A mobile-based airway clearance care system using deep learning-based vision technology to support personalized home-based pulmonary rehabilitation for COAD patients: Development and usability testing.

Background: Excessive mucus secretion is a serious issue for patients with chronic obstructive airway disease (COAD), which can be effectively managed through postural drainage and percussion (PD + P) during pulmonary rehabilitation (PR). Home-based (H)-PR can be as effective as center-based PR but lacks professional supervision and timely feedback, leading to low motivation and adherence. Telehealth home-based pulmonary (TH-PR) has emerged to assist H-PR, but video conferencing and telephone calls remain the main approaches for COAD patients. Therefore, research on effectively assisting patients in performing PD + P during TH-PR is limited. Objective: This study developed a mobile-based airway clearance care for chronic obstructive airway disease (COAD-MoAcCare) system to support personalized TH-PR for COAD patients and evaluated its usability through expert validation. Methods: The COAD-MoAcCare system uses a mobile device through deep learning-based vision technology to monitor, guide, and evaluate COAD patients' PD + P operations in real time during TH-PR programs. Medical personnel can manage and monitor their personalized PD + P and operational statuses through the system to improve TH-PR performance. Respiratory therapists from different hospitals evaluated the system usability using system questionnaires based on the technology acceptance model, system usability scale (SUS), and task load index (NASA-TLX). Results: Eleven participant therapists were highly satisfied with the COAD-MoAcCare system, rating it between 4.1 and 4.6 out of 5.0 on all scales. The system demonstrated good usability (SUS score of 74.1 out of 100) and a lower task load (NASA-TLX score of 30.0 out of 100). The overall accuracy of PD + P operations reached a high level of 97.5% by comparing evaluation results of the system by experts. Conclusions: The COAD-MoAcCare system is the first mobile-based method to assist COAD patients in conducting PD + P in TH-PR. It was proven to be usable by respiratory therapists, so it is expected to benefit medical personnel and COAD patients. It will be further evaluated through clinical trials.

Assessment of Rare Case on Patient with Filariasis-Associated Bilateral Pleural Effusion

@#Bilateral pleural effusion is fluid accumulation in both lungs of pleural spaces. The clinical manifestations of bilateral pleural effusion (chylothorax) caused by filariasis are so rare that they are often challenging to diagnose. This case study described a 21-year-old woman, domiciled in Sumatra, with complaints of shortness of breath and swollen legs. Radiological examination results found bilateral pleural effusion. Initially, it was suspected that the effusion was caused by tuberculosis, Systemic Lupus Erythematosus (SLE), and malignancy; however, treatments for these did not improve the patient’s condition. A Water Seal Drainage (WSD) was inserted and a chylous or chylothorax pleural effusion was obtained, and microfilaria was founded in the nocturnal blood examinations. Oxygen and nursing interventions were administered using lung expansion and postural drainage techniques, supported by education on effective coughing and deep breathing, along with the fulfillment of nutritional needs and dietary adjustments

Effect of different targeted calyxes on the treatment of multi-site calculi in the postural drainage lithotripsy system.

Objectives: We developed a postural drainage lithotripsy system (PDLS) that can provide an individualized inversion and overturning angle and uses gravity to remove residual fragments (RFs). This study aimed to evaluate the effect of different targeted calyces on treating multi-site stones in PDLS. Methods: A total of 20 stones with different sizes and diameters of 0-4 mm were placed in the kidney model through ureteroscopy, and 20 stones were evenly scattered in the middle calyx and the lower calyx of the model. The ventral-middle calyx, the dorsal-middle calyx, the ventral-lower calyx, and the dorsal-lower calyx were used as the targeted calyx of PDLS to treat multi-site stones. During treatment, if the stone moved from the starting position of the renal calyx to the ureteropelvic junction, it was recorded as "passing through." The clearance rate was recorded, and the efficacy of different targeted calyxes in the treatment of multiple-site calyx was compared. Each model was treated with four different targeted calyxes, and 20 models were tested 80 times. Results: When the lower calyx was the targeted calyx, the total stone clearance rate was higher than when the middle calyx was the locating calyx (94.5 vs. 64%, P = 0.000), and the result was statistically significant. Conclusions: Choosing the lower calyx as the targeted calyx, we can obtain a better stone clearance rate. However, there is no significant difference between the ventral lower calyx and the dorsal lower calyx.

