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Revista Brasileira de Terapia Intensiva 2013To perform an assessment of the available literature on manual hyperinflation as a respiratory physical therapy technique used in pediatric patients, with the main... (Review)
Review
OBJECTIVE
To perform an assessment of the available literature on manual hyperinflation as a respiratory physical therapy technique used in pediatric patients, with the main outcome of achieving airway clearance.
METHODS
We reviewed articles included in the Lilacs (Latin American and Caribbean Literature on Health Sciences/Literatura Latino Americana e do Caribe em Ciências da Saúde), Cochrane Library, Medline (via Virtual Health Library and PubMed), SciELO (Scientific Electronic Library), and PEDro (Physiotherapy Evidence Database) databases from 2002 to 2013 using the following search terms: "physiotherapy (techniques)", "respiratory therapy", "intensive care", and "airway clearance". The selected studies were classified according to the level of evidence and grades of recommendation (method of the Oxford Centre for Evidence-Based Medicine) by two examiners, while a third examiner repeated the search and analysis and checked the classification of the articles.
RESULTS
Three articles were included for analysis, comprising 250 children (aged 0 to 16 years). The main diagnoses were acute respiratory failure, recovery following heart congenital disease and upper abdominal surgery, bone marrow transplantation, asthma, tracheal reconstruction, brain injury, airway injury, and heterogeneous lung diseases. The studies were classified as having a level of evidence 2C and grade of recommendation C.
CONCLUSIONS
Manual hyperinflation appeared useful for airway clearance in the investigated population, although the evidence available in the literature remains insufficient. Therefore, controlled randomized studies are needed to establish the safety and efficacy of manual hyperinflation in pediatric patients. However, manual hyperinflation must be performed by trained physical therapists only.
Topics: Child; Humans; Insufflation; Respiratory Therapy
PubMed: 24213091
DOI: 10.5935/0103-507X.20130043 -
Respiratory Medicine and Research Nov 2020
Topics: Administration, Inhalation; Aerosols; COVID-19; Cross Infection; Disease Transmission, Infectious; Equipment Contamination; Humans; Nebulizers and Vaporizers; Oxygen Inhalation Therapy; Pandemics; Respiratory Therapy; Risk Factors; SARS-CoV-2
PubMed: 32763845
DOI: 10.1016/j.resmer.2020.100778 -
Seminars in Respiratory and Critical... Feb 2019Mechanical ventilation practices in patients with acute respiratory distress syndrome (ARDS) have progressed with a growing understanding of the disease pathophysiology.... (Review)
Review
Mechanical ventilation practices in patients with acute respiratory distress syndrome (ARDS) have progressed with a growing understanding of the disease pathophysiology. Paramount to the care of affected patients is the delivery of lung-protective mechanical ventilation which prioritizes tidal volume and plateau pressure limitation. Lung protection can probably be further enhanced by scaling target tidal volumes to the specific respiratory mechanics of individual patients. The best procedure for selecting optimal positive end-expiratory pressure (PEEP) in ARDS remains uncertain; several relevant issues must be considered when selecting PEEP, particularly lung recruitability. Noninvasive ventilation must be used with caution in ARDS as excessively high respiratory drive can further exacerbate lung injury; newer modes of delivery offer promising approaches in hypoxemic respiratory failure. Airway pressure release ventilation offers an alternative approach to maximize lung recruitment and oxygenation, but clinical trials have not demonstrated a survival benefit of this mode over conventional ventilation strategies. Rescue therapy with high-frequency oscillatory ventilation is an important option in refractory hypoxemia. Despite a disappointing lack of benefit (and possible harm) in patients with moderate or severe ARDS, possibly due to lung hyperdistention and right ventricular dysfunction, high-frequency oscillation may improve outcome in patients with very severe hypoxemia.
Topics: Continuous Positive Airway Pressure; High-Frequency Ventilation; Humans; Hypoxia; Noninvasive Ventilation; Positive-Pressure Respiration; Respiration, Artificial; Respiratory Distress Syndrome; Tidal Volume
PubMed: 31060090
DOI: 10.1055/s-0039-1683896 -
Respiratory Care Nov 2022Mechanical ventilation is commonly used in the pediatric intensive care unit. This paper reviews studies of pediatric mechanical ventilation published in 2021. Topics... (Review)
Review
Mechanical ventilation is commonly used in the pediatric intensive care unit. This paper reviews studies of pediatric mechanical ventilation published in 2021. Topics include physiology, ventilator modes, alarms, disease states, airway suctioning, ventilator liberation, prolonged ventilation, and others.
Topics: Humans; Child; Respiration, Artificial; Intensive Care Units, Pediatric; Respiratory Therapy; Respiration; Suction; Ventilator Weaning; Airway Extubation
PubMed: 36100276
DOI: 10.4187/respcare.10311 -
Journal of the Royal Society of Medicine Nov 1980
Topics: Humans; Respiratory Therapy
PubMed: 7241433
DOI: 10.1177/014107688007301103 -
Respiratory Care Feb 2015There is no doubt that therapist-directed protocols are an effective way of providing therapy to patients in need of respiratory care. Therapist-directed protocols have...
There is no doubt that therapist-directed protocols are an effective way of providing therapy to patients in need of respiratory care. Therapist-directed protocols have been shown to provide the right therapy to the right patients in an effective and efficient manner. The current investigation presents us with an additional reason for promoting the use of therapist-directed protocols by suggesting a reduced readmission rate in the therapist-directed care group. Respiratory therapists must advocate for the continued or expanded use of these therapist-driven protocols as a way of assisting their institutions to potentially reduce COPD readmissions and minimize CMS reimbursement reductions.
