Postural Drainage Research Articles

Chest physiotherapy techniques in neurological intensive care units of India: A survey.

Context:Neurological intensive care units (ICUs) are a rapidly developing sub-specialty of neurosciences. Chest physiotherapy techniques are of great value in neurological ICUs in preventing, halting, or reversing the impairments caused due to neurological disorder and ICU stay. However, chest physiotherapy techniques should be modified to a greater extent in the neurological ICU as compared with general ICUs.Aim:The aim of this study is to obtain data on current chest physiotherapy practices in neurological ICUs of India.Settings and Design:A tertiary care hospital in Karnataka, India, and cross-sectional survey.Subjects and Methods:A questionnaire was formulated and content validated to assess the current chest physiotherapy practices in neurological ICUs of India. The questionnaire was constructed online and a link was distributed via E-mail to 185 physiotherapists working in neurological ICUs across India.Statistical Analysis Used:Descriptive statistics.Results:The response rate was 44.3% (n = 82); 31% of the physiotherapists were specialized in cardiorespiratory physiotherapy and 30% were specialized in neurological physiotherapy. Clapping, vibration, postural drainage, aerosol therapy, humidification, and suctioning were used commonly used airway clearance (AC) techniques by the majority of physiotherapists. However, devices for AC techniques such as Flutter, Acapella, and standard positive expiratory pressure devices were used less frequently for AC. Techniques such as autogenic drainage and active cycle of breathing technique are also frequently used when appropriate for the patients. Lung expansion therapy techniques such as breathing exercises, incentive spirometry exercises, and positioning, proprioceptive neuromuscular facilitation of breathing are used by majority of physiotherapists.Conclusions:Physiotherapists in this study were using conventional chest physiotherapy techniques more frequently in comparison to the devices available for AC.

Comparative analysis of the effects of two chest physical therapy interventions in patients with bronchiolitis during hospitalization period.

Objective To evaluate and compare the effects of two chest physiotherapy interventions in patients hospitalized due to acute bronchiolitis.Methods Prospective randomized study with a sample of 83 calls for 29 patients aged between 3 months and 1 year hospitalized for acute bronchiolitis. Patients were distributed randomly into two groups: Group 1, submitted to postural drainage, tapping and tracheal aspiration; and Group 2, submitted to postural drainage, expiratory acceleration flow and tracheal aspiration. Assessments were made before and 10 and 60 minutes after the end of therapy. Patients also underwent drug treatment. The endpoint was to compare two physical therapy interventions as to clinical improvement in infants with acute bronchiolitis by means of oxygen saturation and the Respiratory Distress Assessment Instrument score. The parents/guardians was requested to answer a questionnaire about the treatment applied before the last evaluation in order to measure their satisfaction related to the interventions made.Results The groups were similar regarding the use of antibiotics and bronchodilators. A greater number of patients used corticosteroids in Group 2. A relevant improvement was observed on Respiratory Distress Assessment Instrument score with physical therapy, with reduction of the score 10 minutes after interventions, and the same score 60 minutes later, with no differences between techniques applied. There was no significant variation of pulse oximetry after chest physiotherapy. Most items assessed by the questionnaire had satisfactory answers.Conclusion No differences were observed between groups regarding the items assessed (time required to discharge from study, pulse oximetry in room air and disease severity according to the Respiratory Distress Assessment Instrument score). Parents answered positively about the effects of therapy in the majority of items in the questionnaire, both for the expiratory acceleration flow technique and for tapping.

P104 Nebulised hypertonic saline improves quality of life in adult patients with non-cystic fibrosis bronchiectasis

BackgroundNebulised hypertonic saline (HTS) improved lung function, quality of life and exacerbation frequency in a study of patients with non-cystic fibrosis (CF) bronchiectasis1. It may improve chest clearance by increasing...

