Respiratory care
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Review
Safety Assessment Criteria for Early Active Mobilization in Mechanically Ventilated ICU Subjects.
Although studies have confirmed the safety and feasibility of early active mobilization, its implementation status is still unsatisfactory. The most important obstacle is ensuring patient safety. Comprehensively assessing the physical condition of patients considered for mobilization is the basis of safety. However, appropriate guidance is lacking. We performed a systematic review to extract and summarize current safety assessment criteria for the early active mobilization of mechanically ventilated patients in the ICU. ⋯ The safety assessment criteria should focus on cardiac reserve, respiratory reserve, consciousness, and muscle strength. It is especially important to note whether the parameters are stable because parameter stability can be more representative of a patient's condition than absolute values. We provide a flow diagram for clinical safety assessments; however, some limitations exist, and this assessment requires further validation and optimization.
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Review
Incentive Spirometry for Prevention of Postoperative Pulmonary Complications After Thoracic Surgery.
Incentive spirometry is frequently used after thoracic surgery as an adjunct to physiotherapy. Despite its widespread use, it has remained challenging to demonstrate a clinical benefit in terms of either incidence of postoperative pulmonary complications or hospital stay. ⋯ The problem with studies published to date is that there are many limitations, not least of which is the challenge of achieving patient adherence with performing incentive spirometry as prescribed. Despite the lack of evidence, there remains an appetite for persevering with incentive spirometry in the postoperative thoracic surgical patient because it is a relatively inexpensive intervention that motivates many patients to perform regular breathing exercises long after the therapist has moved on to the next patient.