Oscilometria de impulso e espirometria em escolares submetidos ao teste de caminhada de seis minutos / Impulse oscillometry and spirometry in schoolers submitted to the six-minute walk test

RESUMO Objetivo: Verificar as repercussões do teste de esforço submáximo na mecânica respiratória e na função pulmonar de escolares. Métodos: Estudo transversal com escolares de 7 a 14 anos submetidos à avaliação da mecânica respiratória por sistema de oscilometria de impulso (IOS) e da função pulmonar pela espirometria. Realizou-se também o teste de caminhada de seis minutos (TC6), todos segundo os padrões da Sociedade Torácica Americana. O TC6 foi executado duas vezes com intervalo de 30 minutos entre cada teste. O IOS e a espirometria foram feitos antes do primeiro TC6 (pré-TC6) e repetidos imediatamente após o primeiro TC6 (pós-TC61) e após o segundo TC6 (pós-TC62). A comparação dos resultados nos três tempos do estudo se deu por análise de variância para medidas repetidas (teste post-hoc de Bonferroni) ou teste de Friedman, sendo significante p≤0,05. Resultados: Participaram 21 sujeitos; 53% masculinos e idade média de 10,9±2,3 anos. Encontraram-se diferenças entre resistência total (R5) e resistência central das vias aéreas (R20) nos 3 tempos do estudo (p=0,025 e p=0,041, respectivamente). A análise post-hoc indicou aumento de resistência R5 entre pré-TC6 e pós-TC61 (R5=0,540±0,100 versus 0,590±0,150 kPa/L/s, p=0,013; e R20=0,440±0,800 versus 0,470±0,100 kPa/L/s, p=0,038). A única variável espirométrica com alteração no decorrer do tempo foi o fluxo expiratório forçado 25-75% (FEF25-75%) (p=0,003). Conclusões: As repercussões encontradas foram: aumento da resistência total e da resistência central das vias aéreas e redução do FEF25-75% após o TC6 em escolares, sugerindo a necessidade de mais atenção na realização de testes submáximos em crianças com alguma predisposição a alterações das vias aéreas.

ABSTRACT Objective: To verify repercussions of submaximal exercise testing on respiratory mechanics and pulmonary function in schoolchildren. Methods: Cross-sectional study, with children aged 7 to 14 years, who had their respiratory mechanics assessed by impulse oscillometry (IOS), and pulmonary function by spirometry. They performed the six-minute walk test (6MWT), as per the standards by the American Thoracic Society. The 6MWT was performed twice with a 30-minute interval. IOS and spirometry were performed before the first 6MWT (Pre-6MWT) and immediately after the first (Post-6MWT1) and second walking tests (Post-6MWT2). The results in these three phases were compared by analysis of variance for repeated measures (post-hoc Bonferroni test) or by the Friedman's test, with p≤0.05 considered significant. Results: Twenty-one subjects participated in the study: 53% were males and mean age was 10.9±2.3 years. There were differences between total resistance (R5) and central airway resistance (R20) at the three phases of assessment (p=0.025 and p=0.041, respectively). Post-hoc analysis indicated increase in R5 when Pre-6MWT and Post-6MWT1 were compared (R5=0.540±0.100 versus 0.590±0.150 kPa/L/s, p=0.013; and R20=0.440±0.800 versus 0.470±0.100 kPa/L/s, p=0.038). Forced expiratory flow 25-75% (FEF25-75%) changed over time (p=0.003). Conclusions: Repercussions were: increase in central and total airway resistance and reduction of FEF25-75% after 6MWT in schoolchildren, suggesting that greater attention should be given to submaximal tests in children with predisposition to airways alterations.

