indicated but ordered) or...
BACKGROUND
A respiratory therapy consult service (RTCS) may reduce misallocation of treatments. Misallocation consists of over-ordering (ie, therapy not indicated but ordered) or under-ordering (ie, therapy indicated but not ordered). The rate of agreement with RTCS-based orders is defined as the percentage of patients with no misallocation. This study was undertaken to compare current misallocation and agreement with historical benchmark rates at a hospital with an RTCS (ie, the Main Campus, or "on-MC") and 2 hospitals that did not have an RTCS (ie, off-Main Campus, or "off-MC").
METHODS
After approval by the institutional review board, data were collected during normal rounds. A respiratory therapist (RT) determined if the patient had an order for RTCS, what their treatments were, and whether treatment indications were present. RTCS treatments included aerosol therapy, bronchopulmonary hygiene, re-inflation, supplemental oxygen, oxygen monitoring, and suctioning. Agreement and misallocation were compared with chi-square or z-tests with < .05 indicating significance.
RESULTS
The agreement rate for the RTCS on-MC was less than the benchmark rate established 20 years ago (63% vs 86%, = .004), ascribed to misallocation of a single therapy, bronchopulmonary hygiene. The agreement rate with the RTCS on-MC was higher than that with off-MC RTCS (63% vs 33%, < .001). Non-RTCS-based orders on-MC also had higher rates of agreement than orders with off-MC RTCS.
CONCLUSIONS
While the overall rate of agreement was lower with the RTCS currently than in the past, the decline seems solely attributable to a decline in the appropriateness of orders for bronchopulmonary hygiene. In addition, the rate of agreement for non-RTCS-based orders on-MC (71%), where the RTCS has been available for over 20 years, was higher than agreement rate for non-RTCS-based therapies off-MC (20%), where the RTCS has not yet been available. These findings suggest continued efficacy of the RTCS with the need for ongoing vigilance to assure optimal RTCS performance.
Topics: Humans; Medical Overuse; Referral and Consultation; Respiratory Therapy
PubMed: 31040205
DOI: 10.4187/respcare.06710