Respiratory Muscle Training Reduces Respiratory Complications and Improves Swallowing Function After Stroke: A Systematic Review and Meta-Analysis

ObjectiveTo investigate whether respiratory muscle training is capable of reducing the occurrence of respiratory complications and improving dysphagia (swallowing or cough function) after stroke.Data SourcesCochrane Library, Excerpta Medical Database (EMBASE), PUBMED, and Web of Science were searched for studies published in English; the China Biology Medicine (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), and Wanfang Database were searched for studies published in Chinese up to August 10, 2021.Study SelectionEleven randomized control trials (RCTs) (N=523) met the inclusion criteria were included in this systematic review.Data ExtractionData and information were extracted by two reviewers independently and disagreements was resolved by consensus with a third coauthor. Primary outcome was the occurrence of respiratory complications, secondary outcomes would be represented by swallowing and cough function. The quality of each included RCT were assessed by Cochrane risk-of-bias criteria and the GRADE evidence profile was provided to present information about the body of evidence and judgments about the certainty of underlying evidence for each outcome.Data SynthesisRespiratory muscle training reduced the risk of respiratory complications (relative risk, 0.51; 95% confidence interval [CI], 0.28-0.93; I²=0%; P=.03; absolute risk difference, 0.068; number need to treat, 14.71) compared with no or sham respiratory intervention. It also decreased the liquid-type Penetration-Aspiration Scale scores by 0.81 (95% CI, –1.19 to –0.43; I²=39%; P<.0001). There was no significant association between respiratory muscle training and Functional Oral Intake Scale (FOIS) scores, cough function: increased FOIS scores by 0.47 (95% CI, –0.45 to 1.39; I²=55%; P=.32), decreased peak expiratory cough flow of voluntary cough by 18.70 L per minute (95% CI, –59.74 to 22.33; I²=19%; P=.37) and increased peak expiratory cough flow of reflex cough by 0.05 L per minute (95% CI, –40.78 to 40.87; I²=0%; P>.99).ConclusionThis meta-analysis provided evidence that respiratory muscle training is effective in reducing the risk of respiratory complications and improving dysphagia by reducing penetration or aspiration during swallowing liquid bolus after stroke. However, there was no sufficient evidence to determine that respiratory muscle training improves cough function. Additional multicenter studies using larger patient cohorts are required to validate and support these findings. Furthermore, long-term follow-up studies should be performed to measure outcomes, while avoiding bias due to confounding factors such as heterogeneity of the etiologies of dysphagia.     

Dysphagia Characteristics of Patients Post SARS-CoV-2 During Inpatient Rehabilitation

ObjectiveTo investigate dysphagia in patients recovering from SARS-CoV-2 admitted to acute inpatient rehabilitation by summarizing clinical swallow evaluation and videofluoroscopic swallow study findings.DesignRetrospective cohort study.SettingUrban inpatient rehabilitation hospital.ParticipantsThe first inpatients admitted with SARS-CoV-2 (N=40) who participated in a videofluoroscopic swallow study.InterventionsNot applicable.Main Outcome MeasuresPatient characteristics upon admission (duration of intubation, tracheostomy status, comorbidities, videofluoroscopic swallow study (VFSS) completion at previous level of care); admission International Dysphagia Diet level (IDDSI); Mann Assessment of Swallowing Ability (MASA), Functional Oral Intake Scale (FOIS), dysphagia severity rating; penetration aspiration scale (PAS) rated during VFSS; and IDDSI level recommended after completion of VFSS.ResultsTwenty percent of patients had been evaluated by videofluoroscopy in acute care. Nineteen of 37 (51%) individuals were upgraded to IDDSI level 7 regular diet with level 0 thin liquids and achieved a FOIS of 7 after the completion of the VFSS. Five individuals (13%) received a diet downgrade or remained on the same diet recommendations from their admission. Total numerical score (TNS) of less than 170 on the MASA predicted presence of aspiration in 27% of patients (6 of 22). Seventy-two percent of the sample (16 of 22) had a TNS less than 170 but did not demonstrate any instances of aspiration. The odds of patients having a PAS of 3 or greater increased by approximately 15% (odds ratio, 1.15; 95% confidence interval, 1.03-1.27; P=.013). Thus, with each additional day of intubation during acute care stay, there was a 15% greater likelihood of having airway invasion.ConclusionsInstrumental swallow evaluations are imperative to diagnose and treat dysphagia in the post-coronavirus disease population. Because of the heterogeneity of this population, high incidence of prolonged intubation, and limitations of the clinical swallowing evaluation, instrumental assessments need to be performed on a more consistent basis as infection prevention protocols evolve.     

