Đánh giá hiệu quả phục hồi chức năng hô hấp trên bệnh nhân Covid-19

2022 ◽  
Author(s):  
Huu Son Nguyen
Keyword(s):  
Care Center ◽  
Underlying Disease ◽  
Rehabilitation Program ◽  
Test Results ◽  
Cross Sectional ◽  
Life Scale ◽  
Independent Life ◽  
Rehabilitation Exercises ◽  
Respiratory Rehabilitation ◽  
Main Factor

TÓM TẮT Đặt vấn đề: Bệnh nhân Covid-19 cần kết hợp nhiều phương pháp điều trị trong có phục hồi chức năng hô hấp. Nghiên cứu này giúp đánh giá hiệu quả của Chương trình Phục hồi chức năng (PHCN) hô hấp ở bệnh nhân Covid-19 nặng và nguy kịch. Đối tượng và phương pháp: Nghiên cứu tiến cứu trên mẫu thuận tiện gồm 65 bệnh nhân được chẩn đoán Viêm phổi do Covid-19 mức độ nặng, nguy kịch được điều trị cải thiện tại Trung tâm Hồi sức Tích cực Bệnh viện Trung Ương Huế tại TP Hồ Chí Minh. Đánh giá lại khả năng hồi phục của bệnh nhân sau 1 tuần dựa trên chỉ số SpO2, thang điểm khó thở Borg và thang điểm độc lập sinh hoạt Barthel. So sánh hiệu quả hồi phục chức năng hô hấp chọn kiểm định tổng hạng Wilcoxon. Kết quả: Tuổi nhỏ nhất là 19 tuổi, lớn nhất là 93 tuổi, nhóm bệnh có độ tuổi 50 - 59 chiếm tỷ lệ nhiều nhất, chiếm 29.2 %. Tỷ lệ mắc bệnh ở nữ lớn hơn nam (tương ứng 56,9% và 43,1%). Thời gian đang nằm viện ngắn nhất là 6 ngày, dài nhất là 47 ngày. Các bệnh nhân được tiến hành tập PHCN hô hấp ngay từ đầu khi mới vào viện và suốt quá trình bệnh nằm viện. Tăng huyết áp là yếu tố bệnh nền hay gặp nhất chiếm 61,8%. Các biện pháp hỗ trợ thông khí hay liệu pháp oxy thì sử dụng mask cannula là chủ yếu chiếm 96,5%. SpO2 tăng 98% (95,5 - 99%) lên 99% (97 - 100%) có ý nghĩa thống kê với p < 0.05. Thang điểm khó thở Borg giảm từ 2 (1 - 4) xuống 1 (0,5 - 2) có ý nghĩa thống kê với p < 0,05. Thang điểm độc lập chức năng sinh hoạt Barthel tăng từ 80 (67,5 - 100) lên 100 (80 - 100), có ý nghĩa thống kê với p < 0,05. Kết luận: Chương trình phục hồi chức năng hô hấp góp phần thúc đẩy sự hồi phục của bệnh nhân Covid-19. ABSTRACT EFFECTIVENESS OF PULMONARY REHABILITATION IN COVID-19 PATIENTS Background: Covid-19 patients need a combination of treatment methods, including respiratory rehabilitation. This study aims to evaluate the effectiveness of the Respiratory Rehabilitation Program in Covid-19 patients. Methods: A cross - sectional descriptivestudy was carried out in 65 patients with severe and critical Covid-19 pneumonia who were receiving improved treatments at the Intensive Care Center of Hue Central Hospital in Ho Chi Minh City. The patient’s ability to recover after one week was re - evaluated based on SpO2 index, Borg dyspnea scale and Barthel’s independent life scale. The effectiveness of respiratory rehabilitation was compared using the Wilcoxon sum test. Results: The age ranged from 19 to 93 years. The age group from 50 to 59 years old was made up the largest proportion, accounting for 29.2%. The prevalence was higher in women than men (56.9% vs. 43.1%, respectively). The shortest hospital stay was six days, and the longest was 47 days. The patients experienced respiratory rehabilitation exercises from the beginning when they were admitted to the hospital and throughout their stay. Hypertension was the most common underlying disease factor, accounting for 61.8%. Ventilation support measured or oxygen therapy using mask cannula is the main factor accounting for 96.5%. SpO2 statistically increased from 98% (95.5 - 99%) to 99% (97 - 100%) (p < 0.05). The Borg dyspnea scale statistically decreased from 2 (1 - 4) to 1 (0.5 - 2) (p < 0.05). Barthel’s independent functional - life scale statistically increased from 80 (67,5 - 100) to 100 (80 - 100) (p < 0.05). Conclusion: Respiratory rehabilitation program contributes to the recovery of Covid-19 patients Keywords: Respiratory, rehabilitation, Covid-19.

