Incentive Spirometry Research Articles

Comparative effect of incentive spirometry and diaphragm breathing to functional capacity in COVID-19 patient in an isolated ward

Background: COVID-19 affects the multiorgan system, mostly the respiratory system. Symptoms might vary from upper respiratory manifestation to acute respiratory distress syndrome, with the main feature being impairment of gas exchange. This pulmonary impairment might lead to a decrease in functional capacity, which cause activity limitation. Thus, COVID-19 patient requires the right pulmonary rehabilitation strategy to improve pulmonary function and prevent further pulmonary complications. This study aimed to compare the effectiveness of incentive spirometry and diaphragm breathing exercise on cardiorespiratory functional capacity in COVID-19 patients. Methods: Subjects were divided into two groups of breathing exercises, the incentive spirometry group and the diaphragm breathing exercise group. They performed breathing exercises for 5 days, and the functional capacity was measured by a test named 4-meter gait time test (4MGT) and 30 sit-to-stand test (30STS). The test was taken before and after performing breathing exercises. Results: These two respiratory exercises significantly affected the functional capacity in a good manner (p < 0.05). The incentive spirometry had improved 30STS (P = 0.763) and 4MGT results (P = 0.674), as well as diaphragm breathing exercise did to 30STS (P = 0.456) and 4MGS (P = 0.441). Conclusion: In conclusion, diaphragm breathing exercises and incentive spirometry improved the functional capacity of COVID-19 patients. However, incentive spirometry showed a larger effect on 30STS and 4MGT compared to diaphragm breathing exercises.

Preoperative Pulmonary Rehabilitation to Prevent Postoperative Pulmonary Complications following Open Heart Surgery: A Narrative Review

Background: Numerous medical disciplines have recognized the preoperative period as a crucial phase to enhance patient recovery and outcomes. Patients perform preoperative pulmonary rehabilitation with inspiratory or expiratory muscle training to enhance lung protection. Despite the variety of breathing techniques in the clinical setting, the literature lacks a conclusive evidence regarding which technique is more effective. Research question: In adult patients undergoing open heart surgeries, is preoperative pulmonary rehabilitation of benefit in preventing postoperative pulmonary complications, shorten length of stay in the intensive care unit (ICU) or hospital? Methods: The authors conducted a search in electronic databases regarding the current evidence of preoperative pulmonary rehabilitation. Subjects: Patients undergoing Coronary Artery Bypass Grafts (CABG) and/or valvular surgery. Intervention: Any pulmonary intervention, such as incentive spirometer, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery, single or combined. Outcome measures: The incidence of persistent post-concussion symptoms (PPCSs), pulmonary function test (PFT), ventilation period, length of stay in ICU and hospital Results: The authors conducted an initial search in the systematic reviews, which yielded 16 published articles. Furthermore, the authors search in the randomized controlled trials and this yielded 72 articles. The relevancy of the selected publications was determined by reviewing their titles, keyword, and abstracts. Overall a total of eight randomized controlled trials (RCTs) and six systematic reviews involving 3908 participants were included in this review. Conclusion: Preoperative pulmonary rehabilitation utilizing various breathing techniques reduces the incidence of postoperative pulmonary complications. Keywords Preoperative Care, Breathing Exercises, Postoperative Complications, Coronary Artery Bypass, Cardiac Surgery.

Design of a device for the assessment of dyspnea patients

Dyspnea is a disorder that occurs because of shortness of breath and may lead to multiple complications. Intoxicated dyspnea patients are those who are addicted to alcohol, as well as have breathing problems. Mostly, problems faced by dyspnea patients are inhalation, when they take alcohol with severe concentration. For intoxicated dyspnea patients, there is a continuous need for alcohol breath testing along with breath indicators, since, an individual is prone to alcohol addiction, and faces problems of breathing such as asthma, hypertension, etc. The severe outbreak of dyspnea in these individuals may be deadly. To handle this condition, an alcoholic meter along with an incentive spirometer is designed that helps in the assessment of breathing problems by measuring the alcohol concentration and inhaled air. Several parameters have opted for both inhalation detection and alcohol concentration which include the severity of health problems encompassing asthma, hypertension for the detection of inhaled air, and normal, moderate, severe alcohol concentration. The working of the proposed device is validated through the analysis of these parameters. The results are obtained on the graph as well as on display, which shows a variation in the range among every individual with respect to selected parameters either in incentive spirometer (inhalation detection) or alcoholic meter, and these ranges are also displayed in a numeric form on LCD. The idea is to design an economical and portable device for intoxicated dyspnea patients for emergency conditions which is a combination of an alcoholic meter with an incentive spirometer (IS) for the measurement of alcohol concentration along with breathing problems by making use of sensors. This unique idea of combining an alcoholic meter with an incentive spirometer will aid intoxicated dyspnea patients in case of emergency.