Topics: Humans; Physician's Role; Pneumonia, Bacterial; Pulmonary Disease, Chronic Obstructive; Pulmonary Medicine; Respiratory Therapy
PubMed: 25634881
DOI: 10.4187/respcare.03898 -
Respiratory Care Jun 2022Teaching and learning using simulation-based methods is increasing in health professions education; however, the prevalence of simulation use in respiratory care...
BACKGROUND
Teaching and learning using simulation-based methods is increasing in health professions education; however, the prevalence of simulation use in respiratory care programs to date has not been explored.
METHODS
All 412 Commission on Accreditation for Respiratory Care (CoARC)-accredited entry-into-practice respiratory care programs were e-mailed a survey inquiring about simulation use as an educational tool in their programs.
RESULTS
Of the initial 412 programs contacted, 124 returned the survey, for a 30% response rate. More than three-quarters of programs reported using simulation including 87% of associate degree programs, 75% of bachelor's degree programs, and 100% of master's degree programs. Simulation modalities differed by course and program as did length of simulation activities and debriefings. Simulation hours may not be substituted for learner's clinical time under CoARC guidelines, and 69% of respondents agreed with this stance; however, 66% of responding programs have mandatory simulation learning activities, and 68% believe the amount of simulation should be increased. The survey also revealed respiratory care faculty have limited training in the use of simulation.
CONCLUSIONS
Simulation-based teaching and learning is widespread and varied, but there is a lack of faculty development in its use among respiratory care programs.
Topics: Faculty; Humans; Learning; Respiratory Therapy; Surveys and Questionnaires
PubMed: 35169065
DOI: 10.4187/respcare.08673 -
International Journal of Environmental... Feb 2023The use of autogenic drainage (AD) in patients with cystic fibrosis (CF) has been officially approved; therefore, the purpose of this study was to compare the efficiency...
The use of autogenic drainage (AD) in patients with cystic fibrosis (CF) has been officially approved; therefore, the purpose of this study was to compare the efficiency of the leading therapeutic techniques based on AD in patients with CF; Among patients with CF assessments were made of spirometric parameters, percent blood oxygen saturation, and the general feeling of the patients (Borg, VAS, and mMRC dyspnea scale) before and after therapy using AD, using AD in connection with a belt or a Simeox device and AD in combination with both a belt and Simeox device simultaneously. The best therapeutic effects were generated by the combination of AD with the belt and with the Simeox device. The greatest improvements were observed for FEV1, FVC, PEF, FET, saturation, and patient comfort. In patients <10.5 years of age, the increase in the level of FEV3 and FEV6 was significant in comparison to older patients. Due to their efficacy, therapies connected with AD should be applied not only in hospital departments but also during daily patient care. Given the particular benefits observed in patients <10.5 years of age, it is important to guarantee real accessibility to this form of physiotherapy, especially in this age group.
Topics: Humans; Cystic Fibrosis; Drainage, Postural; Respiratory Therapy; Lung; Physical Therapy Modalities
PubMed: 36900829
DOI: 10.3390/ijerph20053822 -
Respiratory Care Apr 2015The respiratory therapist has had integrated adjuncts to improve mucus clearance for decades. However, there is a lack of literature describing the impact of these... (Review)
Review
The respiratory therapist has had integrated adjuncts to improve mucus clearance for decades. However, there is a lack of literature describing the impact of these interventions on specific patient populations, resulting in an inability to make recommendations about the use of devices and techniques. The purpose of this article is to review recent literature regarding airway clearance therapies in a manner that is most likely to have interest to the readers of Respiratory Care.
Topics: Airway Management; Drainage, Postural; Humans; Mucus; Respiratory Therapy
PubMed: 25784773
DOI: 10.4187/respcare.04095 -
Respiratory Care Jun 2017Asthma exacerbation is a common reason for children to present to the emergency department. If primary therapies fail to halt the progression of an asthma flare, status... (Review)
Review
Asthma exacerbation is a common reason for children to present to the emergency department. If primary therapies fail to halt the progression of an asthma flare, status asthmaticus often leads to hospital, and potentially ICU, admission. Following the initial administration of inhaled β agonists and systemic corticosteroids, a wide array of adjunct medical therapies may be used to treat status asthmaticus. Unfortunately, the data supporting the use of these adjunct therapies are often unclear, conflicting, or absent. This review will present the physiologic basis and summarize the supporting data for a host of adjunct therapies, including ipratropium, intravenous β agonists, methylxanthines, intravenous and inhaled magnesium, heliox (helium-oxygen mixture), ketamine, antibiotics, noninvasive ventilation, inhaled anesthetics, and extracorporeal membrane oxygenation. Finally, we present a suggested care map for escalating to these therapies in children with refractory status asthmaticus.
Topics: Administration, Inhalation; Anesthetics, Inhalation; Anti-Asthmatic Agents; Child; Combined Modality Therapy; Emergency Service, Hospital; Extracorporeal Membrane Oxygenation; Helium; Humans; Ipratropium; Oxygen; Respiration, Artificial; Respiratory Therapy; Status Asthmaticus
PubMed: 28546381
DOI: 10.4187/respcare.05174