The Scientific Basis for Postoperative Respiratory Care

Postoperative pulmonary complications (PPCs) are common and expensive. Costs, morbidity, and mortality are higher with PPCs than with cardiac or thromboembolic complications. Preventing and treating PPCs is a major focus of respiratory therapists, using a wide variety of techniques and devices, including incentive spirometry, CPAP, positive expiratory pressure, intrapulmonary percussive ventilation, and chest physical therapy. The scientific evidence for these techniques is lacking. CPAP has some evidence of benefit in high risk patients with hypoxemia. Incentive spirometry is used frequently, but the evidence suggests that incentive spirometry alone has no impact on PPC. Chest physical therapy, which includes mechanical clapping and postural drainage, appears to worsen atelectasis secondary to pain and splinting. As with many past respiratory therapy techniques, the profession needs to take a hard look at these techniques and work to provide only practices based on good evidence. The idea of a PPC bundle has merit and should be studied in larger, multicenter trials. Additionally, intraoperative ventilation may play a key role in the development of PPCs and should receive greater attention.

Comparison of conventional pulmonary rehabilitation and high‐frequency chest wall oscillation in primary ciliary dyskinesia

Enhancement of mucociliary clearance by pulmonary rehabilitation (PR) is advocated in primary ciliary dyskinesia (PCD). Our primary aim was to compare the efficacy and safety of postural drainage, percussion and vibration [conventional PR (CPR)], and high frequency chest wall oscillation (HFCWO) by studying change in pulmonary function. Our secondary aim was to evaluate patient preferences regarding the two methods. This was a controlled randomized crossover study. PCD patients between the ages of 7 and 18 years were assigned to two groups, first group performed airway clearance with CPR at hospital for 5 days and after a 2-day washout period HFCWO was applied to the same group at home. HFCWO was applied first to the other group and then these patients were hospitalized for CPR. The primary outcome measure of the study was pulmonary function test (PFT). The secondary outcomes were pulse arterial oxygen saturation (SpO2 ) and the perceived efficiency and comfort level. PFT values of patients increased significantly after both PR methods (before/after): CPR: FVC: 77.0 ± 14.1/81.8 ± 13.0 (P = 0.002); FEV1 : 72.9 ± 14.8/78.7 ± 13.5 (P = 0.001); PEF: 73.8 ± 14.5/82.5 ± 14.5 (P = 0.001); FEF25-75 : 68.6 ± 27.6/74.9 ± 29.3 (P = 0.007). 75.1 ± 15.3/80.3 ± 13.9 (P = 0.002); FEV1 : 71.4 ± 16/77.4 ± 14.6 (P = 0.001); PEF: 70.9 ± 18.0/78.3 ± 17.7 (P = 0.002); FEF25-75 : 70.5 ± 23.4/76.4 ± 25.6 (P = 0.006). There were no significant differences in % predicted FVC, FEV1 , PEF, and FEF25-75 increased values with CPR and HFCWO. HFCWO was found more comfortable (P = 0.04). Two PR methods were found efficient and no desaturation occurred during PR. PFTs were significantly increased after both PR methods. There were no differences in PFTs and SpO2 between the CPR and HFCWO groups. Both PR methods were found efficient. HFCWO was found more comfortable. HFCWO may be an option in patients with chronic pulmonary disease and low adherence to PR.

Postural Drainage and Manual Lymphatic Drainage for Lower Limb Edema in Women with Morbid Obesity After Bariatric Surgery

The aim of this study was to evaluate the effects of postural drainage (PD) and manual lymphatic drainage (MLD) techniques on edema in the lower limbs of women with morbid obesity submitted to bariatric surgery. A total of 47 women between 20 and 40 yrs old with a body mass index of 40 kg/m or higher were randomly placed in three groups: control group (n = 15), PD group (PDG, n = 16), and MLD group (n = 16). Lower limb perimetry was carried out in the first and third days of the postoperative period. All patients underwent six sessions of conventional physical therapy, plus additional six sessions of PD for the PDG or six sessions of MLD for the MLD group. Intragroup analysis showed volume reductions in the PDG and the MLD group after the treatment protocol. Comparison of the pretreatment and posttreatment deltas among the groups showed a larger change in volume for the PDG compared with the control group and a larger change in volume for the MLD group compared with the control group or the PDG. The treatment protocols promoted reductions in volume values, suggesting that both techniques could be used to help reduce lower limb edema among this population. Nevertheless, the best results were obtained with MLD.

