Feasibility of Chest Wall and Diaphragm Proprioceptive Neuromuscular Facilitation (PNF) Techniques in Mechanically Ventilated Patients

Physical therapy is part of the treatment for patients admitted to ICU. Proprioceptive neuromuscular facilitation (PNF) is one of the physiotherapy concepts including manual techniques and verbal stimulation. The purpose of this paper is to examine the feasibility of PNF techniques in mechanically ventilated (MV) ICU patients. Another aim is to verify whether the technique using resistance during the patient’s inhalation will have a different effect than the technique used to teaching the correct breathing patterns. Methods: Patients admitted to tertiary ICU were enrolled in this study, randomly divided into two groups, and received four 90-second manual breathing stimulations each. The following vital signs were assessed: HR, SBP, DBP, and SpO2. Results: 61 MV ICU adult patients (mean age 67.8; 25 female and 36 male) were enrolled in this study. No significant differences in HR, SBP, and DBP were observed both for two techniques measured separately and between them. Statistically significant differences were noticed analysing SpO2 in the rhythmic initiation technique (RIT) group (p-value = 0.013). Conclusions: Short-term PNF interventions did not influence clinically relevant vital parameters among MV patients and seem to be feasible in this group of ICU patients.

Ultrasonographic Changes of Abdominal Muscles in Subjects with and without Chronic Low Back Pain

Chronic low back pain (CLBP) is a prevalent disfunction in the spine, affecting both women and men. The implication of the abdominal muscles in this disfunction has been studied, including wrong breathing patterns or inactivity of this area. However, there is a lack of studies examining changes in thickness of abdominal with ultrasonography. Thus, the aim of this study is to analyze the differences in the thickness of abdominal muscles at rest and during breathing between subjects with and without CLBP. A total of 72 subjects were divided in two groups: participants with CLBP (n = 36) and participants without CLBP (n = 36). In both groups, the thickness of the four abdominal muscles was measured and compared at rest and during breathing with ultrasonography. In TrA and IO there were no significant differences between groups, but those subjects with CLBP increased the muscle thickness more than participants without pain during breathing. In EO there were no differences in muscle thickness between groups and between rest and breathing. In RA, subjects with CLBP showed less muscle thickness than subjects without pain during breathing, but no changes were found at rest. In conclusion, the deepest abdominal muscles, TrA and IO, appear to increase their thickness and RA appear to decrease more in subjects with CLBP, in comparison with healthy participants.

Reconciling Oxygen and Aerosol Delivery with a Hood on In Vitro Infant and Paediatric Models

This study aimed to evaluate optimal aerosol and oxygen delivery with a hood on an infant model and a paediatric model. A facemask and a hood with three inlets, with or without a front cover, were used. A small-volume nebuliser with a unit-dose of salbutamol was used for drug delivery and an air entrainment nebuliser was used to deliver oxygen at 35%. Infant and paediatric breathing patterns were mimicked; a bacterial filter was connected to the end of a manikin trachea for aerosol drug collection, and an oxygen analyser was used to measure the oxygen concentration. For the infant model, inhaled drug dose was significantly higher when the nebuliser was placed in the back of the hood and with a front cover. This was verified by complementary computational simulations in a comparable infant-hood model. For the paediatric model, the inhaled dose was greater with a facemask than with a hood. Oxygen delivery with a facemask and a hood with a front cover achieved a set concentration in both models, yet a hood without a front cover delivered oxygen at far lower concentrations than the set concentration.

Comparative Transcriptomic Analysis of Regenerated Skins Provides Insights into Cutaneous Air-Breathing Formation in Fish

Cutaneous air-breathing is one of the air-breathing patterns in bimodal respiration fishes, while little is known about its underlying formation mechanisms. Here, we first investigated the skin regeneration of loach (Misgurnus anguillicaudatus, a cutaneous air-breathing fish) and yellow catfish (Pelteobagrus fulvidraco, a water-breathing fish) through morphological and histological observations. Then, the original skins (OS: MOS, POS) and regenerated skins (RS: MRS, PRS) when their capillaries were the most abundant (the structural foundation of air-breathing in fish) during healing, of the two fish species were collected for high-throughput RNA-seq. A total of 56,054 unigenes and 53,731 unigenes were assembled in loach and yellow catfish, respectively. A total of 640 (460 up- and 180 down-regulated) and 4446 (2340 up- and 2106 down-regulated) differentially expressed genes (DEGs) were respectively observed in RS/OS of loach and yellow catfish. Subsequently, the two DEG datasets were clustered in GO, KOG and KEGG databases, and further analyzed by comparison and screening. Consequently, tens of genes and thirteen key pathways were targeted, indicating that these genes and pathways had strong ties to cutaneous skin air-breathing in loach. This study provides new insights into the formation mechanism of cutaneous air-breathing and also offers a substantial contribution to the gene expression profiles of skin regeneration in fish.

