Impact of inspiratory vs expiratory incentive spirometry on obstructive, restrictive, and mixed ventilatory impairments: Study protocol. Effect of incentive spirometry on respiratory impairments.

Background: Interferential therapy (IFT) is the application of two medium frequency currents to the skin to stimulate and activate different systems in the body using specific frequencies and frequency ranges. IFT aims to reduce myalgia in the chest and upper back, reduce muscular fatigue and induce mucus expectoration. This study is designed to test the efficacy of IFT on asthma patients recently exposed to SARS-CoV-2 virus. Methods: Twenty-eight (28) patients aged 18 and above with bronchial Asthma attending the respiratory clinic at the Lagos State University Teaching Hospital, Ikeja (LASUTH) will be assessed for the study eligibility. The study design will be a double-blinded, randomized control trial with two intervention groups and two parallel placebo control groups. IFT will be administered as an intervention to asthma patients with and without a history of COVID-19 exposure for 20 minutes. Six continuous outcome variables at different points will be utilized as an outcome measure. Selected Baseline Pulmonary Function Test (PFT) and Cardiopulmonary Variables (CVS) will be assessed on entry into the study, Quality of life and asthma control will be evaluated every two (2) weeks of the study. Data obtained will be analyzed using descriptive and inferential statistics of repeated ANOVA; P<0.05. Discussion: The study outcome will compare the efficacy of IFT on Bronchial Asthma patients with Post COVID-19 exposure, identify the relationship between the Intervention on Asthma patients with or without COVID-19 exposure.

Preliminary Study: Immediate Effect of the Slow Deep Breathing Exercise and Sustained Maximal Inspiration with Volume-Oriented Incentive Spirometry on the Diffusing Lung Capacity in Healthy Young Participants

Slow-deep breathing exercise (SDBE) while using a volume-oriented type of incentive spirometry (VIS) device (SDBE/VIS) is one of the techniques in chest physical therapy designed to improve lung volume and oxygenation. However, the immediate effect of SDBE/VIS paired with a sustained maximal inspiration (SMI) on diffusing lung capacity (DLC), has not been documented. This preliminary study aimed to evaluate the immediate effect of SDBE/VIS paired with the SMI technique on DLC in healthy participants. Twenty healthy sedentary adults (11 males and 9 females) aged 20 to 23 years were recruited into this cross-over study and randomly assigned to one of 2 ordered groups; SDBE/VIS paired with SMI followed by SDBE/VIS alone or SDBE/VIS alone followed by SDBE/VIS with SMI. During each of the 2-testing sessions, the participants performed 3 sets of 5 SDBE/VIS trials which were controlled by ensuring that each participant reached their maximal vital capacity; derived from their pulmonary function test. The DLC for carbon monoxide (DLCO), alveolar volume (VA), and total lung capacity (TLC) was assessed prior to (baseline) and after each of the 5 experimental trials. A 3-min rest period was given between each set of 5 trials and 1 week between testing sessions. The results demonstrated that SDBE/VIS paired with the SMI technique significantly increased both the DLCO (mL/min/mmHg and %) and VA (L and %) when compared to the baseline values. Whereas, SDBE/VIS without using the SMI technique did not alter the DLCO, VA or the DLCO/VA. However, both SDBE/VIS with and without the SMI technique showed a significant increase the TLC (L and %), with the TLC from SDBE/VIS paired with SMI was significantly higher than when the SDBE /VIS was performed without using the SMI technique. Thus, it appears that performing SDBE/VIS exercised paired with the SMI technique has a significant and positive effect on DLC.

Seeking Inspiration: Examining the Validity and Reliability of a New Smartphone Respiratory Therapy Exergame App

Background: Clinically valid and reliable simulated inspiratory sounds were required for the development and evaluation of a new therapeutic respiratory exergame application (i.e., QUT Inspire). This smartphone application virtualises incentive spirometry, a longstanding respiratory therapy technique. Objectives: Inspiratory flows were simulated using a 3 litre calibration syringe and validated using clinical reference devices. Syringe flow nozzles of decreasing diameter were applied to model the influence of mouth shape on audible sound levels generated. Methods: A library of calibrated audio inspiratory sounds was created to determine the reliability and range of inspiratory sound detection at increasing distances separating the sound source and smartphones running the app. Results: Simulated inspiratory sounds were reliably detected by the new application at higher air inflows (high, medium), using smaller mouth diameters (<25 mm) and where smartphones were held proximal (< = 5 cm) to the mouth (or at distances up to 50 cm for higher airflows). Performance was comparable for popular smartphone types and using different phone orientations (i.e., held horizontally, at 45° or 90°). Conclusions: These observations inform future application refinements, including prompts to reduce mouth diameter, increase inspiratory flow and maintain proximity to the phone to optimise sound detection. This library of calibrated inspiratory sounds offers reproducible non-human reference data suitable for development, evaluation and regression testing of a therapeutic respiratory exergame application for smartphones.