scholarly journals EFFECT OF ENTERIC OXYGEN THERAPY ON HELICOBACTERIOSIS IN THE REHABILITATION OF CHILDREN WITH CHRONIC GASTRODUODENAL PATHOLOGY

2018 ◽  
Vol 63 (4) ◽  
pp. 69-72
Author(s):  
Sh. T. Turdieva
Keyword(s):  
Breath Test ◽  
Oxygen Therapy ◽  
Standard Treatment ◽  
Eradication Therapy ◽  
Underlying Disease ◽  
Rehabilitation Program ◽  
Test Results ◽  
Treatment Need ◽  
Comprehensive Rehabilitation

The purpose of the study was to investigate the effect of enteric oxygen therapy on helicobacteriosis in the rehabilitation of children with chronic gastroduodenal pathology. 286 children and adolescents aged from 6 to 15 years with chronic gastritis, duodenitis, gastroduodenitis, gastric ulcer and duodenal ulcer were examined. To study the effectiveness of  the recommended rehabilitation program, all patients were also divided into two rehabilitation groups, identical in age and clinical forms of the underlying disease. Determination of Helicobacter pylori (Hp-carrier) was performed using the breath test.Studies have shown that after the conventional course of eradication therapy, helicobacteriosis reduced to an average of 23.6%, but was not completely cured, or reinfection was observed. After primary rehabilitation, enteric oxygen therapy in combination with a prophylactic course of eradication therapy, a decrease in the Hp-carrier ratio on average by 14.3% was observed.It was concluded that patients with chronic gastroduodenal pathology after a course of standard treatment need rehabilitation therapy. After a comprehensive rehabilitation program there was observed a significant reduction in Hp-carrier up to 5 times, on the background of an improvement of laboratory and endoscopic test results. 

The German Version of the Satisfaction With Life Scale (SWLS)

2011 ◽  
Vol 27 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Heide Glaesmer ◽  
Gesine Grande ◽  
Elmar Braehler ◽  
Marcus Roth
Keyword(s):  
Convergent Validity ◽  
Satisfaction With Life ◽  
Age Groups ◽  
Population Based ◽  
Factorial Invariance ◽  
Satisfaction With Life Scale ◽  
Small Samples ◽  
Cross Sectional ◽  
Confirmatory Factor Analyses ◽  
Life Scale

The Satisfaction with Life Scale (SWLS) is the most commonly used measure for life satisfaction. Although there are numerous studies confirming factorial validity, most studies on dimensionality are based on small samples. A controversial debate continues on the factorial invariance across different subgroups. The present study aimed to test psychometric properties, factorial structure, factorial invariance across age and gender, and to deliver population-based norms for the German general population from a large cross-sectional sample of 2519 subjects. Confirmatory factor analyses supported that the scale is one-factorial, even though indications of inhomogeneity of the scale have been detected. Both findings show invariance across the seven age groups and both genders. As indicators of the convergent validity, a positive correlation with social support and negative correlation with depressiveness was shown. Population-based norms are provided to support the application in the context of individual diagnostics.

Clinical features and outcome of acquired haemophilia A

2010 ◽  
Vol 30 (03) ◽  
pp. 156-161 ◽  
Author(s):  
R. Gheisari ◽  
B. Bomke ◽  
T. Hoffmann ◽  
R. E. Scharf
Keyword(s):  
Respiratory Diseases ◽  
Care Center ◽  
Treatment Algorithm ◽  
Early Death ◽  
Underlying Disease ◽  
Pulmonary Sarcoidosis ◽  
Relative Increase ◽  
Laboratory Evaluation ◽  
Haemophilia A ◽  
Acquired Haemophilia

