Secretion Clearance Research Articles

The Flow-Pressure and Cardiopulmonary Responses of Manual Chest Percussion with Different Ranges of Oscillation Frequency in Healthy Subjects

Manual chest wall percussion (MP) is a technique for secretion clearance which commonly use. However, MP is performed by physiotherapists throughout a broad range of the oscillation frequency, which might result in different physical properties and cardiopulmonary responses of MP. Investigate the flow, pressure and cardiorespiratory response during MP with 3 frequencies in healthy subjects. Twenty-one healthy subjects (8 men and 13 women) were recruited into this crossover study. MP was applied with 3 frequency ranges, including low (4.0 ± 0.5), medium (5.5 ± 0.5), and high (6.5 ± 0.5) Hz, for 3 min in the neutral side lying on left side. A flow sensor (Model SS11LA) and a pressure sensor (Model SS13L) were used to measure Inspiratory-expiratory (I-E) flow rate and pressure through mouth. A bedside monitor (BSM 2351k, Nihon Kohden) was used to measure cardiopulmonary response. All dependent variables were measured pre- (resting), during, and post- (recovery) MP application. Both I-E flow rate and pressure were increased from resting significantly in all frequencies MP, but they were not different among the 3 frequency ranges. The E flow rate was increased to 0.41 - 0.44, 0.49 - 0.52 and 0.41 - 0.49 L/s (min-max) during MP application at low, medium, and high frequency compared to resting (0.31 - 0.36 L/s), respectively. The E pressure was increased to 0.40 - 0.41, 0.44 - 0.47 and 0.39 - 0.47 cmH2O (min-max) during MP application at low, medium, and high frequency compared to resting (0.20 - 0.22 cm H2O), respectively. However, the increment of the 3 frequency ranges did not affect the cardiovascular functions except respiratory rate, which was increased only 2 breaths/min from resting. In conclusion, airflow and pressure were slightly increased during MP but did not affect cardiopulmonary functions in healthy subjects. Further study in patients is needed. HIGHLIGHTS Manual chest wall percussion is a secretion clearance technique which commonly used. Whether manual chest wall percussion frequency is capable of increasing expiratory flow rate by the same amount. The percussion force might be the most prominent factor affecting the expiratory flow rate. The frequency of chest wall percussion does not affect cardiovascular response. Medium and high frequencies cause a minor rise in the respiratory rate but have no impact on minute ventilation. GRAPHICAL ABSTRACT

Менеджмент болю при множинних переломах ребер: огляд

Trauma is a leading cause of death in people younger than 40 years, and on the third place after cardiovascular and oncological disease overall. Chest trauma is a fi nding in up to 60 % of patients with multiple trauma and has a mortality rate as high as 20–25 %. Rib fractures are the most common fi ndings in patients with thoracic trauma with mortality rates among hospitalised patients between 10 and 22 %. The mortality rate is higher in elderly patients and patients with flail chest. The incidence of pneumonia in the elderly population with three to four and more than six rib fractures is 31 % and 51 %, respectively. Pain due to rib fractures is challenging to manage but effective analgesia reduces hypoventilation, promotes deep breathing, sufficient coughing, clearance of secretions, and better adherence to chest physiotherapy. Th erefore, high-quality analgesia is not only increasing patient comfort but also is very important in preventing complications and improving the outcome. Th e purpose of this review is to analyse the modern literature regarding pain management for a patient with rib fractures and extract the best evidence-based practice.

Modeling the effects of external oscillations on mucus clearance in obstructed airways.

Various therapeutic methods are employed to facilitate the clearance of secretions accumulated in the respiratory tracts of individuals with lower respiratory tract disorders. High-frequency chest wall oscillation (HFCWO) device, designed to apply variable amplitude and frequency vibrations to the individuals' chests, stands out among these therapies. In this study, the effectiveness of this treatment method was investigated numerically using computational fluid dynamics (CFD) on the generated mucus-obstructed bronchial geometry. The conducted analyses compared the effects of vibrations acting in the axial, radial, and tangential directions on the clearance of mucus, which exhibits non-Newtonian flow behavior with shear-thinning properties. Simultaneously, the effects of changes in vibration amplitude and frequency, pressure differentials, fluid properties, and ciliary movements on the flow were separately examined and interpreted. The findings demonstrate that ciliary movements are insufficient in mucus-accumulated airways, applied vibrations enhance mucus clearance, and potential improvements in flow are quite sensitive to boundary conditions.