Application of modified postural drainage in treating stubborn pulmonary infection after cardiothoracic surgery

Objective To explore application effect of modified postural drainage on treating stubborn pulmonary infection after cardiothoracic surgery.Methods Totals of 88 patients with stubborn pulmonary infection after cardiothoracic surgery were chosen,and randomly divided into the experimental group (n =47)and the control group (n =41).The control group received conventional drug therapy and nutritional support treatment,while the experimental group received modified postural drainage method in addition.Two groups'treating time,rehabilitation conditions,antibiotic use time were compared.Results Fifteen days after modified postural drainage,41 cases in the experimental group and 21 cases in the control group had smaller lesion,and the difference was statistically significant (x2 =32.19,P ＜ 0.01).The score of physical function,physical role,general health condition,vitality,and psychological health in SF-36 scale was respectively (52.22 ±9.27),(56.87 ± 9.22),(58.69 ± 7.54),(49.33 ± 8.25),(53.28 ± 7.89) in the experimental group,and (41.54 ± 10.11),(44.28 ± 10.41),(45.22 ± 8.29),(33.21 ± 9.57),(42.74 ± 8.03) in the control group,and the differences were statistically significant (t =3.45,2.65,4.21,3.54,2.58,respectively;P ＜0.05).There were no obvious adverse reactions in both groups.Conclusions Modified postural drainage,better than simple drug therapy,can promote the recovery of stubborn pulmonary infection after cardiothoracic surgery. Key words: Drainage, postural; Cardiothoracic surgery; Stubborn pulmonary infection

Proper method for preoperative chest preparation of patients listed for cardiac surgery

Postoperative pulmonary complication (PCCs) after cardiac surgery are a major source of morbidity and mortality, and increase length of hospital stay and resource utilization. The preoperative including prehospitlization period before CARDIAC surgery maybe used to improve a patients pulmonary condition. The efficacy of preoperative non-invasive CPAP and BIPAP machine use, chest physiotherapy (CPT) and postural drainage, frequent nebulization plus inspiratory muscle training (IMT) in reducing the incidence of PPCs in high-risk patients undergoing CARDIAC surgery has not yet been determined. To evaluate the prophylactic efficacy of our new preoperative chest preparation strategy (strategy A) on the incidence of PPCs in high risk patients scheduled for elective CARDIAC surgery compared with classic routinely used one (Strategy B). A single blind, randomized clinical trial conducted at the Cardiac Center of Kind Fahad Armed forces Hospital, Jeddah, Saudi Arabia, with the enrollment between November 2011 and October 2012. Of 500 patients referred for elective CARDIAC surgery, 100 (20%) met criteria for high risk of developing PPCs, of whom were enrolled and followed up until discharge from hospital after dividing him to two groups, our new preoperative chest preparation strategy group (group A) and classic routinely used group (group B). Patients were randomly assigned to receive either preoperative strategy (n = 50) or usual care B strategy (n = 50). Both groups received the postoperative physical therapy. Incidence of PPCs especially pneumonia, duration of postoperative intubation and invasive ventilation, Intensive Care Unit (ICU) stay and hospitalization incidence of requiring re-intubation and impact of both strategies on postoperative patient compliance to respiratory therapy. Both groups were comparable at baseline. After CARDIAC surgery, PPCs were present in 10 (20%) of patients in the A group and 25 (50%) of patients B group. Pneumonia occurred in 5 (10%) of patients in the A group and in 7 (14%) of patients in the B (OR 95% CI). Median days range 6–18 days in the B group. Finally, postoperative patients compliance to respiratory therapy was significantly improved. Preoperative A strategy reduced the incidence of PPCs an duration of postoperative hospitalization in patients at high risk of developing pulmonary complication undergoing CARDIAC surgery. Also, postoperative patient compliance to respirartory therapy was significantly improved.

Thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage

Retrospective analysis of the clinical efficacy and feasibility of patients with thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. A total of 18 patients with thoracolumbar tuberculosis (TB), between February 2007 and February 2011, underwent one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. And the clinical efficacy was evaluated based on surgery duration time, the blood loss, the postural drainage of time, neurological status that was recorded by American Spinal Injury Association (ASIA) Impairment Scale, the fate of bone graft fusion, kyphosis angle, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which were collected at certain time. The average follow-up period was 34 months (range 18-48 months). 18 patients suffered from seriously neurological deficits pre-operatively, of which 16 patients returned to normal at final follow-up. The surgery duration time was 197 ± 37.9 min, and the blood loss was 815 ± 348.5 ml. The postural drainage of time was 7.2 ± 2.7 days. The psoas abscesses disappeared in all cases, within the time range of 6-9 months (mean 7.4 ± 1.2 months). All patients of the grafted bones were thoroughly fused, with a fusion time ranging from 4 to 12 months (mean 7.8 months). Kyphosis angle was 44.32 ± 7.26° on average pre-operative and returned to 11.72 ± 2.85° at 6 weeks after operation; kyphosis angle was 13.10 ± 2.39° at final follow-up. The values of ESR and CRP were significant declined at 6 weeks post-operative, and returned to normal levels at final follow-up. With standardized anti-TB chemotherapy, thoracolumbar spinal tuberculosis with psoas abscesses could be effectively treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage.