Effect of the High Frequency Chest Wall Oscillation (HFCWO) on Pulmonary Function and Walking Ability in Stroke Patients

PURPOSE: This investigation aimed to determine the effects of treadmill training (TT) and high frequency chest wall oscillation (HFCWO) on pulmonary function and walking ability in stroke patients as well as propose an exercise program to improve cardiovascular function. METHODS: Twenty hemiplegic stroke patients were randomized to either the control group (CG) (n=10) or the experimental group (EG), which received TT and HFCWO (n=10). Pulmonary function was quantitated using patient forced vital capacity (FVC) and forced expiratory volume at one second (FEV1) while walking speed was assessed by the 10m walking test (10MWT). Further, walking endurance was determined utilizing the 6-minute walk test (6MWT). Subjects of the EG performed the study protocol for 60 minutes, five times a week for six weeks; CG patients did not participate in regular exercise. To determine significance for the differences observed before and after exercise, within-group and between-group comparisons were conducted utilizing paired and independent t-tests, respectively, with the level of significance set at α=0.05. RESULTS: Within-groups, significant differences were observed in both FVC and FEV1 (p<0.01) following completion of the study protocol. Further, between-group comparisons demonstrated significant differences in both FVC (p<0.05) and FEV1 (p<0.01). Post-exercise, significant changes in the 10MWT and 6MWT score were observed between the EG and CG (p<0.01). Further, statistically significant differences were observed in 6MWT scores between-groups (p<0.05). CONCLUSION: The TT and HFCWO effectively improved pulmonary function and walking ability in subjects with stroke. The proposed program can be applied to stroke patients as a useful therapy.

Correlations between forced oscillation technique parameters and pulmonary densitovolumetry values in patients with acromegaly

The aims of this study were to evaluate the forced oscillation technique (FOT) and pulmonary densitovolumetry in acromegalic patients and to examine the correlations between these findings. In this cross-sectional study, 29 non-smoking acromegalic patients and 17 paired controls were subjected to the FOT and quantification of lung volume using multidetector computed tomography (Q-MDCT). Compared with the controls, the acromegalic patients had a higher value for resonance frequency [15.3 (10.9-19.7) vs 11.4 (9.05-17.6) Hz, P=0.023] and a lower value for mean reactance [0.32 (0.21-0.64) vs 0.49 (0.34-0.96) cm H2O/L/s2, P=0.005]. In inspiratory Q-MDCT, the acromegalic patients had higher percentages of total lung volume (TLV) for nonaerated and poorly aerated areas [0.42% (0.30-0.51%) vs 0.25% (0.20-0.32%), P=0.039 and 3.25% (2.48-3.46%) vs 1.70% (1.45-2.15%), P=0.001, respectively]. Furthermore, the acromegalic patients had higher values for total lung mass in both inspiratory and expiratory Q-MDCT [821 (635-923) vs 696 (599-769) g, P=0.021 and 844 (650-945) vs 637 (536-736) g, P=0.009, respectively]. In inspiratory Q-MDCT, TLV showed significant correlations with all FOT parameters. The TLV of hyperaerated areas showed significant correlations with intercept resistance (rs=−0.602, P<0.001) and mean resistance (rs=−0.580, P<0.001). These data showed that acromegalic patients have increased amounts of lung tissue as well as nonaerated and poorly aerated areas. Functionally, there was a loss of homogeneity of the respiratory system. Moreover, there were correlations between the structural and functional findings of the respiratory system, consistent with the pathophysiology of the disease.

Analysis of acoustic frequency and wave amplitude generated by the Oscillatory Thoracic Thixotropic Device (Diottix(r)) in human chest / Análisis de la frecuencia acústica y amplitud de las ondas sonoras generadas por el Dispositivo Oscilatorio Torácico Tixotrópico (Diottix(r)) en el tórax humano / Análise da frequência acústica e amplitude das ondas sonoras geradas pelo Dispositivo Oscilatório Torácico Tixotrópico (Diottix(r)) no tórax humano

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.