Is it feasible to avoid suction before spontaneous breathing is established?

Suctioning of the posterior pharynx immediately after birth during neonatal resuscitation can produce a vagal response resulting in bradycardia or apnea. The feasibility of delaying any airway suctioning and avoiding deep suctioning has not been studied. To test the hypothesis that newborn resuscitation is feasible with the following two guidelines: 1) avoiding any suctioning until the infant establishes spontaneous respiration, and 2) avoiding the use of deep suction with catheters. A quality improvement project was implemented using these two guidelines. Infants' mouth was cleaned with a dry cloth. No suction was started until infants establish spontaneous breathing. Then, bulb suction was used to clear secretions from the sides of the mouth and the nose without reaching the back of the pharynx. Deep suction using catheters was not used. Neonatal staff and physicians received biweekly training to support these changes. Resuscitation data before and after the practice change were compared. A total of 999 sequential cases were compared; of them 501 and 498 infants were resuscitated before and after the implementation of the new practice, respectively. Suction before spontaneous breathing occurred in 12.4% in the first cohort. There were no differences between groups except for less use of oxygen with the new guidelines (12.4% vs 4.4%, P < 0.001). Avoidance of any suction prior to spontaneous breathing and not applying deep suction with catheters are feasible during newborn resuscitation. These practices are associated with decreased exposure to oxygen in the delivery room.

Expert consensus on clinical application of mechanical airway clearance techniques

Mechanical airway clearance techniques refer to the therapeutic method of using mechanical means to clear airway secretions and maintain airway patency. Currently, mechanical airway clearance techniques are widely used in clinical practice and have significant effects in clearing respiratory secretions, improving symptoms of respiratory distress, and preventing and reducing respiratory tract infections. However, up to now, there is no consensus, guidance, or standardized procedures for the clinical application of mechanical airway clearance techniques. Therefore, the Respiratory Care Group of Chinese Thoracic Society organized relevant experts to write the consensus on the clinical application of mechanical airway clearance techniques, and systematically describe the definition, historical development, working principles and mechanisms, and clinical applications of mechanical airway clearance techniques. The aim is to increase awareness of mechanical airway clearance techniques, to provide clinical practitioners with standardized procedures for the application of mechanical airway clearance techniques, and to guide the standardized clinical practice.

The efficiency of high flow nasal cannula for respiratory support in adults in the intensive care unit when compared to regular oxygen, non-invasive ventilation, or non-invasive positive pressure ventilation: A systematic review

Objective We aimed to compare the effectiveness of HFNC to NIV or NIPPV, conventional oxygen treatments, for respiratory support in adult intensive care unit patients. Method: In compliance with The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline, this systematic review study was carried out. We looked through Google Scholar, Cochrane, PubMed, and electronic databases to find randomized controlled trials that were released between 2017 and 2023. Result and conclusion: Five randomized controlled trials (with different primary outcomes: hospital length of stay, PaO2/FIO2 ratio, post-extubation vital signs, ABG, respiratory failure three days after extubation, and 28-day mortality rate) were included in this systematic review. Among non-hypercapnic patients at high risk of extubation failure, HFNC may be more advantageous than standard oxygen in delaying the onset of respiratory failure; in terms of vital signs and ABGs, HFNC is a viable replacement for NIV in the weaning of hypercapnic COPD patients; additionally, HFNC improved patient comfort and secretion clearance.

