Treatment Of Respiratory Complications Research Articles

The ultrasound estimation of extravascular lung water in volume controlled versus pressure controlled ventilation after one lung ventilation in Thoracoscopic surgery. A-comparative study

ABSTRACT Background Thoracoscopic surgeries are an absolute indication of one lung ventilation OLV, the choice of using volume-controlled ventilation (VCV) or pressure controlled ventilation (PCV) remains controversial. Respiratory complications are major cause of postoperative morbidity which is associated with increased extravascular lung water (EVLW). Assessment of (EVLW) helps in early detection and treatment of respiratory complications. Lung ultrasound (LUS) has been suggested as reliable method of assessment of EVLW. This study was designed to figure out whether there was any difference in OLV by either PCV or VCV on EVLW water in the ventilated lung using LUS score and arterial oxygenation. Methodology 50 patients were randomly assigned into two groups; Group V: received VCV (Vt 7 ml/kg ideal body weight) Group P: received PCV (To achieve Vt 7 ml/kg ideal body weight, Pmax 30 cmh2o) Results We found that both techniques PCV and VCV showed no statistically significant differences as regards the ultrasound score at different timings of measurement; (T0) before induction of anesthesia, (T5) immediately at the end of operation after extubation, and (T6) 2 hours after ICU admission. Where P values were 0.525, 0.309, and 0.597 consecutively, we also found there were no statistically significant differences between the two groups regarding hemodynamics, arterial blood gases, ventilatory parameters. Conclusion We concluded that when utilizing VCV & PCV in OLV in thoracospic surgeries there was no statistically significant difference regarding EVLW score measured by LUS in the ventilated lung.

Role of the physical therapist in the immediate postoperative period of liver transplantation

Liver transplantation has been the most suitable choice for the treatment of end-stage liver disease. And it is in the postoperative period of liver tx that the monitoring of respiratory complications guarantees survival after this procedure. The objective of this study is to evaluate the role of physical therapy in the immediate postoperative period of liver transplantation. Methodology: This is a literature review with publications from 2012 to 2022, including original scientific and opinion articles referring to liver transplantation, upper abdominal surgery, laparotomy, and physical therapy. The reviews on the topic and the reference list of all articles considered important were consulted with the aim of new articles for inclusion. Studies in children and literature reviews were excluded. Result: after analyzing 20 articles, it was observed the importance of a preoperative physiotherapeutic evaluation for a better performance in the possible pulmonary complications in the postoperative period of liver transplantation. Conclusion: Physiotherapy is effective in the treatment of respiratory complications in the immediate postoperative period of liver transplantation.

Mechanical insufflation-exsufflation for the prevention and treatment of respiratory complications in acute cervical spinal cord injury: A retrospective service evaluation

Background A cervical spinal cord injury (CSCI) is a life-changing event resulting in neurological weakness. Acutely, respiratory complications are the leading cause of mortality. Mechanical insufflation-exsufflation (MI-E) is used to augment cough and promote airway clearance in the prevention and treatment of respiratory complications in this population. The incidence of respiratory complications in subjects with CSCI who receive MI-E is not widely reported. Objectives To report on the incidence of respiratory complications and to evaluate the clinical application of MI-E in subjects with acute traumatic CSCI. Methods This was a retrospective case note review. Data was collected for subjects with a traumatic CSCI admitted to a U.K. major trauma centre between January 2017 and September 2018. The incidence of respiratory complications on admission and 3 weeks post-admission were collected. Where used, detail relating to MI-E clinical application was recorded. Results 33 subjects were eligible for inclusion. The overall incidence of respiratory complications was 21% (7/33). There was no significant difference in occurrence of respiratory complications between those who received MI-E and those who did not. There was a significant difference in the clinical application of therapeutic MI-E compared to prophylactic MI-E. The ‘number of cycles’ and ‘exhale pressure’ settings were found to be significantly greater in those receiving therapeutic treatment (p = <0.001; p = 0.002 respectively). Reporting of other MI-E parameters and treatment detail was poor. Conclusion Whilst the findings of this review may suggest that MI-E provides no additional benefit in the prevention of respiratory complications following acute traumatic CSCI, firm conclusions cannot be drawn due the small sample and poor treatment detail reporting. Further incidence reporting in a multi-site study, including those with thoracic injuries is warranted.