Changes in Breathing Patterns after Surgery in Severe Laryngomalacia

Background: Most of the studies regarding the surgical treatment of severe laryngomalacia (LM) have been aimed at describing the efficacy of the treatment in terms of improvement of clinical symptoms or anatomical findings. There are no studies specifically aimed at analyzing the changes in breathing patterns following surgical treatment for severe LM. Objective: To review the breathing pattern changes before and after corrective surgery in infants with severe LM. Study design: A series of retrospective cases at a tertiary referral children’s hospital. Methods: Retrospective chart review of 81 infants who underwent supra-glottoplasty (SGP) for severe laryngomalacia between 2011 and 2020 at Bambino Gesù Children’s Hospital of Rome, Italy. Among the patients, 47 (58%) were male and 34 (42%) were female. Twenty-one patients (26%) had one or more comorbidities condition. The data collected included age, symptoms, a polysomnography/pulse oximetry study, growth rate, the findings from flexible endoscopy, pre- and post-supra-glottoplasty (SGP) pulmonary function tests (PFTs) and, when indicated, 24 h pH-metry. Breathing patterns were studied during restful, normal sleep, using an ultrasonic flow-meter (Exhalyzer, Viasys) which measured: Tidal Volume (Vt), Respiratory Rate (RR), time to peak expiratory flow/expiratory time ratio (tPTEF/Te, an index of the patency of the lower airways) and mean expiratory/mean inspiratory flow ratio (MEF/MIF, an index of the patency of the upper airways) evaluated before surgical procedure (T1) and 3–6 weeks after (T2). Pre- and post-operative mean data were calculated and comparisons made with a Student T-test. Results: The surgical procedure was well tolerated by all infants and no intraoperative or post-operatory long-term complications were noted. In T1, breathing patterns were characterized by low tidal volume and high tPTEF/Te and MEF/MIF ratios, suggesting a severe reduction in the patency of the upper airways in all patients. After surgery (T2), all the previously mentioned variables significantly improved, reaching normal values for the child’s age. Conclusions: Supra-glottoplasty, as already described in several studies, is a safe and efficient procedure to treat severe laryngomalacia during infancy. The improvement in breathing patterns after surgery was reliably confirmed by a lung function test in our study, which showed the diagnostic value of testing respiratory functionality in the laryngomalacia and comparing them to clinical and endoscopic data. Moreover, considering the results obtained, we also propose the use of this available, dependable test to verify its therapeutic effects (post-surgery) and to monitor future respiratory development in these infants. Moreover, we believe that further studies will provide detailed grading guidelines for gravity of the LM, based on these functional lung tests.

Identification and management of dysfunctional breathing in primary care

Dysfunctional breathing can lead to a range of symptoms that can be confused with neurological, respiratory and cardiac disease. Heather Henry and Charlotte Wells give an overview of the signs, symptoms, diagnosis and treatment of this condition General practice nurses (GPNs) are often on the front-line of respiratory assessment. Dysfunctional breathing (often termed breathing pattern disorder) is a term that relates to changes in breathing patterns. Since dysfunctional breathing can be confused with neurological, respiratory and cardiac disease, this article will help GPNs to understand the signs, symptoms, diagnosis and treatment.

PENGARUH TERAPI ACTIVE CYCLE OF BREATHING TECHNIQUE (ACBT) TERHADAP FREKUENSI PERNAFASAN (RESPIRATORY RATE) PADA PENDERITA TUBERKULOSIS PARU DI RUMAH SAKIT UMUM IMELDA PEKERJA INDONESIA MEDAN

Pulmonary tuberculosis is a major public health problem in the world and is the second leading cause of death from infectious diseases. The purpose of this study was to determine the effect of active cycle of breathing technique (ACBT) therapy on breathing frequency in patients with pulmonary tuberculosis. Quantitative research method, with a Quasi Experimental research design with a pre-test and one-group post-test approach. The study was carried out in the Orchid room of the Imelda Indonesian Workers General Hospital in Medan in July - August 2021. The study population was 45 patients with pulmonary tuberculosis and the sample technique of this study was Nonprobability Sampling. The number of samples was 41 pulmonary tuberculosis patients according to the researcher's criteria. The data analysis technique used is Wilcoxon test analysis. The results of the study There was an effect of breathing patterns before the administration of active cycle of breathing technique (ACBT) Therapy on the improvement of respiratory frequency in patients with pulmonary tuberculosis with a value of M ± SD = 17.1081 ± 2.94188. There is an effect of breathing pattern after administration of active cycle of breathing technique (ACBT) Therapy on the respiratory frequency of Pulmonary Tuberculosis Patients with a value of M ± SD = 27.0400 ± 2.82076. There is a difference in the effect of breathing patterns before and after administration of active cycle of breathing technique (ACBT) therapy on the Improvement of respiratory frequency in pulmonary tuberculosis patients with a significant value of 0.000 < 0.005. Abstrak Tuberkulosis paru adalah masalah pokok kesehatan pada masyarakat didunia dan merupakan penyebab kematian ke dua dari penyakit infeksi. Tujuan penelitian untuk mengetahui pengaruh pemberian terapi active cycle of breathing technique (ACBT) terhadap frekuensi pernafasan pada penderita tuberkulosis paru. Metode penelitian kuantitatif, dengan desain penelitian Quasi Eksperiment dengan pendekatan pre test dan post test one group. Penelitian dilaksanakan di ruangan Anggrek Rumah Sakit Umum Imelda Pekerja Indonesia Medan pada bulan Juli - Agustus 2021. Populasi penelitian sebanyak 45 orang pasien Tuberkulosis Paru dan teknik sampel penelitin ini adalah Nonprobability Sampling. Jumlah sampel 41 orang pasien tuberkulosis paru sesuai dengan kriteria peneliti. Teknik analisa data yang digunakan adalah analisis uji Wilcoxon. Hasil penelitian ada pengaruh pola nafas sebelum pemberian terapi active cycle of breathing technique (ACBT) terhadap perbaikan frekuensi pernafasan pada penderita tuberkulosis paru dengan nilai M ± SD =17.1081 ± 2.94188. Ada pengaruh pola nafas sesudah pemberian terapi active cycle of breathing technique (ACBT) terhadap frekuensi pernafasan pasien tuberkulosis paru dengan nilai M ± SD = 27.0400 ± 2.82076. Ada perbedaan pengaruh pola nafas sebelum dan sesudah pemberian terapi active cycle of breathing technique (ACBT) terhadap perbaikan frekuensi pernafasan pasien tuberkulosis paru dengan nilai signifikan 0,000 < 0,005.

