A B C D E F G H I J K L M N O P Q R S T U V W X Y Z All
Vats, Neeraj
- Extubation Outcome after Spontaneous Breathing Trials with T-tube or Pressure Support Ventilation
Authors
1 Rajiv Gandhi Cancer Institute & Research Center, Sec. 5 Rohini, New Delhi
2 Faculty of Engineering Technology, IN
3 Faculty Of Applied Science, Manav Rachna International University, Faridabad, IN
Source
Indian Journal of Physiotherapy & Occupational Therapy-An International Journal, Vol 6, No 2 (2012), Pagination: 82-84Abstract
A 2-h T-tube trial of spontaneous breathing was used in selecting patients ready for extubation and discontinuation of mechanical ventilation. However, some doubt remains as to whether it is the most appropriate method of performing a spontaneous breathing trial. We carried out a prospective, randomized, study involving patients who had received mechanical ventilation for more than 48 h and who were considered by their physicians to be ready for weaning according to clinical criteria and standard weaning parameters. Patients were randomly assigned to undergo a 2-h trial of spontaneous breathing in one of two ways: with a T-tube system or with pressure support ventilation of 7 cm H2O. If a patient had signs of poor tolerance at any time during the trial, mechanical ventilation was reinstituted. Patients without these features at the end of the trial were extubated. Of the 20 patients assigned to the T-tube group, 15 successfully completed the trial and were extubated; 5 of them required reintubation. Of the 20 patients in the group receiving pressure support venti¬lation, 17 were extubated and 3 of them required reintubation. The percentage of patients failing the trial and ICU mortality was significantly higher when the T-tube was used. Clinical evolution during the trial was not different in patients reintubated and successfully extubated. Spontaneous breathing trials with pressure support or T-tube are suitable methods for successful dis¬continuation of ventilator support in patients without problems to resume spontaneous breathing.Keywords
Pressure Support Ventilation, T-Tube, Extubation Outcome, Spontaneous Breathing Trials
References
- Gandía, F., and J. Blanco. 1992. Evaluation of indexes predicting the outcome of ventilator weaning and value of adding supplemental in spiratory load. Intensive Care Med. 18:327–333.
- Sassoon, C. S. H., and C. K. Mahutte. 1993. Airway occlusion pressure and breathing pattern as predictors of weaning outcome. Am. Rev. Respir. Dis. 148:860–866.
- Mohsenifar, Z., A. Hay, J. Hay, M. I. Lewis, and S. K. Koerner. 1993. Gastric intramural pH as a predictor of success or failure in weaning patients from mechanical ventilation. Ann. Intern. Med. 119:794–798.
- Yang, K., and M. J. Tobin. 1991. A prospective study of indexes predict¬ing outcome of trials of weaning from mechanical ventilation. N. Engl. J. Med. 324:1445–1450.
- Brochard, L., A. Rauss, S. Benito, G. Conti, J. Mancebo, N. Rekik, A. Gaspareto, and F. Lemaire. 1994. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am. J. Respir. Crit. Care Med. 150:896–903.
- Esteban, A., F. Frutos, M. J. Tobin, I. Alia, J. F. Sotsoma, I. Vallverdú, R. Fernández, M. A. dE la Cal, S. Benito, R. Tomás, D. Carriedo, S. Macias, and J. Blanco, for the Spanish Lung Failure Collaborative Group. 1995. A comparison of four methods of weaning patients from mechanical ventilation. N. Engl. J. Med. 332:345–350.
- Fiastro, J. F., M. P. Habib, and S. F. Quan. 1988. Pressure support com¬pensation for inspiratory work due to endotracheal tubes and demand continuous positive airway pressure. Chest 93:499–505.
- Brochard, L., F. Rua, H. Lorino, F. Lemaire, and A. Harf. 1991. In¬spiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube. Anesthesiology 75:739– 745.
- Nathan, S. D., A. M. Ishaaya, S. K. Koerner, and M. J. Belman. 1993. Prediction of minimal pressure support during weaning from mechan¬ical ventilation. Chest 103:1215–1219.
- Le Gall, J. R., S. Lemeshow, and F. Saulnier. 1993. A new simplified acute physiology score (SAPS II) based on a European/North Ameri¬can multicenter study. J.A.M.A. 270:2957–2963.