A10.22 Response to MTX Plus Prednisone in Camera II Using a Multi-Biomarker Disease Activity (Vectra™DA) TEST and DAS28-ESR

<b>Introduction:</b> Aspiration pneumonia (AP) is a dominant form of community-acquired, hospital-acquired and nursing and healthcare-associated pneumonia, and a leading cause of death among ageing populations.However, the risk factors for fatal outcome in AP with postural drainage (PD) have not been fully evaluated. <b>Aims and objectives:</b> The purpose of the present study was to determine the risk factors for fatal outcome in AP with PD. <b>Methods:</b> Retrospective study from 04/2014 to 03/2015 of patiens with clinically and radiologically confirmed AP and were performed PD in our hospital. We conducted a case-control study using 33 cases with dead and 95 age- and sex-frequency-matched controls with alive. <b>Result:</b> A total of 128 AP cases with PD were identified. There were 73(57%) male patients, the mean age was 83±9 years. In the univariateanalysis, daily oxygen therapy was a significant risk factor for fatal outcome in AP with PD (odds ratio[OR], 2.81, 95% confidence interval [CI], 1.17-6.78, P&lt;0.05), WBC of at the end of antibiotic treatment (OR, 4.04,95% CI, 2.03-8.05, P&lt;0.01) and CRP (OR, 3.61, 95% CI, 1.58-8.22, P&lt;0.01). In the multiple logistic regression analysis, the risk factors for fatal outcome associated with AP with PD after adjustment for age,sex, bmi and smoking status, were daily oxygen therapy (OR, 6.23, 95% CI, 2.55-15.2, P&lt;0.01), WBC of at the end of antibiotic treatment (OR, 5.02, 95% CI, 2.30-10.9, P&lt;0.01) and CRP (OR, 3.71,95% CI, 1.56-8.82, P&lt;0.01). <b>Conclusion:</b> The risk factors for fatal outcomes in AP with PD were clearly daily oxygen therapy, WBC and CRP of the end of antibiotic therapy. These results could help improve clinical management for AP with PD.

Adherence to Airway Clearance Therapies by Adult Cystic Fibrosis Patients

Airway clearance therapy (ACT) is critical in cystic fibrosis (CF). To determine rates of self-reported adherence to ACT by patients treated in an adult CF program, to identify patient characteristics associated with poor adherence, to typify adherence according to ACT technique, and to indicate reasons for poor adherence. Our cross-sectional study included CF subjects age 16 years and older. Enrollees were evaluated via general structured questionnaire, adherence questionnaire, clinical assessment, spirometry, and S(pO(2)) values. Each was stratified by self-reporting protocol as high, moderate, or poor adherence to ACT. Concordance between physiotherapist recommended ACT technique and self-reported subject adherence was subjected to agreement analysis. Of the 63 subjects studied, 38 (60%) qualified as high adherence, 12 (19%) as moderate adherence, and 13 (21%) as poor adherence. Logistic regression identified education level (less than high school) as an independent factor associated with poor adherence (odds ratio 10.2, 95% CI 1.23-84.7, P = .03). Positive expiratory pressure (κ = 0.87) and flutter device (κ = 0.63) usage both corresponded with a high level of agreement, while active cycle of breathing technique (κ = 0.40) and autogenic drainage (κ = 0.39) each showed moderate agreement. Agreement was low for percussion and postural drainage (κ = 0.23). Reasons given most frequently for poor adherence to ACT were "not enough time to do ACT" (28%), "cannot be bothered" (16%), and "do not enjoy ACT technique" (8%). Many (32%) provided no reason. Study outcomes showed a high rate of ACT adherence in adult CF subjects. Lower level of education was the most important factor in poor adherence to ACT. Self-reported adherence and treatment recommendations were in best agreement with positive expiratory pressure and flutter device techniques.

