Sputum Evacuation Research Articles

Effect of Hope Theory combined with active cycle of breathing techniques on pulmonary rehabilitation among COPD patients: A quasi-experiment study

BackgroundPulmonary rehabilitation plays a positive role in improving exercise tolerance and reducing readmission rates in patients with chronic obstructive pulmonary disease (COPD), while the adherence of pulmonary rehabilitation in COPD patients is still poor. The active cycle of breathing techniques based on the Hope Theory is a method to enhance patients' confidence in overcoming the disease and improve the intrinsic motivation of exercise through symptom improvement such as cough and sputum evacuation ability. ObjectivesTo investigate the effect of Hope Theory education combined with the active cycle of breathing techniques on pulmonary rehabilitation of COPD patients, including exercise adherence, cough and sputum evacuation ability, hope index and exercise self-efficacy. MethodsThe study assigned 70 COPD patients hospitalized into intervention and control groups to receive the active cycle of breathing techniques based on Hope Theory or routine treatment in order of admission. Data for cough and sputum evacuation ability, hope, exercise confidence were collected at baseline and after the program. Exercise adherence was assessed at the end of 1, 4 and 8 week following discharge. ResultsThe actual number of sample consisted of 65 patients divided into intervention (n = 33) and control (n = 32) groups due to severe complications, explicit refusal, disinterest and loss to follow-up. After two weeks of intervention, exercise adherence of the intervention group were better than those of the control group at the end of 4 and 8 week of discharge (P < 0.05). And there was an improvement in cough and sputum evacuation ability, hope and exercise self-efficacy outcomes in the intervention group, with a statistically significant difference between the two groups (P < 0.05). ConclusionThe active cycle of breathing techniques based on Hope Theory education can improve cough and sputum evacuation ability, hope index, exercise self-efficacy, and exercise adherence of COPD patients.

Prevalence of antimicrobial-resistant Pseudomonas aeruginosa strains isolated from patients with cystic fibrosis

Introduction. Violation of sputum evacuation in patients with cystic fibrosis leads to the persistence of microorganisms. Most often, the microorganisms are isolated from sputum in patients with cystic fibrosis: Staphylococcus aureus, Pseudomonas aeruginosa, Burkholderia cepacia complex, etc. For the treatment of infections caused by P. aeruginosa, the following groups of antibiotics are used: aminoglycosides, carbapenems, polymyxins, cephalosporins, fluoroquinolones, inhibitor-protected penicillins and fosfomycin.Aim. To the study is to determine antimicrobial resistance in P. aeruginosa isolated from patients with cystic fibrosis.Materials and methods. An analysis of 87 results of sputum, biomaterial from the posterior wall of the pharynx and nose was made.Results and discussion. Biomaterial was taken from the nasal in 4.6% cases, from the posterior pharyngeal wall in 35.6% and sputum in 59.8%. The lowest level of resistance was registered in strains isolated from the nasal cavity. Microorganisms isolated from the posterior pharyngeal wall showed a higher level of antibiotic resistance. The sensitivity data of sputum isolates were similar to the results from the posterior pharyngeal wall. The highest level of resistance was obtained to aminoglycosides (19.3%) and carbapenems (14.8%). In addition, 12.5% of P. aeruginosa isolates were resistant to sodium colistimethate, 10.2% to fluoroquinolones. The lowest level of insensitivity was found to cephalosporins (5.7%) and protected beta-lactams (4.5%). The revealed trend of decreasing sensitivity, in our opinion, is associated with a greater frequency of antibiotic use.Conclusion. Chronic P. aeruginosa infection in patients with CF contributes to a more severe course of the disease and increases the risk of complications.

