ABSTRACT
@#Objective To observe the effect of abdominal electrical stimulation combined with high-frequency chest wall oscillation on airway clearance ability in critical ill patients with tracheostomy. Methods From January to June, 2021, a total of 84 critical ill patients with tracheostomy in the department of Critical Care Medicine, Zhongda Hospital, Southeast University, were randomly divided into control group (n = 28),experimental group A (n = 28) and experimental group B (n = 28). All the groups received routine therapy and early activities; while high-frequency chest wall oscillation was added to experimental group A, and abdominal electrical stimulation combined with high-frequency chest wall oscillation were added to experimental group B, for two weeks. Their involuntary cough peak flow (ICPF), Clinical Pulmonary Infection Score (CPIS), diaphragmatic excursion (DE), diaphragmatic thickness fraction (DTF) and thickness of abdominal muscle (Tab) were measured before and after treatment. Results The improvement of CPIS, ICPF and Tab were better in the experimental group B than in the other two groups (P < 0.05). The improvement of DE and DTF were slightly better in experimental group B, however, there was no significant difference among groups (FDE = 0.514, FDTF = 1.582, P > 0.05). The thickness d-values of rectus abdominis, musculi obliquus internus abdominis and musculus transversus abdominis were positively correlated with the d-value of ICPF in the exprimental group B (r > 0.415, P < 0.05). ICPF was highly negatively correlated with CPIS before treatment for all the patients (r = -0.702, P < 0.001). No adverse events occurred during the intervention period. Conclusion Abdominal electrical stimulation combined with high-frequency chest wall oscillation could improve airway clearance ability in critical ill patients with tracheostomy.
ABSTRACT
ABSTRACT Several respiratory diseases are characterized by hypersecretion, requiring airway clearance therapy (ACT). Oral high-frequency oscillation (OHFO) devices are effective to enable daily ACT; however, they are still too expensive to become available for low-income patients. We sought to develop a low-cost device (OHFO-LC) and compare its physical properties with those OHFO commercially available (Shaker and Flutter). The OHFO-LC was developed from polyvinyl chloride material and one stainless steel sphere. Pressures and frequencies were measured at flows of 4, 6, 8, 10 and 15L/min. Pressures at the mouthpieces were measured by a transducer connected to a microcomputer. The oscillation frequencies were obtained from the graph of the pressure. The frequencies and pressures were compared among groups using one-way Anova and Tukey's post hoc tests, p≤0.05. There were no differences among the frequencies of the three devices in all tested flows. The OHFO-LC device showed a higher positive expiratory pressure compared with the Shaker at all tested flows (4 L/min: 4.7±1.2 vs. 1.0±0.2 cmH2O; 6 L/min: 8.6±1.5 vs. 3.5±0.5 cmH2O; 8 L/min: 10.8±1.6 vs. 5.4±0.2 cmH2O; 10 L/min: 13.5±1.2 vs. 7.7±0.4 cmH2O; 15 L/min: 14.3±1.1 vs. 7.8±0.2 cmH2O; OHFO-LC vs. Shaker; p≤0.05) and at 10 and 15 L/min compared with Flutter (10 L/min: 13.5±1.2 vs. 7.5±1.2 cmH2O; 15 L/min: 14.3±1.1 vs. 8.2±1.2 cmH2O; OHFO-LC vs. Flutter, p≤0.05). The cost of the OHFO-LC device was much lower than both the Shaker and the Flutter. Our results showed that the OHFO-LC had physical properties with similar frequencies but higher pressures than other OHFO devices that are commercially available. Future studies are necessary to evaluate its clinical efficacy.
