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Respiratory Care Jun 2024
Topics: Humans; Pulmonary Medicine; Respiratory Therapy
PubMed: 38942596
DOI: 10.4187/respcare.12174 -
Revista Brasileira de Cirurgia... 2008The aim of this work is to make a critical review about the different techniques of respiratory physiotherapy used following cardiac surgery and this effectiveness in... (Review)
Review
The aim of this work is to make a critical review about the different techniques of respiratory physiotherapy used following cardiac surgery and this effectiveness in reverting pulmonary dysfunction. It has been used as reference publications in English and Portuguese using as key words thoracic surgery, respiratory exercises, physical therapy modalities, postoperative complications and myocardial revascularization, contained in the following databases BIREME, SciELO Brazil, LILACS, PUBMED, from 1997 to 2007. A secondary search of the reference list of identified articles also was made. It has been selected eleven randomized trials (997 patients). For the articles included incentive spirometry was used in three; deep breathing exercises in six; deep breathing exercises added to positive expiratory pressure in four and positive airway pressure added to inspiratory resistance in two. Three trials used intermittent positive pressure breathing. Continuous positive airway pressure and bi-level positive airway pressure has been used in three and two trials. The protocols used in the studies were varied and the co interventions were present in a big part of these. The different analyzed varieties and the time of postoperatory follow up make a comparative analysis difficult. Pulmonary dysfunction is evident in the postoperatory period of cardiac surgery. The use of noninvasive ventilation has been associated with good results in the first postoperatory days. Despite the known importance of postoperatory respiratory physiotherapy, until now, there is no literary consensus about the superiority of one technique over the others.
Topics: Cardiac Surgical Procedures; Humans; Lung Diseases; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Respiratory Therapy
PubMed: 19229431
DOI: 10.1590/s0102-76382008000400018 -
Neonatology 2013The aim of this conceptual review is to provide the reader with a broad perspective on progress made in respiratory support of preterm infants over the past five... (Review)
Review
The aim of this conceptual review is to provide the reader with a broad perspective on progress made in respiratory support of preterm infants over the past five decades. Landmark discoveries are described in their historical context and underlying theories of lung protection are discussed. The review finishes by integrating different approaches and perspectives into a state-of-the-art concept for lung-protective ventilation in this fragile patient population. Improvements in neonatal respiratory support in the 1970s and 1980s have contributed to dramatic improvements of mortality and morbidity rates among neonates with respiratory failure. Continuous positive airway pressure, antenatal corticosteroids and surfactant replacement therapy revolutionized the care of preterm infants. With the recognition that atelectrauma, volutrauma and oxygen toxicity are the main factors contributing to ventilator-induced lung injury, lung-protective strategies, including noninvasive respiratory support, tidal volume targeting during conventional mechanical ventilation and high frequency ventilation were developed in the 1990s. Given the fact that progress made in the last decade has only resulted in minor improvements in mortality and morbidity rates of neonates with respiratory failure, it seems unlikely that further refinements of current technologies will produce giant leaps forward in high-resource countries. It appears that entirely new approaches would be required. In contrast, knowledge and technology transfer of basic respiratory support strategies (e.g. use of oxygen, simple systems to provide continuous positive airway pressure), could have an enormous impact on the prognosis of neonates with respiratory failure in low-resource countries.
Topics: Adrenal Cortex Hormones; Continuous Positive Airway Pressure; High-Frequency Ventilation; History, 20th Century; History, 21st Century; Humans; Infant, Newborn; Infant, Premature; Pulmonary Surfactants; Respiration, Artificial; Respiratory Insufficiency; Respiratory Therapy
PubMed: 24107385
DOI: 10.1159/000354419 -
Pediatric Emergency Care May 2008Noninvasive ventilation (NIV) refers to the delivery of ventilatory support using techniques that do not require an endotracheal airway. Noninvasive ventilation is being... (Review)
Review
Noninvasive ventilation (NIV) refers to the delivery of ventilatory support using techniques that do not require an endotracheal airway. Noninvasive ventilation is being used with increased frequency in a variety of clinical situations in the emergency department, intensive care unit, and prehospital environment. This article reviews the history of NIV, the rationale for its use, and the evidence of efficacy in both the adult and pediatric literature. This article also describes equipment and techniques currently available for administration of NIV as well as new trends in noninvasive respiratory support.
