Conventional Chest Physiotherapy Research Articles

A Randomized Case-Control Study on High-Frequency Chest Wall Oscillator Versus Conventional Chest Physical Therapy in Spinal Cord Injury Subjects

Study Design: This study is a randomized case-control trial. Setting: Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India. Background: Spinal cord injury (SCI) often results in severe respiratory dysfunction, leading to increased morbidity and mortality. Respiratory complications, including atelectasis and pneumonia, are prevalent and exacerbated by compromised lung function and ineffective cough. CCPT poses risks like hypoxemia and arrhythmias. HFCWO has emerged as a promising alternative, facilitating airway clearance and improving lung function without manual intervention. Despite its efficacy in other conditions, its specific benefits in SCI require further study. Objective: To study the effect of High-Frequency Chest Wall Oscillator versus Conventional Chest Physical Therapy in candidates with Spinal Cord Injury. Methodology: A sample of 78 SCI patients was selected, with 71 completing the study. Patients were divided into Group A (HFCWO) and Group B (CCPT). Baseline vital, clinical, and radiological parameters were recorded. Group A received HFCWO twice daily for 15 minutes over 5 days, while Group B received CCPT that included positioning, percussions on the affected lobe, and mechanical vibration for 5 days as indicated. Suctioning was performed post-intervention in both groups. Parameters were re-evaluated post-treatment and after 5 days by an intensivist. Results: The median (IQR) age of participants was 32 (18 to 60). Wilcoxon signed- rank test was used for intragroup analysis. The intervention group (HFCWO) had a median age of 49, and the control group (CCPT) had a median age of 22.In the HFCWO group, RR significantly decreased and SpO2 significantly increased (p<0.05) from Day 1 to Day 5. No significant changes were observed in HR and MAP. PEEP, FiO2, and ROASSCI significantly decreased (p<0.05). In the CCPT group, RR, HR, and MAP significantly increased (p<0.05), with no significant change in SpO2. PEEP and FiO2 significantly decreased, but ROASSCI did not change. Both groups showed significant improvement in Chest X-ray scores (p<0.05). Conclusion: This study compares High-Frequency Chest Wall Oscillator (HFCWO) with conventional chest physical therapy (CCPT) in spinal cord injury patients. HFCWO showed superior improvements in clinical and radiological parameters, facilitating earlier ventilator weaning. These findings suggest that HFCWO is a more effective alternative to CCPT for airway clearance in intubated SCI patients.

Massive pulmonary atelectasis in infants of 1st and 8/12 years of age: Report of a case

Background: an exhaustive search of the descriptors in Mesh was carried out , using original national and international articles from Pubmed, Medlineplus , LILACS journals, in Spanish in English. The problem raised is given because conventional chest physiotherapy (CFT) continues as one of the main interventions in the treatment of pulmonary atelectasis, however; Why is FTC still used in the management of pulmonary atelectasis if there is not enough evidence to demonstrate its effectiveness as a therapeutic intervention? Method: in the present study, qualitative methodology will be used to present a clinical case of an infant younger than 1 year and 8 months, who developed massive right pulmonary atelectasis without the slightest clinical suspicion of a foreign body (FB) in the right bronchus, which since the Initially it was managed with FTC maneuvers, without the expected result and development of complications inherent to the intervention. Results : In this case report, an early diagnosis of the reason why the infant developed right pulmonary atelectasis is required, managed with an intervention without sufficient evidence of its effectiveness for the resolution of the present respiratory complication and without the diagnosis of the true cause of the same.

