Chest Physiotherapy for Mechanically Ventilated Children: A Systematic Review

2021 ◽  
Author(s):  
Emma Shkurka ◽  
Jo Wray ◽  
Mark Peters ◽  
Harriet Shannon
Keyword(s):  
Systematic Review ◽  
Tidal Volume ◽  
Clinical Importance ◽  
Pediatric Intensive Care ◽  
Chest Physiotherapy ◽  
Mechanically Ventilated ◽  
Sustained Change ◽  
Clinically Significant ◽  
Critical Appraisal Skills ◽  
The Impact

AbstractThe aim of this study was to appraise and summarize the effects of chest physiotherapy in mechanically ventilated children. A systematic review was completed by searching Medline, Embase, Cinahl Plus, PEDro, and Web of Science from inception to February 9, 2021. Studies investigating chest physiotherapy for mechanically ventilated children (0–18 years), in a pediatric intensive care unit were included. Chest physiotherapy was defined as any intervention performed by a qualified physiotherapist. Measurements of effectiveness and safety were included. Exclusion criteria included preterm infants, children requiring noninvasive ventilation, and those in a nonacute setting. Thirteen studies met the inclusion criteria: two randomized controlled trials, three randomized crossover trials, and eight observational studies. The Cochrane risk of bias and the Critical Appraisal Skills Program tools were used for quality assessment. Oxygen saturations decreased after physiotherapy involving manual hyperinflations (MHI) and chest wall vibrations (CWV). Although statistically significant, these results were not of clinical importance. In contrast, oxygen saturations improved after the expiratory flow increase technique; however, this was not clinically significant. An increase in expiratory tidal volume was demonstrated 30 minutes after MHI and CWV. There was no sustained change in tidal volume following a physiotherapy-led recruitment maneuver. Respiratory compliance and dead-space increased immediately after MHI and CWV. Atelectasis scores improved following intrapulmonary percussive ventilation, and MHI and CWV. Evidence to support chest physiotherapy in ventilated children remains inconclusive. There are few high-quality studies, with heterogeneity in interventions and populations. Future studies are required to investigate multiple physiotherapy interventions and the impact on long-term outcomes.

scholarly journals Does the Use of Positive End Expiratory Pressure (PEEP) During Surgery Decrease Respiratory Complications Twenty-Four Hours Post Operative?

2016 ◽  
Author(s):  
Malgorzata Majewski
Keyword(s):  
Systematic Review ◽  
Research Question ◽  
Pulmonary Complications ◽  
Nurse Anesthetists ◽  
Flow Diagram ◽  
Positive End Expiratory Pressure ◽  
Respiratory Complications ◽  
Critical Appraisal Skills ◽  
Randomised Controlled ◽  
The Impact

<p>General anesthesia can lead to pulmonary compromise during surgery. Nurse anesthetists in the operating room are responsible for minimizing pulmonary complications while managing ventilation through mechanical ventilation. Positive end-expiratory pressure (PEEP) can be used to improve oxygenation, prevent airway collapse and facilitate expansion of alveoli during each breath. Yet the use of PEEP varies among clinicians, as supported by the literature. The goal of this systematic review was to evaluate the impact of PEEP intra-operatively on selected respiratory outcomes. The research question was: Does the use of positive end expiratory pressure (PEEP) during surgery decrease respiratory complications 24 hours post-operative? This review was guided by the Preferred Reporting Items for Systematic Review (PRISMA) flow diagram and checklist. Within study quality was assessed with The Critical Appraisal Skills Programme (CASP) Randomised Controlled Trials Checklist and Popay’s guidelines were followed for a narrative cross study synthesis. Seven studies were included in this systematic review. Results demonstrated less impaired gas exchange with higher PEEP and overall respiratory compliance was greater in subjects who were managed with PEEP. Most PEEP groups demonstrated less pulmonary infiltrates post operatively as well as less atelectasis and pleural effusions. Using PEEP intra-operatively generated higher oxygen saturation post-operatively and fewer patients who received PEEP needed 100% oxygen in the recovery unit. This review yielded evidence related to the intraoperative use of PEEP that nurse anesthetists may use to guide their anesthesia practice.</p>

scholarly journals Rheumatic Fever Associated with Antiphospholipid Syndrome: Systematic Review