POST-COVID PULMONARY COMPLICATIONS IN THE OUTPATIENT SETTING: ARE WE PREPARED FOR THE AVALANCHE?

POST-COVID PULMONARY COMPLICATIONS IN THE OUTPATIENT SETTING: ARE WE PREPARED FOR THE AVALANCHE?

Acute Care Physical Therapy and Sickle Cell Disease

Background and Purpose: Vaso-occlusive crises (VOC) are the most common cause for hospitalization in children and adolescents with sickle cell disease (SCD) in the United States. Physical therapy interventions provide nonpharmacological pain management and help hospitalized patients maintain mobility and function, but little is known about their application to the unique pathophysiology of those with SCD. The purpose of this review is to summarize evidence relevant to the physical therapy management of children and adolescents hospitalized with VOC. Methods: A literature search of PubMed, Cochrane, CINAHL, and EMBASE databases was performed using key words relevant to physical therapy interventions for children and adolescents with SCD and acute pain. Results: Sixteen articles were included in this review. Interventions identified included heat, mobilization, transcutaneous electrical nerve stimulation, massage, yoga, mindfulness, breathing exercises, virtual reality, incentive spirometry, and patient/family education. Conclusions: Physical therapists may be able to aid in the acute pain management of patients with SCD. Current literature relies on small observational studies making generalization difficult. Future studies are critical to improve evidence-based physical therapy practice in this population.

Ultrasound-guided, continuous erector spinae plane (ESP) block in minimally invasive thoracic surgery—comparing programmed intermittent bolus (PIB) vs continuous infusion on quality of recovery and postoperative respiratory function: a double-blinded randomised controlled trial

BackgroundMinimally invasive thoracic surgery (MITS) has been shown to reduce postoperative pain and contribute to better postoperative quality of life as compared to open thoracic surgery (Bendixen et al., Lancet Oncol 17:836–44, 2016). However, it still causes significant post-operative pain. Regional anaesthesia techniques including fascial plane blocks such as the erector spinae plane block (ESP) have been shown to contribute to post-operative pain control after MITS (Finnerty et al., Br J Anaesth 125:802–10, 2020). Case reports relating to ESP catheters have described improved quality of pain relief using programmed intermittent boluses (PIB) instead of continuous infusion (Bendixen et al., Lancet Oncol 17:836–44, 2016). It is suggested that larger, repeated bolus dose may provide superior pain relief, possibly because of improved spread of the local anaesthetic medications (Ilfeld and Gabriel, Reg Anesth Pain Med 44:285–86, 2019). Evidence for improved spread of local anaesthetic may be found in one study which demonstrated that PIB increased the spread of local anaesthetic medication compared to continuous infusions for continuous paravertebral blocks, which are another type of regional anaesthesia technique for the chest wall (Hida et al., Reg Anesth Pain Med 44:326–32, 2019). Similarly, regarding labour epidural analgesia, the weight of evidence is in favour of PIB providing better pain relief compared with continuous infusion (Onuoha, Anesthesiol Clin 35:1–14, 2017).Since fascial plane blocks, such as ESP, rely on the spread of local anaesthetic medication between muscle layers of the chest wall, intermittent boluses may be particularly useful for this group of blocks. However, until recently, pumps capable of providing automated boluses in addition to patient-controlled boluses were not widely available. To best of our knowledge, there are no randomised controlled trials comparing continuous infusion versus intermittent bolus strategies for erector spinae plane block for MITS in terms of patient centred outcomes such as quality of recovery.MethodsThis trial will be a prospective, double-blinded, randomised controlled superiority trial. A total of 60 eligible patients will be randomly assigned to receive an intermittent bolus regime of local anaesthetic vs a continuous infusion of local anaesthetic. The medication will be delivered via an ultrasound-guided erector spinae plane block catheter which will be inserted by an anaesthesiologist while the patient is under general anaesthetic before their MITS surgery begins. The primary outcome being measured is the Quality of Recovery (QoR-15) score between the two groups 24 h after surgery. Secondary outcomes include respiratory testing of maximal inspiratory volume measured with a calibrated incentive spirometer, area under the curve for Verbal Rating Score for pain at rest and on deep inspiration versus time over 48 h, total opioid consumption over 48 h, QoR-15 score at 48 h and time to first mobilisation.DiscussionDespite surgical advancements in thoracic surgery, severe acute post-operative pain following MITS is still prevalent. This study will provide new knowledge and possible recommendations about the efficacy of programmed intermittent bolus regimen of local anaesthetic vs a continuous infusion of local anaesthetic via an ultrasound-guided erector spinae plane catheter for patients undergoing MITS.Trial registrationThis trial was pre-registered on ClinicalTrials.gov Identifier: NCT05181371. Registered on 6 January 2022. All item from the World Health Organization Trial Registration Data set have been included.