Topics: Continuous Positive Airway Pressure; Emergency Service, Hospital; Humans; Intensive Care Units; Intermittent Positive-Pressure Ventilation; Lung Diseases; Pediatrics; Respiratory Therapy; Transportation of Patients
PubMed: 18496121
DOI: 10.1097/PEC.0b013e31816ffbe8 -
Chest Aug 1996To assess the impact of a respiratory therapy consult service (RTCS) on practices and appropriateness of ordering respiratory care services. (Comparative Study)
Comparative Study
OBJECTIVE
To assess the impact of a respiratory therapy consult service (RTCS) on practices and appropriateness of ordering respiratory care services.
DESIGN
Nonrandomized prospective observational cohort study with concurrent controls.
SETTING
Adult non-ICU inpatient wards of an academic medical center.
PATIENTS
A convenience sample of 98 adult non-ICU inpatients at the Cleveland Clinic Hospital, representing 20 inpatient clinical services. Patients whose respiratory care plans were determined by respiratory care practitioners using sign and symptom-based algorithms to specify treatment comprised the treatment group (n = 51, respiratory therapy consult group). The nonconsult group (n = 47) were patients whose respiratory care plans were specified by their own physicians.
INTERVENTION
Specification of the respiratory care plan by the RTCS vs by the physicians themselves. Use of the RTCS was at the discretion of the managing physician.
OUTCOME MEASURES
Types and number of respiratory care treatments, length of hospital stay, costs of the respiratory therapy provided, appropriateness of respiratory care orders (based on comparison of the actual respiratory care orders with a reference respiratory care plan generated by a study investigator who was kept blind to the actual respiratory care plan), and adverse respiratory events.
RESULTS
Patients for whom the RTCS was requested by their physicians had a greater severity of respiratory illness based on having a lower triage score, but were otherwise similar at baseline. Fewer initial orders for respiratory care were discordant with the reference algorithms in RTCS patients (15% +/- 26% [SD]) than in nonconsult patients (43% +/- 36%; p < 0.001), and a smaller fraction of RTCS patients received at least one discordant initial respiratory care order (37% vs 72%; p < 0.001). Though provided to sicker patients with longer lengths of hospital stay, RTCS-directed care incurred similar respiratory care costs per patient ($335.63 +/- $272.69 [RTCS] vs $349.06 +/- $273.27; p = 0.72).
CONCLUSIONS
These results suggest that the RTCS can be an effective strategy to allocate respiratory care strategies appropriately while conserving the costs of providing respiratory care.
Topics: Adult; Allied Health Personnel; Female; Health Services Misuse; Hospital Charges; Hospital Costs; Hospitalization; Humans; Length of Stay; Male; Medical Staff, Hospital; Middle Aged; Prospective Studies; Referral and Consultation; Respiratory Therapy
PubMed: 8697845
DOI: 10.1378/chest.110.2.422 -
Jornal de Pediatria 2010To review the most relevant articles regarding the technical aspects of inhalation therapy, inhalers currently available, and especially major advances in inhalation... (Review)
Review
OBJECTIVES
To review the most relevant articles regarding the technical aspects of inhalation therapy, inhalers currently available, and especially major advances in inhalation therapy in pediatrics.
SOURCES
Articles of MEDLINE database from 1983 were reviewed, in addition to book chapters, and the most important studies were selected according to the criteria established for this article.
SUMMARY OF THE FINDINGS
Conventional nebulizers have a number of inconveniences, and breath-enhanced and breath-actuated inhalers are more attractive options. Among dry powder inhalers, we highlight those using passive and active powder dispersion mechanisms, which provide higher rates of drug deposition in the lung. Among pressurized metered-dose inhalers, we highlight breath-actuated, breath-coordinated, and velocity-modifying inhalers. These inhalers should be used preferably together with spacers, since the use of spacers produces a twofold increase in pulmonary drug deposition.
CONCLUSIONS
For children younger than 8 years, pressurized metered-dose inhalers with spacers are the most appropriate devices, since they provide a practical approach associated with greater lung deposition. In children older than 8 years who can generate high inspiratory flow rates, dry powder devices are best suited.