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Felipe da Silva ◽  
Jozélio de Carvalho
Keyword(s):  
Systematic Review ◽  
Differential Diagnosis ◽  
Rheumatic Fever ◽  
Antiphospholipid Syndrome ◽  
Clinical Presentation ◽  
Clinical Importance ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Clinical Associations ◽  
The Impact

Objective. To evaluate the clinical associations between rheumatic fever and antiphospholipid syndrome and the impact of coexistence of these two diseases in an individual.Methods. Systematic review in electronics databases, regarding the period from 1983 to 2012. The keywords: “Rheumatic Fever,” “Antiphospholipid Syndrome,” and “Antiphospholipid Antibody Syndrome” are used.Results. were identified 11 cases described in the literature about the association of rheumatic fever and antiphospholipid syndrome. Clinical presentation of rheumatic fever was characterized by the predominance of carditis (11/11) and chorea (7/11). Regarding the manifestations of APS, the stroke was observed in 7/11 (63.6%), with one of them having probable embolic origin.Conclusion. The present study brings the information that the association between APS and RF is quite rare, however, is of great clinical importance. Doctors who deal with the RF should include in their differential diagnosis the APS, especially in the presence of stroke in patients with RF and whose echocardiogram does not show intracavitary thrombi.

scholarly journals Comparison of ventilation parameters and blood gas analysis in mechanically-ventilated children who received chest physiotherapy and suctioning vs. suctioning alone

2017 ◽  
Vol 56 (5) ◽  
pp. 285
Author(s):  
Monalisa Elizabeth ◽  
Chairul Yoel ◽  
Muhammad Ali ◽  
M. Sjabroeddin Loebis ◽  
Hasanul Arifin ◽  
...  
Keyword(s):  
Pediatric Intensive Care ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Chest Physiotherapy ◽  
Blood Gas ◽  
Mechanically Ventilated ◽  
Airway Clearance ◽  
Blood Gas Analyses ◽  
Age Range ◽  
Single Blind

Background Chest physiotherapy and suctioning are routine methods for airway clearance in mechanically-ventilated children. However, chest physiotherapy has not been confirmed to affect ventilation parameters, such as tidal volume (TV), peak inflation pressure (PIP), peak inspiratory flow (PIF), and peak expiratory flow (PEF), as well as blood gas analysis (BGA) values in pediatric intensive care unit (PICU) patients.Objective To determine the efficacy of chest physiotherapy and suctioning vs. suctioning alone for improving the mechanical ventilation parameters and BGA.Methods This randomized, single-blind, clinical trial was conducted from November 2012 to June 2013 in the PICU at Haji Adam Malik Hospital, Medan. A total of 40 mechanically-ventilated pediatric patients were enrolled and divided into either the chest physiotherapy and suctioning group (24 subjects) or the suctioning alone group (16 subjects). Subjects underwent treatment, followed by monitoring of their ventilation parameters and blood gas analyses. Data were analyzed by independent t-test and Mann-Whitney test.Results Subjects comprised of 23 boys and 17 girls, with an age range of 1–204 months. After the respective treatments (chest physiotherapy and suctioning vs. suctioning alone), the ventilation parameters were as follows: median TV (60.0 vs. 56.5 mL, respectively; P=0.838), median PEF (10.4 vs. 10.8 I/s, respectively; P=0.838), median PIF (7.4 vs. 8.2 I/s, respectively; P=0.469), and mean PIP (17.3 vs. 15.6 cmH2O, respectively; P=0.23). The BGA values were: median pH (7.4 vs. 7.3, respectively; P=0.838), median pCO2 (38.4 vs. 36.2 mmHg, respectively; P=1.000), mean pO2 (136.6 vs. 139.2 mmHg, respectively; P=0.834), median HCO3 (20.4 vs. 22.7 mmol/L, respectively; P=0.594), median TCO2 (22.0 vs. 23.7 mmol/L, respectively; P=0.672), mean BE (-4.3 vs. -3.1 mmol/L, respectively; P=0.629), and median O2 saturation  (98.5 vs. 98.3 %, respectively; P=0.967).Conclusion In mechanically-ventilated children in the PICU, ventilation parameters and BGA values are not significantly different between subjects who received both chest physiotherapy and suctioning and those who received suctioning alone.

scholarly journals Tidal Volume in Pediatric Ventilation: Do You Get What You See?