- Matthews, J. N. S., D. G. Altman, M. J. Campbell, and P. Royston. 1990. Analysis of serial measurements in medical research.B.M.J. 300:230– 235.
- Wright, P. E., J. J. Marini, and G. R. Bernard. 1989. In vitro versus in vivo comparison of endotracheal tube airflow resistances.Am. Rev. Respir. Dis. 140:10–16.
- Shapiro, M., R. K. Wilson, G. Casar, K. Bloom, and R. B. Teague. 1986. Work of breathing through different sized endotracheal tubes. Crit. Care. Med. 14:1028–1031.
- Demers, R. R., M. J. Sullivan, and J. Paliotta. 1977. Air flow resistances of endotracheal tubes (letter). J.A.M.A. 237:1362.
- Ishaaya, A. M., S. D. Nathan, and M. J. Belman. 1995. Work of breath¬ing after extubation. Chest 107:204–209.
- MacIntyre, N. R. 1986. Respiratory function during pressure support ventilation. Chest 89:677–683.
- Brochard, L., F. Pluskwa, and F. Lemaire. 1987. Improved efficacy of spontaneous breathing with inspiratory pressure support.Am. Rev. Respir. Dis. 136:411–415.
- Brochard, L., A. Harf, H. Lorino, and F. Lemaire. 1989. Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. Am. Rev. Respir. Dis. 139:513–521.
- Tobin, M. J., W. Perez, S. M. Guenther, B. J. Semmes, M. J. Mador, S. J. Allen, R. F. Lodato, and D. R. Dantzker. 1986. The pattern of breath¬ing during successful and unsuccessful trials of weaning from mechan¬ical ventilation. Am. Rev. Respir. Dis. 134:1111–1118.
- Lemaire, F., J. L. Teboul, L. Cinotti, G. Giotto, F. Abrouk, G. Steg, I. Macquin-Mavier, and W. M. Zapol. 1988. Acute left ventricular dys¬function during unsuccessful weaning from mechanical ventilation. Anesthesiology 69:171–179.
- Cooper, K. R., and B. A. Phillips. 1982. Effect of short-term sleep loss on breathing. J. Appl. Physiol. 53:855–858.
- Pavlin, E. G., R. H. Holle, and R. B. Schoene. 1989. Recovery of airway protection compared with ventilation in humans after paralysis with curare. Anesthesiology 70:381– 385.
- Effect of Deep Breathing Exercises and Incentive Spirometry in the Prevention of Post Operative Pulmonary Complications in the Patients of Cancer Esophagus undergoing Esophagectomy
Authors
1 Physiotherapist, Rajiv Gandhi Cancer Institute & Research Centre, Sec.- 5, Rohini, New Delhi 110 085, IN
Source
Indian Journal of Physiotherapy & Occupational Therapy-An International Journal, Vol 3, No 3 (2009), Pagination: 60-67Abstract
PurposeThe purpose of this study was 1) to evaluate the efficacy of deep breathing exercises over no chest physiotherapy 2) to evaluate the efficacy of incentive spirometry over no chest physiotherapy 3) to evaluate the efficacy of deep breathing exercises over incentive spirometry.
Inclusion criteria
Both sexes i.e. male&female were included in the study. Adults undergoing any type of esophagectomy for carcinoma of esophagus were also included because this population of adults represents with similar probable mechanisms for the development of pulmonary complications i.e. above the age of 18 years. Middle aged people& old people were also included in the study because they are more prone to develop post operative pulmonary complications after anesthesia.
Patients who gave their written consent for conducting this study on them. Patients who were not referred for physiotherapy even after esophagectomy were included in control group.
Only those patients who were assessed&examined preoperatively&for the initial 5 post operative days were included. Cooperative patients who followed the given instructions (such as the use of I.S.) properly.
Methods
Three groups of patients were made keeping 10 patients in each group. Group 1 patients were given deep breathing exercises manually, group 2 patients were asked to do incentive spirometry only& group 3 was control group. Deep breathing exercises were given in lying position with the head end of bed raised to 30-40 degrees. Incentive spirometry was given in sitting position with foot supported. The study was conducted in the post surgical unit of Rajiv Gandhi Cancer Institute&Research Center Sector 5 Rohini New Delhi -85 (India). Chest expansions at axilla, nipple&xiphisternum, Single breath count, Peak expiratory flow rate&oxygen saturation were the dependant variables.