Symptomatic treatment of cough in children

Cough is one of the most common symptoms in paediatric practice. Cough nature, duration, intensity, frequency, time and cause of occurrence should be considered in the differential diagnosis of its causes. Sputum evacuation disorders and changes in its rheological properties are indications for the prescription of mucoactive drugs. Despite the fact that the drugs included in this group have different mechanisms of action, all of them restore mucociliary clearance and lead to effective evacuation of secretions from the respiratory tract. Herbal medicinal products can be used along with classic mucoactive drugs (mucolytics, mucopegulators and mucokinetics). Ivy leaves are an example of a well-known and meticulously researched source of phytopharmaceutical products, they are included in the ESCOP monograph and entered into the positive list of the German Commission E. The efficacy and safety of ivy leaf products have been demonstrated in various controlled clinical studies. The authors presented a review of published clinical studies and non-interventional studies involving a total of 65,383 patients suffering from both acute and chronic respiratory diseases. The studies demonstrated the efficacy of ivy leaf extract preparations as achievement of a higher level of bronchodilation and surfactant production, which led to bronchospasmolytic, secretolytic, expectorant and, in turn, antitussive action. Herbal medicinal products are now actively used in the treatment of new coronavirus infection. Hedelix is one of the ivy leaf extract pharmaceutical preparations approved for use in children over the age of two years.

Approach to selecting mucoactive medications to treat cough in children

Cough is the most common symptom of acute respiratory infections in children. Rational approaches to the therapy of cough should be based on the diagnosis and analysis of cough features. In accordance with sputum quality and quantity, a dry (unproductive, minimally productive) and wet (productive) cough is distinguished. The cough can be acute (up to 4 weeks), subacute, chronic, recurrent in duration. Cough assessment should involve considering the following characteristics: rhythm, timbre, nature, intensity, time of onset, duration, frequency, body position while coughing, impact of cough on the patient’s condition and sleep; presence of airway obstruction, etc. All presentations of cough can change during the development of the disease, which must be considered in the diagnosis and therapy. These characteristics of cough help the therapist select a rational therapy. Particular attention is paid to the therapy of wet cough, which is based on the stimulation of mucociliary clearance, restoration of the drainage function of the lungs; improvement of sputum elimination, thinning and removal of viscous bronchial secretion from the respiratory tract; prevention of mucostasis. The article discusses the pharmacokinetics and mechanism of action for Ambroxol in terms of its indications for OTC drug delivery, clinical data on the use of ambroxol in children. The primary mechanism of action for Ambroxol involves stimulation of surfactant synthesis, a complex mechanism that is not yet fully understood, but which provides Ambroxol with effective mucokinetic and secretion-stimulating properties, thus contributing to mucus clearance, which facilitates expectoration and productive cough.

Фітотерапія гострих респіраторних вірусних захворювань

У статті наведено методи фітотерапії гострих респіраторних захворювань та їх ускладнень у дітей і дорослих. Також наводяться показання та протипоказання до проведення фітотерапії хворим на гострі респіраторні вірусні інфекції, правила призначення лікарських рослин дітям з урахуванням віку дитини та зазначенням доз фітопрепаратів, методів фітотерапії залежно від стадії захворювання, частоти використання лікарських трав та тривалості курсу лікування. Стаття містить рекомендації з використання лікарських трав для лікування гострих респiраторних вiрусних захворювань та їх ускладнень, таких як риніт, ларингіт, бронхіт, гiпертермiчний синдром, у дітей та дорослих. У статті наведені рекомендації професора О.Д Барнаулова щодо фітотерапії гострих респiраторних вiрусних захворювань, педіатра-фітотерапевта О.А. Данилюк щодо фітотерапії у дітей, правила застосування деяких лікарських рослин за Ю.І. Коршиковою, схема дозування фітопрепаратів дітям, запропонована Н.П. Меньшиковою, а також практичні рекомендації щодо складання фітосборів для лікування і профілактики гострих респіраторних вірусних інфекцій та прописи фітотерапевта О.В. Костарева.

The effect of intrapulmonary percussive ventilation in pediatric patients: A systematic review.

Intrapulmonary percussive ventilation (IPV) is frequently used in clinical practice to enhance sputum evacuation and lung recruitment. However, the evidence in different respiratory pathologies, especially in children, is still lacking. This systematic review aims to enlist the effectiveness of IPV as an airway clearance technique in pediatric patients. A systematic literature search was performed in PubMed, Web of Science, and the Cochrane Library databases. Studies were included if the subjects suffered from a respiratory disease requiring airway clearance and the mean age of the sample was <18 years. After screening, nine articles remained for further analysis. Three of the nine articles examined patients with cystic fibrosis (CF). No significant differences in lung function or expectorated mucus were found compared to conventional chest physiotherapy. On the other hand, significant beneficial results were found for the treatment or prevention of atelectasis in non-CF patients using IPV. Similar results were seen when comparing therapies for neuromuscular/neurological patients. One study found that IPV reduced hospital stay and improved the clinical status of children with acute bronchiolitis compared to no physiotherapy. Severe adverse events did not occur in the included studies. A limited number of studies investigated IPV in the pediatric population. Despite the heterogeneity across the studies and the small sample sizes, the results seem promising. IPV is suggested to be a safe and effective alternative for airway clearance. Future research is required to confirm these results and to further analyze the possible benefits in different respiratory pathologies.

