Respiratory care
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Randomized Controlled Trial
Mechanical Insufflation-Exsufflation Versus Conventional Chest Physiotherapy in Children With Cerebral Palsy.
The cough mechanism is often impaired in children with quadriplegic spastic cerebral palsy, accounting for the high prevalence of pneumonia and atelectasis requiring prolonged hospitalization. Conventional chest physiotherapy (CPT) is a current technique recommended at the onset of lower-respiratory infections in cerebral palsy. Previous studies have demonstrated the usefulness of mechanical insufflation-exsufflation (MI-E) in children with neuromuscular disease. To date, there has been no study of MI-E in children with quadriplegic spastic cerebral palsy. The objective of the study is to compare the efficacy in reducing hospital stay and improvement of atelectasis between MI-E and CPT in children with quadriplegic spastic cerebral palsy with lower-respiratory infections. ⋯ MI-E is proven to be beneficial in shortening the duration of airway clearance in children with quadriplegic spastic cerebral palsy presenting with lower-respiratory infections and atelectasis. MI-E is a safe and efficient intervention for airway clearance.
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Despite many advances in respiratory care and mechanical ventilation, neonatologists lack an objective tool to aid in decision making for timely extubation. Electrical activity of the diaphragm (EAdi), a measure of neural respiratory drive and inspiratory load, may be a useful predictor of extubation success in preterm neonates. The objective of this work was to investigate whether peak EAdi could distinguish successful versus failed extubation in mechanically ventilated preterm infants. ⋯ This small study suggests that the pre-extubation peak EAdi does not predict extubation success. (ClinicalTrials.gov registration NCT02144363.).
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Extracorporeal membrane oxygenation (ECMO) is used as a rescue therapy before and after lung transplantation, but little is known about functional recovery or complications after ECMO in this cohort. This study aimed to describe early physical function and leg complications in subjects who received ECMO before or after lung transplantation, and to compare functional outcomes to a matched cohort of subjects who did not require ECMO. ⋯ In subjects requiring ECMO before or after lung transplantation, 82% survived to hospital discharge, but leg complications were common and physical function was poor at ICU discharge. Physical function improved over time, however subjects who required ECMO had a longer period of hospitalization and worse physical function at ICU and hospital discharge than those who did not require ECMO.
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Noninvasive ventilation is an effective treatment for a significant proportion of patients with acute respiratory failure. The success of noninvasive ventilation, however, depends on several factors, a major one being the selection of the proper interface. The choice and application of the interface in patients with acute respiratory failure is a considerable challenge for any treatment team. This review discusses the different types of interfaces that can be used in patients with acute respiratory failure, the differences between nasal, oro-nasal, and total face masks and the helmet, as well as the effect of interface type on treatment success and upper airway patency, mask fitting, problems related to the interface, and the relationship between ventilator type and interface choice.
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Editorial Clinical Trial
Development and Feasibility of a Home Pulmonary Rehabilitation Program With Health Coaching.
Pulmonary rehabilitation (PR) is an effective intervention for COPD. However, traditional center-based PR programs suffer from low uptake. Home-based PR is a viable solution, but few studies have shown the effectiveness of remote PR, as there is a scarcity of systems that can be easily adopted in clinical practice. The aim of this report is to communicate the development and feasibility of a home PR program that includes commercially available technology that allows the PR health coach to follow the patient through his or her PR process and to present the design of a prospective clinical trial. ⋯ A home PR program was developed that integrated health coaching and a home PR system that facilitated remote monitoring. Pilot testing indicated that the program is well-developed and feasible in a population of individuals with COPD. (ClinicalTrials.gov registration NCT02999685.).