Determination of furosemide and its glucuronide metabolite in plasma, plasma ultrafiltrate and urine by HPLC-MS/MS with application to secretion and metabolite formation clearances in non-pregnant and pregnant women

Furosemide (FUR) has been used in probe drugs cocktails for in vivo evaluation of the renal transporters OAT1 and OAT3 activities in studies of drug-drug interactions (generally using probenecid as an inhibitor) and drug-disease interactions. The objective of this study was to develop and validate methods for FUR and its glucuronide metabolite (FUR-GLU) analysis in plasma, plasma ultrafiltrate and urine for application in pharmacokinetics studies: a pilot drug-drug interaction study in pregnant women (n = 2), who received a single oral dose of FUR (40 mg) and in another occasion a single oral dose of probenecid (750 mg) before a single oral dose of FUR (40 mg), and in non-pregnant women participants (n = 12), who only received a single oral dose of FUR (40 mg). The samples preparation for FUR in 50 µL of plasma and plasma lysate were carried by acidified liquid-liquid extraction, while 50 µL of urine and 200 µL of plasma ultrafiltrate were simply diluted with the mobile phase. The methods presented linearities in the range of 0.50 – 2500 ng/mL of plasma and plasma lysate, 0.125 – 250 ng/mL of plasma ultrafiltrate, and 50 – 20,000 ng/mL of urine. FUR-GLU methods presented linearities in the range of 0.125 – 250 ng/mL of plasma ultrafiltrate and 50 – 20,000 ng/mL of urine. Precision and accuracy evaluations showed coefficients of variation and relative errors < 15%. In the pregnant women participants, the mean values of FUR CLrenal, CLsecretion, CLformation. FUR-GLU and CLnon-renal were all reduced when probenecid was administered with FUR (8.24 vs 2.89 L/h, 8.15 vs 2.80 L/h, 3.86 vs 1.75 L/h, 48.26 vs 22.10 L/h, respectively). Non-pregnant women presented similar values of FUR CLrenal, CLsecretion, CLformation. FUR-GLU to the pregnant women who received FUR only. Finally, FUR fraction unbound (fu) resulted in values of approximately 1% in pregnant women and to 0.22% in non-pregnant women. These developed and validated methods for FUR and FUR-GLU quantification in multiple matrices can allow the further investigation of UGT1A9/1A1 and the fu when FUR is administered as an OAT 1 and 3 in vivo probe.

The Impact of High-Frequency Chest-Wall Compression on Mechanical Ventilation Delivery and Flow Bias.

It is unclear if high-frequency chest-wall compression (HFCWC) has a role to assist with secretion clearance in patients on mechanical ventilation. The effect of HFCWC on the delivery of mechanical ventilation is unknown. This study describes the effect of HFCWC on mechanical ventilation delivery and flow bias in an orally intubated and mechanically ventilated bench model. An orally intubated mannequin was mechanically ventilated in 5 commonly used modes of ventilation at settings that reflect current practice. HFCWC was applied via a randomized combination of oscillation frequencies and pressure settings. Mechanical ventilator flow, flow bias, and breathing frequency were measured before and during the application of HFCWC. HFCWC led to 3- to 7-fold increases in ventilator-delivered breathing frequency during synchronized intermittent mandatory ventilation, bi-level (with pressure support), bi-level-assist, and pressure-regulated volume control modes of ventilation. Only in the bi-level mode without pressure support was the ventilator breathing frequency unaffected by HFCWC. During HFCWC, peak inspiratory flow to peak expiratory flow ratios toward an expiratory flow bias, particularly at higher HFCWC pressures, only in pressure-regulated volume control and synchronized intermittent mandatory ventilation modes were peak inspiratory flow to peak expiratory flow ratios of <0.9 generated that would facilitate secretion clearance. HFCWC led to 3- to 7-fold increases in ventilator breathing frequency delivered by mechanical ventilation except in the bi-level mode. The bi-level mode may be the optimal mode to use HFCWC to minimize disruption to the delivered ventilator breathing frequency. The peak inspiratory flow to peak expiratory flow ratios < 0.9, the optimal flow bias for secretion clearance, was only achieved in the pressure-regulated volume control and synchronized intermittent mandatory ventilation modes. However, the findings in this bench model with a fixed low compliance may not be generalizable to the patient in the ICU, and we recommend further investigation into the effects of HFCWC in the patient in the ICU.