Topics: Child; Humans; Nebulizers and Vaporizers; Respiration; Respiratory Therapy; Respiratory Tract Diseases
PubMed: 20938588
DOI: 10.2223/JPED.2024 -
Current Opinion in Critical Care Feb 2017Severe respiratory failure due to the acute respiratory distress syndrome (ARDS) might require rescue therapy measures beyond even extended standard care to ensure... (Review)
Review
PURPOSE OF REVIEW
Severe respiratory failure due to the acute respiratory distress syndrome (ARDS) might require rescue therapy measures beyond even extended standard care to ensure adequate oxygenation and survival. This review provides a summary and assessment of treatment options that can be beneficial when the standard approach fails.
RECENT FINDINGS
'Life-threatening' conditions or refractory hypoxemia during mechanical ventilation are more a matter of personal rating than an objective diagnosis based on defined and/or unanimously agreed thresholds that would mandate the use of rescue therapies. Although the outcome might vary with different rescue procedures, most of them will improve oxygenation. Prone positioning maintains a predominant role as rescue therapy in severe hypoxemia and does not only improve oxygenation in but also survival of ARDS patients. Recruitment maneuvers can have temporary positive effects. Inhaled nitric oxide, as well as high-frequency oscillatory ventilation might acutely improve oxygenation and can be used as a 'bridge' to alternative rescue therapies, but neither provides any survival advantage by itself and might even be detrimental. Although increasingly employed in other than the rescue indication, extracorporeal membrane oxygenation should still primarily be used in patients who do not respond to differentiated mechanical ventilation, which includes a careful evaluation of nonextracorporeal membrane oxygenation rescue therapies that might be combined in order to overcome the life-threatening situation. Early involvement of an ARDS or extracorporeal membrane oxygenation center should be considered to ensure optimal care.
SUMMARY
A well timed, multimodal approach is required for patients with ARDS suffering from life-threatening hypoxemia. Understanding the limits of each type of rescue measure is of vital importance.
Topics: Extracorporeal Membrane Oxygenation; High-Frequency Ventilation; Humans; Prone Position; Respiration, Artificial; Respiratory Distress Syndrome; Respiratory Therapy
PubMed: 27898438
DOI: 10.1097/MCC.0000000000000374 -
Respiratory Care Feb 2010Despite a plethora of publications on the art and science of respiratory care, a number of basic issues remain unanswered. These clinical controversies are often settled...
Despite a plethora of publications on the art and science of respiratory care, a number of basic issues remain unanswered. These clinical controversies are often settled by expert opinion and personal bias. By definition, a controversy has compelling arguments for each side of the issue. This Respiratory Care Journal Conference addressed 12 clinical controversies, ranging from spirometry screening for chronic lung disease to the timing of tracheostomy. This paper is a concise synopsis of the salient points of each side of each argument and provides the points of consensus and points of contention. When appropriate, further research is suggested to address still unanswered questions.
Topics: Humans; Respiratory Therapy
PubMed: 20105347
DOI: No ID Found -
Nihon Rinsho. Japanese Journal of... 1980
Review
Topics: Humans; Intermittent Positive-Pressure Ventilation; Positive-Pressure Respiration; Respiratory Distress Syndrome; Respiratory Therapy
PubMed: 6997553
DOI: No ID Found -
Revue Des Maladies Respiratoires Apr 2018This article reports an exchange of unbiased arguments between Mr Guy Postiaux speaking in favour of respiratory physiotherapy in acute viral bronchiolitis in the... (Review)
Review
This article reports an exchange of unbiased arguments between Mr Guy Postiaux speaking in favour of respiratory physiotherapy in acute viral bronchiolitis in the newborn and Prof. Jean-Christoph Dubus arguing against. A review of the literature suggests that traditional methods of physiotherapy should be abandoned because they are not validated and because they have harmful side effects. The latest Cochrane revue (2016) suggests the use of slow expiration techniques that have some validated elements and cause no harmful side effects. Large multicentre studies should be undertaken to confirm or refute the results of the five studies in the Cochrane review. Their analysis would allow extraction of objective evidence for the efficacy of slow expiration techniques on the relief of bronchopulmonary obstruction and the reduction of the degree of severity in the short and medium term. Studies of the effect of ambulatory respiratory physiotherapy for bronchiolitis of a moderate degree not requiring hospitalisation are not available. An evaluation is needed which is based on the pathophysiology of multifactorial bronchial obstruction and on the physical signs, of which auscultation is the cornerstone.
Topics: Acute Disease; Bronchiolitis, Viral; Humans; Infant, Newborn; Physical Therapy Modalities; Respiratory Therapy
PubMed: 29754840
DOI: 10.1016/j.rmr.2017.08.003