Oxygen desaturation in a transgender man: initial concerns and recommendations regarding the practice of chest binding: a case report

BackgroundOver 1.4 million US adults identify as transgender when gender identity differs from the sex assigned at birth [1]. Although transgender patients face adverse health outcomes, they remain an understudied population [2]. A 2017 study surveyed 411 practicing clinicians and found that 80% had been involved in treating a transgender patient, but 80.6% had never received training on transgender care [3]. The purpose of this report is to describe prolonged desaturation in one case of a transgender patient who wore a chest binder intraoperatively owing to a lack of preoperative recognition.Case presentationA 19-year-old transgender male of African-American descent with anxiety and class 3 obesity presented for an esophagogastroduodenoscopy to evaluate a 2-year history of upper abdominal pain unresponsive to proton pump inhibitor therapy, with a plan for monitored anesthesia care. His medications included sertraline, pantoprazole, zolpidem, ergocalciferol, leuprolide, and testosterone cypionate. Preoperatively, the patient was instructed to remove all clothing and to don a patient gown while in the bathroom. The attending anesthesiologist then conducted the interview and examination in the preoperative holding area. The patient was induced with 250 mg of propofol, and reassuring respirations were noted by capnography. Respirations and oxygen saturation remained stable upon insertion of the endoscope. Four minutes later, the patient’s oxygen saturation rapidly decreased to 50% and end-tidal capnography was lost. The endoscope was removed, and the patient was given 200 mg of propofol and 20 mg succinylcholine. His oxygen saturation recovered to 80% and 100% after 2 and 5 minutes, respectively, of ventilation with 100% inspired oxygen. No further oxygen desaturation was noted throughout the procedure, and the patient was closely monitored for signs of respiratory difficulty during an uneventful postoperative course. After full emergence, it was revealed that the patient had been wearing a chest binder throughout the operative procedure. The patient was counseled on the necessity to communicate the presence of this accessory prior to all future procedures.ConclusionIn the clinical narrative, a healthy patient was observed to have prolonged oxygen desaturation after induction of anesthesia. Laryngospasm was suspected clinically owing to the sudden absence of end-tidal carbon dioxide. Prolonged oxygen desaturation despite appropriate interventions suggests the contribution of additional factors. We speculate that the presence of a chest binder intraoperatively predisposed the patient to more rapid oxygen desaturation less responsive to typical therapy. A chest binder would introduce mechanical restriction to the patient’s breathing owing to its inherent design to compress. Although the patient was asked to remove all clothing, specific instructions were not provided regarding the removal of a chest binder. The presence of chest binding was also absent in the electronic health record, despite the documented presence of the patient’s preferred gender, hormonal therapy regimen, and medical history. Ultimately, this case reflects the gap between practitioner knowledge and hospital guidelines and the practices of transgender patients. In reviewing existing literature and the potential for atelectasis with external compression, we would consider that patients refrain from chest binding for 12–24 hours before surgical procedures, resume no sooner than 24 hours after ambulation, and participate in diagnostic incentive spirometry pre- and postoperatively.