Mechanical insufflation-exsufflation to promote extubation success in critically ill adults on intensive care: protocol for a randomised controlled feasibility trial

BackgroundExtubation failure, defined as reintubation within 48 h, is associated with increased intensive care unit (ICU) length of stay and higher mortality risk. One cause of extubation failure is secretion retention, resulting from an inability to cough effectively. Mechanical insufflation-exsufflation (MI-E) simulates a cough aiding secretion clearance. However, MI-E is not routinely used in the ICU for invasively ventilated patients. This study aims to determine feasibility and acceptability of a randomised controlled trial (RCT) examining MI-E use to promote extubation success in intubated, ventilated adults.MethodsIt is a single-centre, feasibility RCT with semi-structured interviews, economic scoping, and exploratory physiology study.The feasibility RCT (n = 50) will compare standard care to a MI-E protocol including a minimum of two MI-E sessions via the endotracheal tube prior to extubation. Post-extubation, MI-E will be delivered via facemask or mouthpiece up to two times/day for 48 h. MI-E settings will be individualised. All patients will receive standard care (no MI-E) in relation to mechanical ventilation, weaning, rehabilitation, physiotherapy techniques such as positioning, manual airway clearance techniques, manual/ventilator hyperinflation, endotracheal suctioning, and nebulisation. Clinical data collection will occur before, on completion, and 5-min post-physiotherapy sessions (intervention/control arms). Resource use will be calculated for each 24-h period. Analyses will be descriptive and address feasibility outcomes including participant recruitment and attrition, proportion of MI-E treatment sessions completed, dataset completeness, and frequency of adverse events and acceptability.Semi-structured online interviews informed by the Theoretical Framework of Acceptability (TFA) with patients, clinicians, and family members will explore the acceptability of the MI-E intervention and study processes.Interview data will be analysed using reflexive thematic analysis based on TFA domains through first-level coding.The embedded physiology study will use electrical impedance tomography and lung ultrasound to explore lung recruitment and de-recruitment during MI-E in a subset of 5–10 patients.DiscussionThis study will examine feasibility and acceptability of a RCT protocol of MI-E to promote extubation success. Study findings will inform design modification and conduct of a future adequately powered trial. Furthermore, the study will contribute and advance the understanding of MI-E use in critically ill intubated adults.Trial registrationISRCTN 24603037; IRAS 303674

Serratus plane block and erector spinae plane block in the management of pain associated with rib fractures in chest trauma: a brief report from a single-center

Pain harms the clinical course of individuals with rib fractures. Patients with more than three fractured ribs are more likely to have lung problems because pain can impede lung ventilation and secretion clearance due to difficulty coughing, resulting in atelectasis and hypoxia. Systemic analgesia to invasive regional anesthesia procedures such as thoracic epidural, paravertebral catheters, intercostal nerve blocks, and fascial plane blocks are all alternatives for analgesia in chest trauma. The study’s goal is to evaluate the analgesic efficacy of erector spinae plane (ESP) and serratus anterior plane (SAP) blocks in chest injuries, as well as their effect on improving respiratory metrics. For this objective, fifteen cases of isolated thoracic trauma resulting in rib fractures were reviewed retrospectively. All patients were at least 18 years old, spontaneously breathing, and had received a chest wall fascial plane block for pain relief. All patients reported practically instantaneous pain alleviation, with the onset occurring around 10 minutes after the block operation. One patient required oxygen therapy, but the rest were quickly weaned due to improved respiratory mechanics. Our findings suggest that chest wall anesthetic blocks are a safe and effective therapy for pain caused by rib fractures. At admission, the median NRS was 7 (RF 6:26.7%; 7:26.7%; 8:26.7%; 9:13.3%; 10:6.7%), with a minimum of 6 and a maximum of 10 (IQR: 1.5, CV: 0.2). All patients reported immediate pain relief that began around 10 minutes after the block was done; the average decrease in NRS was 6.8 points. They have also been shown to be effective and beneficial in improving respiratory parameters and lowering oxygen support.

Genetic ablation of synaptotagmin-9 alters tomosyn-1 function to increase insulin secretion from pancreatic β-cells improving glucose clearance.