Practice patterns of physiotherapists in neonatal intensive care units: A national survey

Objective:To determine practice pattern of physiotherapists in the neonatal intensive care units (ICUs) in India with regards to cardiopulmonary and neuromuscular physiotherapy.Materials and Methods:A cross-sectional survey was conducted across India, in which 285 questionnaires were sent via e-mail to physiotherapists working in neonatal intensive care units.Results:A total of 139 completed questionnaires were returned with a response rate of 48.7%, with a majority of responses from Karnataka, Maharashtra and Gujarat. More than 90% of physiotherapists performed chest physiotherapy in neonatal ICUs. Chest physiotherapy assessment predominantly focused on vital parameter assessment (86%) and in treatment predominantly focused on percussion (74.1%), vibration (75.5%), chest manipulation (73.3%), postural drainage (67.6%) and suction (65.4%). In neuromuscular physiotherapy more than 60% of physiotherapists used positioning, and parent education, whereas more than 45% focused on passive range of motion exercise and therapeutic handling.Conclusion:The practice pattern of physiotherapists for neonates in neonatal intensive care units involves both chest physiotherapy as well neuromuscular physiotherapy. Chest physiotherapy assessment focused mainly on vital parameter assessment (heart rate, respiratory rate and partial pressure of oxygen saturation SpO2). Treatment focused on airway clearance techniques including percussion, vibration, postural drainage and airway suction. In neuromuscular physiotherapy most physiotherapists focused on parent education and passive range of motion exercise, therapeutic handling, as well as positioning.

Pyopneumothorax Secondary to Aspergillus Infection: A Case Report

A 32 -year- old male presented with complaints of fever, dry cough, breathlessness and right sided chest pain of two months duration. Chest radiograph showed right sided hydropneumothorax which revealed frank pus on diagnostic thoracocentesis, for which tube thoracostomy was done. Despite vigorous broad spectrum antibiotic coverage, postural drainage and chest physiotherapy, there was no clinical improvement. Further work up included serology, pleural fluid culture, closed as well as thoracoscopic guided pleural biopsy revealed growth of Aspergillus fumigatus. Patient was prescribed antifungal medication (Voriconazole) and subsequent thoracotomy with right sided pneumonectomy showed good clinical recovery.

Anaesthetic, Procedure and Complications Management of Serial Whole-Lung Lavage in an Obese Patient with Pulmonary Alveolar Proteinosis: Case Report

The first case of Pulmonary Alveolar Proteinosis (PAP) was described by Rose in 1958, but it is still a rare disorder. PAP is characterized by deposition of lipoproteinaceous material secondary to abnormal processing of surfactant by macrophages. Patients may suffer from progressive dyspnea and cough that at times is accompanied by worsening hypoxia and its course can vary from progressive deterioration to spontaneous improvement. Many therapies have been used to treat PAP including antibiotics, postural drainage, and intermittent positive pressure breathing with aerosolized Acetylcysteine, heparin and saline. At present, the mainstay of treatment is whole lung lavage (WLL). Although generally well tolerated, WLL can be associated with some complications. We report a case of severe PAP through the anaesthetic, procedure and complications management of pulmonary alveolar proteinosis in one patient who has undergone multiple, alternating, single-lung lavages over the past seven years, the last three in our hospital, with improvements in her symptoms following each therapy.

Predicted Effect of Landscape Position on Wildlife Habitat Value of Conservation Reserve Enhancement Program Wetlands in a Tile‐drained Agricultural Region

AbstractJustification for investment in restored or constructed wetland projects are often based on presumed net increases in ecosystem services. However, quantitative assessment of performance metrics is often difficult and restricted to a single objective. More comprehensive performance assessments could help inform decision‐makers about trade‐offs in services provided by alternative restoration program design attributes. The primary goal of the Iowa Conservation Reserve Enhancement Program is to establish wetlands that efficiently remove nitrates from tile‐drained agricultural landscapes. A secondary objective is provision of wildlife habitat. We used existing wildlife habitat models to compare relative net change in potential wildlife habitat value for four alternative landscape positions of wetlands within the watershed. Predicted species richness and habitat value for birds, mammals, amphibians, and reptiles generally increased as the wetland position moved lower in the watershed. However, predicted average net increase between pre‐ and post‐project value was dependent on taxonomic group. The increased average wetland area and changes in surrounding upland habitat composition among landscape positions were responsible for these differences. Net change in predicted densities of several grassland bird species at the four landscape positions was variable and species‐dependent. Predicted waterfowl breeding activity was greater for lower drainage position wetlands. Although our models are simplistic and provide only a predictive index of potential habitat value, we believe such assessment exercises can provide a tool for coarse‐level comparisons of alternative proposed project attributes and a basis for constructing informed hypotheses in auxiliary empirical field studies.