Comparison of the effect of incentive spirometry and deep breathing exercises on hemodynamic parameters of patients undergoing coronary artery bypass graft surgery: A Clinical Trial

Background and ObjectiveHemodynamic changes are among the common complications after coronary artery bypass graft (CABG) surgery. Incentive spirometry (IS) and deep breathing exercises (DBEs) are widely used in patients undergoing CABG surgery. The aim of the present study was to compare the effect of IS and DBEs on hemodynamic and oxygenation parameters of patients undergoing CABG surgery. MethodsThis is a clinical trial that was performed on 40 patients with heart disease who were candidates for coronary artery bypass graft surgery. Participants were selected using convenience sampling and then randomly divided into two groups. One day before surgery, one group was taught how to perform DBE and the other group was taught how to use IS in practice. Hemodynamic and oxygenation indices were measured and recorded before the intervention, the first, second, and the third day after the intervention. Data analysis was carried out using SPSS ver.16 and descriptive and inferential statistical tests. ResultsThe mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the first day after the intervention in patients undergoing the IS group was significantly higher than the DBE group (p<0.05). On the third day after the intervention, the mean arterial oxygen saturation (SaO2) in patients of the IS group was significantly higher than the DBE group and the mean respiratory rate (RR) in patients in the IS group was significantly lower than the DBE group (p <0.05). However, there was no significant difference between the two groups in terms of other indices (p> 0.05). ConclusionThe results showed that IS has a greater effect on hemodynamic and oxygenation indices of patients undergoing CABG compared to DBE, so, it is recommended to use IS to improve hemodynamic and oxygenation indices in these patients.

Admission Triage With Pain, Inspiratory Effort, Cough Score can Predict Critical Care Utilization and Length of Stay in Isolated Chest Wall Injury

Damage to the thoracic cage is common in the injured patient, both when the injuries are confined to this single cavity and as part of the overall injury burden of a polytraumatized patient. In a subset of these patients, the severity of injury to the intrathoracic viscera is either underappreciated at admission or blossom over the following 48-72h. The ability to promptly identify these patients and abrogate complications therefore requires triage of such at-risk patients to close monitoring in a critical care environment. At our institution, this triage hinges on the Pain, Inspiratory effort, Cough (PIC) score, which generates a composite unitless score from a nomogram which aggregates several variables-patient-reported Pain visual analog scale, Incentive spirometry effort, and the perceived adequacy of Cough. We thus sought to audit PIC's discriminant power in predicting intensive care unit (ICU) need. This retrospective cohort study was performed at an urban, academic, level 1 trauma center. All isolated chest wall injuries (excluded any Abbreviated Injury Score >2 in head or abdomen) from January 2020 to June 2021 were identified in the local trauma registry. The electronic medical record was queried for standard demographics, admission PIC score, postadmission destination, ICU and hospital length of stay (LOS), and any unplanned admissions to the ICU. Chi-squared tests were used to determine differences between PIC score outcomes and the recursive partitioning method correlated admission PIC score to ICU LOS. Two hundred and thirty six isolated chest wall injury patients were identified, of whom 194 were included in the final analysis. The median age was 60 (interquartile range [IQR] 50-74) years, 63.1% were male, and the median (IQR) number of rib fractures was 3.0 (2.0-5.0). A cutoff PIC score of 7 or lower was associated with ICU admission (odds ratio [OR] 95% CI: 8.19 [3.39-22.55], P<0.001 with a PPV=41.4%, NPV=91%), and with ICU admission for greater than 48h [OR (95% CI): 26.86 (5.5-43.96), P<0.001, with a PPV=25.9%, NPV=98.7%] but not anatomic injury severity score, hospital LOS or ICU, or the requirement for mechanical ventilation. The association between PIC score 7 or below and the presence of bilateral fractures, flail chest, or sternal fracture did not meet statistical significance. The accurate cut point of the PIC score to predict ICU admission over 48h in our retrospective cohort was calculated as PIC≤7 for P=0.013 and PIC≤6 for P=0.001. Patients with isolated chest wall injuries require effective reproducible triage for ICU-level care. The PIC score appears to be a moderate discriminator of critical care need, per se, as judged by our recorded complication rate requiring critical care intervention. This vigilance may pay dividends in early detection and abrogation of respiratory failure emergencies. Furthermore, PIC score delineation for ICU need appears to be appropriate at 7 or less; this threshold can be used during admission triage to guide care.