RESUMO Diversas doenças respiratórias são caracterizadas por hipersecreção com necessidade de higiene brônquica (HB). Osciladores orais de alta frequência (OOAF) são dispositivos que promovem HB diária; entretanto, seu custo pode ser inviável para aquisição por pacientes com baixa renda. Os objetivos deste estudo foram: desenvolver um OOAF de baixo custo (OOAF-BC) e comparar suas propriedades físicas com as dos disponíveis comercialmente (Shaker e Flutter). O OOAF-BC foi desenvolvido com material de polivinil clorido e uma esfera de aço inoxidável. As pressões e frequências foram mensuradas nos fluxos de 4, 6, 8, 10 e 15 L/min. As pressões nos bocais foram medidas por um transdutor conectado ao computador. As frequências de oscilação foram derivadas do gráfico de pressão. A comparação dos dispositivos foi feita por Anova com post hoc de Tukey, p≤0.05. Não houve diferença entre as frequências dos três dispositivos em todos os fluxos testados. O OOAF-BC apresentou pressão mais alta comparado ao Shaker em todos os fluxos testados (4 L/min: 4,7±1,2 vs. 1,0±0,2 cmH2O; 6 L/min: 8,6±1,5 vs. 3,5±0,5 cmH2O; 8 L/min: 10,8±1,6 vs. 5,4±0.2 cmH2O; 10 L/min: 13,5±1,2 vs. 7,7±0.4 cmH2O; 15 L/min: 14,3±1,1 vs. 7,8±0,2 cmH2O; OOAF-BC vs. Shaker; p≤0.05) e nos fluxos de 10 e 15 L/min comparado ao Flutter (10 L/min: 13,5±1,2 vs. 7,5±1,2 cmH2O; 15 L/min: 14,3±1,1 vs. 8,2±1,2 cmH2O; OOAF-BC vs. Flutter, p≤0.05). O custo do OOAF-BC foi pelo menos seis vezes menor. O OOAF-BC apresentou frequências similares e pressões mais altas que os outros OOAF comercialmente disponíveis. Estudos futuros são necessários para avaliar sua eficácia clínica.
RESUMEN Varias enfermedades respiratorias se caracterizan por hipersecreción, que requiere higiene bronquial (HB). Los osciladores orales de alta frecuencia (OOAF) son dispositivos que promueven la HB diaria; sin embargo, su costo puede no ser factible para la adquisición por parte de pacientes con bajos ingresos. Los objetivos de este estudio fueron desarrollar un OOAF de bajo costo (OOAF-BC) y comparar sus propiedades físicas con las de los disponibles comercialmente (Shaker y Flutter). El OOAF-BC se desarrolló con material de polivinilo clorado y una bola de acero inoxidable. Las presiones y frecuencias se midieron en flujos de 4, 6, 8, 10 y 15 L/min. Las presiones de la boquilla se midieron mediante un transductor conectado a la computadora. Las frecuencias de oscilación se derivaron del gráfico de presión. Se compararon los dispositivos con la utilización de Anova con post hoc de Tukey, p≤0,05. No hubo diferencias entre las frecuencias de los tres dispositivos en todos los flujos probados. El OOAF-BC mostró una presión más alta en comparación con Shaker en todos los flujos probados (4 L/min: 4,7±1,2 vs. 1,0±0,2 cmH2O; 6 L/min: 8,6±1,5 vs. 3,5±0,5 cmH2O; 8 L/min: 10,8±1,6 vs. 5,4±0,2 cmH2O; 10 L/min: 13,5±1,2 vs. 7,7±0,4 cmH2O; 15 L/min: 14,3±1,1 vs. 7,8±0,2 cmH2O; OOAF-BC vs. Shaker; p≤0,05) y con flujos de 10 y 15 L/min en comparación con Flutter (10 L/min: 13,5±1,2 vs. 7,5±1,2 cmH2O; 15 L/min: 14,3±1,1 vs. 8,2±1,2 cmH2O; OOAF-BC vs. Flutter, p≤0,05). El costo de OOAF-BC fue al menos seis veces menor. El OOAF-BC mostró frecuencias similares y presiones más altas que otros OOAF disponibles comercialmente. Se necesitan estudios futuros para evaluar su eficacia clínica.