Early rehabilitation during extracorporeal membrane oxygenation has minimal impact on physiological parameters: A pilot randomised controlled trial

BackgroundPatients on extracorporeal membrane oxygenation (ECMO) often require prolonged periods of bed rest owing to their severity of illness along with the care required to maintain the position and integrity of the ECMO cannula. Many patients on ECMO receive passive exercises, and rehabilitation is often delayed owing to medical instability, with a high proportion of patients demonstrating severe muscle weakness. The physiological effects of an intensive rehabilitation program started early after ECMO commencement remain unknown.ObjectivesThe primary objective of this study was to describe the respiratory and haemodynamic effects of early intensive rehabilitation compared with standard care physiotherapy over a 7-d period in patients requiring ECMO.MethodsThis was a physiological substudy of a multicentre randomised controlled trial conducted in one tertiary referral hospital. Consecutive adult patients undergoing ECMO were recruited. Respiratory and haemodynamic parameters, along with ECMO settings, were recorded 30 min before and after each session and continuously during the session. In addition, the minimum and maximum values for these parameters were recorded outside of the rehabilitation or standard care sessions for each 24-h period over the 7 d. The number of minutes of exercise per session was recorded.ResultsFifteen patients (mean age = 51.5 ± standard deviation of 14.3 y, 80% men) received ECMO. There was no difference between the groups for any of the respiratory, haemodynamic, or ECMO parameters. The minimum and maximum values for each parameter were recorded outside of the rehabilitation or standard care sessions. The intensive rehabilitation group (n = 7) spent more time exercising per session than the standard care group (n = 8) (mean = 28.7 versus 4.2 min, p < 0.0001). Three patients (43%) in the intensive rehabilitation group versus none in the standard care group mobilised out of bed during ECMO.ConclusionsIn summary, early intensive rehabilitation of patients on ECMO had minimal effect on physiological parameters.     

普拉提训练对脑卒中恢复中期患者肺功能及下肢运动功能的影响

目的：观察普拉提训练对脑卒中恢复中期患者肺功能及下肢运动功能的影响。方法：将符合纳入标准的47例脑卒中恢复中期患者随机分为对照组24例和观察组23例。2 组患者均给予常规康复训练,观察组患者于常规康复训练基础上联合普拉提训练。2组患者于治疗前、治疗6周后分别采用用力肺活量（FVC）、一秒用力呼气容积（FEV1）、呼气流量峰值（PEF）和FEV1/FVC评估肺功能,疲劳严重程度量表（FSS）评估患者疲劳度,Fugl-Meyer下肢运动功能量表(FMA-L)评价患者下肢运动功能。比较2组患者肺功能、疲劳度变化情况及下肢运动功能。结果: 治疗前,2组患者FVC、FEV1、FEV1/FVC、PEF及FMA-L、FSS评分比较均差异无统计学意义。治疗6周后,2组FVC、FEV1、PEF及FMA-L评分均较治疗前明显提高(P<0.05),且观察组高于对照组(P<0.05);2组FSS评分均较治疗前明显降低(P<0.05),且观察组低于对照组(P<0.05);2组FEV1/FVC治疗前后及组间比较差异无统计学意义。结论: 普拉提训练可有效提高脑卒中恢复中期患者肺功能及下肢运动功能,缓解疲劳度,临床治疗应充分重视脑卒中患者的肺功能训练。     

Comparing rehabilitation outcomes for patients admitted to the intensive care unit with COVID-19 requiring mechanical ventilation during the first two waves of the pandemic: A service evaluation