A single center study that evaluates the preclinical use of a newly developed software and moving bed system to facilitate the spontaneous excretion of residual fragments after primary stone treatment (RIRS or PCNL).

PURPOSE: We developed a Postural Drainage Lithotripsy System (PDLS) that uses the patient's computed tomography urography (CTU) data to reconstruct the three-dimensional figure of the renal pelvis, provides an individualized inversion and overturning angle and uses gravity to remove residual fragments (RFs). The purpose of this study was to investigate PDLS in the treatment of renal RFs. METHODS: A stone with a diameter of 4.0 mm was placed in the upper, middle, and lower calyx of the renal model. A total of 60 trials were applied to 20 renal models. The movement trajectory, passage rate, and postural drainage angle of calculi during the treatment of PDLS were observed. RESULTS: All of the stones in 60 trials were observed to move during treatment, and 53/60 (88%) were relocated successfully to the renal pelvis. The passage rate of the upper calyx was 14/20 (70%), that of the middle calyx was 20/20 (100%), and that of the lower calyx was 19/20 (95%). CONCLUSIONS: PDLS can provide individualized inversion and reversal angles and remove stones from the renal model. More clinical trials are needed to verify the above view and evaluate its efficacy.

Terapia Respiratoria para pacientes COVID-19 con enfermedad activa / Respiratory Therapy for COVID-19 patients with active disease

El drenaje postural implica una combinación de técnicas, que incluyen múltiples posiciones para drenar los pulmones, percusión, vibración, respiración profunda y tos. La fisioterapia de tórax, que incluye técnicas de drenaje postural y percusión, permite que la gravedad elimine la acumulación de moco en los pulmones en pacientes con COVID-19 con dificultad respiratoria. Estas técnicas también ayudan a abrir ambas vías respiratorias y a llevar más oxígeno a los sacos de aire y a mejorar la circulación a los pulmones.

Postural drainage involves a combination of techniques, including multiple positions to drain the lungs, percussion, vibration, deep breathing, and coughing. Chest physical therapy, including percussion and postural drainage techniques, allows gravity to remove mucus build-up in the lungs in COVID-19 patients with respiratory distress. These techniques also help open both airways and deliver more oxygen to the air sacs and improve circulation to the lungs.

Application of prone position in acute respiratory distress syndrome of pediatrics / 中华实用儿科临床杂志

Acute respiratory distress syndrome (ARDS) is a common critical disease in department of pediatrics.Mechanical ventilation is one of the effective means for the treatment of ARDS.In the past,in order to comfort and care for patients,the supine or semi supine position were used often.Recently,many studies have showed that prone position could change the respiratory mechanics and reduce intrathoracic pressure,avoiding lung injury caused by over stretch and hyperinflation,which is significant in improving ARDS gas exchange.

Effects of manual percussion during postural drainage on lung volumes and metabolic status in healthy subjects.

OBJECTIVE: The aim of this study was to evaluate the influence of manual percussion during three different positions of postural drainage (PD) on lung volumes and metabolic status. METHODS: Twenty six healthy volunteers (13 women and 13 men), with a mean age of 20.15 ± 1.17 years, participated. They were randomized into three standard positions of PD (upper, middle, or lower lobes) and given manual percussion at a frequency of 240 times per minute for 5 min. Lung volumes, including tidal volume (TV), inspiratory reserve volume (IRV), expiratory reserve volume (ERV) and vital capacity (VC); and metabolic status, such as oxygen consumption (VO2), carbon dioxide (VCO2), respiratory rate (RR), and minute ventilation (VE) were evaluated. RESULTS: The lung volumes showed no statistical difference in VC or IRV from percussion during PD in all positions, except for the lower lobe, where increased TV and decreased ERV were found when compared to PD alone. Furthermore, percussion during PD of the upper and middle lobes did not affect RR or VE, when compared to PD alone. In addition, percussion during PD of the middle and lower lobes increased VO2 and VCO2 significantly, when compared to PD alone, but it did not influence PD of the upper lobe. CONCLUSION: This study indicated that up to 5 min of manual percussion on PD of the upper and middle lobes is safe mostly for lung volumes, RR, and VE, but it should be given with care in PD conditions of the lower lobe.