SummaryWe have performed a monocenter study on 29 consecutive patients with acquired haemophilia A who were referred for diagnosis and treatment to the Düsseldorf Haemophilia Comprehensive Care Center between March 2001 and February 2010. Patients, methods: 18 men (age: 44–86 years) and 11 women (age: 20–83 years). For laboratory evaluation, a standardized staged protocol of aPTT, FVIII : C activity and concentration, mixing studies with patient and normal plasma, and quantification of inhibitor titers (Bethesda assay) was used. Diagnostic work-up included elaborate examinations for any underlying disease. Results: In 18 (62%) of the 29 patients with acquired haemophilia A, an underlying disorder was identified, including 9 patients with respiratory diseases (31%), 7 patients with autoimmune disorders (24%), one with malignancy, and one with postpartum state, while in 11 patients (38%) acquired haemophilia A remained idiopathic. Haemotherapy of bleeding, suppression or elimination of the inhibitor, and induction of immunotolerance to endogenous FVIII:C were performed according to a treatment algorithm. Predefined clinical endpoints were control of bleeding, eradication of the inhibitor, complete or partial remission (CR, PR), relapse, or early death (≤30 days). Of the 29 patients in total, 22 individuals achieved CR (76%), three had PR, one relapsed, and three died within 30 days (one of acute myocardial infarction while on anti-haemorrhagic treatment, one of sepsis while on immunosuppression due to active acquired haemophilia A, one of lung bleeding in association with pre-existing pulmonary sarcoidosis). Conclusion: This monocenter study demonstrates that control of life-threatening bleeding, eradication of the inhibitor, and induction of tolerance to endogenous FVIII have significantly improved the clinical outcome of acquired haemophilia A. Our data also suggest a shift in underlying disorders associated with acquired haemophilia A, whereby, in comparison to published studies, a relative increase in the proportion of patients with respiratory diseases is present.

FAKTOR PERSONAL YANG BERHUBUNGAN DENGAN KOMITMEN ORGANISASI PERAWAT RSUD EMBUNG FATIMAH BATAM

2020 ◽  
Vol 5 (3) ◽  
pp. 875
Author(s):  
Asfri Sri Rahmadeni
Keyword(s):  
Organizational Commitment ◽  
Turnover Rate ◽  
Sampling Technique ◽  
Hospital Nurses ◽  
Test Results ◽  
Personal Factors ◽  
High Turnover ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test

<p class="Normal1"><em>Commitment is the attitude or behavior of likes or dislikes shown by someone against the organization at work. Indonesia is recorded as a nurse who has a low organizational commitment (76%) so it harms services. This phenomenon in the hospital can be seen from the indicator of the high turnover rate of nurses which reaches 30.9% which exceeds the standard &lt;5%. Many factors affect organizational commitment. The purpose of this study was to analyze the Personal Factors Associated with Organizational Commitment of Hospital Nurses. This study is a cross-sectional analytic study and purposive sampling technique with a sample of 59 nurses. Chi-Square test results obtained personal factors that have a relationship with organizational commitment Nurse Hospital is age with p = 0,000 and education with p = 0,000, personal factors not related to organizational commitment are gender p = 1,053 and years of service with p = 1,147. Hospitals should conduct research/surveys on Organizational Commitment periodically as an evaluation material in the context of the organization's development and development in the future</em>.</p>

Faktor yang Berhubungan dengan Penggunaan Partograf dalam Persalinan oleh Bidan Praktik Mandiri

2020 ◽  
Vol 2 (2) ◽  
pp. 72-80
Author(s):  
Niluh Nita Silfia
Keyword(s):  
Total Population ◽  
Sampling Technique ◽  
Population Data ◽  
Statistical Test ◽  
Influential Factor ◽  
Test Results ◽  
Cross Sectional ◽  
Factors Associated ◽  
Survey Results ◽  
Research Criteria

Partographs are guidelines for childbirth observations that will facilitate labor assistants in first identifying emergency cases and complications for mothers and fetuses. Preliminary survey at the Sigi Community Health Sub-Center (Pustu) of the 8 Pustu midwives found two midwives (25%) to complete a complete partograph, six midwives (75%) incomplete. The purpose of this study was to determine the determinant factors associated with the use of partographs in labor. The design of this study used observational analytic methods with a cross-sectional approach. 24 BPM survey results were obtained with 30 samples of midwives who met the research criteria and data completeness. The sampling technique was by the total population. Data analysis used logistic regression. The multivariate analysis results showed that APN training was the most influential factor in the use of partographs in labor by midwives. Statistical test results obtained a POR value of 37.7 (95% CI 12.1 - 60.2). This study suggests that midwives must have APN certificates to be valid in providing services.