ObjectivesTo compare rehabilitation outcomes of patients admitted to the intensive care unit with COVID-19 and mechanically ventilated during wave 1 and 2, receiving two different models of physiotherapy delivery.MethodsAdults admitted to the intensive care unit between October–March 2021 (wave 2) with a confirmed diagnosis of COVID-19 and mechanically ventilated for >24 hours were included. During wave 2, rehabilitation was provided by physiotherapists over five days, with only emergency respiratory physiotherapy delivered at weekends. Rehabilitation status was measured daily using the Manchester Mobility Score to identify time taken to first mobilise and highest level of mobility achieved at ICU discharge. Outcomes were compared to data previously published from the same ICU during ‘wave 1’ (March–April 2020) when a seven-day rehabilitation physiotherapy service was provided.ResultsA total of n = 291 patients were included in analysis; 110 from wave 1, and 181 from wave 2. Patient characteristics and medical management were similar between waves. Mean ± SD time to first mobilise was slower in wave 2 (15 ± 11 days vs 14 ± 7 days), with overall mobility scores lower at both ICU (MMS 5 (Step transferring) vs MMS 4 (standing practice) (4), p < 0.05) and hospital (MMS 7 (Mobile > 30 m MMS) vs MMS 6 (Mobile < 30 m MMS), p < 0.0001) discharge. Significantly more patients in wave 2 required ongoing rehabilitation either at home or as an inpatient compared to wave 1 (81 % vs 49 %, p = 0.003).ConclusionThe change in physiotherapy staff provision from a seven-day rehabilitation service during wave 1 to a five day rehabilitation service with emergency respiratory physio only at weekends in wave 2 was associated with delayed time to first mobilise, lower levels of mobility at both intensive care unit and hospital discharge and higher requirement for ongoing rehabilitation at the point of hospital discharge.     

Philadelphia versus Miami-J cervical collar's impact on pulmonary function

PurposeThe purpose of this study was to compare the effect of two types of cervical collars (Philadelphia and Miami-J) on pulmonary function and ventilation in healthy volunteers through spirometry, peak flow meter, and capnograph.MethodInitially, subjects were randomized into two groups in which the sequence of collars' fixation was reversed. Afterward, we assessed the pulmonary parameters without a cervical collar in all participants. Each group underwent two additional test conditions, including measurements after wearing a Philadelphia and Miami-J cervical collar. In any case, we took the measurements half an hour after the collar fixation.ResultsThe mean age of participants was 48.34 ± 1.35 years. Following either type of collars application, there was a statistically significant decrease in FEV1, FEV1/FVC, FEF25–75%, and PEF (p < .001). However, FVC was not significantly changed (p = .157).ConclusionIn summary, we noted a statistically significant expiratory flow obstruction after both the Philadelphia and Miami-J cervical collar. These changes were not clinically significant in healthy volunteers, albeit may have ramifications in patients with pre-existing respiratory compromise.     

Respiratory muscle training improves exercise tolerance and respiratory muscle function/structure post-stroke at short term: A systematic review and meta-analysis

BackgroundPrevious reviews relating to the effects of respiratory muscle training (RMT) after stroke tend to focus on only one type of training (inspiratory or expiratory muscles) and most based the results on poor-quality studies (PEDro score ≤4).ObjectivesWith this systematic review and meta-analysis, we aimed to determine the effects of RMT (inspiratory or expiratory muscle training, or mixed) on exercise tolerance, respiratory muscle function and pulmonary function and also the effects depending on the type of training performed at short- and medium-term in post-stroke.MethodsDatabases searched were MEDLINE, PEDro, CINAHL, EMBASE and Web of Science up to the end of April 2020. The quality and risk of bias for each included study was examined by the PEDro scale (including only high-quality studies) and Cochrane Risk of Bias tool.ResultsNine studies (463 patients) were included. The meta-analysis showed a significant increase in exercise tolerance [4 studies; n = 111; standardized mean difference [SMD] = 0.65 (95% confidence interval 0.27–1.04)]; inspiratory muscle strength [9 studies; n = 344; SMD = 0.65 (0.17–1.13)]; inspiratory muscle endurance [3 studies; n = 81; SMD = 1.19 (0.71–1.66)]; diaphragm thickness [3 studies; n = 79; SMD = 0.9 (0.43–1.37)]; and peak expiratory flow [3 studies; n = 84; SMD = 0.55 (0.03–1.08)] in the short-term. There were no benefits on expiratory muscle strength and pulmonary function variables (forced expiratory volume in 1 s) in the short-term.ConclusionsThe meta-analysis provided moderate-quality evidence that RMT improves exercise tolerance, diaphragm thickness and pulmonary function (i.e., peak expiratory flow) and low-quality evidence for the effects on inspiratory muscle strength and endurance in stroke survivors in the short-term. None of these effects are retained in the medium-term. Combined inspiratory and expiratory muscle training seems to promote greater respiratory changes than inspiratory muscle training alone.     