Effects of manual chest compression and descompression maneuver on lung volumes, capnography and pulse oximetry in patients receiving mechanical ventilation / Efeitos da manobra de compressão e descompressão torácica nos volumes pulmonares, capnografia e oximetria de pulso em pacientes submetidos à ventilação mecânica

OBJECTIVES: The aims of this study were to evaluate whether there are changes in lung volumes, capnography, pulse oximetry and hemodynamic parameters associated with manual chest compression-decompression maneuver (MCCD) in patients undergoing mechanical ventilation (MV). Method: A prospective study of 65 patients undergoing to MV after 24 hours. All patients received bronchial hygiene maneuvers and after 30 minutes they were submitted to ten repetitions of the MCCD during 10 consecutive respiratory cycles in the right hemithorax and than in the left hemithorax. The data were collected before the application of the maneuver and after 1, 5, 10, 15, 20, 25, 30, 35 and 40 minutes following application of the maneuver. RESULTS: There were statistical significant (p<0.0001) improvements in the following parameters after MCCD maneuver during all phases of data collection until 40 minutes: inspiratory tidal volume (baseline: 458.2±132.1 ml; post 1 min: 557.3±139.1; post 40 min: 574.4±151), minute volume (baseline: 7.0±2.7 L/min; post 1 min: 8.7±3.3; post 40 min: 8.8±3.8), and pulse oximetry (baseline: 97.4±2.2%; post 1 min: 97.9±1,8; post 40 min: 98.2±1.6; p<0.05). There was a reduction in CO2 expired (baseline: 35.1±9.0 mmHg; post 1 min: 31.5±8.2; post 40 min: 31.5±8.29; p<0.0001). There was no statically significant changes in heart rate (baseline: 94.5±20.5 mmHg; post 1 min: 94.7±20.5; post 40 min: 94.92±20.20; p=1) and mean arterial pressure (baseline: 91.2±19.1 bpm; post 1 min: 89.5±17.7; post 40 min: 89.01±16.88; p=0.99). The variables were presented in terms of means and standard deviations. CONCLUSION: The MCCD maneuver had positive effects by increasing lung volume and pulse oximetry and reducing CO2 expired, without promoting hemodynamic changes in patients undergoing mechanical ventilation.

OBJETIVOS: Avaliar a presença de alterações nos volumes pulmonares, oximetria de pulso, capnografia e alterações hemodinâmicas associadas à intervenção da manobra de compressão e descompressão torácica (MCDT) nos pacientes submetidos à ventilação mecânica (VM). Método: Tratou-se de um estudo prospectivo em que foram incluídos 65 pacientes em VM há mais de 24 horas. O protocolo consistiu na aplicação de manobras de higiene brônquica e, após 30 minutos, os pacientes eram submetidos a dez repetições da MCDT em dez respirações consecutivas no hemitórax direito e, posteriormente, no hemitórax esquerdo, coletando os dados antes e após a aplicação da manobra nos tempos 1, 5, 10, 15, 20, 25, 30, 35 e 40 minutos. RESULTADOS: Constatou-se aumento significante (p<0,001) do volume corrente inspiratório (pré: 458,2±132,1 ml; pós 1 minuto: 557,3±139,1; pós 40 minutos: 574,4±151), volume minuto corrente (pré: 7,0±2,7 L/min; pós 1 minuto: 8,7±3,3; pós 40 minutos: 8,8±3,8) e oximetria de pulso (pré: 97,4±2,2%; pós 1 minuto: 97,9±1,8; pós 40 minutos: 98,2±1,6; p<0,05). Ocorreu redução no CO2 expirado (pré: 35,1±9,0 mmHg; pós 1 minuto: 31,5±8,2; pós 40 minutos: 31,5±8,29; p<0.0001). Não houve alteração significante da frequência cardíaca (pré: 94,5±20,5 mmHg; pós 1 minuto: 94,7±20,5 e pós 40 minutos: 94,9±20,2; p=1) e pressão arterial média (pré: 91,2±19,1 bpm; pós 1 minuto: 89,5±17,7 e pós 40 minutos: 89,0±16,8; p=0,99). As variáveis foram expressas em média e desvio-padrão. CONCLUSÃO: A MCDT possibilita a otimização dos volumes pulmonares, da oximetria de pulso e a redução do CO2 expirado sem promover alterações hemodinâmicas significantes nos pacientes submetidos à ventilação mecânica.

