Hypoxaemia during chest physiotherapy in patients with cystic fibrosis

McDonnell, Tim; McNicholas, WT; FitzGerald, M. X.

doi:10.1007/bf02960715

Cited by 48 publications

(20 citation statements)

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“…Chest clapping has also been shown to cause an increase in hypoxaemia [29,30], but, when short periods of chest clapping (<30 s) have been combined with three or four thoracic expansion exercises, no fall in oxygen saturation has been seen [31]. Some patients with severe lung disease demonstrate oxygen desaturation with self chest clapping [32].…”

Section: Percussion and Vibrationmentioning

confidence: 99%

Physiotherapy for airway clearance in adults

1999

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Techniques for augmenting, when necessary, the normal mucociliary and cough clearance mechanisms of the lungs are not new, but, in more recent years, techniques have been developed which are effective, comfortable and can be used independent of an assistant in the majority of adolescents and adults.Postural drainage with chest clapping and chest shaking has, in most parts of the world, been replaced by the more effective techniques of the active cycle of breathing, autogenic drainage, R-C Cornet1, Flutter1, positive expiratory pressure mask, highfrequency chest wall oscillation and intrapulmonary percussive ventilation. Glossopharyngeal breathing is being considered again and is often a useful technique for increasing the effectiveness of cough in patients with tetraplegia or neuromuscular disorders.The evidence in support of these techniques is variable, and the literature is confusing and conflicting. There may or may not be significant differences among the techniques in the short or long term. Many of the regimens now include the forced expiratory manoeuvre of a "huff" and this has probably increased the effectiveness of airway clearance. If objective differences are small, individual preferences and cultural influences may be significant in increasing adherence to treatment and in the selection of an appropriate regimen or regimens for an individual patient.

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Section: Percussion and Vibrationmentioning

confidence: 99%

Physiotherapy for airway clearance in adults

1999

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“…Desaturation has been described during CPT. 5,29 It has been suggested that desaturation can be prevented by allowing sufficiently long periods of quiet breathing between the FET maneuvers. 7 In our study, desaturation occurred immediately after the FET maneuvers during the control session, consistent with a role of bronchial collapse and prolonged expiration.…”

Section: Spomentioning

confidence: 99%

“…The quiet breathing periods are essential to prevent bronchospasm and oxygen desaturation. 5,6 In a study by Pryor and colleagues 7 during postural drainage with assisted breathing by a physiotherapist, arterial oxygen saturation as assessed by pulse oximetry (Spo 2 ) did not fall during CPT when thoracic expansion exercises combined with chest clapping alternated with periods of relaxed breathing. However, this study involved discontinuous Spo 2 and therefore may have missed episodes of transient arterial oxygen desaturation.…”

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confidence: 98%

Chest Physiotherapy in Cystic Fibrosis: Improved Tolerance With Nasal Pressure Support Ventilation