Implementing a systematic care pathway for management of dysphagia after cardiothoracic surgery

ObjectivesThis longitudinal quality improvement study explored the impact of a new multidisciplinary dysphagia care pathway on swallow screening referrals, patient journeys and swallow outcomes in patients after cardiac surgery.Research methodologyThe new dysphagia care pathway consisted of i) nurse chart review triaging using established risk factors, ii) nurse swallow screening (including a cough reflex test and water swallow test) and iii) rapid referral routes to speech pathology. All patients referred for swallow screening in 2020 after the commencement of the new dysphagia care pathway were included (n = 114). Data was compared to two historical, published data sets at the research site (n-41 in 2012–2013 and n = 121 in 2013–2016).SettingCardiovascular intensive care unit.Results52% failed chart review and 29% failed cough reflex test. All patients who passed chart review and cough reflex test returned to a normal diet without need for speech pathology referral. Silent aspiration rates were high in those who failed chart review and the cough reflex test (42%, 43% respectively). For those who received a swallow screen, enteral feeding rates were 70% on first assessment and 27% by discharge from the unit in historical data (2013–2016). In comparison, in 2020, enteral feeding rates were 44% and 8% respectively.ConclusionsReferrals for nurse swallow screening and speech pathology increased following the introduction of the care pathway. There has been a reduction in enteral feeding rates and length of enteral feeding at discharge. High rates of silent aspiration in those who fail screening suggests stepwise nurse dysphagia screening successfully picks up at-risk patients.     

The effects of respiratory muscle training on improvement of the internal and external thoraco-pulmonary respiratory mechanism in COPD patients

IntroductionChronic obstructive pulmonary disease (CPOD) is a severe, incapacitating pathology. Inspiratory and/or expiratory muscle training may favorably impact the indicators of both specific and general improvement with regard to this disease. We are hypothesizing that when combined with bronchial decluttering, this training will have a beneficial effect on lung function and quality of life in these patients.MethodFourty COPD subjects classified Gold I and Gold II and aged 60.38 ± 8.02 years were divided into four groups of 10. Three of the groups were trained with the help of Threshold^® tools used for (1) inspiratory, (2) expiratory and (3) inspiratory and expiratory purposes; their training supplemented the decluttering and lower limb muscle exercise that the 4th group concurrently received. The patients underwent 16 rehabilitation sessions over an 8-week period. The variables consisted in: (1) forced expiratory volume in 1 s (FEV1) and spirometrically measured peak expiratory and inspiratory flow rates (PEFR and PIFR); (2) fatigability, dyspnea, heart rate and walking distance evaluated during the 6-minute walk test; (3) maximum inspiratory pressure and (4) maximum expiratory pressure as assessed by the Threshold^® tools and (5) the signs of quality of life in terms of the Saint-George's respiratory questionnaire (SGRQ) score.ResultsOnly in group 1, there was significant improvement with regard to FEV1 and PEFR. There was no PIFR modification in any of the groups. On the other hand, signs of quality of life scores along with dyspnea, fatigability and heart rate showed significant improvement in the three experimental groups, and significant improvement in maximum inspiratory pressure was observed in groups 1 and 3.DiscussionWhen associated with decluttering techniques, diaphragmatic rehabilitation and lower limb muscle exercise along with psychological support and educational efforts, respiratory muscle training is beneficial when compared with the usual protocols in rehabilitation of COPD patients.     