Application of wavelet analysis in pick-up of breath signal from oscillations in chest wall / 生物医学工程学杂志

In order to pick up breath signal from correlated noise background of the pulse of heart and artery etc, an algorithm based on wavelet de-noising has been introduced. With wavelet db4, the raw signal was decomposed into the scale space of six layers; threshold treatment was done with the self-adaptive threshold created by Stein's Unbiased Risk Estimate; then the wavelet coefficients were reconstructed. The result showed that the noise was significantly depressed.

Computer simulation study on physiological feedback parameters during chest compression / 生物医学工程学杂志

To have a thorough understanding of the CPR quality based on patients' various physiological states, the doctors must do something to simulate the chest compression physiological feedback parameters (CCPFP). The CCPFP simulation plays an important role in raising efficiency of CPR training and improving chest compression quality. In this study, the CCPFP, including cardiac output (CO), coronary perfusion pressure (CPP), partial pressure of End-tidal CO2 (PETCO2) and mean arterial relaxation pressure (MARP), was simulated using Charles F. Babbs' Model. Simulation results showed that the effect of compression depth upon CCPFP was important in the range of 2-6 cm, whereas compression rate had little effect on the CCPFP higher than 100/min; the thoracic factor is inversely proportional to the CCPFP with fixed compression depth and compression rate. The CCPFP simulation can be implemented at the various physiological statuses, and verified well with the animal experimental results and the clinical results.

Effect of multimodality chest physiotherapy on the rate of recovery and prevention of complications in patients with mechanical ventilation: A prospective study in medical and surgical intensive care units.

Background: Mechanically ventilated patients have an increased risk of complications leading to ventilation weaning more difficult resulting in excessive morbidity and mortality. Chest physiotherapy plays an important role in management of ventilated patients. However, these techniques have been studied on patients as a single entity or with combination of two techniques. The present study was designed to evaluate the effect of multimodality chest physiotherapy on the rate of recovery and prevention of complications in adult ventilated patients. Materials and Methods: Out of 173 patients who were randomly allocated to two groups, 86 patients received MH and suctioning in control group and 87 patients were treated with multimodality chest physiotherapy in the study group twice daily till they were extubated. All patients were followed up for the global outcomes and complications during mechanical ventilation. Results: There were significant improvements in terms of rate of recovery in study group compared to the control group (P = 0.000). Complication rates were higher with 61.6% in the control group as compared to 26.4% in the study group. Duration of hospitalization was longer in the study group (16 ± 9.40 days) as compared to the control group (12.8 ± 6.12 days). Successful weaning from mechanical ventilation was noted in 58 patients in the study group and 24 patients in the control group which was statistically significant. Conclusions: Multi-modality chest physiotherapy protocol has shown to prevent ventilator-associated pneumonia and enhance the clinical outcome in ventilated patients and may be recommended as a treatment option in ICU. It has also shown to enhance the weaning process and proved to be safe.

Fisioterapia respiratória na fibrose cística / Respiratory physiotherapy in cystic fibrosis

A fisioterapia torácica convencional (FTC) foi introduzida na década de 1950 como padrão-ouro nos cuidados dos pacientes com fibrose cística (FC), no entanto há poucas evidências para que seu uso seja mantido na rotina diária. Neste trabalho, revisamos a evolução das condutas fisioterapêuticas em pacientes portadores de FC, bem como as novas opções de tratamento, com base nas evidências descritas na literatura nos últimos anos. Na últimas décadas, a fisioterapia respiratória modificou-se consideravelmente introduziu-se novas abordagens, tais como técnicas ativas, os pacientes são mantidos em posições mais confortáveis, que se mostram mais eficazes do que as convencionais. Entre elas, destacamos a pressão expiratória positiva (PEP), PEP oscilatória, ciclo ativo da respiração, aumento do fluxo expiratório, drenagem autógena e drenagem autógena modificada. O paciente deve conhecer e eventualmente participar, juntamente ao profissional, da definição da técnica mais apropriada a seu caso. Para tal, uma boa relação fisioterapeuta-paciente é de fundamental importância.