189 Airway clearance techniques currently used in a cystic fibrosis center in Argentina

Introduction: Nowadays modern physiotherapy has proven to be an effective approach to Cystic Fibrosis treatment although many patients still had a tendency to continue with conventional therapies. Objective: To describe which method of the Airway Clearance Techniques (ACT) patients perform and to know if they had incorporated exercise as a part of their treatment. Methods: Cross sectional, observational study. Data of physiotherapy techniques (ACT, exercise and Inhaled Therapy) were collected. Results: There were 110 patients attended in our clinic. From these, 101 patients (92%) perform some kind of ACT. 30 (27.2%) perform MPD /C (Modified Postural Drainage and Chest Compression), 29 (26.3%) prefer PD/Pc (postural drainage and percussion), 36 (32.7%) ACBT (active cycle of breathing technique) and 12 (10.9%) PEP (Positive Expiratory Pressure) and Osc. PEP (Oscillating Positive Expiratory Pressure) with other techniques. Only 39 patients (35.4%) were daily assisted by a physiotherapist. 88 patients were able to perform exercise according to their age, although 70 (79.5%) usually do. Related to inhaled therapy, 84 of 110 patients (76.3%) use DNase and 42 (38.1%) Hypertonic Saline. Conclusions: Although many patients still prefer PD/ Pc, a considerable number of them had incorporated modern physiotherapy. A great number of patients had understood the importance of an active life and they perform some type of sport or exercise according to the child’s age and abilities.

190 Patient perceptions of physiotherapy and the role of airway clearance techniques within an adult cystic fibrosis clinic

Introduction: Nowadays modern physiotherapy has proven to be an effective approach to Cystic Fibrosis treatment although many patients still had a tendency to continue with conventional therapies. Objective: To describe which method of the Airway Clearance Techniques (ACT) patients perform and to know if they had incorporated exercise as a part of their treatment. Methods: Cross sectional, observational study. Data of physiotherapy techniques (ACT, exercise and Inhaled Therapy) were collected. Results: There were 110 patients attended in our clinic. From these, 101 patients (92%) perform some kind of ACT. 30 (27.2%) perform MPD /C (Modified Postural Drainage and Chest Compression), 29 (26.3%) prefer PD/Pc (postural drainage and percussion), 36 (32.7%) ACBT (active cycle of breathing technique) and 12 (10.9%) PEP (Positive Expiratory Pressure) and Osc. PEP (Oscillating Positive Expiratory Pressure) with other techniques. Only 39 patients (35.4%) were daily assisted by a physiotherapist. 88 patients were able to perform exercise according to their age, although 70 (79.5%) usually do. Related to inhaled therapy, 84 of 110 patients (76.3%) use DNase and 42 (38.1%) Hypertonic Saline. Conclusions: Although many patients still prefer PD/ Pc, a considerable number of them had incorporated modern physiotherapy. A great number of patients had understood the importance of an active life and they perform some type of sport or exercise according to the child’s age and abilities.

