Respiratory Rehabilitation In Patients Research Articles

The importance of Alpha-1 Antitrypsin (AAT) and respiratory rehabilitation in patients with lung diseases

Abstract: Background: The incidence of lung diseases is very high worldwide, especially in the case of lung cancer, pulmonary tuberculosis, and obstructive ventilatory dysfunctions. Alpha-1 antitrypsin (AAT) is synthesized mainly by hepatocytes, and one of its roles is to inhibit protease activity in the body's biological fluids following the phenomenon of programmed cell death, which is also called apoptosis. Acute lung diseases, but especially chronic ones, can cause, in addition to pulmonary and extrapulmonary manifestations, social and psychological impact, which is why a complex, interdisciplinary respiratory rehabilitation program is necessary. Objectives: Our study aimed to determine the correlation between alpha-1 antitrypsin values and lung diseases (pulmonary tuberculosis, lung cancer, asthma, and COPD) and to evaluate the influence of the individualized respiratory rehabilitation program in these diseases. Methods: We carried out a retrospective study between February 2022 and March 2023 in the Pneumology Department of the "Victor Babeș" Clinical Hospital of Infectious Diseases and Pneumoftiziology, Craiova. It included 189 patients diagnosed with pulmonary tuberculosis, lung cancer, or obstructive ventilatory dysfunctions (chronic obstructive pulmonary disease – COPD or asthma). Alpha-1 antitrypsin was collected from all patients. Respiratory rehabilitation was carried out both during hospitalization and in an out-patient setting for a maximum period of 6 months after discharge, with some patients even using telemedicine. Results: Increased values of alpha-1 antitrypsin were detected in advanced stages of the disease, and a clear improvement of clinical and functional parameters was observed after inclusion in the rehabilitation program. Conclusions: Detection of alpha-1 antitrypsin deficiency (AATD) is rare. The majority of patients diagnosed with lung cancer in advanced stages showed increased values of alpha-1 antitrypsin, AAT being able to be used as a follow-up marker in response to oncological treatment. Respiratory rehabilitation benefits in pulmonary tuberculosis, lung cancer, COPD, and asthma, regardless of the form of the disease. An interdisciplinary approach is necessary for the optimal treatment and control of lung diseases.

Efficacy of respiratory rehabilitation in patients with COVID-19: a retrospective study

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of confirmed cases and deaths globally. The purpose of this study was to investigate the therapeutic effect of airway clearance technology combined with prone ventilation on patients infected with COVID-19.Methods38 patients with COVID-19 (severe) who were treated in the intensive rehabilitation group of Shengli Oilfield Central Hospital. They were randomly divided into a control group and an observation group. The control group received prone position ventilation intervention, and the observation group received airway clearance technology combined with prone position ventilation intervention. The changes of oxygen and index, procalcitonin (PCT), interleukin-6 (IL-6) and chest X-ray image indexes were compared between the two groups.ResultThere was no significant difference in age, gender and other general data between the control group and the observation group. The results showed that oxygen index, PCT, IL-6 and chest X-ray image index in the observation group were better than that indexes in the control group.ConclusionAirway clearance technology combined with prone ventilation intervention in patients with COVID-19 can improve the total effective rate and oxygenation index, improve the inflammatory indicators and respiratory function of patients. And it may be widely promoted and used in the treatment of patients with COVID-19 (severe).

Program ERAS® – The importance of respiratory rehabilitation in patients undergoing colorectal surgery

Program ERAS® – The importance of respiratory rehabilitation in patients undergoing colorectal surgery

Dysphagia and respiratory rehabilitation in patients with Post-ICU Syndrome

Post-ICU Syndrome (PICS) is a complex disease with multiple aspects, including physical, cognitive, and psychological health problems. Dysphagia persists in patients with PICS and is independently associated with adverse clinical outcomes after discharge. With the development of the level of intensive care, dysphagia of PICS needs more attention. Although several risk factors related to dysphagia in PICS have been proposed, the exact mechanism is still unclear. Respiratory rehabilitation is an important non-pharmacological therapy, which offers short-and long-term rehabilitation in critical patients, but its application is insufficient in dysphagia of PICS. In view of the lack of consensus on the rehabilitation treatment of dysphagia after PICS currently, the article elaborates on the related concepts, epidemiology, potential mechanisms and the application of respiratory rehabilitation in patients with dysphagia of PICS, in order to provide a reference for the clinical development of respiratory rehabilitation in patients with dysphagia of PICS.