Physical therapy in infants and preschool children with burns: retrospective descriptive study

Introduction: Burns are traumatic injuries that occur due to external events, and particularities of pediatric patients make it more serious condition. Physical therapy is essential to the recovery of children victims of burns and it should be started early during hospitalization. Objective: Define initial and final physical therapy care in children victims of burns, during the period of hospitalization, in a Burn Treatment Centers (BTC). Methods: Retrospective and descriptive study by means of gathering information in medical records of children victims of burns, convenience sample, consisted of patients in the 0-6 age group, that were interned in BTC of University Hospital/ UEL, from January 2011 to February 2014. Results: Data from 102 medical records were collected, physical therapy was realized in 94 (92.1%) cases, being respiratory physical therapy, placements, motor physical therapy, orthosis indication and orientation. In the first, second, last but one and last sessions, the most used breathing techniques were clearence maneuvers; the general placements was the most used; during motor physical therapy, the gait /walking and orientation were used with more frequency in last assistance. Conclusion: The initial physical therapy emphasizes the clearence maneuvers for prevention and treatment of respiratory complications that threaten the survival of the patient. The activities focused on functionality were adressed throughout the hospital stay, especially in the final stage. The physical therapy sessions progressed from passive techniques to active, according to the evolution of patients

Low dose anti-inflammatory radiotherapy for the treatment of pneumonia by covid-19: A proposal for a multi-centric prospective trial

BackgroundCOVID-19 is a highly contagious viral infection with high morbidity that is draining health resources. The biggest complication is pneumonia, which has a serious inflammatory component, with no standardized treatment. Low-dose radiation therapy (LD-RT) is non-invasive and has anti-inflammatory effects that can interfere with the inflammatory cascade, thus reducing the severity of associated cytokine release and might be useful in the treatment of respiratory complications caused by COVID-19. Study design and methodsThis multicentric prospective clinical trial seeks to evaluate the efficacy of bilateral lung LD-RT therapy as a treatment for interstitial pneumonia in patients with COVID-19 for improving respiratory function.This prospective study will have 2 phases: I) an exploratory phase enrolling 10 patients, which will assess the feasibility and efficacy of low-dose lung irradiation, evaluated according to an increase in the PaO2/FiO2 ratio of at least 20% at 48–72 h with respect to the pre-irradiation value. If a minimum efficiency of 30% of the patients is not achieved, the study will not be continued. II) Non-randomized comparative phase in two groups: a control group, which will only receive pharmacological treatment, and an experimental arm with pharmacological treatment and LD-RT. It will include 96 patients, the allocation will be 1: 2, that is, 32 in the control arm and 64 in the experimental arm. The primary end-point will be the efficacy of LD-RT in patients with COVID-19 pneumonia according to an improvement in PaO2/FiO2. Secondary objectives will include the safety of bilateral lung LD-RT, an improvement in the radiology image, overall mortality rates at 15 and 30 days after irradiation and characterizing anti-inflammatory mechanisms of LD-RT by measuring the level of expression of adhesion molecules, anti-inflammatory cytokines and oxidative stress mediators.Trial registration: ClinicalTrial.gov NCT-04380818 https://clinicaltrials.gov/ct2/show/NCT04380818?term=RADIOTHERAPY&cond=COVID&draw=2&rank=4.

Progress in diagnosis and treatment of respiratory complications in children with neuromuscular diseases

神经肌肉疾病是指一系列累及周围神经系统和（或）肌肉的疾病，它们有着共同的病理生理机制，并可引起呼吸系统并发症，部分可死于呼吸功能不全。了解儿童神经肌肉疾病呼吸功能特点及其影响，加强这些儿童的呼吸道管理和康复治疗，对于减少呼吸系统并发症的发生、改善生活质量和预后有重要意义。本文介绍儿童神经肌肉疾病的分类、常见呼吸问题和发病机制、呼吸评估及呼吸管理等。.

Kinetic therapy in multiple trauma patients with severe thoracic trauma: a treatment option to reduce ventilator time and improve outcome.