Breathing Exercise untuk Meningkatkan Fungsi Respirasi pada Pasien Pasca Pembedahan Abdomen

This study aims to determine the effective breathing exercise technique on respiratory function in post-abdominal surgery patients. This research design is a literature study using the search engines Science Direct, EBSCO, Wiley Online, and Clinical Key. The results showed similarities in the interventions applied, namely breathing exercises with various techniques such as deep breathing exercise, coughing activity, balloon blowing exercise, pursed lip exercise, diaphragm breathing exercise, inspiratory muscle exercise, and incentive spirometer volume and flow control exercise. The intervention was performed with a duration of 10 minutes within five days preoperatively and postoperatively. In conclusion, preoperative breathing exercises can improve lung function performance and reduce the risk of postoperative pulmonary complications.&#x0D; Keywords: Breathing Exercise, Respiratory Function, Post Abdominal Surgery

Preoperative Incentive Spirometer to Prevent Postoperative Pulmonary Complications following Open Heart Surgeries: A Randomized Single Blinded Multi-Centric Clinical Trial

Objectives: To determine the effect preoperative use of an Incentive Spirometer (IS) has on preventing postoperative pulmonary complications among patients undergoing open heart surgeries.&#x0D; Methods: A prospective, randomized, controlled single-blinded parallel-group design. Data were collected from January 9th 2022 to April 1st 2022. A total of n = 64 eligible patients were equally randomized to either intervention or control group. Patients in the intervention group performed preoperative IS training for two days before the scheduled surgery. The primary endpoint was the incidence of in-hospital PPCs. The secondary endpoints were postoperative Peak Expiratory Flow Rate (PEFR), Intensive Care Unit (ICU) stay, Hospital Length of Stay (HLOS).&#x0D; Results: Patients in the intervention group had a lower incidence of postoperative pulmonary complications compared to the control group (12.5% and 21.8%). There was a statistical significant difference between the two groups regarding postoperative PEFR, HLOS and intensive care unit stay.&#x0D; Conclusions: Preoperative rehabilitation (involving incentive spirometer is related to a lower incidence of postoperative pulmonary complications for the group that received the intervention. Training with preoperative incentive spirometer resulted in a shortening of hospital length of stay and Intensive Care Unit (ICU) stay.&#x0D; Trial registration: The study was registered in the Iranian Clinical Trial Registry, this at https://www.irct.ir/ reference number (IRCT20211224053503N1).

Things We Do for No Reason™: Routine use of postoperative incentive spirometry to reduce postoperative pulmonary complications.

Things We Do for No Reason™: Routine use of postoperative incentive spirometry to reduce postoperative pulmonary complications.

Comparison of the Efficacy of Two Different Plane Blocks in Isolated Bypass Surgery: A Prospective Observational Study

This study evaluated the effects of serratus anterior plane block (SPB) and its combination with transverse thoracic muscle plane block (TTPB) on analgesia, opioid consumption, incentive spirometry performance, and patient comfort. A prospective, observational study. A university hospital. Adult patients scheduled for elective cardiac surgery with cardiopulmonary bypass. Patients who received intravenous patient-controlled analgesia only were labeled as the control group. Patients who received additional SPB were labeled as the SPB group, and patients who received additional SPB and TTPB were labeled as the SPB+TTPB group. The visual analog scores for pain (VAS), time to first analgesic requirement, total tramadol requirement, incentive spirometry values, and patient comfort indices were recorded during the first 36 postoperative hours. From October 2020 to October 2021, data from 95 patients were analyzed. The VAS score was lower in the SPB+TTPB group at 0, 14, and 18 hours (p < 0.001, p=0.028, p=0.047, respectively). Time to first analgesic was longer in the SPB+TTPB group (8 hours v 0-2 hours, p=0.001). Total tramadol consumption was similar among groups. Incentive spirometer performance was superior in the SPB+TTPB group (p < 0.001). The SPB group had similar success at 0, 14, and 18 hours. Although pain scores and opioid consumption were similar, the addition of TTPB to SPB improved pain scores during patient mobilization and incentive spirometry capacity.

