Aust J Physiother
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Randomized Controlled Trial Clinical Trial
Active cycle of breathing techniques in non-invasive ventilation for acute hypercapnic respiratory failure.
We hypothesised that applying the active cycle of breathing techniques (ACBT) in patients with acute hypercapnic respiratory failure undergoing non-invasive ventilation would improve patient outcome. Thirty-four patients were randomised so that 17 patients with acute hypercapnic respiratory failure received the ACBT and non-invasive ventilation (ACBT group), and 17 patients received non-invasive ventilation alone (control group). The primary outcome measure was length of time requiring non-invasive ventilation, and secondary outcome measures were change in acute physiology score, change in arterial blood gas values, total duration of non-invasive ventilation, and length of stay in the intensive care unit. ⋯ Length of time in need of non-invasive ventilation was significantly lower in the ACBT group than in the control group (5.0 days vs 6.7 days, p = 0.03). There was no significant difference in length of stay in the intensive care unit between the two groups (8.0 vs 9.4 days, p = 0.31). The use of ACBT may have positive effects in the treatment of patients with acute hypercapnic respiratory failure, resulting in a shorter length of time requiring non-invasive ventilation.
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Comparative Study
Predisposing factors for occasional and multiple falls in older Australians who live at home.
This study, which was part of a larger study on the Health Status of Older People conducted in Melbourne, Australia, aimed to identify factors that discriminate between multiple and occasional falls amongst older people living at home. It used a survey of 1000 Australians aged 65 years and over. Subjects were classified as multiple fallers (two or more falls in the past year), occasional fallers (one fall in the past year), or non-fallers. ⋯ Multiple fallers were also more likely to be women (OR 1.61, 95% CI 1.03 to 2.51). More multiple fallers (17%) than occasional fallers (9%) reported being very afraid of falling. Intervention strategies should take into account these differing predisposing factors for multiple and occasional falls.
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Randomized Controlled Trial Comparative Study Clinical Trial
Head-down tilt and manual hyperinflation enhance sputum clearance in patients who are intubated and ventilated.
The purpose of this prospective randomised cross-over study was to measure peak expiratory flow rates during manual hyperinflation and to determine if the addition of a head-down tilt to physiotherapy treatment increased sputum production in patients who are intubated and ventilated. Twenty patients who were intubated, ventilated and haemodynamically stable were randomised to a sequence of physiotherapy treatment in a flat side-lying or a head-down tilt position. Peak expiratory flow rates were measured for each breath during manual hyperinflation using a Vitalograph peak flow meter. ⋯ Static pulmonary compliance improved significantly following physiotherapy treatment (p = 0.003). The mean difference and 95% confidence intervals pre- and post-treatment for static pulmonary compliance were 5.18 (2.14 to 8.22) ml/cmH(2)O. The results suggest that addition of a head-down tilt to physiotherapy treatment, including manual hyperinflation, in patients who are intubated and ventilated, increases sputum production and improves peak expiratory flow.
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Although tilt tables are used by physiotherapists to reintroduce patients to the vertical position, no quantitative evidence is available regarding their use within intensive care units (ICUs) of Australian hospitals. The purpose of this study was to evaluate the use of tilt tables in physiotherapy management of patients in ICUs across Australia. Ninety-nine physiotherapists working in Australian public ICUs were contacted via mail and asked to complete a questionnaire regarding their use of tilt tables in practice. ⋯ Techniques often combined with tilt table treatment included upper limb exercises (93.1%) and breathing exercises (86.2%). Standing with assistance of the tilt table is used by the majority of physiotherapists working in Australian ICUs. A moderate level of agreement is demonstrated by physiotherapists regarding indications to commence tilt table treatment and adjunct modalities combined with standing with assistance of the tilt table.
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Clinical Trial
The effect on expiratory flow rate of maintaining bag compression during manual hyperinflation.
Operator performance during the expiratory phase of manual hyperinflation appears to vary between physiotherapists for Mapleson-B or C circuits. Some physiotherapists release the valve but maintain compression of the bag, whereas others release both the valve and the bag. The effect of this difference on peak expiratory flow rate (PEFR) has not been reported. ⋯ Maintaining bag compression significantly reduced PEFR (1.54 (0.08) vs 2.00 (0.07) l/sec, p = 0.008) and increased I:E flow rate ratio (0.65 (0.04) vs 0.50 (0.02), p = 0.02) for the Mapleson-C circuit at a 1.4 litre target volume. There were no significant differences for these measures between techniques when subjects emptied the bag. The effect needs to be confirmed in the clinical setting.