Application of the three-step sputum elimination in nursing patients with severe inhalation burns

Objective To explore the effects of the three-step sputum elimination on preventing pulmonary complications in patients with burns complicated with severe inhalation injury. Methods Totally 81 patients with burns complicated with severe inhalation injury who received artificial airway between April 2015 and April 2016 were selected as a control group who received conventional nursing, while another 72 patients with burns complicated with severe inhalation injury who received artificial airway from May 2016 to April 2017 were selected as an observation group who received pulmonary nursing with the three-step sputum elimination, namely, 1) sufficient and effective airway humidification, 2) standardized beating procedure, and 3) effective catherization. The number of days with indwelling cannula and the incidence of pulmonary infection between the patients in the two groups were then observed. Results Totally 13 patients in the observation group (18.06%) and 49 patients in the control group (60.49%) showed pulmonary infection (χ2=7.826, P<0.01) . The number of days with indwelling cannula of the patients in the observation group, (14.02±1.21) d, was shorter than that of the patients in the control group, [ (19.04±1.63) d, (t=3.563, P<0.05) ]. Conclusions The key to treatment of patients with burns complicated with severe inhalation injury lies in effective measures taken to eliminate airway obstruction and ensure airway patency in patients. Enhanced management of artificial airway, correct and effective sputum elimination and early wound treatment can improve clinical efficacy and reduce the incidence of pulmonary infection. Key words: Burns, inhalation; Artificial airway; Pulmonary infection; Three-step sputum elimination

Study on the expectoration effect of improved nursing intervention of infants' pneumonia

Objective To explore the expectoration effect of improved nursing intervention of infants' pneumonia. Methods A total of 237 cases of children with pneumonia were divided into intervention group (119 cases )and control group (118 cases )according to random number table method.The patients of the two groups were given routine therapy care in accordance with the doctor's advice.On the basis of this, the intervention group implemented the improved all-in-one nursing intervention mode, including oxygen-driven intermittent inhalation, new-style chest percussion, postural improved drainage and audio-visual training therapy.The control group were given the traditional routine nursing method. Results After the elimination of sputum, the breathing, heart rate and blood oxygen of the two groups were compared and the differences were statistically significant(P<0.01). The effective duration of sputum, dyspnea remission time, sputum rale disappearance time, pulmonary rales disappeared time, the normal temperature time and hospitalization time of the two groups were compared and the differences were statistically significant(P<0.01). The total effectiveness rate of the intervention group was significantly higher than that of the control group, and the difference between the two groups was statistically significant(P<0.05). The incidence of complications of the intervention group was significantly lower than that of the control group, and the differences were statistically significant(P<0.05). Conclusions Improved nursing intervention model can effectively remove respiratory obstruction, improve the function of gas exchange and reduce the complications, so as to improve the effect of treatment of infant pneumonia. Key words: Infant pneumonia; Nursing intervention; Sputum elimination; Effect evaluation

Mechanical Insufflation-Exsufflation for Patients With Bronchiectasis and After Tracheal Stenting