Effect of Combined Chest Mobilization with Conventional Chest Physical Therapy on Vital Signs and Respiratory Parameters in Critically-Ill Children

Effect of Combined Chest Mobilization with Conventional Chest Physical Therapy on Vital Signs and Respiratory Parameters in Critically-Ill Children

Ventilatory Effect of Proprioceptive Neuromuscular Facilitation Patterns in Critically Ill Patients: A Brief Review

Background: The Intensive Care Unit (ICU) plays a crucial role in managing patients with life-threatening conditions, and the mortality rate of mechanically ventilated patients in developed countries is on the rise. Chest complications during ICU stays, such as respiratory failure and pneumonia, pose significant challenges in patient care, requiring continuous and vigilant medical and physiotherapy intervention. Objective: This narrative review explores the role of Proprioceptive Neuromuscular Facilitation (PNF) techniques in chest physiotherapy for mechanically ventilated patients, aiming to assess their impact on respiratory parameters and overall patient outcomes. Method: A comprehensive analysis of relevant literature was conducted, focusing on studies investigating the ventilatory effects of PNF in different patient populations, including neurological injuries, organophosphorus poisoning, and chronic obstructive pulmonary disease (COPD). Results: The reviewed studies demonstrated that incorporating PNF techniques, such as intercostal stretch and anterior basal lift, alongside conventional chest physiotherapy, positively influenced respiratory rates, oxygen saturation, and pulmonary compliance. These findings suggest that PNF can be an effective adjunct in preventing pulmonary complications and improving outcomes in mechanically ventilated patients. Conclusion: The evidence presented in this narrative review supports the integration of PNF techniques into chest physiotherapy for mechanically ventilated patients. The positive outcomes reported in the literature suggest that PNF can be a valuable adjunct to conventional care, contributing to better respiratory function and potentially reducing complications associated with immobility. Keywords: Intensive Care Unit (ICU), Mechanical ventilation, Physiotherapy intervention, Chest complications, Chest physiotherapy techniques, PNF techniques

Effect of breather device on respiratory muscle strength and quality of life in coronary artery bypass grafting patients: A randomised control trial protocol

Coronary artery bypass surgery is widely spread and done for multiple vessel disease, and still a well-established therapy option for coronary artery disease. Reduced respiratory muscle strength has been linked to decreased functional capacity in heart surgery, which has been linked to a prolonged recovery period for lung functions and onset of physical deconditioning, which can last for more than a week. Other common postoperative complications include urinary tract infections, renal failure, limb ischemia, pleural effusion, and hematologic abnormalities. Alterations in lung capacity and size, malfunction of the alveoli, decrease in the central respiratory stimulus, and mechanical issues with thoracic function are all brought on by respiratory consequences. Therefore, to prevent or reduce postoperative pulmonary complications, it is typically advised that patients who have had heart surgery engage in breathing exercises and chest physical therapy. The Breather is a breathing apparatus that uses resistance breathing through various-sized orifices to strengthen respiratory muscles. In addition to healthy people and athletes, breather devices can be used for training, therapy, prevention, or rehabilitation of a variety of pulmonary and other disorders. As there is limited literature showing the efficacy of a breather device in coronary artery bypass grafting (CABG) patients, therefore a need for a study to find the efficacy of a breather device in assessing strength of respiratory muscle and quality of life in CABG patients. Treatment will be given for three weeks with five sessions per week twice a day. Pre- and post-treatment outcomes will be noted. In this study, results are expected to prove the Breather device is as effective or more effective than conventional chest physiotherapy for refining respiratory muscle strength and quality of life. CTRI registration: CTRI/2023/05/053052

The effects of aerobic exercises compared to conventional chest physiotherapy on pulmonary function, functional capacity, sputum culture, and quality of life in children and adolescents with cystic fibrosis: a study protocol for randomized controlled trial study