2021 ◽  
Vol 11 (1) ◽  
pp. 98
Author(s):  
Erik Koomen ◽  
Joppe Nijman ◽  
Ben Nieuwenstein ◽  
Teus Kappen
Keyword(s):  
Tidal Volume ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Pediatric Intensive Care ◽  
Clinical Decision ◽  
Lung Protective Ventilation ◽  
Mechanical Ventilators ◽  
Technical Factors ◽  
Clinically Significant ◽  
The University

Mechanical ventilators are increasingly evolving into computer-driven devices. These technical advancements have impact on clinical decisions in pediatric intensive care units (PICUs). A good understanding of the design of mechanical ventilators can improve clinical care. Tidal volume (TV) is one of the corner stones of ventilation: multiple technical factors influence the TV and, thus, influence clinical decision making. Ventilator manufacturers make various design choices regarding the phase, site and conditions of TV measurement as well as algorithmic processing choices. Such choice may impact the measurement and subsequent display of TV. A software change of the TV measuring algorithm of the SERVO-i® (Getinge, Solna, Sweden) at the PICU of the University Medical Centre Utrecht was studied in a prospective cohort. It showed, as example, a clinically significant impact of 8% difference in reported TV. Design choices in both the hardware and software of mechanical ventilators can have a clinically relevant impact on the measurement of tidal volume. In our search for the optimal TV for lung-protective ventilation, such choices should be taken into account.

scholarly journals Impact of Motivational Interviewing by Social Workers on Service Users: A Systematic Review

2019 ◽  
Vol 29 (8) ◽  
pp. 863-875 ◽  
Author(s):  
Sally Boyle ◽  
Jitka Vseteckova ◽  
Martyn Higgins
Keyword(s):  
Systematic Review ◽  
Motivational Interviewing ◽  
Social Workers ◽  
Service User ◽  
Service Users ◽  
Ongoing Training ◽  
Critical Appraisal Skills ◽  
The Impact ◽  
Positive Effect ◽  
Synthesis Approach

Purpose:This systematic review was undertaken to determine the effectiveness of motivational interviewing (MI), by social workers, on service user outcomes.Methods:A literature search was undertaken between 2007 and 2018. All eligible studies were analyzed using the Critical Appraisal Skills Programme tool. As heterogeneity was high, a narrative synthesis approach was employed, using thematic analysis for categorizing data.Results:Eleven studies met the inclusion criteria and were included in this review. MI had a positive effect on service user experience, but this was not consistent. Training was variable, but the evidence suggests that practitioner’s need ongoing training, supervision, or coaching while providing MI.Discussion:There is a paucity of research examining the impact of MI on children, which was a limitation of this review. There is a need for more qualitative research to surface views and experience of service users to determine why MI is effective.

scholarly journals Under-triage of older trauma patients in prehospital care: a systematic review

2021 ◽  
Author(s):  
Abdullah Alshibani ◽  
Meshal Alharbi ◽  
Simon Conroy
Keyword(s):  
Systematic Review ◽  
Older Patients ◽  
Prehospital Care ◽  
Trauma Patients ◽  
Inclusion Criteria ◽  
Prehospital Triage ◽  
Index Terms ◽  
Critical Appraisal Skills ◽  
The Impact ◽  
Triage Decisions