Effectiveness of respiratory rehabilitation in patients with COVID-19: A meta-analysis.

Examine effectiveness of respiratory rehabilitation and moderating factors on lung function and exercise capacity in post-COVID-19 patients. Meta-analysis. R software 4.0.2 assessed the effectiveness of respiratory rehabilitation adopting the random-effects model and presenting standardised mean differences (SMDs). Heterogeneity was determined by Cochran's Q and I2 . The Cochrane Risk of Bias 2.0 and MINORS evaluated quality of the included studies. A comprehensive search was undertaken in Cochrane, Embase, Ovid-MEDLINE, Scopus, NCBI SARS-CoV-2 Resources, ProQuest, Web of Science and CINAHL until March 2022. Of the 5703 identified studies, 12 articles with 596 post-COVID-19 patients were included. Eleven of our twelve studies had moderate to high quality and one study had high risk of bias assessed with MINORS and RoB 2 tool. Overall, respiratory rehabilitation was effective in improving forced expiratory volume in 1 s (1.14; 95%CI 0.39-1.18), forced vital capacity (0.98; 95%CI 0.39-1.56), total lung capacity (0.83; 95%CI 0.22-1.44), 6-minute walk distance (1.56; 95%CI 1.10-2.02) and quality of life (0.99; 95%CI 0.38-1.60). However, no significant differences were observed for ratio of the forced expiratory volume in 1 s to the forced vital capacity of the lungs, anxiety and depression. Respiratory rehabilitation for post-COVID-19 patients was effective in those without comorbidities, performed four types of exercise programs, frequency ≥3 times/week and rehabilitation time 6 weeks. Respiratory rehabilitation improved lung function, exercise capacity and quality of life in post-COVID-19 patients. The findings suggest rehabilitation programs for post-COVID-19 patients should use multiple respiratory exercise programs with frequency of ≥3 times per week for longer than 6 weeks. These findings will help improve the implementation of respiratory rehabilitation programs for post-COVID-19 patients. Our findings can be used to develop patient-centred respiratory rehabilitation interventions by nurses and clinicians for post-COVID-19 patients. PRISMA guideline was followed. No patient or public contribution.

Респираторная реабилитация пациентов с COVID-19: текущее состояние проблемы

Objective of the Review: To summarise the data from literature sources on respiratory rehabilitation of patients with the novel coronavirus infection; to assess the current state and perspectives. Key Points. The novel coronavirus infection (COVID-19) is a highly contagious acute respiratory disease with primary involvement of upper and lower respiratory tract, organs and systems of the body. The symptoms of the disease vary from asymptomatic carrier to clinically severe viral pneumonia that requires oxygen therapy and respiratory support. Respiratory rehabilitation is vital for patient recovery. Globally, there is more and more professional information and databases on respiratory rehabilitation of COVID-19 patients, since the common methods of rehabilitation after a respiratory disease can be ineffective or unsafe. Conclusion. Respiratory rehabilitation should be an integral part of COVID-19 therapy, starting from ICU once the patient’s condition has stabilised. Rehabilitation should be personalised. Future studies will help in understanding the development path of pulmonary rehabilitation in order to improve the quality of patients’ life and to facilitate faster activity restoration. Keywords: rehabilitation, respiratory rehabilitation, coronavirus infection, COVID-19, breathing exercises.