Continuous lateral rotational therapy (CLRT) has been described as a promising approach for prophylaxis and treatment of respiratory complications in critically ill patients over two decades ago. However, meta-analyses failed to demonstrate any significant benefit on outcome by CLRT, possibly due to the heterogeneity and low overall quality of available studies. Observational trial over a 3-year period on outcome in trauma patients (Injury Severity Score, ISS ≥16) with severe thoracic injury (Abbreviated Injury Scale, AISThorax ≥3) initially treated with CLRT as standard of care. Epidemiological data, injury severity, and pattern and physiological parameters were recorded. Outcome indicators were time on mechanical ventilation, length of stay, rates of pneumonia, sepsis and acute respiratory distress syndrome, hospital mortality, and rates of re-intubation. Additionally, data are compared with the results from the TraumaRegister® of the German Trauma Society. Over the 3-year period 76 patients with ISS ≥16/AISThorax ≥3 received CLRT, equaling 24% of all patients with ISS ≥16 between 18 and 80years. Mean ISS was 35.3 (standard deviations, SD 12.2) [71.1% male, 97.4% blunt trauma, mean age 43.9years (SD 18.7)]. Mean time on CLRT was 3.3days (SD 2.2), time on mechanical ventilation 7.8days (SD 7.1), and 9.2% had to be re-intubated due to respiratory complications. CLRT-related complications occurred in 8.9%. Overall 25% of the patients developed pneumonia (VAP=13.2%). Despite a significantly higher ISS we observed shorter times on mechanical ventilation and intensive care unit in our collective in comparison to data published from the nationwide TraumaRegister®. CLRT remains a therapeutic option to reduce pulmonary complications after severe chest trauma in our center. However, a RCT is needed to study the effects of other treatment options such as early extubation and non-invasive ventilation or prone/supine positioning.

Elevated Extravascular Lung Water Index (ELWI) as a Predictor of Failure of Continuous Positive Airway Pressure Via Helmet (Helmet-CPAP) in Patients With Acute Respiratory Failure After Major Surgery

IntroductionNIV is increasingly used for prevention and treatment of respiratory complications and failure. Some of them are admitted to the PACU with advanced hemodynamic monitors which allow quantification of extravascular lung water (EVLW) by transpulmonary thermodilution technique (TPTD) and pulmonary vascular permeability (PVP) providing information on lung edema. AimThe objective of this study was to ascertain if EVLW index and PVP index may predict failure (intubation) or success (non-intubation) in patients developing acute respiratory failure (ARF) in the postoperative period following major abdominal surgery, where the first line of treatment was non-invasive continuous positive airway pressure via a helmet. MethodsHemodynamic variables, EVLWI and PVPI, were monitored with a transpulmonary thermodilution hemodynamic monitor device (PiCCO™) before and after the application of CPAP. ResultsAvoidance of intubation was observed in 66% of patients with Helmet-CPAP. In these patients after the first hour of application of CPAP and PaO2/FiO2 ratio significantly increased (303.33±65.2 vs 141.6±14.6, P<.01). Before starting, Helmet-CPAP values of EVLWI and PVPI were significantly lower in non-intubated patients (EVLWI 8.6±1.08 vs 11.8±0.99ml/kg IBW, P<.01 and PVPI 1.7±0.56 vs 3.0±0.88, P<.01). An optimal cut-off value for EVLWI was established at 9.5, and at 2.45 for PVPI (sensitivity of 0.7; specificity of 0.9, P<.01). ConclusionIn this type of patient the physiological parameters that predict the failure of Helmet-CPAP with the greatest accuracy were the value of the EVLWI and PVPI before Helmet-CPAP institution and the PaO2/FiO2 ratio and the respiratory rate after 1h of CPAP.

La elevación del índice de agua pulmonar extravascular como factor predictivo del fracaso de la presión continua en la vía aérea con casco (CPAP-Helmet) en pacientes con insuficiencia respiratoria aguda tras intervención quirúrgica mayor