BackgroundCystic fibrosis (CF) is an autosomal recessive disorder caused by abnormal function of the chloride ion channels and characterized by pancreatic insufficiency and chronic endobronchial airway infection. Pulmonary dysfunction is very common and could lead to a reduction in the quality of life. Airway clearance techniques (ACT) and physical exercises are introduced as one of the main components of treatment. Therefore, it will be of interest to examine the effect of aerobic exercises compared to conventional chest physiotherapy (CPT) on pulmonary function, functional capacity, sputum culture, and quality of life in patients with CF.MethodsThirty patients with CF will participate in a double-blind parallel controlled trial containing 18 sessions of treatment. Group A consists of CPT and placebo aerobic exercise, and group B includes aerobic exercise and placebo CPT. Pulmonary function, functional capacity, sputum culture, and quality of life will be evaluated with a spirometry test, 6-min walk test (6MWT), sputum culture test, and the Cystic Fibrosis Questionnaire-Revised (CFQ-R), respectively, before and after the intervention.DiscussionWe will evaluate and compare the effectiveness of aerobic exercises and conventional chest physiotherapy on pulmonary function, functional capacity, sputum culture, and quality of life. Comparing these two treatment patterns can contribute to a better understanding of the effectiveness. Therefore, if there is a significant difference between the two treatments, the superior treatment will be prioritized clinically.Trial registrationhttps://www.irct.ir, IRCT20210505051181N5. Registered on 19 February 2023.

Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis.

Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis.

Effects of Chest Physiotherapy in Preterm Infants with Respiratory Distress Syndrome: A Systematic Review.

Preterm birth carries a higher risk of respiratory problems. The objectives of the study are to summarize the evidence on the effect of chest physiotherapy in the treatment of respiratory difficulties in preterm infants, and to determine the most appropriate technique and whether they are safe. Searches were made in PubMed, WOS, Scopus, Cochrane Library, SciELO, LILACS, MEDLINE, ProQuest, PsycArticle and VHL until 30 April 2022. Eligibility criteria were study type, full text, language, and treatment type. No publication date restrictions were applied. The MINCIR Therapy and PEDro scales were used to measure the methodological quality, and the Cochrane risk of bias and Newcastle Ottawa quality assessment Scale to measure the risk of bias. We analysed 10 studies with 522 participants. The most common interventions were conventional chest physiotherapy and stimulation of the chest zone according to Vojta. Lung compression and increased expiratory flow were also used. Heterogeneities were observed regarding the duration of the interventions and the number of participants. The methodological quality of some articles was not adequate. All techniques were shown to be safe. Benefits were described after conventional chest physiotherapy, Vojta's reflex rolling, and lung compression interventions. Improvements after Vojta's reflex rolling are highlighted in the comparative studies.

Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old.