SESSION TITLE: Airways Global Case Reports I SESSION TYPE: Global Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: Mechanical insufflation-exsufflation (MI-E) is primarily used in patients with neuromuscular disease with reduced sputum expectoration strength. Although patients with bronchiectasis and those after airway stenting retain strength for sputum expectoration, the presence of abundant and viscous sputum and reduced ciliary motility of the airway epithelium make sputum expectoration difficult. The efficacy of MI-E for these diseases is yet to be ascertained. CASE PRESENTATION: Case 1: An 83-year-old woman presented with advanced bronchiectasis and showed colonization of mucoid-type Pseudomonas aeruginosa. Her hospitalization frequency had increased owing to increased sputum and respiratory discomfort, and long-term antibiotic administration had resulted in drug-resistant Pseudomonas aeruginosa infection. We introduced MI-E (CoughAsist E70® Philips Respironics, Japan) with the aim of improving the symptoms through sputum expectoration. The MI-E pressure was +20/-35 cm H2O; oscillations (10 Hz, ±5 cm H2O) were simultaneously used during exhalation. The peak cough flow (PCF) was 190 L/min. A large amount of sputum was easily expectorated, and she showed improved percutaneous arterial O2 saturation after MI-E. Her fever pattern also gradually improved along with a decrease in the sputum volume. On day 19, her neutrophil count normalized, and the C-reactive protein also decreased to pre-hospitalization levels. The required oxygen level also decreased to 3L from 5L before hospitalization, and her P/F ratio improved from 170 to 320. The patient was discharged at day 22 after MI-E introduction and continued undergoing MI-E at home. Case 2: A 58-year-old man with airway narrowing due to advanced lung cancer was hospitalized after severe dyspnea progression. Subsequently, a Y-type silicon stent was placed in the tracheal bifurcation. The day after stenting, his dyspnea improved significantly; however, his sputum production increased and he experienced expectoration difficulties. Hence, MI-E was introduced. The MI-E pressure was +30/-40 cm H2O; oscillations (10 Hz, ±5cm H2O) were used simultaneously during exhalation. The PCF was about 170 L/min. Sputum was easily expectorated and his dyspnea improved. Once the patient was accustomed to the technique, he began operating the MI-E himself and was able to expectorate his sputum with appropriate timing. DISCUSSION: The MI-E was shown to be effective in patients with decreased sputum expectoration strength, such as those with neuromuscular disease. However, both patients in our report were able to effectively expectorate sputum at a lower PCF than is recommended in cases with neuromuscular diseases, probably because the CoughAsist E70® device we used had an oscillatory function and improvement in maintenance of a constant airway pressure may have enabled sputum elimination from a more peripheral airway region. In Case 1, the efficacy of home usage was brief, but the patient was elderly and may have therefore found it difficult to comprehend the usage of the MI-E leading to poor implementation. CONCLUSIONS: This is the first study to report the effectiveness of MI-E in patients with bronchiectasis and airway stenting. MI-E was useful for the removal of large amounts of viscous sputum in patients with bronchiectasis and in those after airway stenting. The results of this study suggest that sputum elimination may lead to improvement in clinical symptoms. Future studies are warranted to conduct prospective investigation on the usefulness of MI-E in patients with various chronic respiratory diseases. Reference #1: Vianello A, Corrado A, Arcaro G,et al. Mechanical insufflation-exsufflation improves outcomes for neuromuscular disease patients with respiratory tract infections. Am J Phys Med Rehabil. 2005 ;84 :83-88 Reference #2: Winck JC, Gonçalves MR, Lourenço C,et al. Effects of mechanical insufflation-exsufflation on respiratory parameters for patients with chronic airway secretion encumbrance. Chest. 2004 ;126 :774-780. Reference #3: Chatwin M, Ross E, Hart N,et al.Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness. Eur Respir J. 2003 ;21 :502-508. DISCLOSURE: The following authors have nothing to disclose: Hibiki Kanda, Shuichi Yano, Shinichi Iwamoto, Emiko Nishikawa, Toru Kadowaki, Kanako Kobayashi, Masahiro Kimura, Toshikazu Ikeda No Product/Research Disclosure Information

Efeitos da ELTGOL e do Flutter® nos volumes pulmonares dinâmicos e estáticos e na remoção de secreção de pacientes com bronquiectasia