Correlation between peak expiratory flow and abdominal muscle activity in elderly women while holding maximum expiration and performing the side bridge exercise

IntroductionExpiratory flow is important to minimize the risk of infection by expelling foreign substances from the lungs. Abdominal muscle activities primarily produce expiratory flow. However, data on the association of abdominal muscle activity during expiratory effort and abdominal exercise posture with expiratory flow rate is limited. This study aimed to assess the correlation between expiratory flow and abdominal muscle activity while holding maximum expiration and performing the side bridge exercise in elderly women.MethodsRectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscle activity was measured using electromyography in 14 elderly women (82.8 ± 6.7 years), who could walk independently while performing 2 tasks: holding their breath after maximum expiration in the crook-lying position (maximum expiration), and performing the side bridge exercise on their knees without breathing instruction (side bridge). Peak expiratory flow (PEF) was obtained using a peak flow meter. Correlations between PEF and the abdominal muscle activity were determined using the Spearman rank correlation coefficient.ResultsThe correlation coefficients between PEF and RA, EO, and IO activity while holding maximum expiration were 0.407 (p = 0.149), −0.345 (p = 0.227), and 0.732 (p = 0.003), respectively. The correlation coefficients between PEF and RA, EO, and IO activity while performing the side bridge exercise were −0.297 (p = 0.303), −0.552 (p = 0.041), and 0.147 (p = 0.615), respectively.ConclusionsHigher IO activity while holding maximum expiration or lower EO activity while performing the side bridge exercise was related to higher PEF. Thus, maximum expiration and abdominal exercise might be effective in the improvement or prevention of the decrease of expiratory flow.     

Usability and acceptability of a mobile application prototype for a combined behavioural activation and physical rehabilitation intervention in acute respiratory failure survivors

BackgroundAcute respiratory failure survivors experience depression symptoms and new impairments in physical function. Behavioural activation, an evidence-based nonpharmacological treatment for depression, combined with physical rehabilitation, is a promising intervention. Notably, mHealth applications (Apps) are potentially effective methods of delivering home-based interventions.ObjectivesThe objective of this study was to evaluate the usability and acceptability of a prototype App to deliver a combined, home-based behavioural activation and rehabilitation intervention to acute respiratory failure survivors.MethodsA prospective user-preference study was conducted with acute respiratory failure survivors and self-designated care partners. Survivors were adults with at least mild depression symptoms before hospital discharge who received mechanical ventilation in the intensive care unit for ≥24 h. Survivors and care partners reviewed the App during a single in-person home visit and completed the System Usability Scale (range: 0–100; score >73 considered “good”) and a semistructured interview.ResultsTen patient/care partner dyads completed study. The median [interquartile range] patient age was 50 [40–64] years, and 50% were female. The median System Usability Scale scores among patients and care partners were 76 [68–83] and 88 [75–94], respectively. Qualitative feedback supported usability and acceptability of the App, with three themes reported: (1) stigma associated with depression, (2) App as a motivator for recovery, and (3) App providing multidisciplinary support for survivor and care partner.ConclusionsA mobile App prototype designed to deliver a combined behavioural activation and rehabilitation intervention was usable and acceptable to survivors of acute respiratory failure and their care partners. Given the reported stigma associated with depression, the self-directed App may be particularly valuable for motivation and multidisciplinary support.     

The respiratory effects of a Pilates method protocol: Randomized clinical trial

ObjectivesTo evaluate the respiratory effects of a Pilates method (PM) protocol in adult women.DesignSingle-blind randomized controlled trial.SettingsHealthy women were randomized into two groups using the Random.org online tool: a Pilates group (PG) (n = 33) and a control group (CG) (n = 29).ParticipantsSixty-two healthy women, aged 18–44 years, sedentary or irregularly active B (as defined by the international physical activity questionnaire [IPAQ]). The intervention consisted of 16 sessions of PM. protocol twice a week for the PG. The CG without intervention.Main outcomes measuresThe variables evaluated were maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), peak expiratory flow (PEF), tidal volume (TV), respiratory frequency (RF), minute volume (MV), and slow vital capacity (SVC).ResultsThe results showed significant evidence of the beneficial respiratory effects of the PM protocol when the PG was compared with the CG: increased MIP (p = 0.001), and a significant increase in TV (p = 0,047).ConclusionThe PM protocol used in this study may be effective for respiratory muscle strength because it improved MIP and TV.Clinical trial registrationhttps://ensaiosclinicos.gov.br/rg/RBR-5b6wc3.     

