Respiratory Muscle Rehabilitation in Patients with Prolonged Mechanical Ventilation: A Targeted Approach.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

Insight among people with severe mental illness, co-occurring PTSD and elevated psychotic symptoms: Correlates and relationship to treatment participation.

BACKGROUND: There is a dearth of research on what factors are predictive of insight among people with severe mental illness and co-occurring PTSD. METHOD: Data were drawn from 146 participants with severe mental illness, co-occurring PTSD and elevated psychotic symptoms participating in a randomized controlled trial comparing two interventions for PTSD among people with severe mental illness. We examined the clinical and demographic correlates of insight at baseline, the relationship between baseline insight and treatment participation, the relationship between treatment participation and post-treatment insight, and the relationship between change in insight and change in other clinical variables. RESULTS: Impaired insight was relatively common, with roughly half the sample demonstrating mild or moderate impairment at baseline. Baseline insight was associated with fewer psychotic and disorganized symptoms, and greater emotional discomfort and PTSD knowledge, but was not associated with negative symptoms, PTSD symptoms, depression/anxiety, or treatment participation. Participation in PTSD treatment was associated with increased insight at post-treatment. Improved insight was associated with improvements in disorganization and negative symptoms, but not with knowledge of PTSD or positive symptoms. DISCUSSION: The findings suggest that engagement in treatment that includes educating people about PTSD may lead to improvements in insight and related improvements in other psychiatric symptoms.

[Respiratory Muscle Training: State of the Art]. / Atemmuskeltraining: State-of-the-Art.

Specific respiratory muscle training (IMT) improves the function of the inspiratory muscles. According to literature and clinical experience, there are 3 established methods: 1.) resistive load 2.) threshold load and 3.) normocapnic hyperpnea. Each training method and the associated devices have specific characteristics. Setting up an IMT should start with specific diagnostics of respiratory muscle function and be followed by detailed individual introduction to training. The aim of this review is to take a closer look at the different training methods for the most relevant indications and to discuss these results in the context of current literature. The group of neuromuscular diseases includes muscular dystrophy, spinal muscular atrophy, amyotrophic lateral sclerosis, paralysis of the phrenic nerve, and injuries to the spinal cord. Furthermore, interstitial lung diseases, sarcoidosis, left ventricular heart failure, pulmonary arterial hypertension (PAH), kyphoscoliosis and obesity are also discussed in this context. COPD, asthma, cystic fibrosis (CF) and non-CF-bronchiectasis are among the group of obstructive lung diseases. Last but not least, we summarize current knowledge on weaning from respirator in the context of physical activity.

Técnicas ventilatorias en el asma: una revisión de la literatura / No disponible

Introducción: Los pacientes con asma tienen una alta sensibilidad broncorreactiva que no consiguen controlar adecuadamente aun estando sujetos a varias dosis de medicación. Esto tiene una repercusión directa en su vida cotidiana y en su sintomatología. Queremos realizar una revisión para comprobar la efectividad de las técnicas ventilatorias en pacientes asmáticos y qué efectos positivos se consiguen por medio de la fisioterapia respiratoria. Metodología: Se han realizado búsquedas de los últimos 12 años, principalmente en Pubmed y Cochrane, para comprobar las publicaciones actuales. Debían estudiar calidad de vida (QoL), síntomas, signos de hiperventilación, frecuencia respiratoria (FR), fracción exhalada de CO2 (ETCO2) y medicación. Para su análisis se han extraído en tablas siguiendo el modelo PICO (paciente, intervención, comparación y resultados) pasando la escala Delphi y valorar la calidad metodológica. Resultados: Se ha considerado estadísticamente significativo p<0,05, encontrándose mejora en la QoL, permitiendo un mejor control del asma, menos ausencias laborales/escolares (p=0,02), menos visitas al médico de urgencias (p=0,03) y menos dosis en su medicación (p<0,05). Se ha visto una mejora de síntomas con menor impacto en sus actividades, menor depresión y ansiedad, y mejora de la marca de salud mental (MCS) a los 6 meses y 12 meses. Se ha encontrado relación entre FR y ETCO2. Sin efectos adversos documentados p<0,05. Conclusión: La práctica de técnicas ventilatorias produce una mejoría beneficiosa en la QoL, sobre el control de la enfermedad, sobre las exacerbaciones, disminuyen las dosis de medicación, control de síntomas y reduce casos de depresión/ansiedad, por tanto, mejora la salud mental y la emocional. Se necesita seguir estudiando en esta dirección para poder incluir este tratamiento en las guías de práctica clínica