Stimulus-coupled insulin secretion from the pancreatic islet β-cells involves the fusion of insulin granules to the plasma membrane (PM) via SNARE complex formation-a cellular process key for maintaining whole-body glucose homeostasis. Less is known about the role of endogenous inhibitors of SNARE complexes in insulin secretion. We show that an insulin granule protein synaptotagmin-9 (Syt9) deletion in mice increased glucose clearance and plasma insulin levels without affecting insulin action compared to the control mice. Upon glucose stimulation, increased biphasic and static insulin secretion were observed from ex vivo islets due to Syt9 loss. Syt9 colocalizes and binds with tomosyn-1 and the PM syntaxin-1A (Stx1A); Stx1A is required for forming SNARE complexes. Syt9 knockdown reduced tomosyn-1 protein abundance via proteasomal degradation and binding of tomosyn-1 to Stx1A. Furthermore, Stx1A-SNARE complex formation was increased, implicating Syt9-tomosyn-1-Stx1A complex is inhibitory in insulin secretion. Rescuing tomosyn-1 blocked the Syt9-knockdown-mediated increases in insulin secretion. This shows that the inhibitory effects of Syt9 on insulin secretion are mediated by tomosyn-1. We report a molecular mechanism by which β-cells modulate their secretory capacity rendering insulin granules nonfusogenic by forming the Syt9-tomosyn-1-Stx1A complex. Altogether, Syt9 loss in β-cells decreases tomosyn-1 protein abundance, increasing the formation of Stx1A-SNARE complexes, insulin secretion, and glucose clearance. These outcomes differ from the previously published work that identified Syt9 has either a positive or no effect of Syt9 on insulin secretion. Future work using β-cell-specific deletion of Syt9 mice is key for establishing the role of Syt9 in insulin secretion.

Effect of Effective Cough on Sputum Expulsion in Patients with ARI (Acute Respiratory Infection)

ISPA or ARI (Acute Respiratory Infection) is an acute respiratory illness that lasts about 14 days and usually affects the throat, nose and lungs. A frequent problem in patients with acute respiratory infections is the inability to clear secretions from the airways which can lead to ineffective airway clearance. One of the non-pharmacological management of ARI can be done with effective cough training. The purpose of this study was to determine the effect of effective cough on sputum discharge in patients with ARI at Sumber Kasih General Hospital, Cirebon City in 2022.&#x0D; This research design uses pre experiment with one group pre test-post test design. The research subjects were 90 ARI patients at Sumber Kasih General Hospital, Cirebon City with the sampling technique used was accidental sampling. The research instrument was a sputum discharge observation sheet. &#x0D; The results of the study obtained data from the pretest results showed that sputum discharge in patients with ARI before effective cough training was carried out in the outgoing category, namely 54 people (60%). While the results of the posttest showed that sputum discharge in patients with ARI after effective coughing exercises with the outgoing category was 81 people (90%). Based on the results of the Wilcoxon test, the significance value (sig.2-tailed) &lt;0.05 (p=0.000), then based on the decision-making criteria, Ha is accepted, meaning that effective cough training can increase sputum discharge in patients with ARI at Sumber Kasih General Hospital, Cirebon City.&#x0D; It is hoped that nurses can provide education about effective cough training to increase sputum discharge in patients with ARI, so that patients with ARI are able to practice it at home

Activation Mechanism of CcGSDMEb-1/2 and Regulation for Bacterial Clearance in Common Carp (Cyprinus carpio).

Gasdermin E (GSDME), to date, is considered the only direct executor of the pyroptosis process in teleost and plays an important role in innate immunity. In common carp (Cyprinus carpio), there contains two pairs of GSDME (GSDMEa/a-like and GSDMEb-1/2), and the pyroptotic function and regulation mechanism of GSDME still remain unclear. In this study, we identified two GSDMEb genes of common carp (CcGSDMEb-1/2), which contain a conserved N-terminal pore-forming domain, C-terminal autoinhibitory domain, and a flexible and pliable hinge region. We investigated the function and mechanism of CcGSDMEb-1/2 in association with inflammatory and apoptotic caspases in Epithelioma papulosum cyprinid cells and discovered that only CcCaspase-1b could cleave CcGSDMEb-1/2 through recognizing the sites 244FEVD247 and 244FEAD247 in the linker region, respectively. CcGSDMEb-1/2 exerted toxicity to human embryonic kidney 293T cells and bactericidal activity through its N-terminal domain. Interestingly, after i.p. infection by Aeromonas hydrophila, we found that CcGSDMEb-1/2 were upregulated in immune organs (head kidney and spleen) at the early stage of infection, but downregulated in mucosal immune tissues (gill and skin). After CcGSDMEb-1/2 were knocked down and overexpressed invivo and invitro, respectively, we found that CcGSDMEb-1/2 could govern the secretion of CcIL-1β and regulate the bacterial clearance after A. hydrophila challenge. Taken together, in this study, it was demonstrated that the cleavage mode of CcGSDMEb-1/2 in common carp was obviously different from that in other species and played an important role in CcIL-1β secretion and bacterial clearance.