Evaluation of Respiratory Rehabilitation in Patients with Ankylosing Spondylitis

Abstract Ankylosing spondylitis (AS) (spondylos = vertebra, ankylos = curved) is an inflammatory disease with predominant axial skeletal involvement and obligatory sacroiliac joint involvement, capable of affecting, with varying frequency and severity, peripheral joints and may also have extra-articular determinations. The main motivation of this study is the desire to demonstrate that there is a close relationship between respiratory muscle performance and exercise capacity in patients with ankylosing spondylitis. The methodological approach of the study consisted of a group of 21 patients. Statistical analysis was based on patient characteristics such as age, weight, height, body mass index, and thoracic expansion was measured. For the correct individualization of rehabilitation programs, the clinical form (with thoracic hyperkyphosis or straight spine), the age of the disease, the peripheral joints affected, the stage of injury, the degree of reducibility of the vicious attitudes, the impairment of thoracic breathing, the type of occupational spinal demands, the general condition and associated diseases will be taken into account. The results obtained proved that the application of respiratory physiotherapy procedures, based on the diagnosis, needs and limitations of the patients, correlated with tests to evaluate the quality and effectiveness of the recovery process, shows an increase in abdominal muscle strength that is not statistically significant. The 2-week rehabilitation cure is insufficient to modulate respiratory function and increase respiratory muscle strength. The subjective appreciation given by patients to the cure is due to other physiological changes produced by the rehabilitation cure such as: softening of connective and muscle structures, muscle relaxation.

Voice rehabilitation after laryngectomy: problems, complications and ways of their elimination

Voice rehabilitation after laryngectomy: problems, complications and ways of their elimination

Efficacy and safety of HD-tDCS and respiratory rehabilitation for critically ill patients with COVID-19 The HD-RECOVERY randomized clinical trial

Background and purposeAcute Respiratory Distress Syndrome (ADRS) due to coronavirus disease 2019 (COVID-19) has been associated with muscle fatigue, corticospinal pathways dysfunction, and mortality. High-Definition transcranial Direct Current Stimulation (HD-tDCS) may be used to attenuate clinical impairment in these patients. The HD-RECOVERY randomized clinical trial was conducted to evaluate the efficacy and safety of HD-tDCS with respiratory rehabilitation in patients with moderate to severe ARDS due to COVID-19. MethodsFifty-six critically ill patients were randomized 1:1 to active (n = 28) or sham (n = 28) HD-tDCS (twice a day, 30-min, 3-mA) plus respiratory rehabilitation for up to 10 days or until intensive care unit discharge. The primary outcome was ventilator-free days during the first 28 days, defined as the number of days free from mechanical ventilation. Furthermore, secondary outcomes such as delirium, organ failure, hospital length of stay and adverse effects were investigated. ResultsActive HD-tDCS induced more ventilator-free days compared to sham HD-tDCS. Patients in the active group vs in the sham group experienced lower organ dysfunction, delirium, and length of stay rates over time. In addition, positive clinical response was higher in the active vs sham group. There was no significant difference in the prespecified secondary outcomes at 5 days. Adverse events were similar between groups. ConclusionsAmong patients with COVID-19 and moderate to severe ARDS, use of active HD-tDCS compared with sham HD-tDCS plus respiratory rehabilitation resulted in a statistically significant increase in the number of ventilator-free days over 28 days. HD-tDCS combined with concurrent rehabilitation therapy is a safe, feasible, potentially add-on intervention, and further trials should examine HD-tDCS efficacy in a larger sample of patients with COVID-19 and severe hypoxemia.

Respiratory Rehabilitation in the Covid-19 Patient Care Journey: Summary of International Recommendations

Respiratory disorders are at the fore front of severe COVID-19 disease and can lead to acute respiratory distress syndrome (ARDS). This article provides a few international recommendations for the practice of respiratory rehabilitation in patients infected with the SARS-CoV-2 virus.