Deposition of Inhaled Levofloxacin in Cystic Fibrosis Lungs Assessed by Functional Respiratory Imaging

Pulmonary infections caused by Pseudomonas aeruginosa (PA) represent the leading cause of pulmonary morbidity in adults with cystic fibrosis (CF). In addition to tobramycin, colistin, and aztreonam, levofloxacin has been approved in Europe to treat PA infections. Nevertheless, no lung deposition data on inhaled levofloxacin are yet available. We conducted a Functional Respiratory Imaging (FRI) study to predict the lung deposition of levofloxacin in the lungs of patients with CF. Three-dimensional airway models were digitally reconstructed from twenty high-resolution computed tomography scans obtained from historical patients’ records. Levofloxacin aerosols generated with the corresponding approved nebuliser were characterised according to pharmacopeia. The obtained data were used to inform a computational fluid dynamics simulation of levofloxacin lung deposition using breathing patterns averaged from actual CF patients’ spirometry data. Levofloxacin deposition in the lung periphery was significantly reduced by breathing patterns with low inspiratory times and high inspiratory flow rates. The intrathoracic levofloxacin deposition percentages for moderate and mild CF lungs were, respectively, 37.0% ± 13.6 and 39.5% ± 12.9 of the nominal dose. A significant albeit modest correlation was found between the central-to-peripheral deposition (C/P) ratio of levofloxacin and FEV1. FRI analysis also detected structural differences between mild and moderate CF airways. FRI revealed a significant intrathoracic deposition of levofloxacin aerosols, which distributed preferentially to the lower lung lobes, with an influence of the deterioration of FEV1 on the C/P ratio. The three-dimensional rendering of CF airways also detected structural differences between the airways of patients with mild and moderate CF.

Effects of enriched-potassium diet on cardiorespiratory outcomes in experimental non-ischemic chronic heart failure

Background Chronic heart failure (CHF) is a global health problem. Increased sympathetic outflow, cardiac arrhythmogenesis and irregular breathing patterns have all been associated with poor outcomes in CHF. Several studies showed that activation of the renin-angiotensin system (RAS) play a key role in CHF pathophysiology. Interestingly, potassium (K+) supplemented diets showed promising results in normalizing RAS axis and autonomic dysfunction in vascular diseases, lowering cardiovascular risk. Whether subtle increases in dietary K+ consumption may exert similar effects in CHF has not been previously tested. Accordingly, we aimed to evaluate the effects of dietary K+ supplementation on cardiorespiratory alterations in rats with CHF. Methods Adult male Sprague–Dawley rats underwent volume overload to induce non-ischemic CHF. Animals were randomly allocated to normal chow diet (CHF group) or supplemented K+ diet (CHF+K+ group) for 6 weeks. Cardiac arrhythmogenesis, sympathetic outflow, baroreflex sensitivity, breathing disorders, chemoreflex function, respiratory–cardiovascular coupling and cardiac function were evaluated. Results Compared to normal chow diet, K+ supplemented diet in CHF significantly reduced arrhythmia incidence (67.8 ± 15.1 vs. 31.0 ± 3.7 events/hour, CHF vs. CHF+K+), decreased cardiac sympathetic tone (ΔHR to propranolol: − 97.4 ± 9.4 vs. − 60.8 ± 8.3 bpm, CHF vs. CHF+K+), restored baroreflex function and attenuated irregular breathing patterns. Additionally, supplementation of the diet with K+ restores normal central respiratory chemoreflex drive and abrogates pathological cardio-respiratory coupling in CHF rats being the outcome an improved cardiac function. Conclusion Our findings support that dietary K+ supplementation in non-ischemic CHF alleviate cardiorespiratory dysfunction.