Effect of different endotracheal suctioning methods on clearance of airway secretions in patients with craniocerebral injury and tracheotomy

Effect of different endotracheal suctioning methods on clearance of airway secretions in patients with craniocerebral injury and tracheotomy

Effectiveness of video assisted teaching on knowledge and practice regarding suctioning of children on mechanical ventilator among nurses working in paediatric department

Background: Airway secretion clearance is a normal process that is essential for preventing respiratory infections, atelectasis, pulmonary haemorrhage and maintaining airway patency. In order to ensure this, effective and safe suction is necessary. Thus, endotracheal suctioning removes secretions which gets accumulated in the endotracheal tube through using negative suction pressure. The study aimed to assess the effectiveness of video assisted teaching on knowledge and practice regarding suctioning of children on mechanical ventilator among nurses working in pediatric department. Methods: Data were collected with the help of demographic-profile, Self-Structured knowledge questionnaire and Rating scale tool from 38 samples using Purposive sampling technique who met the inclusion criteria. The pretest data collected before intervention and post-test data collected after one week of video assisted teaching. Results: The result revealed that post intervention knowledge score was found to be more (20.44±2.68) than pre intervention knowledge score (14.31±2.77), t=9.19. Post intervention attitude score was found to be more (26.86±3.30) than pre intervention attitude score (18.52±3.68), t=8.17 at 0.05 level of significance. Conclusions: These findings revealed that the video assisted teaching programme on knowledge and practice was effective.

760-P: Discovery of GSBR-1290, a Highly Potent, Orally Available, Novel Small Molecule GLP-1 Receptor Agonist

Peptidic glucagon-like peptide 1 receptor agonists (GLP-1RAs) are established treatments for patients with Type 2 Diabetes Mellitus (T2DM) and obesity. However, the need for injection and cold chain storage may limit the utility of most peptidic GLP-1RAs. An oral small molecule GLP-1RA that offers enhanced bioavailability and stability could be more convenient and accessible to patients. Here we report the discovery of GSBR-1290, a highly potent, orally available, novel small molecule GLP-1RA and the characterization of its in vitro and in vivo pharmacology profiles. GSBR-1290 is a small molecule GLP-1RA with high binding affinity to human GLP-1R. GSBR-1290 strongly activated GLP-1R Gαs cAMP pathway without inducing measurable β-arrestin recruitment signaling, which indicates it is a fully biased agonist. The insulin secretion stimulation effect of GSBR-1290 was evaluated in a functional human pancreatic beta cell line, in which GSBR-1290 showed dose dependent induction of insulin secretion. The in vivo efficacy of GSBR-1290 on insulin secretion, glucose control and food intake were evaluated in nonhuman primates (NHPs). In an acute intravenous glucose tolerance test (ivGTT), a single dose of GSBR-1290 strongly induced insulin secretion and glucose clearance. In a repeated dosing study, GSBR-1290 administered orally once daily for 7-day demonstrated robust increase in insulin secretion and glucose clearance in ivGTT and a dose dependent reduction of food intake and body weight. Overall, GSBR-1290 demonstrated potent in vivo efficacy in stimulating insulin secretion, improving glucose tolerance, and reducing food intake and body weight. In conclusion, GSBR-1290 is a highly potent, orally available, fully biased GLP-1RA. Human clinical trials are underway to further evaluate GSBR-1290 as a potential therapy for T2DM and obesity. Disclosure T.Mao: Employee; Structuretx. X.Lin: Employee; Structure Therapeutics. Q.Meng: Employee; Beijing Stonewise Technology, Structure Therapeutics Inc. H.Zhang: Employee; Structuretx. J.J.Zhang: Employee; Structure Therapeutics Inc. S.Shi: Employee; Structure Therapeutics Inc. Z.Guan: Employee; Structure Therapeutics. X.Jiang: Employee; Structure Therapeutics. F.Zhang: Employee; Structure Therapeutics, Eternity BioSciences, Stock/Shareholder; Novo Nordisk. H.Lei: Employee; Structure Therapeutics.