The Influence of Respiratory Component on Satisfaction with Physical Therapy after Cardiosurgical Interventions

The purpose of the study was to investigate the effect of additional respiratory physical therapy on the level of satisfaction with physical therapy among patients after cardiac surgery. Materials and methods. The study involved 150 patients. The patients were randomly divided into three groups: control (respiratory physical therapy was limited to cough), group of incentive spirometry (in classes with a physical therapist patients performed additional 3 approaches of 10 breaths through the simulator; they received recommendations for hourly performance of a similar number of cycles of exercise), a group of patients who received additional respiratory physical therapy with positive expiratory pressure in the form of exhalation into a bottle of water through a tube (number of repetitions and recommendations are similar to those received by the previous group). All groups underwent the same protocol of mobilization and use of therapeutic physical exercises in the procedure of therapeutic gymnastics. Performing exercises with breathing simulators began on the first postoperative day. Results and discussion. A questionnaire (17 questions) was used to assess the satisfaction with physical therapy. The survey was conducted on the seventh postoperative day. The answers were distributed on a 5-point Likert scale from 1 point to 5 points. The key preoperative indicators and time indicators of surgical interventions of the examined groups did not differ significantly. Analysis of satisfaction with physical therapy revealed a high level in all items of the questionnaire. Statistical differences between the groups were found in only three items of the questionnaire, but they were not related to either the use of equipment or diligence in treatment or the content of physical therapy. The overall score of the questionnaire did not differ in groups according to the Kraskel-Wallis criterion, and Me indicators (25%; 75%) were in the control group – 81 (77; 85) points, in the group of stimulating spirometry – 81 (72; 85) points in the group with positive expiratory pressure – 79 (73; 84) points (χ2 = 4.560; p = 0.102). Conclusion. Additional respiratory physical therapy did not affect the overall satisfaction rate and results of most items of the questionnaire. The differences found in the three items did not indicate any effect of the use of respiratory physical therapy on the level of satisfaction, as higher scores in these items were in the control group. All items in the questionnaire received high scores

Successful anaesthetic management of a COVID-positive patient with multiple comorbidities: regional anaesthesia to the rescue

The perioperative anaesthetic management of a case of COVID-19 pneumonia with multiple systemic comorbidities, posted for unilateral below knee amputation and debridement of hand, poses a uniquely challenging scenario for the anaesthesiologist. We hereby report such a case which was managed successfully using ultrasound-guided popliteal and wrist block along with perioperative use of high flow nasal cannula, incentive spirometry and awake proning.

Preoperative incentive spirometry for preventing postoperative pulmonary complications in patients undergoing coronary artery bypass graft surgery: a prospective, randomized controlled trial

Background Postoperative pulmonary complications (PPCs) often occur after cardiac operations and are a leading cause of morbidity, inhibit oxygenation, and increase hospital length of stay and mortality. Although clinical evidence for PPCs prevention is often unclear and crucial, measures occur to reduce PPCs. One device usually used for this reason is incentive spirometry (IS). The aim of the study is to evaluate the effect of preoperative incentive spirometry to prevent postoperative pulmonary complications, improve postoperative oxygenation, and decrease hospital stay following coronary artery bypass graft (CABG) surgery patients. Methods This was a clinical randomized prospective study. A total of 80 patients were selected as candidates for CABG at An-Najah National University Hospital, Nablus-Palestine. Patients had been randomly assigned into two groups: incentive spirometry group (IS), SI performed before surgery (study group) and control group, preoperative spirometry was not performed. The 40 patients in each group received the same protocol of anesthesia and ventilation in the operating room. Result The study findings showed a significant difference between the IS and control groups in the incidence of postoperative atelectasis. There were 8 patients (20.0%) in IS group and 17 patients (42.5%) in the control group (p = 0.03). Mechanical ventilation duration was significantly less in IS group. The median was four hours versus six hours in the control group (p < 0.001). Hospital length of stay was significantly less in IS group, and the median was six days versus seven days in the control group (p < 0.001). The median of the amount of arterial blood oxygen and oxygen saturation was significantly improved in the IS group (p < 0.005). Conclusion Preoperative incentive spirometry for two days along with the exercise of deep breathing, encouraged coughing, and early ambulation following CABG are in connection with prevention and decreased incidence of atelectasis, hospital stay, mechanical ventilation duration and improved postoperative oxygenation with better pain control. A difference that can be considered both significant and clinically relevant. Trial registration Thai Clinical Trials Registry: TCTR20201020005. Registered 17 October 2020—retrospectively registered.

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.