The usefulness of respiratory rehabilitation in patients with idiopathic pulmonary fibrosis

The usefulness of respiratory rehabilitation in patients with idiopathic pulmonary fibrosis

Respiratory rehabilitation in patients with amyotrophic lateral sclerosis

Respiratory rehabilitation in patients with amyotrophic lateral sclerosis

Rehabilitation of cardiovascular pathology

It is interesting to evaluate the role of cardiovascular and respiratory rehabilitation in patients undergoing carotid endo-arterectomy by observing the differences between patients undergoing general anesthesia and those under local anesthesia, with the aim of decreasing the risk of de-veloping post-surgical complications, restore respiratory compliance and reduce user hospitali-zation times. The aim of the study was to verify the effectiveness of rehabilitation treatment in a homogeneous group of 20 patients with symptomatic and non-symptomatic stenosis and / or ≥ 70% undergo-ing carotid endarterectomy, 10 under general anesthesia and 10 in loco-regional anesthesia, through a cycle of respiratory rehabilitation according to the rehabilitation protocol of the user undergoing cardiovascular surgery (Evidence Based Physiotherapy and Evidence Based Speech Therapy). From the analysis of these two patients’ groups, conclusions were drawn regarding the validity of physiotherapy treatment in the post-operative recovery of the patient undergoing carotid endarterectomy. Although the literature apparently showed no statistically significant differences between the two types of anesthesia, in our small study we recorded a difference between the two types of respiratory anesthesia. In Loco-regional Anesthesia, we found a stability in the lev-els of peripheral oxygen saturation at discharge compared to pre-operative. In the group of pa-tients undergoing surgery by general anesthesia, peripheral saturimetry values worsened be-tween pre-operative and discharge. The loco-regional anesthesia would seem to be more advantageous from a respiratory point of view than the general anesthesia in the general recovery of the patient. Also from a clinical point of view, in the patients of the loco-regional anesthesia group there was a lower perception of dyspnea, the absence of exacerbation of the cough reflex, a decrease in the difficulty in ex-pectorating and a lesser presence of secretions in the airway.

Rehabilitation of cardiovascular pathology

It is interesting to evaluate the role of cardiovascular and respiratory rehabilitation in patients undergoing carotidendo-arterectomy by observing the differences between patients undergoing general anesthesia and those under localanesthesia, with the aim of decreasing the risk of developing post-surgical complications, restore respiratory compliance and reduce user hospitalization times.The aim of the study was to verify the effectiveness of rehabilitation treatment in a homogeneous group of 20 patientswith symptomatic and non-symptomatic stenosis and / or ≥ 70% undergoing carotid endarterectomy, 10 under general anesthesia and 10 in loco-regional anesthesia, through a cycle of respiratory rehabilitation according to therehabilitation protocol of the user undergoing cardiovascular surgery (Evidence Based Physiotherapy and EvidenceBased Speech Therapy).From the analysis of these two patients’ groups, conclusions were drawn regarding the validity of physiotherapytreatment in the post-operative recovery of the patient undergoing carotid endarterectomy. Although the literature apparently showed no statistically significant differences between the two types of anesthesia, in our small study we recorded a difference between the two types of respiratory anesthesia. In Loco-regional Anesthesia, we found a stabilityin the levels of peripheral oxygen saturation at discharge compared to pre-operative. In the group of patients undergoing surgery by general anesthesia, peripheral saturimetry values worsened between pre-operative and discharge.The loco-regional anesthesia would seem to be more advantageous from a respiratory point of view than the generalanesthesia in the general recovery of the patient. Also from a clinical point of view, in the patients of the loco-regionalanesthesia group there was a lower perception of dyspnea, the absence of exacerbation of the cough reflex, a decreasein the difficulty in expectorating and a lesser presence of secretions in the airway.

Analysis on respiratory rehabilitation in patients with chronic obstructive pulmonary disease aged 40 years or older in China, 2014-2015