Pilates method on pulmonary function and range of motion after coronary artery bypass grafting: A clinical trial

IntroductionCoronary artery bypass grafting (CABG) can compromise pulmonary function and range of motion (ROM) of the shoulder and knee joints due to median sternotomy and saphenectomy, the Pilates method being a strategy for reducing loss.ObjectiveTo evaluate the effect of applying the Pilates method on pulmonary function and ROM in patients undergoing CABG.Methodology: This is a clinical trial. Patients were evaluated preoperatively at discharge from the hospital for shoulder flexion and abduction and knee flexion-extension. In addition, vital capacity(VC), maximum inspiratory pressure(MIP), expiratory pressure(MEP) and peak expiratory flow(PEF) were evaluated. Upon discharge from the Intensive Care Unit (ICU), they were divided into a control group(CG) that received conventional assistance and Pilates(PG) was increased with Pilates method techniques.Results40 patients were analyzed, 25 were men(61%), with a mean age of 66 ± 7 years. At the end, the left shoulder abduction in the CG was 105±9vs115 ± 8 in the PG(p = 0.03), the right shoulder abduction in the CG 104 ± 11vs116 ± 10 in the PG(p < 0.001) and right knee flexion in the CG 78 ± 13vs92 ± 9 in the PG(0.002). In relation to MIP, the CG had a loss of 32 ± 8 while the PG 18 ± 10cmH2O(p < 0.001), the worsening MEP was 31 ± 9(CG)vs29 ± 11cmH2O(PG)(p = 0.53), the VC in the CG reduced 8±9vs6±8 in the PG(p = 0.23) and the PEF reduced 107 ± 5 in the GCvs83 ± 88 in the PG(p = 0.09).ConclusionIt is concluded that the Pilates method decreased the loss of ROM and maximum inspiratory pressure in patients undergoing coronary artery bypass grafting.     

肌内效贴对脑卒中吞咽障碍患者流涎的疗效

目的 观察肌内效贴对脑卒中后流涎的治疗效果。方法 2019年10月至2021年1月,脑卒中后吞咽障碍流涎患者40例随机分为对照组和试验组,各20例。两组均接受常规药物治疗、吞咽常规训练和吞咽困难康复护理,试验组加用肌内效贴,共3周。治疗前后采用功能性经口摄食评估量表(FOIS)、洼田饮水试验(WST)和教师流涎量表(TDS)进行评定。结果 试验组脱落1例。治疗后,两组FOIS、TDS和WST评分均改善(|Z| > 2.000, P < 0.05),试验组均明显优于对照组(|Z| > 3.045, P < 0.01)。结论 配合肌内效贴可进一步改善脑卒中后吞咽障碍患者的流涎。     

呼吸肌训练对亚急性期脑卒中患者呼吸功能的影响

目的探讨呼吸肌训练对亚急性期脑卒中患者呼吸功能的影响。 方法选取50例首次发病亚急性期脑卒中患者,按随机数字表法分为对照组和观察组,每组25例。由于患者失去康复治疗的积极性、出院等原因,有5例患者退出（其中对照组2例,观察组3例）,最终有45例患者完成本研究。2组患者均根据自身功能障碍情况给予相应的常规康复功能治疗,观察组在此基础上增加呼吸肌训练。每日2次,每周6d,康复治疗共3周。分别于治疗前和治疗3周后（治疗后）,对2组患者进行血气分析、肺通气功能测定和呼吸肌肌力测定,并采用Fugl-Meyer运动功能评定量表（FMA）上肢及下肢部分对2组患者的上下肢运动功能进行评定,采用Barthel指数（BI）对2组患者的日常生活活动（ADL）能力进行评分;然后随访观察3个月,分析和比较2组患者肺部感染和再发脑卒中的发生率。 结果治疗后,2组患者动脉氧分压（PaO2）、用力肺活量（FCV）、一秒用力呼气容积（FEV1）、每分钟最大通气量占预计值的百分比（MVV%）、峰值呼气流速（PEF）、最大静止吸气压（PImax）、最大静止呼气压（PEmax）、上肢及下肢Fugl-Meyer运动功能评分、Barthel指数评分均较组内治疗前有明显提高,且差异有统计学意义(P<0.05);且治疗后除FMA和BI评分外,观察组其余各项指标均高于对照组,组间差异有统计学意义(P<0.05)。随访3个月发现,2组患者肺部感染率组间比较,观察组低于对照组,差异亦有统计学意义(P<0.05);而2组患者再发脑卒中的发生率组间比较,差异无统计学意义(P>0.05)。 结论亚急性期脑卒中患者通过呼吸肌训练能有效增加呼吸肌肌力,提高动脉氧分压,改善肺通气功能,降低肺部感染率。     