Acute bronchiolitis is the leading cause of medical emergencies during winter months in infants younger than 24 months old. Chest physiotherapy is sometimes used to assist infants in the clearance of secretions in order to decrease ventilatory effort. This is an update of a Cochrane Review first published in 2005 and updated in 2006, 2012, and 2016. To determine the efficacy of chest physiotherapy in infants younger than 24 months old with acute bronchiolitis. A secondary objective was to determine the efficacy of different techniques of chest physiotherapy (vibration and percussion, passive exhalation, or instrumental). We searched CENTRAL, MEDLINE, Embase, CINAHL, LILACS, Web of Science, PEDro (October 2011 to 20 April 2022), and two trials registers (5 April 2022). Randomised controlled trials (RCTs) in which chest physiotherapy was compared to control (conventional medical care with no physiotherapy intervention) or other respiratory physiotherapy techniques in infants younger than 24 months old with bronchiolitis. We used standard methodological procedures expected by Cochrane. Our update of the searches dated 20 April 2022 identified five new RCTs with 430 participants. We included a total of 17 RCTs (1679 participants) comparing chest physiotherapy with no intervention or comparing different types of physiotherapy. Five trials (246 participants) assessed percussion and vibration techniques plus postural drainage (conventional chest physiotherapy), and 12 trials (1433 participants) assessed different passive flow-oriented expiratory techniques, of which three trials (628 participants) assessed forced expiratory techniques, and nine trials (805 participants) assessed slow expiratory techniques. In the slow expiratory subgroup, two trials (78 participants) compared the technique with instrumental physiotherapy techniques, and two recent trials (116 participants) combined slow expiratory techniques with rhinopharyngeal retrograde technique (RRT). One trial used RRT alone as the main component of the physiotherapy intervention. Clinical severity was mild in one trial, severe in four trials, moderate in six trials, and mild to moderate in five trials. One study did not report clinical severity. Two trials were performed on non-hospitalised participants. Overall risk of bias was high in six trials, unclear in five, and low in six trials. The analyses showed no effects of conventional techniques on change in bronchiolitis severity status, respiratory parameters, hours with oxygen supplementation, or length of hospital stay (5 trials, 246 participants). Regarding instrumental techniques (2 trials, 80 participants), one trial observed similar results in bronchiolitis severity status when comparing slow expiration to instrumental techniques (mean difference 0.10, 95% confidence interval (C) -0.17 to 0.37). Forced passive expiratory techniques failed to show an effect on bronchiolitis severity in time to recovery (2 trials, 509 participants; high-certainty evidence) and time to clinical stability (1 trial, 99 participants; high-certainty evidence) in infants with severe bronchiolitis. Important adverse effects were reported with the use of forced expiratory techniques. Regarding slow expiratory techniques, a mild to moderate improvement was observed in bronchiolitis severity score (standardised mean difference -0.43, 95% CI -0.73 to -0.13; I2 = 55%; 7 trials, 434 participants; low-certainty evidence). Also, in one trial an improvement in time to recovery was observed with the use of slow expiratory techniques. No benefit was observed in length of hospital stay, except for one trial which showed a one-day reduction. No effects were shown or reported for other clinical outcomes such as duration on oxygen supplementation, use of bronchodilators, or parents' impression of physiotherapy benefit. We found low-certainty evidence that passive slow expiratory technique may result in a mild to moderate improvement in bronchiolitis severity when compared to control. This evidence comes mostly from infants with moderately acute bronchiolitis treated in hospital. The evidence was limited with regard to infants with severe bronchiolitis and those with moderately severe bronchiolitis treated in ambulatory settings. We found high-certainty evidence that conventional techniques and forced expiratory techniques result in no difference in bronchiolitis severity or any other outcome. We found high-certainty evidence that forced expiratory techniques in infants with severe bronchiolitis do not improve their health status and can lead to severe adverse effects. Currently, the evidence regarding new physiotherapy techniques such as RRT or instrumental physiotherapy is scarce, and further trials are needed to determine their effects and potential for use in infants with moderate bronchiolitis, as well as the potential additional effect of RRT when combined with slow passive expiratory techniques. Finally, the effectiveness of combining chest physiotherapy with hypertonic saline should also be investigated.

Effects of suryanamaskar on peak expiratory flow rate and quality of life in patients with Chronic Obstructive Pulmonary Disease (COPD)

Background. Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable disease characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. Surya Namaskar is an ancient yogic method to worship the sun. This specific postural and breathing protocols were developed in Indian Subcontinent in the 17th century by Saint Samarth Ramdass. Aim. To find out the effects of Suryanamaskar on peak expiratory flow rate and quality of life in patients with Chronic Obstructive Pulmonary Disease (COPD). Methods. Experimental design, pre and post type. 14 COPD patients, aged 35–50 years, both men and women, grade I and II in GOLD classification was randomly allotted into two groups. The patients had to clear the flexibility tests – Sit and reach test and back scratch test. For the Experimental group (n = 7), Suryanamaskar, with conventional chest physiotherapy intervention, was given for 5 days per week for 6 weeks. For the control group (n = 7), conventional chest physiotherapy intervention was given for the same duration. Outcome measures: Peak expiratory flow rate (l/min), SF–36 questionnaire. Results: The study showed that the peak expiratory flow rate and SF–36 questionnaire showed non-significant result for both the groups as p > 0.05, though there was a clinically significant improvement. Conclusion: This study concluded that there is no statistically significant improvement in PEFR and QOL in COPD patients who performed Suryanamaskar along with chest physiotherapy.

Active cycle of breathing technique for cystic fibrosis.

