ABSTRACT
Purpose: Bronchopleural fistula is a commonest complication developed in post-traumatic cases and the management of which is still a challenge due to lack of scientific evidence. The purpose of this case report is to investigate the effects of physiotherapy treatment in management of patients with bronchopleural fistula. Case Description: A 20-year-old man met with a road traffic accident following which he was diagnosed with hemopneumothorax and ICD was placed. Continuous removal of ICD over 3 to 4 times by patient himself in unconscious state lead to the development of bronchopleural fistula. Results: The patient was seen for 15 sessions over 3 weeks period ( 5 days per week). At discharge, his Functional status score in ICU (FSS-ICU) was 35. He was able to complete exercise tolerance test in 6-minute time interval with 540 meters of distance involving 10 laps with single rest pause during 4th minute. Discussion: Though bronchopleural fistula is considered as a relative complication of physical therapy; this case report suggests that with appropriate care physical therapy along with other medical management team can help to cure it and improve patient’s functional status as well as his quality of living.
ABSTRACT
Introduction: The maturation of respiratory system in children leads to changes in value of respiratory parameters like peak expiratory flow rate (PEFR), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and 6-minute walk distance (6MWD). Accurate analysis and clinical decisionmaking in disease state require reference values for different ages. The current study was undertaken to study pulmonary function and exercise capacity in children and adolescents. Materials and methods: After obtaining Institutional Ethical approval and parental informed consent, 262 subjects aged 9 to 15 years were recruited for the study. They were divided into two age groups, i.e., preadolescent (9-12 years) and early adolescent (13-15 years). Demographic details including age, sex, height, weight, and body mass index (BMI) were noted. Physical activity rating (PAR) scale was used to denote physical activity levels. Peak expiratory flow rate was measured using standard Mini-bell peak flow meter (PFM). The parameters MIP and MEP was measured using micro respiratory pressure meter, and 6-minute walk test (6MWT) was performed as per American Thoracic Society (ATS) guidelines. Results: A significant difference was noted between the two groups in PEFR, MIP, MEP, and 6MWD (p = 0.00). Age showed a strong positive correlation with PEFR (r = 0.613, p = 0.000), MIP (r = 0.676, p = 0.000), and MEP (r = 0.658, p = 0.00) whereas showed a strong negative correlation with 6MWD (r = -0.605, p = 0.00). Height showed a strong positive correlation with MEP (r = 0.720, p = 0.000) whereas a strong negative correlation with 6MWD (r = -0.42, p = 0.00). Weight showed a weak negative correlation with 6MWD (r = -0.328, p = 0.00). Gender difference was noticeable in 6MWD and PEFR (p = 0.00) but not in MIP (p = 0.45) and MEP (p = 0.44). Almost 22.10% of early adolescents were overweight compared to only 7.7% seen in preadolescent group. Conclusion: PEFR and respiratory muscle strength was higher in early adolescents as compared to pre-adolescents. However, exercise capacity reflected by 6 MWD was found to be lower in early adolescents in comparison to pre-adolescents. These findings could be used while interpreting the outcome measures utilized while treating patients and for goal setting in cardiopulmonary rehabilitation in clinical practice.