IntroductionNIV is increasingly used for prevention and treatment of respiratory complications and failure. Some of them are admitted to the PACU with advanced hemodynamic monitors which allow quantification of Extravascular Lung Water (EVLW) by transpulmonary thermodilution technique (TPTD) and Pulmonary Vascular Permeability (PVP) providing information on lung edema. AimThe objective of this study was to ascertain if EVLW Index and PVP Index may predict failure (intubation) or success (non-intubation) in patients developing acute respiratory failure (ARF) in the postoperative period following major abdominal surgery, where the first line of treatment was non-invasive continuous positive airway pressure via a helmet. MethodsHemodynamic variables, EVLWI and PVPI were monitored with a transpulmonary thermodilution hemodynamic monitor device (PiCCO™) before and after the application of CPAP. ResultsAvoidance of intubation was observed in 66% of patients with Helmet-CPAP. In these patients after the first hour of application of CPAP, PaO2/FiO2 ratio significantly increased (303.33±65.2 vs. 141.6±14.6, P<.01). Before starting Helmet-CPAP values of EVLWI and PVPI were significantly lower in non-intubated patients (EVLWI 8.6±1.08 vs. 11.8±0.99ml/kg IBW, P<.01 and PVPI 1.7±0.56 vs. 3.0±0.88, P<.01). An optimal cut-off value for EVLWI was established at 9.5, and at 2.45 for PVPI (sensitivity of 0.7; specificity of 0.9, P<.01). ConclusionIn this type of patient the physiological parameters that predict the failure of Helmet-CPAP with the greatest accuracy were the value of the EVLWI and PVPI before Helmet-CPAP institution and the PaO2/FiO2 ratio and the respiratory rate after one hour of CPAP.

Benefits of standardizing additional airway clearance in the trauma patient population.

The objective of this project was the development of a systematic preventative approach toward the treatment of respiratory complications among the trauma population. The team used and documented existing treatment regimens within specific study groups, to determine an effective structure to combat respiratory complications. The project included retrospective data collected from the Trauma Registry of an American College of Surgeons verified Level 1, adult rural, academic facility. Review data indicated significant inconsistencies in the pulmonary treatment among the trauma population. Pulmonary hygiene orders lacked consistency, and the patient-focused standards of care led to the creation of nonspecific or omitted orders. The results of the analysis revealed that the overall rate of unplanned upgrades to the higher level of care and intubations due to respiratory compromise were significantly impacted by the design of a collaborative pulmonary care regimen defining role delineation, timelines, and education. This project provided support to the credence of the designated pathway.

Pathologies respiratoires liées à l’obésité

SUMMARY Obesity is a chronic disease responsible for an high morbidity and mortality. This is both an organ pathology due to the alteration of the structure of adipose tissue, and systemic disease due to these effects at a distance. Obesity is associated with a many complications, the most frequent are cardiovascular and respiratory diseases, diabetes type 2 and osteoarthritis. The respiratory consequences of obesity are generally underestimated and play a major role in morbidity and mortality associated with obesity. Being overweight impairs lung function. Respiratory complications of obesity are the restrictive syndrome, obesity-hypoventilation syndrome, obstructive sleep apnea syndrome (OSAS), bronchial asthma and pulmonary hypertension. These consequences justify a precise clinical examination of respiratory function and guidance in a specialized unit for suspected OSAS or in the presence of hypoxe- mia with or without hypercapnia. The treatment of respiratory complications is dominated by the prevention of thrombo-embolic disease and the management of sleep apnea and alveolar hypoventilation.

Rotational bed therapy after blunt chest trauma: A nationwide online-survey on current concepts of care in Germany

IntroductionBlunt chest injuries are amongst the most life threatening injuries in adult multiple trauma patients. Nevertheless, the treatment of these thoracic injuries has not been standardized yet. Previous publications have reported on the prevention and the treatment of respiratory complications by using continuous lateral rotational bed therapy (CLRT), but there is still a lack of information using this approach in the presence of pulmonary contusions. Therefore current literature indicates a variety of treatment protocols and its use is contended. MethodsWe submitted a 32-item online-questionnaire to 155 hospitals participating in the nationwide TraumaNetwork to assess current treatment concepts in multiple trauma patients suffering from blunt chest trauma including lung contusions with particular focus on the use of CLRT. Overall, 21 level I, 53 level II and 81 level III trauma centres were contacted. The questionnaire was created using “interview 123 5.5.b.de ND6”. ResultsThe overall response rate was 35.5% (55/155) and responses were received from 10 level I (47.6%), 17 level II (32.1%) and 24 level III (29.6%) trauma centres. Thirty-five of the responders (63.6%) declared to be able to perform lateral rotational bed therapy. For level I and II trauma centres more than 80% were able to apply kinetic positioning in contrast to only 50% of level III trauma centres. Although 42.9% of the participants reported on the existence of standardized treatment protocols, 57.1% failed to report a standardized operating procedure for CLRT. The annual mean number of patients per centre treated via CLRT was 15 (0–130). Treatment modalities such as PEEP and the duration of CLRT also showed great variability. Against this background three out of four centres declared an urgent need for further clinical research in the field. ConclusionsOur data reflect the wide range of different CLRT treatment strategies performed for blunt pulmonary trauma involving lung contusions in German trauma centres. We conclude that a high-quality randomized-controlled trial is warranted to critically assess the role of CLRT in multiple trauma patients with blunt chest trauma to provide a sound basis for future clinical guidelines.