Although respiratory physical therapy is considered fundamental in the treatment of hypersecretive patients, there is little evidence of its physiological and therapeutic effects in bronchiectasis patients. To evaluate the acute physiological effects of ELTGOL and Flutter VRP1® in dynamic and static lung volumes in patients with bronchiectasis and, secondarily, to study the effect of these techniques in sputum elimination. Patients with clinical and radiological diagnosis of bronchiectasis were included. Patients underwent three interventions in a randomized order and with a one-week washout interval between them. Before all interventions patients inhaled two puffs of 100 mcg of salbutamol. There was a cough period of five minutes before and after the control protocol and the interventions (ELTGOL and Flutter VRP1®). After each cough series patients underwent assessments of dynamic and static lung volumes by spirometry and plethysmography. The expectorated secretions were collected during the interventions and during the second cough series, and quantified by its dry weight. We studied 10 patients, two males and eight females (mean age: 55.9±18.1 years). After using Flutter VRP1®and ELTGOL there was a significant decrease in residual volume (RV), functional residual capacity (FRC) and total lung capacity (TLC) (p<0.05). There was a higher sputum production during ELTGOL compared with Control and Flutter VRP1® (p<0.05). The ELTGOL and Flutter VRP1® techniques acutely reduced lung hyperinflation, but only the ELTGOL increased the removal of pulmonary secretions from patients with bronchiectasis.

Acute effects of intrapulmonary percussive ventilation in COPD patients assessed by using conventional outcome parameters and a novel computational fluid dynamics technique

Objective:Chest physiotherapy enhances sputum evacuation in COPD patients. It can be applied as a single technique or as a combination of techniques including intrapulmonary percussive ventilation (IPV). Recently developed assessment techniques may provide new insights into the effect of airway clearance techniques.Participants:Five moderate to severe COPD patients (three females and two males; mean forced expiratory volume in 1 second of 39.49% predicted) who were admitted in the hospital for an acute exacerbation were included in this study.Methods:A novel imaging technique was used, together with other conventional techniques, to visualize the short-term effects of a single IPV treatment in COPD patients.Results:No significant changes were noted in the lung function parameters or arterial blood gases measured within 1 hour after the end of the IPV session. Computed tomography images detected changes in the airway patency after the IPV treatment compared with before treatment. Local resistances, calculated for the three-dimensional models, showed local changes in airway resistance.Conclusion:The effects of a single IPV session can be visualized by functional imaging. This functional imaging allows a calculation of changes in local airway resistance and local changes in airway volume in COPD patients without affecting conventional lung function parameters.

Comparison of expectoration effect between applying the vest airway clearance system and vibration sputum elimination apparatus for elderly postoperative patients

Objective To compare the expectoration effect between applying the vest airway clearance system and vibration sputum elimination apparatus for elderly postoperative patients.Methods A total of 40 patients were randomly divided into the vest group and control group.Both daily volume of sputum excreting of all patients and the incidence rate of postoperative pulmonary infection were compared.Results Daily sputum excreting volume of patients in the vest group increased obviously(P<0.05).However,there were no significant differences between two groups in the incidence rate of postoperative pulmonary infection.Condusions The effect of using the vest airway clearance system for postoperative elderly patients was superior to that of vibration sputum elimination apparatus for sputum excretion. Key words: Elderly; Sputum elimination; Vibration sputum elimination; Vest airway clearance system

Survival of Iranian Patients on Lung Transplant Waiting List: Is There Any Difference?

Objective Lung transplantation is the last treatment option for end-stage pulmonary diseases. Reviewing the characteristics of patients on the lung transplant waiting list is a helpful way to evaluate and prioritize the patients in need of special care. Because we have no information about mortality on the lung transplantation waiting list in Iran, the aim of this study was to evaluate the characteristics and survival rates of these patients. Methods The file of lung transplant candidates listed between 2005 and 2010 were evaluated for patient demographic data, type of disorder, waiting list time, and outcomes of death, transplantation, or alive. Results The 131 patients on our list in this period revealed a mean age of 37 ± 14 years with 86 (66%) males. The most common disorder among waiting list patients was pulmonary fibrosis (n = 52; 40%). Among the 17 (13%) patients who were transplanted, most (35%) suffered from pulmonary fibrosis. The mean waiting time to transplantation was 17.2 ± 11.8 months. Twenty-two patients (7%) died while on the waiting list. The mortality rate was unexpectedly highest among cystic fibrosis patients and then those with bronchiectasis. The mean survival time for all non-transplant patients based on the Kaplan-Meier method was 27.4 months and their 2-year survival rate was 74% based on life tables. Conclusion Although pulmonary fibrosis patients show the poorest survival on lung transplant waiting lists, in other countries, patients with cystic fibrosis and bronchiectasis displayed the worst survival on the Iranian list probably due to their poor rehabilitation and sputum evacuation. We concluded that it is necessary for every center to evaluate the characteristics of its patient cohort to match the activity according to the needs.