Abstract Background It is argued that many older trauma patients are under-triaged in prehospital care which may adversely affect their outcomes. This systematic review aimed to assess prehospital under-triage rates for older trauma patients, the accuracy of the triage criteria, and the impact of prehospital triage decisions on outcomes. Methods A computerised literature search using MEDLINE, Scopus, and CINHAL databases was conducted for studies published between 1966 and 2021 using a list of predetermined index terms and their associated alternatives. Studies which met the inclusion criteria were included and critiqued using the Critical Appraisal Skills Programme tool. Due to the heterogeneity of the included studies, narrative synthesis was used in this systematic review. Results Of the 280 identified studies, 23 met the inclusion criteria. Current trauma triage guidelines have poor sensitivity to identify major trauma and the need for TC care for older adults. Although modified triage tools for this population have improved sensitivity, they showed significantly decreased specificity or were not applied to all older people. The issue of low rates of TC transport for positively triaged older patients is not well understood. Furthermore, the benefits of TC treatment for older patients remain uncertain. Conclusions This systematic review showed that under-triage is an ongoing issue for older trauma patients in prehospital care and its impact on their outcomes is still uncertain. Further high-quality prospective research is needed to assess the accuracy of prehospital triage criteria, the factors other than the triage criteria that affect transport decisions, and the impact of under-triage on outcomes.

scholarly journals Efficacy of vitamin C supplementation as an adjunct in the non-surgical management of periodontitis: a systematic review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hytham N. Fageeh ◽  
Hammam I. Fageeh ◽  
Ashwin Prabhu ◽  
Shilpa Bhandi ◽  
Shahrukh Khan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vitamin C ◽  
Primary Treatment ◽  
Periodontal Therapy ◽  
Cochrane Library ◽  
Synthesis Methods ◽  
Eligibility Criteria ◽  
Vitamin C Supplementation ◽  
Clinically Significant ◽  
Critical Appraisal Skills

Abstract Background and objective The antioxidant potential of vitamin C is useful in reducing oxidative stress, free radicals, and reactive oxygen species, which may assist in the improved outcomes of periodontal therapy. This systematic review was aimed to evaluate the effectiveness of vitamin C supplementation as an adjunct to non-surgical periodontal therapy, in the management of periodontitis. Data sources PubMed, EMBASE, Cochrane Library, and Web of Science. Study eligibility criteria Randomized controlled trials published between January 1990 and March 2020. Participants People 18 years and older with periodontitis. Study appraisal and synthesis methods The Critical Appraisal Skills Programme (CASP) quality appraisal tool. Results The initial search yielded 441 articles out of which six studies fulfilled the inclusion criteria. Vitamin C supplementation helped improve bleeding indices in gingivitis but did not significantly lead to reduction of probing depths or clinical attachment gain for periodontitis. Conclusion Administration of vitamin C as an adjunct to non-surgical periodontal therapy did not result in clinically significant improvements in pocket probing depths at 3 months in periodontitis patients. With the limited evidence available, no recommendation can be made for supplementation of vitamin C in conjunction with initial periodontal therapy for subjects with periodontitis to improve primary treatment outcome measures.

scholarly journals What Will Be the Impact of the COVID-19 Quarantine on Psychological Distress? Considerations Based on a Systematic Review of Pandemic Outbreaks

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 101
Author(s):  
Marco Cavicchioli ◽  
Roberta Ferrucci ◽  
Matteo Guidetti ◽  
Maria Paola Canevini ◽  
Gabriella Pravettoni ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Psychological Distress ◽  
Evidence Based ◽  
The Novel ◽  
Ptsd Symptoms ◽  
Clinically Significant ◽  
Novel Coronavirus ◽  
Restrictive Measures ◽  
The Impact

Background: The novel coronavirus (SARS-CoV-2) and related syndrome (COVID-19) has led to worldwide measures with severe consequences for millions of people. In the light of the psychopathological consequences of restrictive measures detected during previous outbreaks, a systematic review was carried out to provide an evidence-based assessment of possible effects of the current COVID-19 quarantine on mental health. Methods: This review included studies that assessed mental health indexes (e.g., overall psychological distress, depressive and PTSD symptoms) during and after quarantine periods adopted to management different outbreaks (e.g., COVID-19, SARS, MERS). Results: Twenty-one independent studies were included for a total of 82,312 subjects. At least 20% of people exposed to restrictive measures for the management of pandemic infections reported clinically significant levels of psychological distress, especially PTSD (21%) and depressive (22.69%) symptoms. Overall, original studies highlighted relevant methodological limitations. Conclusions: Nowadays, almost one out of every five people is at risk of development of clinically significant psychological distress. Further research on mental health after the current COVID-19 quarantine measures is warranted.

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