Chronic respiratory disease
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Manual lung hyperinflation (MHI) can enhance secretion clearance, improve total lung/thorax compliance and assist in the resolution of acute atelectasis. To enhance secretion clearance in the intubated patient, the evidence highlights the need to maximize expiratory flow. Chronic pulmonary diseases such as chronic obstructive pulmonary disease (COPD) have often been cited as potential precautions and/or contra-indications to the use of manual lung hyperinflation (MHI). ⋯ MHI may also increase right ventricular after load through raised intrathoracic pressures with lung hyperinflation, and may therefore impair right ventricular function in patients with evidence of cor pulmonale. There is the potential for beneficial effects from MHI in the intubated COPD patient group (i.e., secretion clearance), but further research is required, especially on the effect of MHI on inspiratory and expiratory flow rate profiles in this patient group. The more controlled delivery of lung hyperinflation through the use of the mechanical ventilator may be a more optimal means of providing lung hyperinflation and should be further investigated.
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Comparative Study
Dyspnea as clinical indicator in patients with chronic obstructive pulmonary disease.
The aim of this study was to evaluate the relationship between dyspnea and functional, psychosocial and quality of life parameters among persons with chronic obstructive pulmonary disease (COPD). We conducted a cross-sectional study of 90 stable COPD patients recruited from a specialized respiratory clinic. Dyspnea was measured using the ATS-DLD-78 questionnaire modified dyspnea scale (1-5 scale). ⋯ Based on linear regression, dyspnea scores--but not spirometric values--also correlated with indices of anxiety, depression, and neuroticism. Dyspnea correlated more strongly with HRQL and with indices of anxiety and depression than spirometric values. Although spirometry is often used to evaluate disease severity, dyspnea which is a patient centered outcome better reflect overall disease impact among COPD patients.
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Comparative Study
Improving the sampling technique of arterialized capillary samples to obtain more accurate PaO2 measurements.
Arterialized earlobe capillary blood samples (ELCS) have been used as a measurement of blood gas status for over 20 years. There is general acceptance that there is a strong correlation and limits of agreement between arterial and arterialized blood samples with respect to pH and PaCO2. Although the correlation between the arterial and arterialized PaO2 is good, the limits of agreement poor. ⋯ Repeat ELCS of these 21 samples reduced this discrepancy improving the concordance of the measurements (r = 0.98, mean difference +/- 95% limits of agreement: 0.47 +/- 1.0). In one case a difference of 3% remained between the saturations. We conclude that the addition of simultaneous pulse oximetry with ELCS will identify rogue measurements in about 8% of cases highlighting the need for repeat samples and thus increasing the accuracy of the measurement of PaO2 by ELCS.
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Randomized Controlled Trial
Airway clearance in bronchiectasis: a randomized crossover trial of active cycle of breathing techniques (incorporating postural drainage and vibration) versus test of incremental respiratory endurance.
The purpose of this study was to compare the efficacy of the test of incremental respiratory endurance (TIRE) with active cycle of breathing techniques (ACBT) [incorporating postural drainage (PD) and vibration] as methods of airway clearance in adults with bronchiectasis. ⋯ ACBT (incorporating PD and vibration) is a more effective method of airway clearance in bronchiectasis than TIRE during single treatment sessions.