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

To evaluate the effectiveness of chest physical therapy (CP) in reducing the clinical score in infants with acute viral bronchiolitis (AVB). Randomized controlled trial of 30 previously healthy infants (mean age 4.08 SD 3.0 months) with AVB and positive for respiratory syncytial virus (RSV), evaluated at three moments: at admission, then at 48 and 72 hours after admission. The procedures were conducted by blinded assessors to each of three groups: G1 - new Chest Physical therapy- nCPT (Prolonged slow expiration - PSE and Clearance rhinopharyngeal retrograde - CRR), G2 - conventional Chest Physical therapy- cCPT (modified postural drainage, expiratory compression, vibration and percussion) and G3 - aspiration of the upper airways. The outcomes of interest were the Wang's clinical score (CS) and its components: Retractions (RE), Respiratory Rate (RR), Wheezing (WH) and General Conditions (GC). The CS on admission was reduced in G1 (7.0-4.0) and G2 (7.5-5.5) but was unchanged in G3 (7.5-7.0). We observed a change 48 hours after hospitalization in G1 (5.5-3.0) and G2 (4.0-2.0) and in 72 hours, there was a change in G1 (2.0-1.0). The CP was effective in reducing the CS in infants with AVB compared with upper airway suction only. After 48 hours of admission, both techniques were effective and nCPT techniques were also effective in the 72 hours after hospitalization compared with cCPT techniques.

Randomized Crossover Study of Lung Expansion Therapy Using Negative Pressure and Positive Pressure in Bronchiectasis

Background For patients with bronchiectasis, the mechanical mobilization of secretion constitutes a key therapeutic approach. However, the effectiveness of lung expansion therapy to mobilize secretion in bronchiectasis patients has not been investigated extensively. This study compares patients' exercise tolerance and physical assessment outcomes after secretion clearance using intermittent positive pressure breathing (IPPB) or negative pressure ventilation (NPV) as adjuncts to postural drainage. Methods This prospective, randomized crossover study examined the data for 18 stable outpatients with bronchiectasis. The outcomes were compared for four treatment sessions of either IPPB or NPV, used as adjuncts to postural drainage. The short-term outcomes involved pulmonary functions and a six-minute walk test (6MWT). We also assessed pulmonary functions and physical clinical signs as immediate treatment effects. Results Patients' forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and cough efficacy did not change significantly after individual postural drainage sessions using either IPPB or NPV. However, a reduction in the use of accessory muscles was noted after NPV; patients with low baseline FVC might benefit particularly from this reduction (r = 0.699, p < 0.05). No significant differences between two techniques were found for the patient's walking distance. However, the pulse rate after 6MWT was significantly (p < 0.05) lower in the NPV group. Conclusion NPV may provide as an effective adjunct to postural drainage as IPPB in weekly lung expansion therapy for outpatients with bronchiectasis. The benefits of NPV might include a reduction in the use of accessory muscles during lung expansion.

Vulnerability to Contralateral Pneumonia in Patients with Hemispheric Strokes (P07.007)

Objective: We hypothesized that there is laterality in motor deficits and coordination of muscles involved in upper airway and respiration in acute stroke resulting in greater vulnerability to contralateral pneumonia in supratentorial stroke patients. Background Stroke is associated with contralateral focal motor, visual, and sensory deficits. It remains unclear whether there is laterality to muscle deficits involved in upper airway and respiration. Design/Methods: We reviewed medical records, chest radiographs, and laboratory testing to identify patients with pneumonia among a study population of 1033 adults (239 with intracerebral hemorrhage (ICH), and 794 with ischemic stroke) admitted to two University affiliated hospitals from 2008-2010. Hospital-acquired pneumonia was defined by new or progressive radiographic infiltrate and at least two clinical features (fever, leukocytosis, or purulent tracheal secretions) based on definitions used in previous studies. Results: Overall, 76 patients (7.36%) were diagnosed with pneumonia during their hospitalization; 24 patients with bilateral pneumonia at the time of diagnosis were excluded. In all stroke patients with a unilateral stroke, a higher number of unilateral pneumonias were found in the contralateral lung (40) as compared to the ipsilateral lung (12) (OR 3.33, 95% confidence interval [CI] 1.43-7.75) after correction for endotrachial and nasogastric tube placement. The relationship was more prominent in patients with ischemic stroke patients (OR 5.20, 95% CI 1.57-17.18) as compared with patients with ICH ( OR 2.00, 95% 0.57-7.06). Conclusions: Unilateral vulnerability to pneumonia in patients with hemispheric stroke supports targeted chest percussions and postural drainage therapies to reduce the rate of such events and associated morbidity. Disclosure: Dr. Anderson has nothing to disclose. Dr. Chaudhry has nothing to disclose. Dr. Hassan has nothing to disclose. Dr. Anderson has nothing to disclose. Dr. Rodriguez has nothing to disclose. Dr. Suri has nothing to disclose. Dr. Qureshi has nothing to disclose.