Conventional chest physiotherapy (CCP) started to be used in the 1950s as the gold standard in the care of patients with cystic fibrosis (CF). However, there is little evidence that its use is maintained in the daily routine. The present review of the literature presents the evolution of the practice of physical therapy in patients with CF, as well as new treatment options based on the evidence described in recent years. In the last decades respiratory physiotherapy has changed considerably. By means of new approaches, such as active techniques, patients are offered more comfortable positions, which are more effective than the conventional ones. Among these techniques, the following are highlighted: positive expiratory pressure (PEP), oscillatory PEP, active cycle of breathing, expiratory flow increase, autogenic drainage, and modified autogenic drainage. Patients must understand the therapy and help the physical therapist to define the most appropriate technique for their cases. A good physical therapistpatient relationship is crucial so that such objective can be achieved.

Analysis of the Time-Dependent Changes of Chest Compression Quality and Related Rescuer Factors in Cardio-Pulmonary Resuscitation by Lay-Persons

PURPOSE: The study evaluated changes in the quality of chest compressions over 2 min in 30:2 cardio-pulmonary resuscitation (CPR) by lay-persons and analyzed rescuer factors affecting the quality of chest compressions over time. METHODS: CPR training courses attended by 538 adult hospital and university workers (lay-person) were conducted at a university hospital. After 4-hour CPR training, tests were performed using a manikin with Skill-ReporterTM. Data of 459 subjects were analyzed concerning the quality of chest compressions over time and rescuer factors such as age, gender, body mass index, prior CPR training and CPR experience were also analyzed to determine their effect on the change in the quality of chest compressions. RESULTS: Compression depth (p=0.002) showed significant change over 2 min, but the rate (p=0.133), chest recoil (p=0.442) and hand placement (p=0.991) were insignificant. Ineffective compression depth (mean proportions of correct depth<70%) was not observed during the 2 min CPR. Female gender (p<0.001; OR, 5.882, 95% CI, 3.098-11.167) and no CPR training (p=0.004; OR, 2.163, 95% CI, 1.277-3.663) were associated with decline of compression depth. Time-dependent analysis revealed significant ineffective compression depth (<70%) in females and underweight patients (p<0.001). CONCLUSION: Switching compressors at an interval of 2 min is reasonable for 30:2 CPR by lay-persons. But, significant decline of correct compression depth over time in female and underweight rescuers was evident.

High-frequency Chest Wall Oscillation Therapy: Clinical Effectiveness in the Patients with Pulmonary Contusion / 대한구급학회지

BACKGROUND: Pulmonary contusion is the most common pulmonary parenchymal injury in blunt chest trauma and may constitute a life-threatening thoracic injury. In this study, we evaluated the usefulness of high-frequency chest wall oscillation (HFCWO) therapy in patients with pulmonary contusion. METHODS: Patients with lung contusion either received HFCWO therapy using the Vest system (Vest group; n = 18) or received conventional chest physiotherapy (non-Vest group; n = 23). The physiological parameters of the patients, length of stay in hospital and ICU, and the duration of mechanical ventilation were compared between the two groups. Variables, including pulmonary contusion score, percentage of patients receiving mechanical ventilation therapy, and PaO2/FiO2 ratio, were also analyzed. RESULTS: The pulmonary contusion score was higher in the Vest group (p < 0.01), and mechanical ventilation was used more frequently in the Vest group (p = 0.027). Improvement in the PaO2/FiO2 ratio over the first 48 h did not differ between the Vest and Non-Vest groups. No significant differences in the physiological parameters, hospital and ICU stays, and duration of mechanical ventilation were observed between the two groups. CONCLUSIONS: The therapeutic effect of the Vest system in patients with pulmonary contusion was similar to that of conventional chest physiotherapy. Therefore, the Vest system could be considered as an airway clearance technique in the management of patients with pulmonary contusion.

Is it Possible to Perform Chest Compression in Various Alternative Positions in a Confined Space?: A Manikin and Simulation Study

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.

Is it Possible to Perform Chest Compression in Various Alternative Positions in a Confined Space?: A Manikin and Simulation Study

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.

