Justification for Chest Physiotherapy during Ultra‐Protective Lung Ventilation and Extra‐Corporeal Membrane Oxygenation: A Case Study

Cork, Gabriella; Barrett, Nicholas; Ntoumenopoulos, George

doi:10.1002/pri.1563

Cited by 16 publications

(16 citation statements)

References 5 publications

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“…The underlying diseases or clinical conditions that led to the indication of ECMO were cystic fibrosis, (11,19,20,23,31-33,36) pulmonary fibrosis, (11,19,20,23,31-33,36) acute respiratory failure, (21,24,25,36) acute respiratory distress syndrome (ARDS), (11,29,33,35) chronic obstructive pulmonary disease, (11) idiopathic pulmonary disease, (11) pulmonary arterial hypertension, (11) usual interstitial pneumonia, (19) acute viral interstitial pneumonia, (28) pneumonia, (19) bridge to lung transplantation (LT), (22,26,34) asthma, (27) lymphangioleiomyomatosis, (23) pleuroparenchymal fibroelastosis, (32) pulmonary embolism, (37) cardiogenic shock, (37) and ventricular dysfunction after cardiac procedure. (37) One study (30) did not report the reason for using ECMO in the sample (n = 10).…”

Section: Resultsmentioning

confidence: 99%

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Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review

Ferreira¹,

Marcolino²,

Macagnan³

et al. 2019

Revista Brasileira De Terapia Intensiva

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Scientific and technological advances, coupled with the work of multidisciplinary teams in intensive care units, have increased the survival of critically ill patients. An essential life support resource used in intensive care is extracorporeal membrane oxygenation. Despite the increased number of studies involving critically ill patients, few studies to date have demonstrated the safety and benefits of physical therapy combined with extracorporeal membrane oxygenation support. This review identified the clinical outcomes of physical therapy in adult patients on extracorporeal membrane oxygenation support by searching the MEDLINE ® , PEDro, Cochrane CENTRAL, LILACS, and EMBASE databases and by manually searching the references of the articles published until September 2017. The database search retrieved 1,213 studies. Of these studies, 20 were included in this review, with data on 317 subjects (58 in the control group). Twelve studies reported that there were no complications during physical therapy. Cannula fracture during ambulation (one case), thrombus in the return cannula (one case), and leg swelling (one case) were reported in two studies, and desaturation and mild vertigo were reported in two studies. In contrast, improvements in respiratory/pulmonary function, functional capacity, muscle strength (with reduced muscle mass loss), incidence of myopathy, length of hospitalization, and mortality in patients who underwent physical therapy were reported. The analysis of the available data indicates that physical therapy, including early progressive mobilization, standing, ambulation, and breathing techniques, together with extracorporeal membrane oxygenation, is feasible, relatively safe, and potentially beneficial for critically ill adult patients.

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Section: Resultsmentioning

confidence: 99%

“…(37) One study (30) did not report the reason for using ECMO in the sample (n = 10). The duration of ECMO support was reported in 12 studies (19,21-23,25,27,29,30,33-36) and ranged from 1 (19) to 125 (35) days.…”

Section: Resultsmentioning

confidence: 99%

Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review

Ferreira¹,

Marcolino²,

Macagnan³

et al. 2019

Revista Brasileira De Terapia Intensiva

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“…The study by Fiddler and Williams (2000) emphasized the importance of respiratory therapy when proposed to treat or prevent pulmonary complications in ECMO patients; in-bed positioning and postural exercises are vital components of such treatments, promoting lung ventilation and removal of secretions. Furthermore, it has been found that chest physiotherapy plays an important role in order to facilitate secretion clearance and lung function for a patient while on ECMO (Cork et al, 2014). In a series of candidates awaiting lung transplantation, the post-transplantation duration of ventilation and the postoperative ICU stay were shorter in those undergoing rehabilitation while on ECMO (Thiagarajan et al, 2012).…”

Section: Respiratory Therapymentioning

confidence: 99%

Physiotherapy for Patients on Awake Extracorporeal Membrane Oxygenation: A Systematic Review

Polastri

Loforte

Dell’Amore

et al. 2015

Physiother. Res. Int.

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In total, 216 citations were retrieved. Nine citations satisfied our inclusion criteria and were subjected to full-text analysis. The numbers of patients enrolled in the included studies (most of which were case series) were low (n = 52). We found no prospective studies or randomized controlled trials. Overall, subjects on awake ECMO usually received a combination of passive and active physiotherapy, and most achieved an acceptable degree of autonomy after treatment. Emerging research in the field affords preliminary evidence supporting the safety of early mobilization and ambulation in patients on awake veno-venous ECMO support. Copyright © 2015 John Wiley & Sons, Ltd.

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“…Michaels et al 11 used high-frequency percussive ventilation in adult ECMO patients and showed a reduced duration on ECMO. Similarly, Cork et al 12 described the use of various chest physiotherapy and recruitment techniques in adult ECMO patient. Several reports in the pediatric literature have demonstrated the beneficial role of bronchoscopy in the secretion management of pediatric ECMO patients.…”

Section: Discussionmentioning

confidence: 97%

Automated Rotational Percussion Bed and Bronchoscopy Improves Respiratory Mechanics and Oxygenation in ARDS Patients Supported with Extracorporeal Membrane Oxygenation

Sharma

Wille²,

Bellot³

et al. 2016

ASAIO Journal

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Extracorporeal membrane oxygenation (ECMO) has been used to provide "lung rest" through the use of low tidal volume (6 ml/kg) and ultralow tidal volume (<6 ml/kg) ventilation in acute respiratory distress syndrome (ARDS). Low and ultralow tidal volume ventilation can result in low dynamic respiratory compliance and potentially increased retention of airway secretions. We present our experience using automated rotational percussion beds (ARPBs) and bronchoscopy in four ARDS patients to manage increased pulmonary secretions. These beds performed automated side-to-side tilt maneuver and intermittent chest wall percussion. Their use resulted in substantial reduction in peak and plateau pressures in two patients on volume control ventilation, while the driving pressures (inspiratory pressure) to attain the desired tidal volumes in patients on pressure control ventilation also decreased. In addition, mean partial pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FiO2) ratio (109 pre-ARPB vs. 157 post-ARPB), positive end-expiratory pressure (10 cm H2O vs. 8 cm H2O), and FiO2 (0.88 vs. 0.52) improved after initiation of ARPB. The improvements in the respiratory mechanics and oxygenation helped us to initiate early ECMO weaning. Based on our experience, the use of chest physiotherapy, frequent body repositioning, and bronchoscopy may be helpful in the management of pulmonary secretions in patients supported with ECMO.

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Justification for Chest Physiotherapy during Ultra‐Protective Lung Ventilation and Extra‐Corporeal Membrane Oxygenation: A Case Study

Cited by 16 publications

References 5 publications

Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review

Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review

Physiotherapy for Patients on Awake Extracorporeal Membrane Oxygenation: A Systematic Review

Automated Rotational Percussion Bed and Bronchoscopy Improves Respiratory Mechanics and Oxygenation in ARDS Patients Supported with Extracorporeal Membrane Oxygenation

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