Chest Mobility Exercise with Staked Breathing Versus Chest Mobility Exercises with Incentive Spirometery On Chest Expansion with Pleural Effusion Patient: A Comparative Study

Background: Pleural effusion is one of the commonly seen respiratory conditions in India with approximately 1 million people being diagnosed each year. Twenty to forty percent of hospitalized patients with bacterial pneumonia develop pleural effusion. In India unlike western countries, tuberculosis pleura effusion is common. The pleural cavity is involved in approximately 5% of all patients with tuberculosis. Since there was no literature regarding the effectiveness chest mobility exercise with staked breathing or chest mobility exercises with incentive spirometery in pleural effusion. There was a need to find out as to which approach are the best ones to implement. Objective: To compare the efficacy of chest mobility exercise with stacked breathing versus chest mobility exercise with incentive spirometery on chest expansion in patients with pleural effusion. Materials and Method: 20 patients with pleural effusion were selected by easy sampling and randomly assigned into two groups (10 patients each groups). Group A received chest mobility exercises and intensive spirometery and group B received chest mobility exercises and stacked breathing. Both groups were instructed to perform the intervention 3 time per day, 8 to 10 time per session for one week. Chest expansion was measured by thoracic flow cytometry before and after one week of intervention. Result: In group A chest expansion increase from 2.68 to 2.87 which was statistically significant (P value < 0.0023). In Group B the chest expansion increases from 2.94 to 3.09 which was not statistically significant (P value < 0.216). Conclusion: It was concluded from the result that both chest mobility exercises with intensive spirometery and chest mobility exercise with stacked breathing are equally effective in improving the chest expansion in subject with pleural effusion. KEY WORDS: Pleural effusion, Chest mobility exercises, Incentive Spirometry, Stacked breathing, Thoracic flow cytometry.

PRACTICAL ASPECTS ABOUT CLOSED CHEST DRAINAGE CARE: A LITERATURE REVIEW

Context: The drained pleural contents may vary, as well as their drainage, however closed drainage system is the most frequent one and reaches flaws along those who are in charge of their management. Objetive: Provide a comprehensive review about close chest drainage. Methods: A systematic search of the PubMed and Medline databases was conducted on closed drainage system using the following keyword combination: chest tubes AND drainage. Results: From eight hundred eight-three articles retrieved after our preliminary search, 17 articles were chosen for final analysis. Representative schemes were drawn to better understanding of the three types of chest drainage systems for pleura effusion: (i) the closed drainage system; (ii) the open drainage system; and (iii) the suction drainage system. Representative pictures were also developed in order to facilitate additional care in the field. Conclusions: Bringing information together about chest tube management in closed drainage system may imply in a better approach to the patients, minimize institutional cost, minimize material waste and promote efficient communication among the multidisciplinary staff. Understanding details about tubular tube, pig tail tube, one-way bag, one-way valve and collectors is the only way to perform a better approach to the patient who needs closed drainage system.

Transapical Valve-in-Valve-in-Ring for Stenotic Mitral Valve Repair

A 53-year-old woman, previously treated with irradiation and chemotherapy for Hodgkin lymphoma, was referred for redovalve surgery. She had had a pacemaker implantation and undergone coronary bypass surgery, mitral valve repair with a Carpentier-Edwards 28-mm Physio-annuloplasty ring, as well as a mechanical tricuspid valve replacement and a transfemoral CoreValve 26-mm implantation. She had cardiac cachexia, pleura effusion, and a failed mitral valve repair with stenosis. She was judged inoperable for open surgery but suitable for a transapical valve-in-valve implantation on partial femorofemoral bypass. A 26-mm Edwards SAPIEN XT aortic valve inversely mounted on the Ascendra + delivery catheter was balloon expanded into the Physio ring. During expansion, the introducer sheath remained too deep into the left ventricle and rotated the SAPIEN valve upward to the left atrium, creating the onset of a new mitral regurgitation and retaining the stenosis. Another Edwards SAPIEN XT 26-mm valve was then positioned into the first valve in a “valve-in-valve-in-ring” tandem configuration. Both valves were supported by the Physio ring. The stenosis and the regurgitation were thereafter eliminated.