Objective: To understand the situation of respiratory rehabilitation and oxygen inhalation therapy in chronic obstructive pulmonary disease (COPD) patients aged 40 years or older in China, and provide basic information for the development of pulmonary rehabilitation. Methods: The data were from 2014-2015 COPD surveillance in China. Chinese residents aged 40 years or older were recruited through a complex multi-stage stratified cluster sampling from 125 COPD surveillance points in 31 provinces (autonomous regions, municipalities). Standardized face to face electronic questionnaires were used to collect information about respiratory rehabilitation and oxygen inhalation therapy of the patients. Spirometry was performed on all participants, and patients with post- bronchodilator FEV(1)/FVC<70% were diagnosed with COPD. The number of defined COPD patients was 9 134. Based on the complex sampling design, the respiratory rehabilitation treatment rate and oxygen inhalation therapy rate of COPD patients aged 40 years old or older in China were estimated, and the influencing factors were analyzed. Results: A total of 9 118 COPD patients aged 40 years or older were included in the analysis. The rate of respiratory rehabilitation was 0.8% (95CI: 0.6%-1.0%), and the rate of oxygen inhalation therapy was 2.5% (95%CI: 2.0%-2.9%). Among patients with severe symptoms or high risk of acute exacerbation (combined COPD assessment groups B, C, D), the rate of respiratory rehabilitation was 1.4% (95%CI: 0.9%-1.9%), and the rate of oxygen inhalation therapy was 5.4% (95%CI: 4.4%-6.4%). Multivariate logistic regression analysis showed that urban or rural residences, geographic area, awareness of COPD, history of acute exacerbation and severity of airflow restriction had influences on the respiratory rehabilitation rate in the COPD patients. Gender, geographic area, awareness of COPD, history of acute exacerbation, mMRC scores and severity of airflow restriction had influences on the patients' oxygen inhalation therapy rate. Conclusions: The rate of respiratory rehabilitation and oxygen inhalation therapy in COPD patients aged 40 years or older was relatively low in China. It is necessary to explore an effective model of pulmonary rehabilitation and COPD management, so that more COPD patients may have access to scientific pulmonary rehabilitation treatment.

Chronic Obstructive Pulmonary Disease: Proprioception Exercises as an Addition to the Rehabilitation Process.

Respiratory rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is recognized as a cornerstone for the therapeutic path. Physiotherapy involves physical activity with aerobic and anaerobic exercises, which can improve the patient's symptomatic picture, such as motor function, emotional status (depression and anxiety), and improve the pain perception. The training of proprioception is not included in the structure of the exercises proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The training of proprioception is a very useful strategy for stimulating the cerebellum, a neurological suffering area in patients with COPD. The cerebellum sorts information about pain and emotions, as well as motor stimuli. The article discusses the need to introduce proprioception in respiratory rehabilitation protocols, highlighting the neurological relationships with the management of comorbidities.

EFFECT OF PREOPERATIVE RESPIRATORY REHABILITATION IN PATIENTS UNDERGOING CARDIAC SURGERY.

SUMMARYThe aim of the study was to evaluate the effects of preoperative respiratory rehabilitation on functional capacity, length of stay in intensive care unit (ICU), duration of mechanical ventilation (MV) and total hospitalization, as well as to estimate arterial blood gas (ABG) values in patients undergoing cardiac surgery. Nineteen patients were included in the randomized observational study, divided into two groups: group A (intervention) and B (control). Preoperative and postoperative rehabilitation was performed in group A, and only postoperative rehabilitation in group B. Rehabilitation was carried out according to a predefined protocol. We used ABG to evaluate respiratory function, two-minute walk test (2MWT) and sit-to-stand test to assess functional capacity. The following data were obtained from medical documentation: duration of MV, length of stay at ICU, occurrence of postoperative pulmonary complications, and length of total hospitalization in both groups. Significant between-group difference was found for the length of total hospitalization and duration of MV (p<0.05 both). Analysis of the mean values of 2MWT on the last day of hospitalization (p=0.005), sit-to-stand test before surgery (p=0.022) and on the last day of hospitalization (p=0.008) showed statistically significant differences. The length of hospital stay significantly correlated with preoperative rehabilitation in group A (r=0.885; p<0.0001). There was no difference in ABG parameters between the groups. The study showed that preoperative respiratory rehabilitation had an effect on reducing duration of MV and length of total hospitalization, and improved functional capacity.

