ABSTRACT
Purpose of Study Today's mechanical ventilators require adjustments of respiratory rate, inspiratory time, expiratory time and tidal volume to maximize O2 delivery and CO2 removal. Pranayam was first recorded about 7000 years ago, and shows similar results to ventilation. Involving conscious inhalation, exhalation and holding of breath, Pranayam is held prominent in the Yoga Sutra (historical authoritative text on Yoga). Pranayam includes three primary principles: Puraka, Rechaka and Kumbhaka, and the techniques of Kapalbhati and Bhastrika. Slow breathing stimulates the vagus nerve and parasympathetic nervous system, easing inhibition of the sympathetic 'fight or flight' response. Pranayam also enhances nitric oxide (NO) production. Recent studies using NO for COVID-19 treatment via inhaler show promising results in shortening the course, symptom severity and resulting damage. When practiced regularly, Pranayam enhances cellular gas exchange, increasing O2 levels and enhancing detox. This study draws parallels between Pranayam and modern ventilation in management of obstetric and pediatric conditions. Methods Used Literature search of ancient Indian texts (Upanishads and Yoga Vasishta, Bhagavad Gita, Patanjali Yoga Sutras) and recent publications on modern ventilation and its clinical applications. Summary of Results Several therapies in allopathic medicine show similar principles to Pranayam in prevention and management of ailments. Maximizing O2 delivery and CO2 removal is accomplished through low tidal volumes and high rates in conventional mechanical ventilators, and extremely low tidal volumes in high frequency oscillators and jet ventilators. These can be compared to high frequency breaths in Pranayam with air exchange improvement and positive alteration of acid/base balance, aiming to avoid lung injury from high distending pressures, especially for infants. Ventilatory strategies such as high pressure and low rate also have their equivalent in Pranayam. Conclusions Breath manipulations in modern medicine and the ancient technique of Pranayam have a positive impact on preventing many human ailments, especially in the fields of perinatology and pediatrics. Breathing exercises can prevent anxiety episodes, mountain sickness and asthma exacerbations. They are also taught to expectant mothers to reduce labor pain during contractions. Human trials show increased pulmonary function and endogenous NO by regular practice of these techniques, which have been used as an adjuvant in COVID-19 patient care. These parallels between Pranayam and ventilatory techniques show a synthesis of ancient and modern therapy. (Figure Presented).
ABSTRACT
Purpose of Study Burnout is experienced by over 60% of physicians in the US with a 10% increase in the past year, and leads to degradation of patient care, low professional satisfaction, increased physician turnover, and increased healthcare costs. The COVID-19 pandemic has magnified and exacerbated these challenges. Pediatric mental impact from this healthcare crisis has been referred to as the second pandemic, and dealing with it requires health professionals to be centered and resilient. Physicians experiencing burnout can suffer from denial at first, preventing early intervention. One proposed solution is incorporating mindfulness-based meditation into the residency wellness curriculum. This study compared a pilot study in 2019 with a subsequent study in 2021 incorporating changes reflecting lessons learned from the pilot study, to measure burnout in pediatric residents before and after the implementation of a 3 month mindfulness-based meditation curriculum. Methods Used Comparison was made between a pilot study in mindfulness conducted in the department of pediatrics in 2019, and a Phase II in the departments of pediatrics and pastoral care in 2021. The outcome measures were: number of participants attending the sessions and the percentage compliance in filling the initial survey, final survey and post-meditation short surveys. The changes implemented included interdepartmental participation, increase in the number of 'mindfulness ambassadors', making attendance possible virtually (online) as well as physical presence, and making the surveys accessible online instead of paper-only (see table 2). Summary of Results There was a 20% increase in compliance filling the initial and final surveys between the pilot study and phase II (see figure 1). There was also a 30% increase in compliance with post-meditation surveys in 2021 as compared to the pilot study in 2019. It's noteworthy that phase II occurred during the first peak of the COVID pandemic, when residents were stretched thin. It was difficult ensuring consistent participation secondary to this, but phase II showed increased compliance in spite of these challenges. Conclusions Survey participation with consequent increase in the power of the study is critical in making survey-based research studies relevant. The integrity of such studies is often compromised by attenuation in the numbers of participants, as well as incomplete survey filling as a result of 'survey fatigue'. Valuable lessons were learned during the pilot study and when changes were implemented in the subsequent study, statistical power increased, proving higher relevance and effectiveness. (Table Presented).