Introduction: Patients with asthma’s diagnosis have a high sensitive of bronchoreaction, they can not control their own pathology properly and also they need high drug doses. We pretend to review the literature about breathing techniques in asthma and check their positive effects in patients practising those techniques with respiratory physiotherapy. Methodology: We have searched mainly in Pubmed and Cochrane in order to check the publications that we have about breathing techniques of the last 12 years. They must have studied the quality of life (QoL), symptoms, hyperventilation signs, anxiety and depression, respiratory rate (RR) end-tidal CO2 (ETCO2) and drug doses. We have used PICO model to get the results out (patients, intervention, comparison and outcomes) and we used Delphi score to check the methodological quality. Results: We have found statistically significant (p<0.05) in QoL allowing a better control in the asthma, less absenses at work and school (p=0.02), less emergency physicians visits (p=0.03), less drug doses (p<0.05) and improvement in their symptoms with less impact in their daily activities, less depression and anxiety and improvement in their mental health. Found relation between respiratory rate and ETCO2. No negative effects were found p<0.05. Conclusions: Practising breathing techniques shows improvement in QoL, asthma´s control and exacerbations, less drug doses, improvement in their symptoms’ control and less anxiety/depressions cases, so they have better mental and emotional health. We still need studying in this way to introduce those techniques in the clinic practice guides

Inspiratory muscle training in patients with diabetic autonomic neuropathy: a randomized clinical trial.

AIMS AND METHODS: We evaluated the effects of an 8-week inspiratory muscle training (IMT, n = 5) or placebo IMT (P-IMT, n = 5) on maximal respiratory pressures, pulmonary function, functional capacity, and cardiac autonomic control in patients with type 2 diabetes and diabetic autonomic neuropathy (DAN). RESULTS AND CONCLUSIONS: The IMT group had a greater increase in maximum inspiratory pressure as compared to P-IMT (p < 0.05). The IMT improved inspiratory muscle strength in patients with DAN.

Does respiratory muscle training improve cough flow in acute stroke? Pilot randomized controlled trial.

BACKGROUND AND PURPOSE: Cough protects the lungs from aspiration. We investigated whether respiratory muscle training may improve respiratory muscle and cough function, and potentially reduce pneumonia risk in acute stroke. METHODS: We conducted a single-blind randomized placebo-controlled trial in 82 patients with stroke (mean age, 64±14 years; 49 men) within 2 weeks of stroke onset. Participants were masked to treatment allocation and randomized to 4 weeks of daily expiratory (n=27), inspiratory (n=26), or sham training (n=25), using threshold resistance devices. Primary outcome was the change in peak expiratory cough flow of maximal voluntary cough. Intention-to-treat analyses were conducted using ANCOVA, adjusting for baseline prognostic covariates. RESULTS: There were significant improvements in the mean maximal inspiratory (14 cmH2O; P<0.0001) and expiratory (15 cmH2O; P<0.0001) mouth pressure and peak expiratory cough flow of voluntary cough (74 L/min; P=0.0002) between baseline and 28 days in all groups. Peak expiratory cough flow of capsaicin-induced reflex cough was unchanged. There were no between-group differences that could be attributed to respiratory muscle training. There were also no differences in the 90-day incidence of pneumonia between the groups (P=0.65). CONCLUSIONS: Respiratory muscle function and cough flow improve with time after acute stroke. Additional inspiratory or expiratory respiratory muscle training does not augment or expedite this improvement. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Unique identifier: ISRCTN40298220.