HUBUNGAN UMUR DAN PARITAS DENGAN PEMILIHAN ALAT KONTRASEPSI METODE OPERASI WANITA (MOW) DI POLIKLINIK KEBIDANAN RS BHAYANGKARA PALEMBANG TAHUN 2012

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Y. Widyastuti Y. Widyastuti
Keyword(s):  
Family Planning ◽  
Medical Records ◽  
Test Results ◽  
Family Planning Services ◽  
Chi Square ◽  
Cross Sectional ◽  
Planning Methods ◽  
Chi Square Test ◽  
Family Planning Methods ◽  
Selection Of

  ABSTRACT [In advanced countries the number of permanent contraception option ( kontap ) approximately 10 % of all national family planning methods , while in Indonesia reached approximately 5.7 % . Based on data obtained from medical records Bhayangkara Hospital Palembang in 2010 the number of achievement when seen from the percentage of contraceptive use is only 9.10 % The purpose of this study is known age and parity relationship with the selection of contraceptive methods Surgery Women ( MOW ) in Palembang RS.Bhayangkara obstetrics clinic in 2012 . This study uses the analytic survey with cross sectional approach . The population in this study were women who become new acceptors were recorded in medical records at the hospital . Palembang Bhayangkara Hospitals January 1, 2012 to December 31 in 2012 . The sample in this study is part of a whole number of new acceptors ( either using contraception methods MOW and other family planning methods ) were registered in the hospital . Palembang Police Hospitals of January 1, 2012 to December 31 years of data 2012.Analisa univariate and bivariate statistical Chi - Square test with significance level α = 0.05 . The results showed there were 80 respondents ( 46.3 % ) who became MOW contraceptive acceptors , acceptors who have old age by 45 respondents ( 56.3 % ) and who has a young age by 35 respondents ( 43.8 % ) . acceptors which have high parity were 44 respondents ( 55 % ) who had low parity and a total of 36 respondents ( 45 % ) . From the results of Chi-square test value obtained ρ = 0.00 is smaller than α = 0.05 . There is a significant correlation between age and the selection of MOW Chi square test results obtained ρ value = 0.00 and there was a significant association between parity with the election MOW Chi square test results obtained ρ value = 0 , . From these results , it is expected to power health, especially family planning services at the hospital . Palembang Police Hospitals in order to improve the quality of family planning services in an effective, efficient , and safe are considered particularly suitable for users of contraception OperatingMethodWomen(MOW).                                      ABSTRAK Di negara sudah maju jumlah pilihan kontrasepsi mantap (kontap) sekitar 10% dari semua metode KB nasional, sedangkan di Indonesia baru mencapai sekitar 5,7 %. Berdasarkan data yang diperoleh dari Rekam medik  Rumah Sakit Bhayangkara Palembang tahun 2010 Jumlah pencapain tersebut jika dilihat dari persentasi penggunaan kontrasepsi MOW hanya  9,10% Tujuan penelitian ini adalah diketahuinya hubungan umur dan paritas dengan pemilihan alat kontrasepsi Metode Operasi Wanita (MOW) di poliklinik kebidanan RS.Bhayangkara Palembang Tahun 2012. Penelitian ini menggunakan metode survey analitik dengan pendekatan cross sectional. Populasi dalam penelitian ini adalah wanita yang menjadi akseptor KB Baru yang tercatat di rekam medik  di RS. Bhayangkara Palembang tanggal 1 januari 2012 sampai dengan 31 Desember  tahun 2012. Sampel dalam penelitian ini adalah sebagian dari seluruh jumlah akseptor KB Baru (baik yang menggunakan alat kontrasepsi Metode MOW maupun Metode KB lain) yang teregister di RS. Bhayangkara Palembang dari tanggal 1 januari 2012 sampai dengan 31 Desember  tahun 2012.Analisa data dilakukan secara univariat dan bivariat dengan uji statistik Chi-Square dengan tingkat kemaknaan α = 0,05. Hasil penelitian menunjukkan dari 80 responden terdapat (46,3%) yang menjadi akseptor kontrasepsi MOW, akseptor yang memiliki umur tua sebanyak 45 responden (56,3%) dan yang memiliki  umur muda sebanyak 35 responden (43,8%). akseptor yang memiliki paritas tinggi sebanyak 44 responden  (55%) dan yang memiliki  paritas rendah sebanyak 36 responden (45%). Dari hasil uji Chi square didapatkan ρ value = 0,00 lebih kecil dari α = 0,05. Ada hubungan yang bermakna antara umur dengan pemilihan MOW dari hasil uji Chi square didapatkan ρ value = 0,00 dan ada hubungan yang bermakna antara paritas dengan pemilihan MOW hasil uji Chi square didapatkan ρ value = 0,.Dari hasil penelitian ini, diharapkan kepada tenaga kesehatan khususnya pelayanan KB  di RS. Bhayangkara Palembang  agar dapat meningkatkan kualitas pelayanan KB secara efektif, efisien, dan aman yang dianggap cocok bagi penggunanya khususnya mengenai kontrasepsi Metode Operasi Wanita (MOW).    