Critically patient and position / 中国小儿急救医学

There is great role of position treta ment in critically paediatric patient.It can not only alleviate the ol cal skin contracture opprse sion,muscle joints,but can cause the redistribution of body fluids. Even changing body position plays a crucial role in a number of specific diseases and treatment modalities. Intensive care unit common position includes seated,semi-seated,supine,semi-supine,left lateral, right lateral op sition na d prone position,anti-trendelenburg position,continuous lateral rotation therapy.The following is a brief introduction to the application of various body positions in the intensive care unit.

Acute hemodynamic responses to 30° head-down postural drainage in stable, ventilated trauma patients: a randomized crossover trial.

OBJECTIVE: To determine whether 30° head-down tilt (HDT) used for secretion clearance is safe for acute trauma patients. BACKGROUND: There are concerns that HDT may lead to cardiac irregularities in intubated patients in the ICU. METHODS: Eleven mechanically ventilated trauma patients (25-42 yrs) without cardiovascular problems received two interventions, one supine HDT for 10 min and a control in the horizontal supine position (HS), in a crossover design. RESULTS: Compared to baseline there were statistically significant (p < 0.05) increases in SBP (6.3 mm Hg; 95% CI 2.5, 12.7) and CVP (7.3 cm H2O; 5.7, 10.0) during 10 min HDT although these were not of clinical concern. Heart rate and oxygen saturation were unchanged. No episodes of arrhythmia or hypoxemia were observed. All values returned close to baseline during 10 min horizontal recovery. There were no significant changes during the control HS intervention. CONCLUSION: 30° HDT entails minimal risk for trauma patients who have no underlying cardiovascular disease.

Effects of manually-assisted cough combined with postural drainage, saline instillation and airway suctioning in critically-ill patients during high-frequency oscillatory ventilation: a prospective observational single centre trial.

BACKGROUND: Chest physiotherapy may aid sputum clearance during conventional ventilation. However, the role of chest physiotherapy during high-frequency oscillatory ventilation (HFOV) is unclear. This study aimed to determine the effects manually-assisted cough (MAC), postural drainage, saline instillation and airway suction during HFOV. METHODS: This was an observational study of a chest physiotherapy intervention in adult critically ill patients during HFOV. Measures included gas exchange, HFOV and haemodynamic variables 1 h before, immediately before, and 15 min, 1 h, 6 h and 12 h after intervention. Wet weight of airway secretions was also measured. Linear mixed modelling compared pre-intervention gas exchange, HFOV and haemodynamic variables with the four specified time-points after intervention. RESULTS: Seventeen adults (ten females) with moderate to severe respiratory failure were studied (age, 49 years SD 14; Acute Physiology and Chronic Health Evaluation II score (APACHE II score) 21 SD 6; PaO2/FiO2 of 139 mmHg SD 51). There was a statistically, although not clinically significant reduction in PaO2/FiO2 for up to 1 h after intervention, but no significant changes in oxygenation index, PaCO2, pH, or haemodynamic parameters up to 12 h after intervention. A reduction in delta pressure (ΔPaw) at 15 min (p < 0.05) and 1 h (p < 0.05) post intervention was not correlated with sputum wet weight. CONCLUSIONS: MAC, postural drainage, saline instillation and airway suctioning during HFOV in critically ill patients was well tolerated with no clinically significant effect on arterial blood gases or haemodynamics. ΔPaw decreased for up to 1 h after intervention, but was not explained by the weight of sputum removed.

Posterior only versus combined posterior and anterior approaches in surgical management of lumbosacral tuberculosis with paraspinal abscess in adults.