Assay of Diphenhydramine HCl in Syrup by High Performance Liquid Chromatography

Cough is a natural response from the respiratory tract by increasing the clearance of secretions and particles from mucus, irritants, foreign particles, and microbes, so that it can act as a body defense. One way that can be done to relieve cough symptoms is to use symptomatic drugs. Diphenhydramine HCl is an antihistamine that belongs to the first generation H1 receptor antagonist (H1 blocker) group which has sedative and anti-allergic properties. Diphenhydramine HCl is used to treat sneeze, runny nose, watery eyes, itches, skin rashes, and other cold symptoms or other allergies. Diphenhydramine HCl is also used to treat motion sickness and to induce sleep. The purpose of this study was to determine the contents of diphenhydramine HCl syrup sold in the market. This test uses the High Performance Liquid Chromatography (HPLC) method with acetonitrile as a mobile phase; water; triethylamine (50;50;0.5). The results obtained the average content of Diphenhydramine HCl 102.5%. So it can be concluded that the cough medicine sample meets the requirements because the contents are not less than 90% and not more than 110% based on the Indonesian Pharmacopoeia Edition VI 2020.&#x0D; Keywords: Cough, Diphenhydramine HCl, High Performance Liquid Chromatography (HPLC)

VivaSight Double-Lumen Tube Versus Conventional Double-Lumen Tube for One-Lung Ventilation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The main objective of this systematic review and meta-analysis was to determine the safety and effectiveness of VivaSight double-lumen tubes (VS-DLTs) in one-lung ventilation (OLV) compared to conventional DLTs (c-DLTs). The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement's guidelines. From the database's inception to December 2022, we searched seven different databases. We included 364 patients from six randomized controlled trials who were scheduled to undergo surgery requiring OLV. The Cochrane risk of bias assessment tool was utilized to determine the risk of bias. The odds ratio (OR) was estimated for categorical variables, while the mean difference was calculated for continuous variables. Patients were randomly assigned to the VS-DLT or c-DLT group. The results revealed that patients in the c-DLT group have longer intubation time than the VS-DLT patients (mean difference [MD] = -90.01; 95% confidence interval [CI], -161.33 to -18.69; P = 0.01). Significantly, more secretions were present in the VS-DLT group than in the c-DLT group (OR = 4.24; CI, 1.96 to 9.13; P = 0.0002). Also, the fiberoptic bronchoscope was used more frequently in the c-DLT group compared to the VS-DLT group (OR = 0.01 [0.00, 0.07]; P < 0.00001). We found that VS-DLT was safe as the pooled analysis showed no significant difference according to side effects such as hoarseness and sore throat. The other outcomes, such as dislodgement, the clearance of secretions, and the quality of lung deflation (excellent), were non-significant between the two groups.

WS14.03 Combined therapeutic strategies for the restoration of airway epithelial integrity and function in cystic fibrosis

Background: In CF airways, dysfunctional Cl– secretion and mucociliary clearance favor bacterial infections contributing to progressive lung damage and respiratory failure, the first cause of morbidity and mortality. We thus devote our efforts to identify novel therapeutic strategies to promote CF lung repair. We previously discovered that the capability of CF airway epithelia to repair is less efficient, than in healthy controls, due to the CFTR defect and bacterial infections, in particular with P. aeruginosa (PA) and S. aureus (SA). Our work also unveiled that CFTR modulators enhance airway repair, but both CFTR rescue and repair improvement are dampened by infection.

EPS8.08 Nintendo Switch™ Ring Fit Adventure™ as an alternative exercise option for people with cystic fibrosis during an inpatient admission: a pilot study of patient’s perceptions

Objective: Exercise is a vital treatment for people with CF (pwCF) and is known to help improve lung function, aid secretion clearance, build strength, improve mood, assist with weight management and maintain healthy bones. However, we know that motivation is often a barrier to pwCF’s participation in exercise and inpatient admissions may hinder this motivation further.