ABSTRACT
Diottix(r) was calibrated at 25 Hz to achieve the frequency indicated in literature as being effective to mobilize the airways secretions. However, the amplitude and frequency of the waves generated by the equipment in different regions of the chest still need to be investigated. The objective of this study was to analyze the frequency and amplitude of waves generated by Diottix(r) in chests of healthy subjects. Diottix(r) was used in the anterior and posterior regions of the chest. The mechanical waves were captured using stethoscopes connected to electret microphones, which were connected to a digital oscilloscope. Frequency and amplitude data were recorded by the stethoscope, positioned in six points in the anterior region and six in the posterior region of the chest, following the positions commonly used in pulmonary auscultation. Signals were recorded and transferred to a computer with software for their analysis. The frequency of waves did not present a significant change (from 24.9 to 26.4 Hz). The wave amplitude in the anterior versus the posterior region in each area of the lung, the upper, middle and lower, had differences. Diottix(r) produces frequencies in the chest according to the calibrated; thus, it can be a complementary resource to bronchial hygiene maneuvers. The amplitudes of waves seem to be affected by other structures like bone parts and heart.
Diottix(r) fue calibrado en 25 Hz para alcanzar la frecuencia indicada en la literatura como eficaz para movilizar secreciones de las vías aéreas. La amplitud y frecuencia de ondas generadas por el equipamiento en las diferentes regiones del tórax aun necesitan de más investigaciones. El objetivo de eso estudio fue analizar la frecuencia y amplitud de ondas generadas por el Diottix(r) en el tórax de sujetos saludables. La aplicación del Diottix(r) fue realizada en las regiones anterior y posterior del tórax. Las ondas mecánicas fueron captadas utilizándose estetoscopios ligados a micrófonos de electret, los cuales estaban ligados a uno osciloscopio digital. Los datos de frecuencia y amplitud fueron captados por lo estetoscopio posicionado en seis puntos en la región anterior y seis en la posterior del tórax, siguiendo las posiciones comúnmente utilizadas en la ausculta pulmonar. Los sígnales fueron registrados y transferidos para una computadora a través de un programa para su análisis de datos. La frecuencia de ondas no presentó variación significativa (del 24,9 al 26,4 Hz). La amplitud de onda en la región anterior versus posterior en cada segmento del pulmón, tercio superior, medio e inferior, presentó diferencia. Lo Diottix(r) produce frecuencias en el tórax según el calibrado. Por lo tanto, puede ser uno recurso complementar a las manobras de higiene de los bronquios. Las amplitudes de ondas parecen ser afectadas por otras estructuras, las cuales incluyen partes óseas y el corazón.
O Diottix(r) foi calibrado a 25 Hz para atingir a frequência indicada na literatura como eficaz a fim de mobilizar secreções de vias aéreas. A amplitude e a frequência das ondas geradas pelo equipamento nas diferentes regiões do tórax ainda precisam ser investigadas. O objetivo de estudo foi analisar a frequência e a amplitude das ondas geradas pelo Diottix(r) no tórax de indivíduos saudáveis. A aplicação do Diottix(r) foi realizada nas regiões anterior e posterior do tórax. As ondas mecânicas foram captadas utilizando estetoscópios conectados a microfones de eletreto, os quais estavam ligados a um osciloscópio digital. Os dados de frequência e amplitude foram captados pelo estetoscópio, posicionado em seis pontos na região anterior e seis na posterior do tórax, seguindo as posições comumente utilizadas na ausculta pulmonar. Os sinais foram registrados e transferidos para um computador por meio de um software para análise deles. A frequência das ondas não apresentou variação significativa (24,9 a 26,4 Hz). A amplitude de onda na região anterior versus posterior em cada segmento do pulmão, terço superior, médio e inferior, apresentou diferença. O Diottix(r) produz frequências no tórax de acordo com o calibrado; desta forma, pode ser um recurso complementar às manobras de higiene brônquica. As amplitudes de ondas parecem ser afetadas por outras estruturas, que incluem as partes ósseas e o coração.