People with cystic fibrosis (CF) experience chronic airway infections as a result of mucus buildup within the lungs. Repeated infections often cause lung damage and disease. Airway clearance therapies aim to improve mucus clearance, increase sputum production, and improve airway function. The active cycle of breathing technique (ACBT) is an airway clearance method that uses a cycle of techniques to loosen airway secretions including breathing control, thoracic expansion exercises, and the forced expiration technique. This is an update of a previously published review. To compare the clinical effectiveness of ACBT with other airway clearance therapies in CF. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched clinical trials registries and the reference lists of relevant articles and reviews. Date of last search: 29 March 2021. We included randomised or quasi-randomised controlled clinical studies, including cross-over studies, comparing ACBT with other airway clearance therapies in CF. Two review authors independently screened each article, abstracted data and assessed the risk of bias of each study. We used GRADE to assess our confidence in the evidence assessing quality of life, participant preference, adverse events, forced expiratory volume in one second (FEV1) % predicted, forced vital capacity (FVC) % predicted, sputum weight, and number of pulmonary exacerbations. Our search identified 99 studies, of which 22 (559 participants) met the inclusion criteria. Eight randomised controlled studies (259 participants) were included in the analysis; five were of cross-over design. The 14 remaining studies were cross-over studies with inadequate reports for complete assessment. The study size ranged from seven to 65 participants. The age of the participants ranged from six to 63 years (mean age 18.7 years). In 13 studies follow up lasted a single day. However, there were two long-term randomised controlled studies with follow up of one to three years. Most of the studies did not report on key quality items, and therefore, have an unclear risk of bias in terms of random sequence generation, allocation concealment, and outcome assessor blinding. Due to the nature of the intervention, none of the studies blinded participants or the personnel applying the interventions. However, most of the studies reported on all planned outcomes, had adequate follow up, assessed compliance, and used an intention-to-treat analysis. Included studies compared ACBT with autogenic drainage, airway oscillating devices (AOD), high-frequency chest compression devices, conventional chest physiotherapy (CCPT), positive expiratory pressure (PEP), and exercise. We found no difference in quality of life between ACBT and PEP mask therapy, AOD, other breathing techniques, or exercise (very low-certainty evidence). There was no difference in individual preference between ACBT and other breathing techniques (very low-certainty evidence). One study comparing ACBT with ACBT plus postural exercise reported no deaths and no adverse events (very low-certainty evidence). We found no differences in lung function (forced expiratory volume in one second (FEV1) % predicted and forced vital capacity (FVC) % predicted), oxygen saturation or expectorated sputum between ACBT and any other technique (very low-certainty evidence). There were no differences in the number of pulmonary exacerbations between people using ACBT and people using CCPT (low-certainty evidence) or ACBT with exercise (very low-certainty evidence), the only comparisons to report this outcome. There is little evidence to support or reject the use of the ACBT over any other airway clearance therapy and ACBT is comparable with other therapies in outcomes such as participant preference, quality of life, exercise tolerance, lung function, sputum weight, oxygen saturation, and number of pulmonary exacerbations. Longer-term studies are needed to more adequately assess the effects of ACBT on outcomes important for people with cystic fibrosis such as quality of life and preference.

Effects of mechanical in-exsufflation in preventing postextubation acute respiratory failure in intensive care acquired weakness patients: a randomized controlled trial.

We hypothesized that the use of mechanical insufflation-exsufflation can reduce the incidence of acute respiratory failure within the 48-hour post-extubation period in intensive care unit-acquired weakness patients. This was a prospective randomized controlled open-label trial. Patients diagnosed with intensive care unit-acquired weakness were consecutively enrolled based on a Medical Research Council score ≤ 48/60. The patients randomly received two daily sessions; in the control group, conventional chest physiotherapy was performed, while in the intervention group, chest physiotherapy was associated with mechanical insufflation-exsufflation. The incidence of acute respiratory failure within 48 hours of extubation was evaluated. Similarly, the reintubation rate, intensive care unit length of stay, mortality at 28 days, and survival probability at 90 days were assessed. The study was stopped after futility results in the interim analysis. We included 122 consecutive patients (n = 61 per group). There was no significant difference in the incidence of acute respiratory failure between treatments (11.5% control group versus 16.4%, intervention group; p = 0.60), the need for reintubation (3.6% versus 10.7%; p = 0.27), mean length of stay (3 versus 4 days; p = 0.33), mortality at Day 28 (9.8% versus 15.0%; p = 0.42), or survival probability at Day 90 (21.3% versus 28.3%; p = 0.41). Mechanical insufflation-exsufflation combined with chest physiotherapy seems to have no impact in preventing postextubation acute respiratory failure in intensive care unit-acquired weakness patients. Similarly, mortality and survival probability were similar in both groups. Nevertheless, given the early termination of the trial, further clinical investigation is strongly recommended. NCT01931228.