Empilhamento de ar e compressão torácica aumentam o pico de fluxo da tosse em pacientes com distrofia muscular de Duchenne / Air stacking and chest compression increase peak cough flow in patients with Duchenne muscular dystrophy

OBJETIVO: Avaliar a eficiência da tosse através do uso de duas manobras manuais de auxílio à tosse. MÉTODOS: Foram selecionados 28 pacientes portadores de distrofia muscular de Duchenne em uso de ventilação mecânica não-invasiva noturna e CVF < 60 por cento do previsto. O pico de fluxo da tosse (PFT) foi medido, com o paciente sentado, em quatro momentos: com esforço expiratório máximo (EEM) de forma espontânea (basal), EEM associado à compressão torácica, EEM após empilhamento de ar com bolsa de ventilação e EEM com o uso dessas duas técnicas (técnica combinada). As três últimas medições foram realizadas em ordem aleatória. Os resultados foram comparados usando o teste de correlação de Pearson e ANOVA para medidas repetidas, seguido do teste post hoc de Tukey (p < 0,05). RESULTADOS: A idade média dos pacientes foi de 20 ± 4 anos, e a CVF média foi de 29 ± 12 por cento. A média de PFT basal, com compressão torácica, com empilhamento de ar e com o uso da técnica combinada foi 171 ± 67, 231 ± 81, 225 ± 80, e 292 ±86 L/min, respectivamente. Os resultados com o uso da técnica combinada foram maiores que aqueles com o uso das duas técnicas separadamente [F(3,69) = 67,07; p < 0,001]. CONCLUSÕES: As técnicas de compressão torácica e de empilhamento de ar foram eficientes para aumentar o PFT. No entanto, a combinação dessas manobras teve um efeito aditivo significativo (p < 0,0001).

OBJECTIVE: To evaluate cough efficiency using two manually-assisted cough techniques. METHODS: We selected 28 patients with Duchenne muscular dystrophy. The patients were receiving noninvasive nocturnal ventilatory support and presented FVC values < 60 percent of predicted. Peak cough flow (PCF) was measured, with the patient seated, at four time points: at baseline, during a spontaneous maximal expiratory effort (MEE); during an MEE while receiving chest compression; during an MEE after air stacking with a manual resuscitation bag; and during an MEE with air stacking and compression (combined technique). The last three measurements were conducted in random order. The results were compared using Pearson's correlation test and ANOVA with repeated measures, followed by Tukey's post-hoc test (p < 0.05). RESULTS: The mean age of the patients was 20 ± 4 years, and the mean FVC was 29 ± 12 percent. Mean PCF at baseline, with chest compression, after air stacking and with the use of the combined technique was 171 ± 67, 231 ± 81, 225 ± 80, and 292 ± 86 L/min, respectively. The results obtained with the use of the combined technique were significantly better than were those obtained with the use of either technique alone (F[3.69] = 67.07; p < 0.001). CONCLUSIONS: Both chest compression and air stacking techniques were efficient in increasing PCF. However, the combination of these two techniques had a significant additional effect (p < 0.0001).

Comparação dos efeitos de duas técnicas fisioterapêuticas respiratórias em parâmetros cardiorrespiratórios de lactentes com bronquiolite viral aguda / Comparison of the effects that two different respiratory physical therapy techniques have on cardiorespiratory parameters in infants with acute viral bronchiolitis