Respiratory Rehabilitation in Patients with Abdominal Aortic Aneurysm Submitted to OPEN and EVAR Treatment: Predictive Factors of Postoperative Pulmonary Complications and Clinical Implications

Background: In the conventional surgical treatment of aneurysms, the respiratory physiotherapy is one of the cornerstones of patient rehabilitation. The endovascular technique, with less invasiveness, has significantly changed the rehabilitative approach to the operated subject. Objective of the study: to evaluate and compare the effectiveness of the pre and post-operative rehabilitation treatment associated with the conventional OPEN surgery compared to the EVAR procedure and their incidence in preventing postoperative respiratory complications. Design: Longitudinal case control study to compare patients who have open surgery with patients who do not have the laparotomy, as in ENDO technique, to look how frequently the postoperative pneumonia and the risk factor was present in each group to determine the relationship between the risk factor, the type of operation and the pneumonia incidence. Setting Data were collected from patients admitted consecutively at the Tor Vergata Hospital with diagnosis of an abdominal aortic aneurysm. Risk factors, type of intervention, pneumonia incidence in postoperative period was evaluted at 30 days. Population: Three hundred and twenty patient were enrolled. Materials and methods: From 2005 to 2016, 320 patients suffering from an abdominal aortic aneurysm were treated consecutively. One hundred eighty one patients were treated using the open technique (group A) and 139 using the EVAR technique (group B). All patients in OPEN group were submitted to respiratory rehabilitation protocol. Risk factors, type of intervention, anesthesia and results of treatment with complications, observed mortality, mean hospital stay were studied. Pre and postoperative respiratory rehabilitation treatment protocol was performed in all of the patients. The data were analyzed with descriptive statistics and inferential statistics using SPSS 18.0 for Windows. Results: From 2005-2010, the postoperative stay (days) was significant shorter for EVAR compared to open (6.47 vs. 10.48; P 0.001). From 2011-2016, the postoperative stay (days) was significant shorter EVAR compared open (4.07 vs. 11.41; P 0.001). The patients treated from 2011 to 2016 for both OPEN and EVAR groups presented an average age 3 years lower compared to the patients treated in the period from 2005-2011 (75.5 to 72.8 for EVAR and from 71,2 to 68,2). The patients treated from 2011 to 2016 for EVAR group presented an average reduction in post-operative hospitalization of 2.4 days (-37.09%) compared to 2005-2011 period. There was a significant higher incidence of pneumonia in the open group (P=0.001). The reduction of the incidence of pneumonia in group A and B during the two different periods from 2005 to 2010 and from 2011 to 2016 was observed. There wasn’t a significant difference in the incidence of pneumonia in patients treated from 2005 to 2010 (P-value=0.1). In patients treated from 2011 to2016 there was a significant increasing the incidence of pneumonia in OPEN group (P=0.001). Conclusion: Rehabilitation physiotherapy plays a fundamental role in the prevention of postoperative complications of patients undergoing OPEN treatment. Despite of the excellent results obteined in patients undergoing OPEN treatment, the lower rate of complications in EVAR group showed better results of this treatment.

The Effect of Wind-instrument Centered Music Therapy on Respiration, Oral Motor and Articulation for Patients with Cervical Cord Injury - Case Study -