Results
It was found that deep breathing exercise and Incentive spirometry are more effective than no chest physiotherapy. The results of the study further suggests that comparison of the two modalities i.e. Incentive spirometry&deep breathing exercises revealed no stastically significant difference among them.
Conclusion
The results of the study concluded that deep breathing exercises& incentive spiromety should be recommended as treatment modalities in the prevention of post operative pulmonary complications in the patients of carcinoma esophagus undergoing esophagectomy.More studies with greater sample population are required for the generalization of the results.
References
- Williams Marie T et al. Chest physiotherapy and cystic fibrosis. Chest 106: 1872-1882; 1994.
- Crowe M. Jean, Bradley Christine et al. Effectiveness of incentive spirometry with physical therapy for patients after coronary artery bypass surgery. Physical therapy. 77: 260-268; 1997.
- Stratton Steven A, Smith Martha et al. Effect of transcutaneous electrical nerve stimulator on forced vital capacity. Physical Therapy. 60: 45-47; 1980.
- Dull Jan, Dull L. William et al. Is maximal inspiratory breathing exercise or incentive spirometry better than early mobilization after cardiopulmonary bypass. Physical therapy. 63: 655-659; 1983.
- Dureuil Bertrand, Viires Naima, Cantineau JP, Aubier Michel & Desmonts JM et al. Diaphragmatic contractility after upper abdominal surgery. American Jr. 1773-1780; 1986.
- Bartlett RH, Gazzaniga AB, Geraghty T.R. et al. Respiratory maneuvers to prevent postoperative pulmonary complications. JAMA. 224: 1017-1021; 1973.
- Mcconnell D.H, Maloney DJ, BuckBerg DG. Postoperative intermittent positive pressure breathing treatment physiologic considerations. J Thorac. Cardio Vascular surgery 68: 944-52; 1974.]
- Bartlett RH, Hauson EL, Moore FD. Physiology of yawning and its application to postoperative care. Surg forum 21: 222-275; 1970.
- Sagher F. A., Roushdy M.A., Hweta A.M. Peak expiratory flow rate nomogram in Libian school childs. Chest. 5: 1-3; 1999.
- Chattergee C. C. Textbook of human physiology. 10th Edition 1991. Sehgal publications chapter 3. Physiology of oxygen saturation. 389-390.
- Kisner Carolyn & Colby Lynn Allen. Textbook of therapeutic exercise, foundation & techniques. 3rd Edition 1996. Jaypee Brothers medical publications New Delhi. Chest physical therapy chapter 19. 665-680.
- Bayer R, Wilkinson D.Directly observed therapy for Tuberculosis. History of an idea. Lancet 345:1545-1548;1995
- Baxter W.D., Williams RHP and Levine R.S. The evaluation of the incentive spirometer in the prevention of postoperative pulmonary complications. British Jr. surgery 98: 389-392; 1971.
- Cordell A. Robert & Ellison G. Robert. Textbook of complication of intra thoracic surgery. 1st Edition 1979. Little brown & company Boston. Joseph W. Rubin’s Chylothorax complicating intrathoracic operations. 359-361
- Coon W.W. and Coller F.A. clinicopathalogic correlation in thromboembolism. Surgery Gynecol. Obstet. 109: 259; 1959.
- Dohi Suji, Gold martin et al. Comparison of two methods of postoperative respiratory care. Chest. 73: 592-601; 1978.
- Ford G T, Guenter C A. et al. Towards Prevention of Postoperative Pulmonary Complications A M. Rev. Respir Dis 130: 4-5; 1984.
- Davidson Stanley, Crompton G.K, Haslett’s Textbook of principals & practice of medicine. Disease of respiratory system. Ed; 17: 326-328; 1995.
- Iverson LIG, Ecker RR, FOX HE, May IA. A comparative study of intermittent positive pressure breathing, the incentive spirometer and blow bottles: the prevention of atelectasis following cardiac surgery. Ann Thoracic surgery 25: 197-200; 1978.
- Jung Ralph, James Wight, Leonard Rosoff, Nurser Richard et al. Comparision of three methods of respiratory care following upper abdominal surgery. Chest. 78: 31-35; 1980.