scholarly journals Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study

RMD Open ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. e001450
Author(s):  
Clementina López-Medina ◽  
Anna Molto ◽  
Joachim Sieper ◽  
Tuncay Duruöz ◽  
Uta Kiltz ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Latin American ◽  
Underlying Disease ◽  
Cross Sectional Study ◽  
Joint Disease ◽  
Joint Involvement ◽  
Cross Sectional ◽  
Small Joint ◽  
Musculoskeletal Manifestations ◽  
Inflammatory Bowel

ObjectivesTo characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world.MethodsCross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated.ResultsA total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%).Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%).ConclusionThese results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.

scholarly journals AB0709 CHARACTERIZATION OF NAILFOLD CAPILLAROSCOPY IN COVID-19: A CASE CONTROL STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1386.2-1387
Author(s):  
P. E. Bermudez Bermejo ◽  
R. Jimenez-Soto ◽  
A. Sanchez Rodríguez ◽  
A. Turrent ◽  
D. Mercado Velasco ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Medical Center ◽  
Microvascular Complications ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Nailfold Capillaroscopy ◽  
Healthy Population ◽  
Healthy Controls ◽  
Clinical Tool ◽  
Cross Sectional

Background:Nailfold capillaroscopy is a relatively easy-to-access, low-cost clinical tool that could help identify early coagulopathy in subjects with SARS-CoV-2, but specific findings vs. controls and its possible prognostic role has not been studied.Objectives:To describe capillaroscopic findings and their usefulness in patients with COVID-19 compared to healthy controls.Methods:We designed a cross-sectional study, carried out in a single care center for critical patients with SARS-CoV-2 pneumonia at the ABC Medical Center, Mexico City, which included patients from an intensive care unit (ICU) and internal medicine ward from March to April 2020. Demographic, biochemical and clinical features were collected. All patients signed the informed consent and the study was approved by the hospital ethics committee. All patients underwent nail capillary imaging of the 3 central fingers of each hand with a portable microscope with 60-100x magnification coupled to a smartphone with 7 megapixel images in an immersion medium. Capillaroscopy was performed in patients who did not have fever or hypothermia, or need vasopressors at the time of evaluation. Control subjects are healthy subjects matched on age and sex from a database of healthy controls without rheumatic diseases. Image evaluation of COVID-19 patients was performed in a blinded way for their characteristics. Prior to the analysis of the images, a pilot test was obtained with 4 rheumatologists in random cases, obtaining an acceptable global agreement in the visualization of capillaries and specific alterations of the nail bed. (Kappa = 0.58, p = 0.0019). Obtained data from capillaroscopies were used to be compared between severe and moderate cases of SARS-CoV-2 pneumonia. Additionally, we compared the findings against a healthy population in order to establish a reference.Results:We included data from 27 patients and 32 controls with similar demographic features. Patients with COVID-19 patients had a mean age of 43 +/- 13.8 years, 63% female. Comorbidities were present in 44.4% with: type II Diabetes Mellitus 18.5%, systemic arterial hypertension 18.5%, and rheumatoid arthritis 3.7%. The mean length of stay time was 13 +/- 7.1 days, 48.1% were admitted to the ICU, and 40.7% required invasive mechanical ventilation. In the capillaroscopic review remarkable findings of patients vs. controls were hemosiderin deposits (33 vs 12.5%, p=0.05), less frequently observable capillaries (77 vs 100%, p=0.005), any abnormality in capillaries (25.9 vs. 6.3%, p=0.03). Of notice, specific findings in COVID-19 patients were capillary tortuosities in 19%, dilatation in 9.5%, serpentine pattern in 4.8%, bush pattern in 9.5% and decreased density in only 4.8% of the cases. No avascular areas or capillaries of neoformation were observed. Finally, the presence of hemosiderin was associated with worse presentation and risk factors for severe COVID-19: Male sex 66.7 vs. 27.8%, (p = 0.024); Admission to ICU 77% vs 33% (p = 0.029); BMI > 30 kg/m2 66.7 vs. 27.8% (p = 0.053). And risk for ICU admission OR = 7.0 (95% CI 1.098 - 44.6). No significant associations were found for abnormalities in capillary morphology.Conclusion:We present one of the first reports of nailfold capillaroscopic findings in patients with COVID-19 and the first to compare to healthy controls. Previous data on this regard suggests the presence of endothelial dysfunction and microvascular complications such as micro hemorrhage or micro thrombosis. Further studies may confirm these findings and prognostic value for worse outcomes in COVID-19 patients.References:[1]Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–13.[2]Cutolo M, Cortes S. capillaroscopic patterns in rheumatic diseases. Acta Reumatol Port. 2007 Jan-Mar;32(1):29-36.[3]Natalello G, De Luca G, Gigante L, et al. Nailfold capillaroscopy findings in patients with coronavirus disease 2019: Broadening the spectrum of COVID-19 microvascular involvement. Microvasc Res. 2021;133:104071.Disclosure of Interests:None declared

Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

2021 ◽  
pp. 1-4
Author(s):  
Ruo S. Chen ◽  
Laurel O’Connor ◽  
Matthew R. Rebesco ◽  
Kara L. LaBarge ◽  
Edgar J. Remotti ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Endotracheal Tube Cuff ◽  
Cross Sectional ◽  
Tube Cuff ◽  
Respiratory Therapists ◽  
Significant Difference

Abstract Introduction: Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O. Objectives: While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers. Methods: This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded. Results: In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients. Conclusion: An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon.

Effect of an interval rehabilitation program with home-based, vibration-assisted training on the development of muscle and bone in children with cerebral palsy – an observational study

2020 ◽  
Vol 33 (8) ◽  
pp. 1083-1092 ◽  
Author(s):  
Ibrahim Duran ◽  
Kyriakos Martakis ◽  
Christina Stark ◽  
Leonie Schafmeyer ◽  
Mirko Rehberg ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Bone Growth ◽  
Muscle Growth ◽  
Rehabilitation Program ◽  
Whole Body ◽  
Cross Sectional ◽  
Home Based ◽  
Children With Cerebral Palsy ◽  
One Year ◽  
Intensive Rehabilitation

AbstractObjectivesIn children with cerebral palsy (CP), the most common cause of physical impairment in childhood, less muscle and bone growth has been reported, when compared with typically developing children. The aim of this study was to evaluate the effect of an intensive rehabilitation program including physiotherapy in combination with 6 months of home-based, vibration-assisted training on muscle and bone growth in children with CP.MethodsWe included children with CP, who participated in a rehabilitation program utilizing whole-body vibration (WBV). Muscle mass was quantified by appendicular lean mass index (App-LMI) and bone mass by total-body-less-head bone mineral content (TBLH-BMC) assessed by Dual-energy X-ray absorptiometry (DXA) at the beginning of rehabilitation and one year later. To assess the functional muscle-bone unit, the relation of TBLH-BMC to TBLH lean body mass (TBLH-LBM) was used.ResultsThe study population included 128 children (52 females, mean age 11.9 ± 2.7). App-LMI assessed in kg/m2 increased significantly after rehabilitation. The age-adjusted Z-score for App-LMI showed no significant change. TBLH-BMC assessed in gram increased significantly. The Z-scores for TBLH-BMC decreased lesser than expected by the evaluation of the cross-sectional data at the beginning of rehabilitation. The parameter $\frac{TBLH-BMC}{TBLH-LBM}$ did not change relevantly after 12 months.ConclusionsMuscle growth and to a lesser extent bone growth could be increased in children with CP. The intensive rehabilitation program including WBV seemed to have no direct effect on the bone, but the observed anabolic effect on the bone, may only been mediated through the muscle.

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