본 연구는 호흡근의 지속적 훈련이 필요한 경수손상 환자에게 취주악기를 사용한 음악치료가 호흡, 구강 운동 및 조음에 미치는 영향에 대해 알아보고자 하였다. 시행되었던 프로그램의 참여자 중 경수손상환자 군에 해당하는 3명의 결과를 선별하여 사후 데이터 분석 하였다. 프로그램에 사용할 취주악기로 호기와 흡기를 모두 활용하는 하모니카를 선택하였다. 기간은 총 6주간 주 1회 30 ~ 40분씩 시행하였고, 소그룹으로 진행 후 개별적으로 연습을 유지하도록 당일 진행내용이 자료로 제공되었다. 평가는 호흡관련 요소인 최대 호기량과 취주악기의 특징을 반영한 구강운동 그리고 조음검사로 시행하였고, 이에 대해 사전사후 결과를 비교하여 확인하였다. 분석결과 최대 호기량이 사전보다 평균 25ml 증가하였으며, 조음은 3.16점 증가하였다. 구강운동은 사전보다 사후에서 11.67점 움직임이 증가하였고, 세부항목 비교 시 입을 제외한 턱과 혀에 대한 점수에서 구강운동기능의 증가가 확인되었다. 이러한 연구결과를 토대로 본 연구는 취주악기를 사용한 음악치료가 경수손상 환자의 호흡재활 분야에 실천적이고 효과적 중재방안이 될 것으로 생각한다.The purpose of this study is to investigate the influence on respiration, oral motor and articulation using wind-instrument centered music therapy for patients with cervical cord injury who need continuous train of respiratory muscle. Three patients with cervical cord injury who needed continuous training of respiratory muscle were selected and post data was analyzed. The harmonica using both exhalation and inspiration was selected as an wind-instrument. Each session was taken 30 ~ 40 minutes, once a week from total 6 weeks with small group. Material about every session s work was provided for individual to maintain practice after program. Oral motor and articulation test was done to assess reflecting features of maximal expiratory flow and wind-instrument of factor related breath. Maximal expiratory flow has increased by average 25ml more, articulation has increased by 3.16 points more and the movement of oral motor has increased 11.67 points more than pre-test from the analyzation. In the comparison of the details, the increase of oral motor function was confirmed from scores on the jaw and tongue except for the lips. Based on the results of this study, this study suggests that wind-instrument centered music therapy will be a practical and effective intervention for respiratory rehabilitation in patients with cervical cord injury.

RESPIRATORY REHABILITATION IN ACUTE CARE OF PATIENTS WITH NEUROPARALYTIC SNAKE ENVENOMATION: CASE SERIES

Background: Snakebite is an environmental hazard associated with significant morbidity and mortality. Neurotoxic envenomations have the potency to cause a broad spectrum of presentations starting from ptosis and ophthalmoplegia to respiratory arrest. These patients require ventilatory assistance in addition to administration of anti-snake venom (ASV) and other supportive measures. Mechanically ventilated patients are at risk for retained secretions due to endotracheal intubation disrupting mucociliary escalator, relative immobility of mechanically patient confined to bed can lead to postoperative atelectasis, impaired cough, and retained secretions and thereby physical therapy may be indicated for patients in the intensive care setting. Materials and Methods: A total of twenty four consecutive patients ranging in age from 25-45 years, who required, mechanical ventilation for respiratory muscle paralysis, secondary to snake envenomation, seen during three months period, recruited from various ICU’s were included in the study. All the patients included were mechanically ventilated on Hamilton Evita ventilator, on volume control (CMV) mode with PEEP<10 cmH 2 O and had stable hemodynamics with heart rate = 60-100 beats/min; MABP = 70-110mm Hg. Patients received chest physiotherapy intervention twice in a day. Effects of physiotherapy treatment were studied on static lung compliance (C ST ), oxygenation ratio (PaO 2 :FiO 2 ratio), partial pressure of carbon dioxide in arterial blood (PaCO 2 ) , cologarithm of activity of dissolved hydrogen ions in arterial blood (pH) and chest X-rays. Measurements of dependent variables were recorded (PRE) before commencement of treatment, 30 minutes and 60 minutes after treatment. Physiotherapy intervention included bronchial hygiene therapy and manual hyperinflation using Mapleson-C circuit. Results: Analysis of variance showed that there was highly significant improvement in C ST mean values (p<0.01) and significant improvement in PaCO 2 mean values (p<0.05). However, pH and PaO 2 :FiO 2 ratio could not reach statistical significance. Comparing mean values with critical difference, significant critical difference was observed between mean values at PRE and Post-30, and between PRE and Post-60 time intervals (p<0.05) for C ST , PaO 2 :FiO 2 ratio and PaCO 2 , respectively. Conclusion: Respiratory rehabilitation of patients with neuroparalytic snake envenomation can be effectively achieved with employment of various physiotherapeutic techniques including manual hyperinflation and bronchial hygiene therapy.