Improving Nursing Compliance with Prescribed Respiratory Therapy in the PACU: Incentive Spirometry, Cough and Deep Breathing

Introduction Major surgeries, anesthesia, and pain can hinder lung expansion, causing atelectasis, and pulmonary dysfunction in the postoperative period. Performing Incentive spirometry (IS), cough and deep breathing (C&DB) exercises are known to prevent postoperative pulmonary complications (PPCs). This project addressed nursing compliance with prescribed incentive spirometry regimen in the postoperative period. Identification of the problem Suboptimal nursing staff compliance with physician's prescribed orders related to the use of IS in postoperative patients. In my daily practice as a PACU RN, it is my observation that IS respiratory therapy is rarely documented as prescribed on patients’ EMR. QI question/Purpose of the study The aim of this study is to improve evidence of nursing staff compliance with the prescribed postoperative respiratory therapy to prevent PPCs. Methods Provided staff in-services in the PACU emphasizing hospital policy, and the benefit of IS and C&DB in preventing PPCs. Also conducted random chart audits to ascertain nursing compliance with prescribed IS and C&DB therapy prior to, and post staff In-services, each yielded (n=40) postoperative patients. Outcomes/Results Post in-service chart audit revealed that (n=35) patients had IS therapy prescribed, of those (n=13) were encouraged by nursing staff to perform IS, and (n=9) complied with frequency prescribed, versus Pre in-service (n=18) patients were prescribed IS therapy, of those (n=7) were encouraged by nursing staff to perform IS, and (n=1) complied with frequency prescribed as per nursing documentation. C&DB therapy was performed by (n=13), and (n=16) patients pre and post in-service respectively Discussion Findings revealed an improvement in nursing compliance with IS prescribed therapy post staff in-service. However, nursing adherence to prescribed IS therapy still remains low. Conclusion This study highlights the clinical issue of therapeutic noncompliance from the nurses’ perspective. Non-compliance to prescribed therapy have adverse effects not only on patient outcomes but also can lead to increased health care costs Implications for perianesthesia nurses and future research Nurses are expected to render prescribed treatment to patients and accurately document. Nursing compliance with these processes is imperative to keep clear communication of care given and to improve postoperative patient outcomes. Factors affecting nursing compliance to prescribed therapies should be explored in future research. Major surgeries, anesthesia, and pain can hinder lung expansion, causing atelectasis, and pulmonary dysfunction in the postoperative period. Performing Incentive spirometry (IS), cough and deep breathing (C&DB) exercises are known to prevent postoperative pulmonary complications (PPCs). This project addressed nursing compliance with prescribed incentive spirometry regimen in the postoperative period. Suboptimal nursing staff compliance with physician's prescribed orders related to the use of IS in postoperative patients. In my daily practice as a PACU RN, it is my observation that IS respiratory therapy is rarely documented as prescribed on patients’ EMR. The aim of this study is to improve evidence of nursing staff compliance with the prescribed postoperative respiratory therapy to prevent PPCs. Provided staff in-services in the PACU emphasizing hospital policy, and the benefit of IS and C&DB in preventing PPCs. Also conducted random chart audits to ascertain nursing compliance with prescribed IS and C&DB therapy prior to, and post staff In-services, each yielded (n=40) postoperative patients. Post in-service chart audit revealed that (n=35) patients had IS therapy prescribed, of those (n=13) were encouraged by nursing staff to perform IS, and (n=9) complied with frequency prescribed, versus Pre in-service (n=18) patients were prescribed IS therapy, of those (n=7) were encouraged by nursing staff to perform IS, and (n=1) complied with frequency prescribed as per nursing documentation. C&DB therapy was performed by (n=13), and (n=16) patients pre and post in-service respectively Findings revealed an improvement in nursing compliance with IS prescribed therapy post staff in-service. However, nursing adherence to prescribed IS therapy still remains low. This study highlights the clinical issue of therapeutic noncompliance from the nurses’ perspective. Non-compliance to prescribed therapy have adverse effects not only on patient outcomes but also can lead to increased health care costs

Effectiveness of autogenic drainage Vs incentive spirometry in intensive care unit

