Proctoclysis for rehydration in children - A scoping review and a pilot survey among medical doctors.

Although proctoclysis (enema) is a historically proven, safe and cost-effective rehydration method that needs little training for users and can effectively replace intravenous hydration in different care settings, it is an uncommon choice for hydration in children with fever and is often missing in official guidelines. To evaluate the usefulness of proctoclysis, this study provides a scoping review of the existing literature. The matched literature was labelled in 5 categories, identifying 6 indication fields that are emphasized in the literature on rectal rehydration. The analysis showed that proctoclysis is mostly used in the context of diagnostic procedures, constipation or in the treatment of a gastrointestinal disease. It is also described as a quick, safe and cost-effective intervention for fluid replacement in emergency, critical care or resource-scarce settings. There are also socio-cultural variations in its use Additionally, we performed a survey on attitudes and experience of medical doctors towards proctoclysis based on a semi-structured questionnaire. In the survey, we analysed the experience of 35 medical doctors from 8 countries. Although we found a general acceptance of enema as beneficial in both hospitalized patients and in home care, doctors expressed the need for more experience with enema and the need for more education materials in order to effectively perform the procedure. Based on our findings, we suggest that further research is necessary examining the attitude towards proctoclysis among parents, nurses and doctors. Enema can have a considerable clinical advantage during home care for gastroenteritis or other infectious diseases with fever to prevent insufficient oral fluid intake resulting in a negative fluid balance. Risks and safety issues are rare and should be considered. However, due to its low level of social acceptability in order to reduce refusal rate, more education is necessary for both medical providers and parents.

The effect of preoperative chest physiotherapy on oxygenation and lung function in cardiac surgery patients: a randomized controlled study.

BACKGROUND: Postoperative pulmonary complications in patients who undergo open heart surgery are serious life-threatening conditions. Few studies have investigated the potentially beneficial effects of preoperative physiotherapy in patients undergoing cardiac surgery. OBJECTIVES: Assess the effects of preoperative chest physiotherapy on oxygenation and lung function in patients undergoing open heart surgery. DESIGN: Randomized, controlled. SETTING: University hospital. PATIENTS AND METHODS: Patients with planned open heart surgery were randomly allocated into an intervention group of patients who underwent a preoperative home chest physiotherapy program for one week in addition to the traditional postoperative program and a control group who underwent only the traditional postoperative program. Lung function was assessed daily from the day before surgery until the seventh postoperative day. MAIN OUTCOME MEASURES: Differences in measures of respiratory function and oxygen saturation. Length of postoperative hospital stay was a secondary outcome. SAMPLE SIZE: 100 patients (46 in intervention group, 54 in control group). RESULTS: Postoperative improvements in lung function and oxygen saturation in the intervention group were statistically significant compared with the control group. The intervention group also had a statistically significant shorter hospital stay (P<.01). CONCLUSION: Preoperative chest physiotherapy is effective in improving respiratory function following open heart surgery. LIMITATIONS: Relatively small number of patients. CONFLICT OF INTEREST: None. REGISTRATION: ClinicalTrials.gov (NCT04665024).