by Alice Yee-men Jones (Nee Ho). / Thesis (M.Phil.)--Chinese University of Hong Kong, 1992. / Includes bibliographical references (leaves [196]-221). / Abstract --- p.i / Publications --- p.iii / Acknowledgement --- p.v / Chapter SECTION I --- INTRODUCTION / Chapter Chapter 1 --- General Introduction --- p.1 / Chapter 1.1 --- Objectives / Chapter 1.2 --- History & Advances in Chest Physiotherapy / Chapter 1.3 --- Problems of Chest Physiotherapy Research / Chapter 1.4 --- Plan of work / Chapter Chapter 2 --- Previous Studies in Chest Physiotherapy --- p.15 / Chapter 2.1 --- Chest Physiotherapy and oxygenation / Chapter 2.2 --- Chest Physiotherapy and sputum clearance / Chapter 2.3 --- Chest Physiotherapy and lung function / Chapter Chapter 3 --- "Chest Physiotherapy Practice in ICUs in Australia, the UK and Hong Kong" --- p.34 / Chapter SECTION II --- METHODS / Chapter Chapter 4 --- Measurement of Oxygenation --- p.55 / Chapter 4.1 --- Measurement of arterial oxygenation / Chapter 4.2 --- Indirect measurement of arterial oxygenation / Chapter Chapter 5 --- Respiratory Function Analysis --- p.66 / Chapter 5.1 --- Spirometry measurement / Chapter 5.2 --- Measurement of lung mechanics / Chapter Chapter 6 --- Transcutaneous Electrical Nerve Stimulation --- p.74 / Chapter SECTION III --- RESPIRATORY PHYSIOTHERAPY TECHNIQUES / Chapter Chapter 7 --- Effects of Percussion and Bagging on Static Lung Compliance --- p.80 / Chapter Chapter 8 --- Peak Expiratory Flow from two Breathing Circuits --- p.106 / Chapter Chapter 9 --- Peak Expiratory Flow in Tracheal Intubated Patients --- p.127 / Chapter SECTION IV --- PHYSIOTHERAPY AND PAIN MANA GEMENT IN ICU PATIENTS / Chapter Chapter 10 --- Transcutaneous Electrical Nerve Stimulation (TENS) following Thoracotomy --- p.142 / Chapter Chapter 11 --- TENS following Cholecystectomy --- p.154 / Chapter Chapter 12 --- TENS and Entonox --- p.167 / Chapter SECTION V --- SUMMARY AND CONCLUSIONS / Chapter Chapter 13 --- Summary --- p.185 / Chapter Chapter 14 --- Conclusion --- p.194 / Chapter SECTION VI --- REFERENCES --- p.197 / Chapter SECTION VII --- APPENDICES --- p.222

O momento ideal para a extubação de crianças graves é ainda difícil de ser avaliado. A razão entre espaço morto e volume corrente (Vd/Vt), como valor preditiva de extubação bem sucedida, já foi testada em adultos e crianças. O objetivo deste trabalho foi avaliar a eficácia do Vd/Vt, como preditivo do sucesso da extubação, em crianças de uma UTI pediátrica geral. Após aplicação dos critérios de inclusão e exclusão, testou-se o Vd/Vt em 86 pacientes extubados num período de 16 meses. Nos estudos estatísticos o índice Vd/Vt médio não discriminou os grupos de falha e sucesso na extubação nas análises uni e multivariada. O valor do índice, com corte em 0,65, foi limitado na sensibilidade e especificidade e mediano na razão de verossimilhança. O estudo sugere que o índice Vd/Vt, pode ser considerado como complementar aos dados de avaliação clínica no momento da extubação. / The ideal moment for extubation of critically ill children is still difficult to determine. The dead-space : tidal volume ratio (Vd/Vt) has been tested as predictor of extubation failure in adults and children. The purpose of this study was to evaluate the efficacy of the Vd/Vt as a predictor of the success of extubation in children admitted to a pediatric intensive care unit. After the inclusion and exclusion criteria, 86 patients were studied during 16 months. The statistical study revealed that the mean Vd/Vt was not able to discriminate between failure and success of extubation in the multivariate analysis. The utility of the Vd/Vt was limited, in terms of sensibility and specificity, using a cutoff of 0,65, but was medially satisfactory in the likelihood ratio. This study suggests that the Vd/Vt can only be considered as complementary to the routine clinical evaluation prior to extubation.

O momento ideal para a extubação de crianças graves é ainda difícil de ser avaliado. A razão entre espaço morto e volume corrente (Vd/Vt), como valor preditiva de extubação bem sucedida, já foi testada em adultos e crianças. O objetivo deste trabalho foi avaliar a eficácia do Vd/Vt, como preditivo do sucesso da extubação, em crianças de uma UTI pediátrica geral. Após aplicação dos critérios de inclusão e exclusão, testou-se o Vd/Vt em 86 pacientes extubados num período de 16 meses. Nos estudos estatísticos o índice Vd/Vt médio não discriminou os grupos de falha e sucesso na extubação nas análises uni e multivariada. O valor do índice, com corte em 0,65, foi limitado na sensibilidade e especificidade e mediano na razão de verossimilhança. O estudo sugere que o índice Vd/Vt, pode ser considerado como complementar aos dados de avaliação clínica no momento da extubação. / The ideal moment for extubation of critically ill children is still difficult to determine. The dead-space : tidal volume ratio (Vd/Vt) has been tested as predictor of extubation failure in adults and children. The purpose of this study was to evaluate the efficacy of the Vd/Vt as a predictor of the success of extubation in children admitted to a pediatric intensive care unit. After the inclusion and exclusion criteria, 86 patients were studied during 16 months. The statistical study revealed that the mean Vd/Vt was not able to discriminate between failure and success of extubation in the multivariate analysis. The utility of the Vd/Vt was limited, in terms of sensibility and specificity, using a cutoff of 0,65, but was medially satisfactory in the likelihood ratio. This study suggests that the Vd/Vt can only be considered as complementary to the routine clinical evaluation prior to extubation.