Effect of Flutter Along with Conventional Chest Physiotherapy on Peak Expiratory Flow Rate among Coronary Artery Bypass Graft Patients

Effect of Flutter Along with Conventional Chest Physiotherapy on Peak Expiratory Flow Rate among Coronary Artery Bypass Graft Patients

“PEEP-ZEEP” Maneuver for Airway Clearance in Mechanically Ventilated Patients: A Scoping Review

Abstract A mechanical ventilator is the standard care to manage airways in intensive care unit (ICU). The inherent complications associated with mechanical ventilation are easy to prevent and control. Ventilator events, including ventilator-associated pneumonia, are crucial issues to manage in critically ill patients. Secretion retention due to compromised mucociliary function and altered lung internal milieu plays a significant concern in ICU outcomes. Physiotherapy involved in ICU plays an essential role in maintaining lung hygiene. Conventional chest physiotherapy is an extrapulmonary technique to remove secretion and maintain bronchial hygiene. Manual hyperinflation and suctioning are the methods that are highly at risk of transmitting lung infection. Generating flow bias through modification in various ventilator parameters is recently in trend to prevent bronchial hygiene-related complications. PEEP-ZEEP maneuver causes the expiratory flow bias by increasing peak expiratory flow. The present scoping review explores the safety and efficacy of the PEEP-ZEEP maneuver for airway clearance in mechanically ventilated patients. The current scoping review aims to identify the use and safety of the PEEP-ZEEP maneuver applied in mechanically ventilated patients for airway clearance. The five databases, i.e., PubMed, PEDro, Google Scholar, Cochrane, and Web of Science, have been searched till October 2022. The published experimental studies included in the review was searched using Boolean operators (“AND” and “OR”) and keywords, i.e., PEEP-ZEEP, Mechanical Ventilator, and Airway Clearance technique. PEEP-ZEEP is a safe and efficient for airway clearance in mechanically ventilated patients, with the need to explore further with a larger sample size and more defined outcomes and population.

Efficacy of Class IV Laser on Post Cesarean Section: A Feasibility Trial

Cesarean section is the consistently used surgical process for life sustaining of both mother and neonates witha prevalence around 53 % in India. Pain, delayed incisional wound healing, sepsis and difficulty of daily lifeactivities are very common complication after cesarean section. This study aims to assess the feasibility of classIV LASER to improve pain, wound healing and quality of life among female underwent cesarean section. Inthis feasibility trial 12 females who underwent cesarean section were recruited after screening in accordance toselection criteria and obtained their consent. The selected participants were divided into two groups (Experimental& Control group) by block randomization. The participants in Experimental group were treated with class IVLASER therapy along with conventional chest physiotherapy management, while the participants in controlgroup were treated with TENS along with conventional chest physiotherapy management. The mean age of theparticipants was 24.92±3.450. A statistically significant difference was found in both the experimental and controlgroup among pain, wound healing and quality of life during within group analysis. However, experimental groupshows significant difference among VAS (p=0.02), REEDA scale (p=.002) and four domains of SF 36 i.e.PF(p=0.004) EF (p=0.009) EHP (p=0.009) P (p=0.004) than the control group during between group analysis. Itconcludes that Class IV LASER is feasible and effective to improve pain, wound healing and quality of lifeamong females underwent cesarian section.