Expectoration effect of airway removal system in elderly with chronic obstructive pulmonary disease

Objective To observe the expectoration effect of airway removal system in elderly with COPD. Methods 108 patients were randomly divided into three groups,36 cases in each group. Artificial beating expectoration was used in control group; vibrating sputum evacuation machine was used in first mechanical group; airway removal system was used in second mechanical group. Compare daily expectoration volume,PaO2,PaCO2,respiration rates,moist rales change,patients' endurance time,nursing workload in three groups pre-therapy and 7 days post-therapy. Results Improvement of moist rales was more obvious in first mechanical group than that in control group and second mechanical group 7 days post-therapy(P ＜ 0. 05),second mechanical group was more obvious than control group(P ＜ 0. 05); improvement of PaO2 and PaCO2 in first mechanical group were more obvious than that in second mechanical group and control group(P ＜0. 05),second mechanical group was more obvious than control group(P ＜ 0. 05),PaO2 and PaCO2 got improvement after expectoration(P ＜ 0. 05); expectoration volume in first mechanical group was larger than second mechanical group and control group(P ＜0. 01); there were no differences in respiration rates of three groups. Endurance time of control group was longer than second mechanical group and first mechanical group(P＜0.05). There was no difference in nursing workload of second mechanical group and control group(P＞0.05),the differencesbetween first mechanical group and control group and second mechanical group were statistically significant(P ＜0. 05). Conclusions Airway removal system and vibrating sputum evacuation machine have favourable expectoration effect,airway removal system can obviously improve lung ventilation quality and work of breathing,decrease nursing workload; but degree of comfort in airway removal system is lower than vibrating sputum evacuation machine and artificial beating expectoration. Key words: Airway removal system; Vibrating sputum evacuation machine; Artificial beating expectoration; Chronic obstructive pulmonary disease

Effects of vibration sputum elimination apparatus in the prevention of patients with severe head injury combined with pulmonary infection

目的 探讨振动排痰机在预防颅脑重症GCS≤8分的患者合并肺部感染中的效果.方法 采用随机分组的方法将患者分为试验组与对照组.试验组采用振动排痰机进行叩背,对照组采用人工叩背.10 d后通过体温、血常规、痰培养、胸片等判断患者有无出现肺部感染,同时记录每次叩背前后血氧饱和度及叩背处皮肤情况.结果 试验组肺部感染率21.6%,对照组54.3%,(P＜0.01),2组存在显著性差异;2组叩背前后血氧饱和度有统计学意义(P＜0.01);试验组皮肤损伤5.4%,对照组为28.6%,(P＜0.01),有统计学意义.结论 振动排痰机及人工叩背均能有效提高患者的血氧饱和度,但前者在预防颅脑重症患者合并肺部感染中的效果优于后者,且安全性高于后者,值得在神经外科护理临床中推广。

Urinary incontinence in girls and female adolescents with cystic fibrosis

Purpose Urinary incontinence (UI) is a known and internationally recognised problem in female adults with cystic fibrosis (CF). UI might have a negative impact on quality of life, but also on lung function, because UI might influence sputum evacuation. The prevalence of UI in young patients ( Material and methods Questionnaires about micturation symptoms, incontinence, perceived competence and quality of life were sent to all 12-18-year old female patients and to parents of all 6-11-year old girls attending our CF center. Results Fifty-four of 79 patients (68%) completed the questionnaires. The prevalence of UI in the total group was 33% (n = 18). Of the 6-11-year old girls 9 of 35 (26%) had UI and 9 of 19 (47%) of the 12-18-year old female patients reported UI. No significant differences in possible risk factors for the development of UI could be demonstrated. Two of 9 adolescent patients reported that UI had an impact on quality of life. We found no differences in perceived competence between the continent and incontinent group. Conclusions UI is more common in female CF patients (33%) than would be expected in the general population of females between 6 and 18 years old (2-10%). UI has no impact on perceived competence, but can have impact on quality of life