et al. 1999

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ABSTRACT. Objective. Chest physiotherapy (CPT) is an integral part of the treatment of patients with cystic fibrosis (CF). CPT imposes additional respiratory work that may carry a risk of respiratory muscle fatigue. Inspiratory pressure support ventilation (PSV) is a new mode of ventilatory assistance designed to maintain a constant preset positive airway pressure during spontaneous inspiration with the goal of decreasing the patient's inspiratory work. The aim of our study was 1) to evaluate respiratory muscle fatigue and oxygen desaturation during CPT and 2) to determine whether noninvasive PSV can relieve these potential adverse effects of CPT.Methods. Sixteen CF patients in stable condition with a mean age of 13 ؎ 4 years participated to the study. For CPT, we used the forced expiratory technique (FET), which consisted of one or more slow active expirations starting near the total lung capacity (TLC) and ending near the residual volume. After each expiration, the child was asked to perform a slow, nonmaximal, diaphragmatic inspiration. After one to four forced breathing cycles, the child was asked to cough and to expectorate. A typical 20-minute CPT session consisted of 10 to 15 FET maneuvers separated by rest periods of 10 to 20 breathing cycles each. During the study, each patient received two CPT sessions in random order on two different days, at the same time of day, with the same physiotherapist. During one of these two sessions, PSV was provided throughout the session (PSV session) via a nasal mask using the pressure support generator ARM25 designed for acute patients (TAEMA, Antony, France). The control session was performed with no nasal mask or PSV. Both CPT sessions were performed without supplemental oxygen. Lung function and maximal inspiratory pressures (PImax) and expiratory pressures (PEmax) were recorded before and after each CPT session.Results. Mean lung function parameters were comparable before the PSV and the control sessions. Baseline pulse oximetry (SpO 2 ) was significantly correlated with the baseline vital capacity (% predicted) and forced expiratory volume in 1 second (FEV 1 ) (% predicted). PSV was associated with an increase in tidal volume (Vt) from 0.42 ؎ 0.01 liters to 1.0 ؎ 0.02 liters. Respiratory rate was significantly lower during PSV. SpO 2 between the FET maneuvers was significantly higher during PSV as compared with the control session. SpO 2 decreases after FET were significantly larger during the control session (nadir: 91.8 ؎ 0.7%) than during the PSV session (93.8 ؎ 0.6%). Maximal pressures decreased during the control session (from 71.9 ؎ 6.1 to 60.9 ؎ 5.3 cmH 2 O, and from 85.3 ؎ 7.9 to 77.5 ؎ 4.8 cmH 2 O, for PImax and PEmax, respectively) and increased during the PSV session (from 71.6 ؎ 8.6 to 83.9 ؎ 8.7 cmH 2 O, and from 80.4 ؎ 7.8 to 88.0 ؎ 7.4 cmH 2 O, for PImax and PEmax, respectively). The decrease in PEmax was significantly correlated with the severity of bronchial obstruction as evaluated based on baseline FEV 1 (% predicted). Forced expiratory flows did...

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“…This consists of a modified active cycle of breathing technique accompanied by physical procedures, such as percussion and shaking, and manually assisted cough [4]. However, intensive physiotherapy is tiring for patients and vigorous physiotherapy can precipitate episodic oxygen desaturation [5]. To improve tolerance, physiotherapy can be combined with assistance from noninvasive positive pressure ventilation (NIPPV) [6], but this approach may still be insufficient to clear secretions adequately, resulting in some patients requiring invasive ventilation.…”

mentioning

confidence: 99%

Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness

Chatwin¹,

Ross²,

Hart³

et al. 2003

Eur Respir J

328

254

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Adults and children with neuromuscular disease exhibit weak cough and are susceptible to recurrent chest infections, a major cause of morbidity and mortality. Mechanical insufflation/exsufflation may improve cough efficacy by increasing peak cough flow. It was hypothesised that mechanical insufflation/exsufflation would produce a greater increase in peak cough flow than other modes of cough augmentation. The acceptability of these interventions was also compared.Twenty-two patients aged 10-56 yrs (median 21 yrs) with neuromuscular disease and 19 age-matched controls were studied. Spirometry was performed and respiratory muscle strength measured. Peak cough flow was recorded during maximal unassisted coughs, followed in random order by coughs assisted by physiotherapy, noninvasive ventilation, insufflation and exsufflation, and exsufflation alone. Subjects rated strength of cough, distress and comfort on a visual analogue scale.In the neuromuscular disease group, mean¡SD forced expiratory volume in one second was 0.8¡0.6 L?s -1 , forced vital capacity 0.9¡0.8 L, maximum inspiratory pressure 25¡16 cmH 2 O, maximum expiratory pressure 26¡22 cmH 2 O and unassisted peak cough flow 169¡90 L?min -1 . The greatest increase in peak cough flow was observed with mechanical insufflation/exsufflation at 235¡111 L?min -1 (pv0.01). All techniques showed similar patient acceptability.Mechanical insufflation/exsufflation produces a greater increase in peak cough flow than other standard cough augmentation techniques in adults and children with neuromuscular disease.

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Hypoxaemia during chest physiotherapy in patients with cystic fibrosis

Cited by 48 publications

References 10 publications

Physiotherapy for airway clearance in adults

Physiotherapy for airway clearance in adults

Chest Physiotherapy in Cystic Fibrosis: Improved Tolerance With Nasal Pressure Support Ventilation

Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness

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