Respiratory distress and its associated factors among preterm neonates admitted to Mizan Tepi University teaching hospital,Bench Maji Zone,South West Ethiopia, 2020

BackgroundRespiratory distress (RD) is a common problem in the neonatal period and one of the most common reasons for neonates to be admitted to the neonatal intensive care unit (NICU) which frequently leads to neonatal mortality. However, there are few studies on neonatal respiratory distress and its associated factors in Ethiopia. This study was aimed to determine the prevalence and associated factors of respiratory distress in the neonatal intensive care unit at Mizan Tepi University teaching hospital.MethodsAn institutional based retrospective cross sectional study was conducted among preterm infants admitted in a neonatal intensive care unit (NICU) of Mizan Tepi University teaching hospital from May 9/2016 to December 30/2019. Simple random sampling technique was used to recruit a predetermined sample size by using registration numbers of the clients enrolled through computer generated random numbers. Binary Logistic regression was used to analyze the association between neonatal respiratory distress and explanatory variables. Explanatory variables that had a P-value of less than 0.25 and fulfilled the assumption of logistic regression from bi-variable logistic regression were considered for the multivariable logistic regression model. The strength of association was evaluated using an odds ratio at 95% confidence interval and a P-value < 0.05 was considered to declare significant associations.ResultThe proportion of respiratory distress in the current study was 34.0% at 95% CI 29.4%–38.6%. Respiratory distress was significantly associated with being a multiple (twin) AOR = 1.8(1.05–3.09), non-cephalic presentation at delivery AOR = 4.9(1.96–12.2), presence of asphyxia AOR = 1.85(1.01–3.69), an APGAR of <7 at 5-min AOR = 1.64(1.18–2.7), and a gestational age between 31 and 34 weeks AOR = 1.85(1.12–3.5).ConclusionThe prevalence of neonatal respiratory distress in the current study was high. Nearly one out of three neonates admitted to Mizan Tepi University teaching hospital NICU's had respiratory distress. Respiratory distress was significantly associated with a low 5-min APGAR score, a gestational age between 28 and 31, a multiple (twin) pregnancy, non-cephalic presentation, and neonatal asphyxia. Therefore, health professionals working in the delivery room and/or the neonatal intensive care unit should be mindful of these associated factors for early detection and appropriate management of RD to ensure better outcomes in all infants presenting with respiratory distress.     

Pulmonary Functions in Patients With Chronic Neck Pain: A Case-Control Study

ObjectiveThe purpose of the study was to investigate pulmonary functions of patients with chronic neck pain and compare them with those of asymptomatic controls.MethodsThis case-control study was conducted with 25 patients with chronic neck pain (age, 26.84 ± 7.89 years) and 27 age-matched asymptomatic controls (age, 25.96 ± 7.13 years). Pulmonary function tests were performed using spirometry (Quark PFT, COSMED, Rome, Italy). Forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), forced expiratory flow at 25% to 75% vital capacity, peak expiratory flow, maximum voluntary ventilation, and the FEV₁/FVC ratio were measured and are expressed as (%) predicted value for patients with chronic neck pain and asymptomatic controls.ResultsThe chronic neck pain group had lower FEV₁ (P = .015), FVC (P = .029), forced expiratory flow at 25% to 75% vital capacity (P = .040), and maximum voluntary ventilation (P = .042) compared with asymptomatic controls; however, FEV₁/FVC (P = .470) and peak expiratory flow (P = .183) were similar in both groups.ConclusionThese results demonstrated that dynamic lung volumes were lower in patients with chronic neck pain compared with asymptomatic controls.