PURPOSE: To compare single-stage posterior transforaminal lumbar interbody fusion, debridement, posterior instrumentation, and postural drainage (posterior-only surgery) with a combined posterior-anterior surgical approach for treatment of adults with lumbosacral spinal tuberculosis (STB) with paraspinal abscess and to determine the clinical feasibility and effectiveness of posterior-only surgical treatment. METHODS: Thirty-nine patients with lumbosacral STB and paraspinal abscess were treated with one of two surgical procedures in our center from September 2003 to December 2012. Nineteen patients were treated with posterior-only surgery (Group A) and 20 were treated with combined posterior-anterior surgery (Group B). Surgery duration, intraoperative blood loss, length of hospitalization, bony fusion rates, complication rates, neurological status, lumbosacral angle correction, and Kirkaldy-Willis functional outcomes of the two groups were compared. RESULTS: The average follow-up period was 39.1 ± 12.0 months for Group A and 40.7 ± 12.4 months for Group B. Under the Frankel classification, all patients improved with treatment. STB was completely cured and grafted bones were fused within 5-11 months in all patients. There were no persistent or recurrent infections or obvious differences in radiological results between the groups. The lumbosacral angle was significantly corrected after surgical management, but loss of correction was seen in both groups. The average operative duration, blood loss, length of hospital stay, and postoperative complication rate of Group A were lower than those of Group B. CONCLUSIONS: Posterior-only surgery is feasible and effective, resulting in better clinical outcomes than combined posterior-anterior surgeries, especially in surgical time, blood loss, hospital stay, and complications.

Airway clearance therapy: finding the evidence.

Disease processes can impair ciliary function, alter secretion production and mucus rheology, and interfere with the cough reflex. Airway clearance therapy has been a cornerstone of therapy aimed at minimizing the devastating effects of airway obstruction, infection, and inflammation due to mucus stasis on the conducting airways and lung parenchyma. Although challenges to performing clinical studies evaluating the effectiveness of airway clearance therapeutic modalities exist, resources are available in the literature. In addition to device evaluations and original clinical research, the expert opinion, systematic reviews, and evidence-based practice guidelines can be found. These tools can be used to develop protocols and pathways to guide our practice. Monitoring and reporting patient, process, and financial outcomes are essential steps germane to the implementation of evidence-based care.

Acute hypoxaemia due to intraoperative lung collapse after repositioning the patient.

Desaturation after induction of anaesthesia and repositioning due to mucus plug causing atelectasis (lung collapse) is a rare event. We present a case of intraoperative right lung collapse due to mucus plug in a patient undergoing left laparoscopic nephrectomy. Hypoxaemia occurred after the induction of anaesthesia and repositioning. X-ray chest revealed right lung collapse and surgery was subsequently postponed. Lung re-expanded after postural drainage and suction. Postoperatively patient was diagnosed to have retrocardiac bronchiectasis. After preoperative preparation with postural drainage, chest physiotherapy, and antibiotics, the patient underwent surgery uneventfully.

Effect of postural drainage assisting trachea suction on meconium aspiration syndrome / 中国小儿急救医学

Objective To evaluate the effect of postural drainage assisting trachea suction on meconium aspiration syndrome. Methods Total 61 cases of asphyxia neonates with MAS who were born in our hospital from Jan,2007 to Dec,2008, were divided into control group (24 cases) and observing group( 37 cases). The neonates in control group had endotracheal suction directly after intubation. But the infant in observing group was treated with endotracheal suction after postural drainage. The amount of suction from endotracheal tube,the complication of MAS and the outcome of these newborns were evaluated. Results The total amount of meconium drainage from endotrachea in observing group was statistics significantly more than that in control group [( 2. 16 ± 1.82) ml vs ( 1.23 ± 0. 97 ) ml, P ＜ 0. 05 )]; The intubating times in observing group were statistical significantly less than that in control group[( 1.19 ± 0. 46) vs ( 1.79 ± 0. 83 ) times, P ＜0. 01 ). The incidence of complication in observing group was 8. 11% ,which was significantly lower than that in control group(29. 17% ,P ＜0. 05). There were shorter needing oxygen time [(21.30 ± 22. 38) h vs (52. 91 ±39. 20) h,P ＜0. 01]and shorter hospitalization days [(9. 24 ±3.94) d vs ( 14. 39 ±6. 49) d,P ＜0.01 )]in observing group than those in control group respectively. The mortality in control group was 4. 17%, and no death occurred in observing group. Apgar scores of the first minute was similar in both groups ( P ＞ 0. 05 ). But there was significant difference(70. 16% vs 58. 34% ,respectively;P ＜0. 05) in the fifth minute Apgar scoring of 8 ～ 10 scores between the observing group and the control group. Conclusion Postural drainage assisting endotracheal suction may remove meconium in trachea effectively, decrease the complications of MAS and shorten the oxygen days and hospitalization time.