Subject(s)
Humans , Male , Young Adult , Chest Wall Oscillation , Musculoskeletal Manipulations/instrumentation , Respiratory Therapy , Positive-Pressure Respiration/instrumentation , Vibration , Electromagnetic Radiation , Physical Therapy Modalities/instrumentation , ThoraxABSTRACT
PURPOSE: Standard chest compression is useful for cardiopulmonary resuscitation of victims but may be difficult to perform in a confined space if the victim is lying on his side. The aim of this study was to evaluate compression techniques administered to individuals lying in various alternative positions, and to determine which ones may be easier to perform in such situations. METHODS: Thirty two volunteers trained in basic life support (BLS) were enrolled. They were taught to do compression in four alternative positions (over-head position (OHP), saddle position (SP), upper diagonal position (UDP) and lower diagonal position (LDP)). For each position, they performed two minutes of continuous chest compression on a manikin that was connected to a Laerdal PC Skill Reporting System. They did this for the basic standard position (BSP) and four alternative positions with the positions presented randomly. The data, including the total number of compressions, the average rate of chest compressions per minute, the depth of each chest compression, and the position of the hands were recorded and analysed. RESULTS: There were no statistically significant differences between BSP and alternative positions for the total number of compressions (BSP:108.8 min-1; OHP:109.5 min-1; SP:107.8 min-1; UDP:108.5 min-1; LDP:107.7 min-1) of chest compressions. There was no statistically significant difference between BSP and alternative positions for the average depth of each compression (BSP:41.9 mm; OHP:44.4 mm; SP:41.8 mm; UDP:42.9 mm; LDP:41.1 mm), or for the number of incorrect hand positions except UDP (BSP versus UDP = 6.4 versus 32.5). p<0.054 is not normally considered significant. The p value has to be 0.050 or smaller. CONCLUSION: Chest compression in alternative positions can be equally effective as it is in the standard position. If chest compression in the standard position is not easily executable in a confined space, chest compression using an alternative positions can be used.
Subject(s)
Cardiopulmonary Resuscitation , Chest Wall Oscillation , Confined Spaces , Deception , Hand , Manikins , Thorax , Uridine DiphosphateABSTRACT
PURPOSE: Standard chest compression is useful for cardiopulmonary resuscitation of victims but may be difficult to perform in a confined space if the victim is lying on his side. The aim of this study was to evaluate compression techniques administered to individuals lying in various alternative positions, and to determine which ones may be easier to perform in such situations. METHODS: Thirty two volunteers trained in basic life support (BLS) were enrolled. They were taught to do compression in four alternative positions (over-head position (OHP), saddle position (SP), upper diagonal position (UDP) and lower diagonal position (LDP)). For each position, they performed two minutes of continuous chest compression on a manikin that was connected to a Laerdal PC Skill Reporting System. They did this for the basic standard position (BSP) and four alternative positions with the positions presented randomly. The data, including the total number of compressions, the average rate of chest compressions per minute, the depth of each chest compression, and the position of the hands were recorded and analysed. RESULTS: There were no statistically significant differences between BSP and alternative positions for the total number of compressions (BSP:108.8 min-1; OHP:109.5 min-1; SP:107.8 min-1; UDP:108.5 min-1; LDP:107.7 min-1) of chest compressions. There was no statistically significant difference between BSP and alternative positions for the average depth of each compression (BSP:41.9 mm; OHP:44.4 mm; SP:41.8 mm; UDP:42.9 mm; LDP:41.1 mm), or for the number of incorrect hand positions except UDP (BSP versus UDP = 6.4 versus 32.5). p<0.054 is not normally considered significant. The p value has to be 0.050 or smaller. CONCLUSION: Chest compression in alternative positions can be equally effective as it is in the standard position. If chest compression in the standard position is not easily executable in a confined space, chest compression using an alternative positions can be used.