Does non-invasive ventilation associated with chest physiotherapy improve outcome after lung resection?

A best evidence topic was constructed according to a structured protocol. The question addressed was whether the use of non-invasive ventilation (NIV) associated with chest physiotherapy (CPT) is effective in preventing respiratory complications in patients undergoing lung resection surgery. Of the 172 papers found using a report search, five presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, the five studies were all in favor of NIV as an adjuvant to CPT for improving outcome after lung resection surgery. Indeed, the interest and benefit has been shown not only in the treatment of postoperative acute respiratory failure, but also in the prevention and treatment of respiratory complications (atelectasis, pneumonia and bronchial congestion). Hence, current evidence shows NIV associated with acute CPT management to be safe and effective in reducing postoperative complications and in improving patient recovery, thus enhancing the choice of available medical care and bettering outcome in lung resection surgery.

Rotational Bed Therapy to Prevent and Treat Respiratory Complications: A Review and Meta-Analysis

Immobility is associated with complications involving many body systems. To review the effect of rotational therapy (use of therapeutic surfaces that turn on their longitudinal axes) on prevention and/or treatment of respiratory complications in critically ill patients. Published articles evaluating prophylaxis and/or treatment were reviewed. Prospective randomized controlled trials were assessed for quality and included in meta-analyses. A literature search yielded 15 nonrandomized, uncontrolled, or retrospective studies. Twenty prospective randomized controlled trials on rotational therapy were published between 1987 and 2004. Various types of beds were studied, but few details on the rotational parameters were reported. The usual control was manual turning of patients by nurses every 2 hours. One animal investigation and 12 clinical trials addressed the effectiveness of rotational therapy in preventing respiratory complications. Significant benefits were reported in the animal study and 4 of the trials. Significant benefits to patients were reported in 2 of another 4 studies focused on treatment of established complications. Researchers have examined the effects of rotational therapy on mucus transport, intrapulmonary shunt, hemodynamic effects, urine output, and intracranial pressure. Little convincing evidence is available, however, on the most effective rotation parameters (eg, degree, pause time, and amount of time per day). Meta-analysis suggests that rotational therapy decreases the incidence of pneumonia but has no effect on duration of mechanical ventilation, number of days in intensive care, or hospital mortality. Rotational therapy may be useful for preventing and treating respiratory complications in selected critically ill patients receiving mechanical ventilation.

Respiratory failure complicating general surgery.

The most common complications following surgery in the average general hospital are probably respiratory. These range from a minor plate of atelectasis to severe cardiorespiratory insufficiency, and they may increase the cost of treatment, lengthen convalescence and occasionally cause severe ill‐health or even death. In an era of the performance of increaszngly bold surgery on elderly patients and of increasing violence, particularly on the roads, the treatment of respiratory complications is becoming more and more a problem for the surgical team. The various problems encountered are discussed in this paper.

Prevention and treatment of respiratory complications in surgery.

RESPIRATORY complications continue to play a significant part in postoperative morbidity and mortality in spite of important advances in anesthetic and surgical management. The reported incidence of these complications ranges from 1.2 per cent1 to 43.5 per cent,2 and the criteria for diagnosis are necessarily arbitrary. The wide margin of safety in the low-risk patient and the remarkable capacity of most patients to recover from complications tend to obscure the importance of the hazard in the ordinary surgical patient. The increase in volume of geriatric surgery and the recent introduction of high-risk cardiopulmonary surgery have again brought into focus the . . .

The Anæsthetist's Viewpoint on the Treatment of Respiratory Complications in Poliomyelitis during the Epidemic in Copenhagen, 1952

The Anæsthetist's Viewpoint on the Treatment of Respiratory Complications in Poliomyelitis during the Epidemic in Copenhagen, 1952