Document Detail


Trendelenburg chest optimization prolongs spontaneous breathing trials in ventilator-dependent patients with low cervical spinal cord injury.
MedLine Citation:
PMID:  20665351     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Chest optimization, an evidence-based protocol-guided multimodal chest physiotherapy consisting of body positioning, sputum mobilization, bronchodilation, and lung hyperinflation, may be routinely administered to ventilator-dependent patients with low cervical spinal cord injury (CSCI) for improving pulmonary functional outcomes that facilitate weaning from mechanical ventilation. We undertook this study to determine whether position-specific chest optimization was associated with changes in spontaneous breathing trial (SBT) duration. Cardiac output (CO), alveolar minute volume (MValv), carbon dioxide elimination (VCO(2)), and static chest compliance (Cst) were measured during chest optimization; then MValv and rapid shallow breathing index (RSBI) were measured during SBT. Study participants (N = 12) were clinically stable ventilator-dependent patients with low CSCI. Trendelenburg chest optimization (TCO) was associated with significant increases in SBT (p < 0.001), CO (p < 0.001), MValv (p < 0.003), VCO(2) (p < 0.001), and Cst (p < 0.002). SBT following TCO was associated with significant increases in MValv (p < 0.03) and RSBI (p < 0.002). These preliminary findings suggest the importance of proper recumbent body positioning during evidence-based, protocol-guided multimodal chest physiotherapy for ventilator-dependent patients with low CSCI.
Authors:
Charles J Gutierrez; Cathy Stevens; John Merritt; Cecille Pope; Mihaela Tanasescu; Glenn Curtiss
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of rehabilitation research and development     Volume:  47     ISSN:  1938-1352     ISO Abbreviation:  J Rehabil Res Dev     Publication Date:  2010  
Date Detail:
Created Date:  2010-07-28     Completed Date:  2010-11-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8410047     Medline TA:  J Rehabil Res Dev     Country:  United States    
Other Details:
Languages:  eng     Pagination:  261-72     Citation Subset:  IM    
Affiliation:
Department of Respiratory Care & Diagnostic Services, James A. Haley Veterans Hospital, Tampa, FL 33612, USA. charles.gutierrez@va.gov
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Breath Tests
Cross-Over Studies
Device Removal / methods
Double-Blind Method
Evidence-Based Medicine
Florida
Head-Down Tilt / physiology*
Hospitals, Veterans
Humans
Intensive Care Units
Intubation, Intratracheal
Male
Middle Aged
Respiration, Artificial
Spinal Cord Injuries / rehabilitation*,  therapy
Supine Position / physiology*
Time Factors
Treatment Outcome
Ventilator Weaning / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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