Background: Intensive Care Units are the most demanding place in hospital setup as they provide clear and fair information to patients and family. Physical therapy involves several techniques that plays significant role in intensive care unit, focusing on goals like recruit lung volume, improving ventilation perfusion, improving oxygenation, promoting secretion clearance. Studies has been conducted regarding effectiveness of Incentive spirometry and autogenic drainage but there was very low data regarding Comparison of Incentive spirometry and autogenic drainage. Objective: The aim of this study was to find the effectiveness of Incentive spirometry vs Autogenic Drainage in Intensive Care Unit. Methodology: This was an experimental study conducted in LIAQUAT NATIONAL HOSPITAL from MAY-NOV. Systematic sampling technique was used, single blinding was done. Samples were allocated into 2 groups. One group receiving autogenic drainage while other receiving incentive spirometry. Total number of 10 sessions were given to each group. Pulmonary function testing and ABGs were used as assessment tools, consent form was signed by participants. Data was analyzed using SPSS 22 Version. Result: The result of autogenic drainage measuring expiratory reserve volume showed that before autogenic drainage the mean of the group was 748+-182.8 and after session of 7 days there was significant increase of expiratory reserve volume as well which is 864+-207.9, Thus the result of this study showed that Autogenic Drainage was statically significant in improving expiratory reserve volume. Conclusion: Result of this study showed Autogenic Drainage was more effective than Incentive Spirometry in improving expiratory reserve volume. Apart from this, Physiotherapists should use these techniques more in ICUs for better results and to reduce mortality rate.

High-flow nasal oxygen therapy in patients after esophageal interventions: аdvantages and disadvantages

BACKGROUND: Pulmonary complications in patients who underwent esophagectomy with one-stage esophagoplasty are a frequent cause of death in the intensive care unit (ICU). However, the use of noninvasive ventilation (NIV) in these patients is not indicated because of the failure of esophagogastric anastomosis. Compared with NIV and standard oxygen therapy, high-flow oxygen therapy (HFOT) reduces the rate of transfer to mechanical ventilation (MV) in the case of acute respiratory failure.&#x0D; AIM: This study aimed to assess the clinical advantages and disadvantages of HFOT in patients with respiratory failure after esophagectomy.&#x0D; MATERIALS AND METHODS: Ninety patients with esophagectomy were examined. Two groups were formed by randomization: group 1 (n=45) with standard respiratory therapy, incentive spirometry, and nasal oxygen therapy with NIV sessions and low end-expiratory pressure (up to 6 mmHg) and group 2 (n=45) with HFOT. Therapy parameters were selected according to oxygenation (PaO2/FiО2) and saturation (SaО2) index values. Parameter changes, session duration, patients tolerance to respiratory therapy methods (from 1 to 10 points), dynamics of chest X-ray pattern, and duration of treatment in ICU were analyzed.&#x0D; RESULTS: The advantages of HFOT were the absence of discomfort during the session, possibility to decrease O2 flow required for an adequate level of oxygenation, high flow with controlled O2 fraction allowed to reach target values of oxygenation index, decreased frequency of patients transfer to MV, and time spent in ICU.&#x0D; CONCLUSIONS: The use of HFOT is justified as part of the complex respiratory therapy in patients with moderate respiratory failure. In patients with severe respiratory failure, HFOT is an alternative to other high-flow techniques and NIV. The choice between these methods should be individualized and depend on the patients condition and ventilation requirement.

Effect of Threshold Inspiratory Muscle Training on Functional Fitness and Respiratory Muscle Strength Compared to Incentive Spirometry in Children and Adolescents With Obesity: A Randomized Controlled Trial.

