ABSTRACT
BACKGROUND: Mechanical insufflation-exsufflation (MI-E) is increasingly used in the home management of children with neuromuscular disease. Research to date has focused on the effect of MI-E on physical health. The aim of this study was to qualitatively investigate the impact of home MI-E on the child and family's lifestyle. METHODS: Eight parents and 3 children participated in semistructured interviews. RESULTS: Five themes emerged from parent interviews demonstrating: (1) lifestyle implications, (2) parents becoming experts, (3) parents developing a sense of control over their child's condition, (4) an element of extra care, and (5) impacts on the parent-child relationship. Developing themes from the child interviews showed them adjusting to and then relying on the device. Home MI-E medicalized the home, but the overall lifestyle impact was positive. CONCLUSIONS: Although involving a small number of subjects, this study demonstrated a mixture of opposing impacts of home MI-E on lifestyle, both enabling and disabling, which need to be considered when introducing home MI-E. The positive impacts included greater ability to manage the child's health, including avoidance of hospital admissions. Negative impacts were greatest for those parents who were sole operators of the device, including a frequently disrupted lifestyle.
Subject(s)
Family Relations/psychology , Home Care Services , Insufflation/psychology , Life Style , Neuromuscular Diseases , Respiratory Therapy/psychology , Adolescent , Adult , Australia , Child , Child, Preschool , Female , Humans , Insufflation/instrumentation , Interviews as Topic , Male , Neuromuscular Diseases/psychology , Parents/psychology , Qualitative Research , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Respiratory Therapy/methodsABSTRACT
BACKGROUND: Nasal insufflation (NI) is a novel treatment method that has been introduced for improving respiration during sleep. NI's warmed and humidified nasal airflow provides ventilatory assistance delivered as a rapidly dispersed pressure head, with minimal side wall pressures, that may affect treatment tolerability. The aim of the current study was to investigate objective and subjective adherence rates for NI therapy in mild to moderate obstructive sleep apnea (OSA). METHODS: Ten patients (three men and seven women; age, 51.3 ± 9.6 years; BMI, 32.2 ± 7.7 kg/m2 [mean ± sd]) with recently diagnosed mild to moderate OSA (10.9 ± 5.8 events/h) were investigated. A crossover design was used to compare adherence to NI and continuous positive airway pressure (CPAP) therapy using a range of objective and subjective measurements. Objective (sleep efficiency (%) and arousal indices (arousal/h)) and subjective evaluations of sleep quality were carried out each night in the laboratory. During in-home treatment, adherence for both therapies was assessed objectively (time on therapy) and subjectively (self-reported sleep diary). RESULTS: Objectively derived adherence values were comparable for CPAP and NI, with both treatment devices sharing similar usage per night (3.5 ± 2.5 vs. 3.6 ± 1.6 h/night; respectively) and the number of nights with at least 4 h of treatment (5.5 ± 4.3 vs. 6.8 ± 3.3 nights/trial, respectively). Self-reported adherence was significantly higher than objectively assessed adherence (p < 0.03). CONCLUSIONS: This study showed similar adherence to NI and CPAP over a short period of usage. A randomized clinical trial is now essential for determining the comparative effectiveness of NI therapy in relation to treatment with CPAP.
Subject(s)
Continuous Positive Airway Pressure/psychology , Insufflation/psychology , Patient Compliance/psychology , Respiratory Therapy/psychology , Sleep Apnea, Obstructive/psychology , Sleep Apnea, Obstructive/therapy , Adult , Ambulatory Care , Cross-Over Studies , Female , Humans , Insufflation/instrumentation , Male , Middle Aged , Polysomnography/instrumentation , Respiratory Therapy/instrumentationABSTRACT
PROBLEMS/OBJECTIVES: Pneumoparotid is a rare condition in which air is insufflated through Stensen's duct into the parotid gland. This causes mostly painless swelling in the parotid region. CASE REPORT: We report on a 7-year old girl presenting with painless unilateral swelling of the left parotid region, present for one month. Computer tomography showed the presence of air in the left parotid gland and in both the left and right Stensen's duct. A thorough history revealed the girl was insufflating the parotid glands intentionally as a response to stress. The patient was comforted and instructed to avoid insufflation manoeuvres, which resulted in complete resolution. CONCLUSION: Pneumoparotid should be considered part of a differential diagnosis in children and adolescents presenting with painless uni- or bilateral swelling of the parotid gland. Supportive and conservative treatment is advocated.