Effectiveness evaluation of vibration sputum elimination apparatus in preventing postoperative pulmonary complications of senile patients

目的 评价振荡排痰机在防治老年病人全麻术后肺部并发症(PPCs)效果.方法 将术前一般情况无显著性差异(P＞0.05)的40例全麻术后的老年病人随机分成治疗组和对照组,各20例.2组均在拔管后给予双腔鼻塞给氧、雾化吸入.治疗组采用振荡排痰机振荡叩击法,对照组采用胸背人工叩击法进行胸部物理治疗辅助排疾.比较2组24 h排痰量;拔管前、拔管后2 h、8h、24 h动脉血气分析及VAS测定值.结果 2组患者术后均出现了低氧血症和高碳酸血症.经过胸部物理治疗后,24 h排痰量治疗组多于对照组(P＜0.05);治疗组动脉血气指标较对照组明显改善(P＜0.05);治疗组VAS测定值及使用镇痛药人数明显低于对照组(P＜0.05).结论 振荡排痰机可辅助体力和耐受力较差的老年全麻术后病人有效排痰,改善术后低氧和高碳酸血症,防治PPCs。

Comparison study on effect of vibration sputum elimination apparatus and manpower beating sputum excretion in senile patients kept the bed

目的 比较振动排痰机与人工扣击对老年长期卧床患者的排痰效果.方法 85例长期卧床老年患者随机分为人工扣击组(46例)和振动排痰机组(39例)行辅助排痰,比较2组排痰量及SpO2和住院期间肺部感染发生率.结果 2组患者经1周治疗后,SpO2均高于入院时;振动排痰机组每日排痰量、1周后SpO2高于人工扣击组,而住院期间肺部感染发生率低于人工扣击组,有显著性差异(P＜0.05).结论 振动排痰机排痰效果优于人工扣击,适于在老年长期卧床患者中作为一种常规理疗手段日常应用。

Coughing reflex induced by electrostimulation of the trachea: a pilot study

Introduction: Pulmonary infections and ateleetases are common complications in Intensive Care, neurological and surgical units. One of the main causes of these complications is insufficient cough activity resulting in sputum retention. In order to treat the problem of insufficient coughing and to reduce the disadvantages of the conventional methods, we developed a new method, which induces a coughing reflex by electric stimulation of the trachea. A literature search on the subject revealed no information. In co-operation with the Department of Bioinformatics of the University of Twente an electrode and electrostimulator were developed and tested in animal study. Methods: Ten patients in the intensive care unit with reduced ability to remove sputum by coughing were included in the study. The frequency of coughing caused by mechanical stimulation of the trachea (suction)was observed and compared with coughing caused by the electrode in position without any stimulation and coughing caused by electrical stimulation. Results: During electrostimulation coughing could be induced in all cases with same or better intensity than with mechanical stimulation. A positive effect on sputum evacuation was observed. No side effects were observed on ECG, oxygen saturation and blood pressure; of the six conscious patients one noticed a slight tingling sensation at the location of the electrode. Conclusions: In this pilot study electrostimulation of the trachea appears to be effective in inducing coughing reflexes in patients with a reduced ability to effectively cough. Also a positive effect on sputum evacuation was observed. The method of electrical stimulation may offer a way to reduce the disadvantages of the conventional method. When the method is applied with assistance of computer or timer, a higher frequency of treatment can be archieved and this may offer a way of improved effectiveness. Because less personnel is needed when using this method, and stay on ICU may be shortened, improved cost-effectiveness can be archieved.

Cystic fibrosis, pathophysiological and clinical aspects

Cystic fibrosis is a lethal, hereditary, until recently little understood disease, which leads to progressive functional disturbances in various organs, including the lungs, liver and pancreas. Knowledge of the genetic and cellular abnormalities is rapidly progressing, but therapy is still symptomatic and based on insufficiently controlled and short-term studies. At present the therapeutic approach aims to combat respiratory infections by optimal antibiotic therapy, combined with techniques to promote sputum evacuation. Additional measures attempt to optimise both nutritional state and physical condition. Median survival has improved from approximately 1 year to about 25 years during the past 3 decades. This article summarises present information on disease mechanisms and treatment.