Category - Part 15
Comparison of Intrapulmonary Percussive Ventilation and Chest Physiotherapy: Discission
No direct relationship between disease severity and response to any respiratory treatment was observed, except for patients receiving IPV. In that case, more severe disease was significantly correlated with greater improvement in FEF25-75 1 h after treatment (r2=0.47, p=0.04), but these differences disappeared by 4 h.
Overall, the respiratory treatments had little differential effects on in vitro sputum physical properties. Canadian health & care mall read only Specifically, a comparison between the treatment groups (STD vs IPV, STD vs HVA/P&PD, and IPV vs HVA/P&PD) revealed no trends with respect to mucus hydration. However, sputum collected after IPV treatment tended to be the most rigid and elastic, while STD-generated sputum was least rigid and elastic. These differences reached statistical significance at simulated cough frequency (100 radian/s) where IPV mucus elasticity was greater than HVA/P&PD sputum (p=0.025), and sputum expectorated after STD was significantly less rigid than HVA/P&PD (p=0.049). Cough clearability of the small airways (4 mm) was significantly greater after HVA/P&PD treatment compared with STD alone (p=0.03), but not in the large (12 mm) model airway.
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Comparison of Intrapulmonary Percussive Ventilation and Chest Physiotherapy: Results
To compare the effects of standard treatment to IPV and to HVA/IPV, within-person statistical analyses were performed for both PFTs and sputum properties. For PFT comparisons, pretreatment and posttreatment PFTs were calculated as percentage of predicted, based on age-appropriate Morris et al or Polgar et al standards for each participant during each treatment. Then the improvement in PFTs was then calculated for each participant using each treatment. Finally, the improvements obtained using the standard treatment were compared with the improvements following each of the other treatments for each participant. Similarly, physical properties of sputum expectorated following standard therapy were compared with physical properties of sputum obtained following IPV or HVA/P&PD for each participant. The appropriate paired Student’s t test statistic and p value were then inspected. In this way, each participant acted as their own control, assumptions or independence in statistical testing were not violated, and power was maximized further buy proventil. Furthermore, this process yields an easily interpretable result. The relationship between severity of CF disease and change from baseline PFTs after each treatment was assessed using standard least squares regression. For all tests, p values of less than or equal to 0.05 were considered significant.
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Comparison of Intrapulmonary Percussive Ventilation and Chest Physiotherapy: Materials
Participants went without breakfast and received regularly prescribed oral medications, but did not receive home chest physiotherapy on each morning of the study. Pulmonary function testing (PFT), including forced vital capacity (FVC), forced expiratory volume in 1 s (FEVi), peak expiratory flow (PEF), and mean forced expiratory flow during the middle half of vital capacity (FEF25-75), was administered by a pulmonary function technician unaware of the treatment regimen to be received by the participant. Buy birth control pills online Link The best of three FVC maneuvers was obtained and recorded for each participant. The same technician and ATS-approved spirometer (Gould System 21, Sanyo, Compton, Calif) were used for all PFT measurements throughout the study.
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Comparison of Intrapulmonary Percussive Ventilation and Chest Physiotherapy: Methods
The two most salient innovations provided by IPV-1 with respect to its application in CF therapy include (1) the simultaneous combination of mechanical with pharmacologic interventions (aerosols) to mobilize endobronchial secretions, and (2) the development of a patient-operated device for chest physiotherapy which may allow greater independence for the adolescent and adult with CF. To date, however, there are few published experimental studies in humans using this instrument, and none involving patients with CF.
We undertook a pilot study in nine patients with CF severity grades of excellent to moderate in order to begin to assess the effectiveness of IPV-1 in facilitating mucus production and mobilization as compared with standard aerosol and chest physiotherapy.
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Comparison of Intrapulmonary Percussive Ventilation and Chest Physiotherapy
The management of the pulmonary complications of cystic fibrosis (CF) focuses on the enhancement of mucociliary clearance to optimize gas exchange and minimize infections due to mucostasis. Achieving this end involves the following: (1) removing mucus from the airways with mechanical or manual chest percussion and postural drainage (P&PD) and cough; (2) increasing airway caliber with beta2-adrenergic aerosols; and (3) controlling acute and chronic infection with antibiotic therapy Link buy ampicillin online. Despite these therapies, the inability to adequately expectorate viscous bronchial secretions, especially from the smallest airways, remains a serious problem for persons with CF.
A number of techniques have been developed to mobilize airway secretions, including vigorous cough, the forced expiration technique, the use of a positive expiratory airway pressure (PEP) mask, and exercise-stimulated deep breathing. Although none of these techniques have been shown to have a therapeutic benefit over conventional P&PD, they offer the advantage of increased patient independence, overcoming a significant barrier to compliance. This is especially true for adolescents and adults with CF.
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Synchronized Intermittent Mandatory Ventilation With and Without Pressure Support Ventilation in Weaning Patients With COPD From Mechanical Ventilation: Appendix
This additional burden is not negligible: Katz and coworkers have shown that the respirator (Puritan Benett 7200) induces an additional inspiratory work ranging from 10 to 40 percent. Fiastro and coworkers predicted that a 1-mm decrease in the tube diameter results in a 67 to 100 percent increase in this work. Nevertheless, low PSV level (6 cm H2O or 8 cm H2O) did not-significantly decrease the OCB of our patients.
The only objective benefit of PSV appeared when considering Vc^resp/sVE which represents the oxygen cost per liter of spontaneous ventilation and expresses the efficiency of the ventilation. The Vo2resp/ sVe significantly decreased across the weaning period in group 1 whereas it significantly increased in group 2 (Table 3 and Fig 4). Buy claritin online in detail Pressure support ventilation could improve the efficiency of the ventilation when added to SIMV. As PSV had allowed patients to breathe with larger sVt and lower Sf, the longer expiratory time might have contributed to reduce intrinsic PEEP and accelerated the recovery in lung mechanics. This could explain why sVt remained constant throughout the weaning period despite the degressive PSV levels and the decrease in Vc^resp/sVE. Nevertheless, these suggestions remain speculative as we did not measure the lung mechanics. The interpretation of our results depends to a large extent on the matching of the two groups of patients.
Synchronized Intermittent Mandatory Ventilation With and Without Pressure Support Ventilation in Weaning Patients With COPD From Mechanical Ventilation: Conclusion
Our study reassessed in patients with COPD the previously described effects of PSV on the breathing pattern. For PSV levels >12 cm H2O, group 1 patients exhibited significant lower sVe and Sf with higher sVt than did group 2 patients. However, despite this difference in sVe, there was no difference in blood gas values between the two groups. Moreover, OCB was similar at these steps between groups 1 and 2. If we considered that OCB is the consequence of the inspiratory work, these results are consistent with those of Fleury and coworkers who found a poor correlation of inspiratory work per liter with sVe. High levels of PSV (“PSV max”) have been defined as the pressure sufficient to provide a tidal volume of 10 to 12 ml/kg. At these levels (above 15 cm H2O), nearly all the respiratory work is performed by the respirator and “PSV max” could be compared with conventional assist mode ventilation with an additional pressure limit To wean patients from MV, the “best PSV” level must unload the respiratory muscles without inducing atrophy, and must facilitate reconditioning without inducing diaphragmatic fatigue.