OBJETIVO: Comparar os efeitos das técnicas de aumento do fluxo expiratório (AFE) e vibração associada à drenagem postural (DP) nos parâmetros cardiorrespiratórios de frequência cardíaca (FC), frequência respiratória (FR) e SpO2 de lactentes com bronquiolite viral aguda (BVA). MÉTODOS: Foram analisados lactentes com diagnóstico clínico e radiológico de BVA. A FC, FR e SpO2 foram registradas em quatro tempos: antes do procedimento e após 10, 30 e 60 min do término do procedimento. Os pacientes foram divididos em três grupos: submetido à AFE; submetido à vibração/DP; e controle. RESULTADOS: Foram incluídos no estudo 81 lactentes, 27 em cada grupo de estudo, com média de idade de 4,52 meses e peso médio de 6,56 kg. Na comparação por ANOVA, as médias da FR, FC e SpO2 nos grupos AFE e vibração/DP não apresentaram diferenças significantes em relação ao grupo controle (p > 0,05). Considerando somente os quatro tempos, houve queda significante dos valores médios de FR nos grupos AFE e vibração/DP em relação ao controle (p < 0,05). CONCLUSÕES: A aplicação de AFE e de vibração associada à DP não apresentou um benefício global na melhora dos parâmetros cardiorrespiratórios em lactentes com BVA. Quando analisados isoladamente no decorrer do tempo, a fisioterapia respiratória parece contribuir na diminuição da FR nesses pacientes.

OBJECTIVE: To compare the expiratory flow increase technique (EFIT) and vibration accompanied by postural drainage (PD) in terms of their effects on the heart rate (HR), respiratory rate (RR) and SpO2 of infants with acute viral bronchiolitis (AVB). METHODS: Infants with clinical and radiological diagnosis of AVB were analyzed. The HR, RR and SpO2 were registered at four time points: prior to the procedure; and at 10, 30 and 60 min after the procedure. The patients were divided into three groups: submitted to the EFIT; submitted to vibration/PD; and control. RESULTS: We included 81 infants, 27 per group, with a mean age of 4.52 years and a mean weight of 6.56 kg. Using ANOVA, we found that the EFIT and vibration/PD groups presented no significant differences in relation to the control group in terms of the mean values for HR, RR or SpO2 (p > 0.05). Considering only the four time points evaluated, the mean RR was significantly lower in the EFIT and vibration/PD groups than in the control group (p < 0.05). CONCLUSIONS: In terms of overall improvement of cardiorespiratory parameters, neither the EFIT nor vibration/PD provided any benefit to infants with BVA. However, over time, respiratory physical therapy seems to contribute to decreasing the RR in these patients.

Efeito de um programa de treinamento de facilitação neuromuscular proprioceptiva sobre a mobilidade torácica / Effect of a training program based on proprioceptive neuromuscular facilitation onto thoracic mobility

A proposta deste estudo foi analisar o efeito de um programa de treinamento de membros superiores baseado nas técnicas de facilitação neuromuscular proprioceptiva (FNP) sobre a mobilidade torácica. Foram estudadas 24 voluntárias sedentárias, idade 22,9 ± 2,9 anos, divididas em grupo controle (GC), que não participou do treinamento, e grupo treinado (GT). O protocolo de treinamento físico foi constituído por um programa de exercícios de FNP, realizado três vezes por semana, durante quatro semanas. Os dois grupos foram submetidos à avaliação da mobilidade torácica por meio de cirtometria, antes e após o período de treinamento. Os dados colhidos foram analisados estatisticamente, com nível de significância á = 5%. Os valores da cirtometria axilar e xifoideana do GC antes e após o período de intervenção não apresentaram alterações significativas (p>0,05). No GT os valores das variáveis foram significantemente maiores após a intervenção (p<0,05). Em conclusão, o protocolo de FNP utilizado parece ser um programa de exercícios eficiente, por promover aumento na cirtometria em um curto período de tempo, sugerindo que pode ser utilizado como recurso fisioterapêutico para o desenvolvimento da mobilidade torácica...

The purpose of this study was to analyse the effect of an upper limb training program based on proprioceptive neuromuscular facilitation (PNF) techniques on thoracic mobility. The study was carried out with 24 sedentary female volunteers,aged 22.9±2.9 years. Participants were divided into a control group (CG), who did not perform any exercise, and a trained group (TG), submitted to training. The physical training protocol consisted of a PNF exercise program, three times a week for four weeks. The two groups were assessed as to thoracic mobility by means of cirtometry before and after the training period. Data were statistically analysed and significance level set at á=5%. In CG, initial axillary and xiphoid cirtometry values showed no significant differences when compared to data obtained on the final evaluation (p>0.05). TG measures, in turn, were significantly higher after the training program (p<0.05). The PNF protocol here proposed seems hence to be an efficient exercise program to promote increase in cirtometry values within a short period of time, suggesting that the it may be used as a physical therapy resource for the development of thoracic mobility...