The Effect of Incentive Spirometer Verses Conventional Chest Physiotherapy on Pulmonary Complications in Coronary Artery Bypass Grafting Patients.

The Effect of Incentive Spirometer Verses Conventional Chest Physiotherapy on Pulmonary Complications in Coronary Artery Bypass Grafting Patients.

Chest physiotherapy for pneumonia in adults.

Chest physiotherapy for pneumonia in adults.

Emphasizing Pulmonary Function With Respiratory Therapy in an Infant With Congenital Adrenal Hyperplasia, Bronchopneumonia and Leptomeningitis

A set of hereditary diseases affecting the adrenal glands, a couple of walnut-sized structures above the kidneys, is known as congenital adrenal hyperplasia (CAH). The adrenal glands generate essential hormones like cortisol, mineralocorticoids, and androgens. It is usually diagnosed in the early neonatal period. The documentation of this case study is aimed to provide a case of an infant with CAH associated with bronchopneumonia and leptomeningitis. Brought with complaints of poor feeding, moderate fever associated with chills, and loose stools, was an 11-months-old patient with a known diagnosis of CAH. Symptoms have shown that the baby was in a possible adrenal crisis. He was intubated with an endotracheal tube after repeated episodes of seizures. Investigations revealed signs of bronchopneumonia and leptomeningitis. A thorough assessment, once completed, helped in analyzing relevant problems to be treated with respiratory therapy. Respiratory therapy, in this case, was aimed at improving the blood oxygen levels and assisting breathing by clearing out secretions and opening up the airways. Parent education was the foremost part of the treatment regime, followed by bronchodilator administration, conventional chest physiotherapy, postural drainage positions in the mother’s lap, lung squeezing technique, and perioral pressure. A holistic and multidisciplinary approach is beneficial in patients with CAH undergoing an adrenal crisis. It needs to be offered to the patients who would be benefited, considering the effect, which needs to be reassessed on specific outcomes with changes in the management with the improving condition.

Effectiveness of Acapella along with institutional based chest physiotherapy techniques on pulmonary functions and airway clearance in post-operative CABG patients.

Patients undergoing Coronary Artery Bypass Graft (CABG) surgery often develop pulmonary complications in the early post-operative period as result of decreased lung function and impaired cough. Conventional physiotherapy in early post-operative period aims at increasing lung volumes and airway clearance. This study aimed to determine the effectiveness of the addition of Acapella to conventional chest physiotherapy in improving lung volumes and secretion clearance in early post-operative CABG patients. Twenty patients of both genders (40-70 years) who had undergone CABG and were in Phase I of Cardiac Rehabilitation were involved in this pilot randomized control trial (9 control, 11 experimental). Post-surgery intervention commenced on post-operative day 2 (POD 2) and continued till POD 6. Patients in the control group were given conventional physiotherapy that included breathing exercises, incentive spirometry and manual techniques. Patient in the experimental group used an Acapella device along with the conventional intervention. Outcome measures considered were pulmonary function parameters (FVC, FEV1 & PEFR) and amount of sputum expectorated. A significant increase in lung volumes was observed in both the groups on POD 6 as compared to POD 2 (). However, the increase was significantly greater on POD 6 in experimental group than the control group [mean difference (95% CI) FVC: 0.44 L (0.24-0.63), FEV1: 0.43 L (0.19-0.66), PEFR: 0.86 L/s (0.57-1.14)]. The amount of sputum expectoration significantly greater in the experimental group as compared to the control group [2.71 mL (0.53-4.90)]. The addition of Acapella enhanced the effect conventional physiotherapy in improving lung volumes and airway clearance in the early post-operative period for CABG patients.

Comparison of Airway Clearance Therapies for Cystic Fibrosis: A Cochrane Review Summary With Commentary.

Several methods exist for airway clearance therapy in people with cystic fibrosis including both devices and techniques. Some of the common modalities include conventional chest physical therapy (CPT), active cycle of breathing, autogenic drainage, positive expiratory pressure (PEP) therapy, high-