BackgroundTo determine the effect of threshold inspiratory muscle training (IMT) on functional fitness and respiratory muscle strength (RMS) compared to incentive spirometry (IS) in children/adolescents with obesity.MethodsA total of 60 obese children/adolescents aged 8–15 years were randomized into the threshold IMT group (n = 20), the IS group (n = 20), or the control group (n = 20). The IMT group performed 30 inspiratory breaths with the intensity set at 40% of baseline maximal inspiratory pressure (MIP) twice daily for 8 weeks; the IS group performed 30 breaths with sustained maximum inspiration twice daily for 8 weeks; and, the control group was assigned no training device for 8 weeks. Six-min walk test (6-MWT), RMS, and spirometry were compared between baseline and 8 weeks.ResultsSix-MWT distance (528.5 ± 36.2 vs. 561.5 ± 35.2 m, p = 0.002) and MIP (121.2 ± 26.8 vs. 135.3 ± 32.1%Predicted, p = 0.03) were significantly improved after 8 weeks of IMT training. There was no significant difference in any evaluated pulmonary function parameters between baseline and 8 weeks in the IS or control groups; however, 6-MWT distance demonstrated a trend toward significant improvement in the IS group (526.9 ± 59.1 vs.549.0 ± 50.6 m, p = 0.10). No significant difference among groups was found for any variable relative to change from baseline to post-training.ConclusionEight weeks of threshold IMT training significantly improved both inspiratory muscle strength (MIP) and functional fitness (6-MWT) in children/adolescents with obesity. Eight weeks of IS training yielded a trend toward significantly improved functional fitness.

Syndrome thoracique aigu chez les patients drépanocytaires adultes

Sickle cell disease is a frequent genetic condition, due to a mutation of the β-globin gene, leading to the production of an abnormal S hemoglobin and characterized by multiple vaso-occlusive events. The acute chest syndrome is a severe complication associated with a significant disability and mortality. It is defined by the association of one or more clinical respiratory manifestations and a new infiltrate on lung imaging. Its pathophysiology is complex and implies vaso-occlusive phenomena (pulmonary vascular thrombosis, fat embolism), infection, and alveolar hypoventilation. S/S or S/β0-thalassemia genotype, a history of vaso-occlusive crisis or acute chest syndrome, a low F hemoglobin level (<5%), a high steady-state hemoglobin level (> 10 g/dL), or a high steady-state leukocytosis (>10 G/L) are the main risk factors. Febrile chest pain, dyspnea, sometimes cough with expectorations are its main clinical manifestations, and bi-basal crackles are found at auscultation. Inferior alveolar opacities with or without pleural effusions are identified on chest X-ray or CT-scan. Management of the acute chest syndrome should be prompt and implies, besides the recognition of severity signs, a multimodal analgesia, oxygen supplementation, sometimes a parenteral antibiotic treatment and the frequent use of blood transfusions especially in the most severe cases. Prevention is important and includes a regular monitoring of hospitalized patients and the use of incentive spirometry.

A Cross-Sectional Study on the Application of IS in Perioperative Pulmonary Function Training in Spine and Orthopedics.

Background The incentive spirometer (IS) is a mechanical device that promotes lung expansion and can be used to prevent and treat postoperative pulmonary complications. In this study, the preventive effect of pulmonary function training with IS on the improvement of pulmonary function and pulmonary complications was observed. Methods From May 2019 to April 2021, 69 scoliosis patients with impaired moderate and severe lung function were divided into the traditional pulmonary training group (n = 32) and IS-enhanced pulmonary training group (n = 35). The patient underwent lung function testing after admission and one week after the start of training and chest CT on the third day after surgery. Results The average age was 13.47 and 15.66, respectively (p = 0.223). The Cobb angles were 83.84 and 83.97 (p = 0.756), respectively, and no statistical difference between the parameters of lung function was detected. After 1 week of respiratory function training, significant improvement in lung function testing parameters including VC%, FVC%, FEV1%, FEV1/FVC, FEV1/VC, and MVV% was found in both groups. Analysis of covariance showed more significant improvement in IS-enhanced group compared to the conventional training group (p < 0.05). The incidence of postoperative pulmonary atelectasis was lower in IS-enhanced group than in traditional groups (2.9% vs. 21.9%, p = 0.043) with no difference in the overall incidence of pulmonary complications (p = 0.164) and shorter preoperative and total hospitalization in the IS-enhanced group. Conclusion Compared to traditional pulmonary function training, IS-enhanced training can significantly accelerate the improvement of pulmonary function testing parameters, shorten the preoperative pulmonary function training time, reduce the incidence of postoperative pulmonary tension complications, and accelerate postoperative rehabilitation.

Preoperative Continuous Positive Airway Pressure Versus Incentive Spirometer in Morbidly Obese Patients Undergoing Bariatric Surgeries: Randomized Comparative Study

Preoperative Continuous Positive Airway Pressure Versus Incentive Spirometer in Morbidly Obese Patients Undergoing Bariatric Surgeries: Randomized Comparative Study