Uso de fijador externo en la inestabilidad de la pared torácica anterior (volet esternal). Presentación de un caso / Use of the external fixative in the instability of the anterior thoraxic wall (sternal volet). A case report

Se presenta un paciente con inestabilidad de la pared torácica anterior y esternón tratado previamente con un dispositivo creado por los autores en 1995 para el volet costal. Las costillas artificiales externas del dispositivo, diseñado para el cerclaje subperióstico, actúan como elemento de fijación y han conseguido resultados satisfactorios. Se presenta un paciente, que producto de un accidente automovilístico, sufre lesiones en cráneo, tórax, abdomen y extremidades, entre las que resaltan contusión cerebral, lesión hepática, fractura de fémur e inestabilidad de la pared torácica anterior. Esta última requirió de prioridad extrema, pues habría llevado rápidamente al paciente a la insuficiencia respiratoria de no ser solucionado el problema. Se realizó la estabilización externa mediante un equipo que se utiliza en nuestro hospital, reutilizable y aplicable en cualquier inestabilidad torácica independientemente de la localización de esta. El fijador se confecciona con láminas de duraluminio maleables que permiten su adaptabilidad e introduce una forma de tratamiento en las lesiones torácicas bilaterales con inestabilidad esternal, situación compleja en la que puede resultar un instrumento valioso de tratamiento(AU)

A patient is presented with uncertainty of the previous thoracic wall and breastbone tried previously with a device created by the authors in 1995 for the costal volet. The external artificial ribs of the device, designed for the cerclaje subperióstico, act as fixation element and they have gotten satisfactory results. A patient is presented that product of an automobile accident, suffers lesions in skull, thorax, abdomen and extremities, among those that stand out cerebral bruise, hepatic lesion, femur fracture and uncertainty of the previous thoracic wall. This last one required of extreme priority, because it would have taken to the patient quickly to the breathing inadequacy of not being solved the problem. He/she was carried out the external stabilization by means of a team that is used in our hospital, reutilizable and applicable in any thoracic uncertainty independently of the localization of this. The fixer is made with sheets of malleable duraluminio that allow its adaptability and it introduces a treatment form in the bilateral thoracic lesions with uncertainty esternal, complex situation in which can be a valuable instrument of treatment(AU)

Efficacy of high frequency chest wall oscillation on pulmonary functions in chronic bronchitis

Twenty male patients with chronic bronchitis participated in this study, after giving a written informed consent, in order to investigate the changes that occur in the ventilatory functions and arterial oxygen saturation percentage as a result for administration of high-frequency chest wall oscillation. The age of the subjects ranged between 60 - 70 years. They underwent a thorough medical and physical examinations. None of the subjects complains of any disease that is contraindicated for the study. High-frequency chest wall oscillation was administered at 8 Hz, 16 Hz, and 24 Hz each for 5 minutes. With a pressure span n15/+ 10 mm Hg. The sessions were daily, fifteen minutes for each session, two sessions per day for three months duration. The session was performed with patients in sitting position and proceeded from the lowest to highest frequency. Pulmonary function tests:f orced vital capacity [PVC] forced expiratory volume in the first second of exhalation [FEV1-] and. artcrial oxygln saturation percentage [O2 sat%] were performed and measured before the first session and then after completion of three months. The results showed that there are significant increase in forced vital capacity [FVC], forced expirafory volume in the first second of exhalation [FEV I] and arterial oxygen saturation percentage [O2 sat%] after administration of high-frequency chest wall oscillation in cases of chronic bronchitis for three months. These effects have been attributed to improved interregional and intraregional gas mixing, mucus shearing due to increased mucus-airflow interaction, enhancement of cilia beat-frequency as a result of the reflex mechanism, and facilitation of the cephaled movement of mucus by the higher expiratory flows