Thesis (MScPhysio)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Aim: The aim of this study is to determine if the addition of a pre-extubation recruitment manoeuvre to standard care is safe and will improve lung compliance and subsequent PaO2/FiO2 (PF ratio) after extubation in postoperative coronary artery bypass graft surgery patients. Design: Prospective, triple blind, randomised, controlled trial. Method: This study was conducted in a private hospital in the Northern suburbs of Cape Town, South Africa. All patients admitted between 03/10/2010 and 22/11/2011, for uncomplicated elective coronary artery bypass graft (CABG) surgery were eligible for inclusion into the study. Patients were randomly allocated into either the intervention group or the control group. The intervention group received a gradual build-up lung recruitment manoeuvre (RM). The primary outcome was PaO2/FiO2 (PF ratio). The secondary outcomes were safety and static lung compliance. ICU length of stay (LOS) and hospital LOS were also recorded. The pre-RM hemodynamic stability of the patient was checked before the intervention and repeated at 5 minutes after the intervention by the nursing sister. Data to calculate static lung compliance was captured at the same time. Criteria for safety and discontinuation of the RM were monitored during the intervention by the principle investigator only. Results: Of the 69 patients eligible for the study 47 were randomly allocated into the intervention group (n=22) and control group (n=25) respectively. Groups were the same at baseline with regards to sex, pulmonary risk, sedation and surgical procedures. The RM could be completed in all patients. The prior defined criteria for discontinuation of the RM were not reached in any of the patients. No adverse effects were noted. The PaO2/FiO2 (PF ratio) decreased significantly in both groups from pre-surgery measurements compared to when measured before the RM (p<0.001). There was a tendency noted for the intervention group to return to pre-surgery measurements of PF ratio within 12 hours after extubation when compared to the control group. There was no significant difference between the groups from extubation to 24 hours (p = 0.6). The static compliance improved at 5 minutes following the RM (p<0.001) and remained improved until extubation (p<0.001) for the intervention group. No difference was noted in the static compliance of the control group over the same time period. The mean hospital length of stay for the intervention group was 8.61 (95% confidence interval 7.26 to 9.96 days) and 10.08 (95% confidence interval 8.52 – 11.63 days) for the control group. Conclusion: A gradual recruitment manoeuvre at 30cmH2O 30minutes before extubation significantly improved static lung compliance within 5 minutes with no adverse hemodynamic side effects. There was noted maintained improved PF ratio at extubation or immediately afterwards for the intervention group and no difference in the PF ratio between the intervention group and control group. / AFRIKAANSE OPSOMMING: Doel: Die doel van hierdie studie is om te bepaal of die toevoeging van ’n pre-ekstubasie herwinningstegniek tot standaard sorg veilig is, en of dit longvervormbaarheid en gevolglike PaO2/FiO2 (PF-verhouding) na ekstubasie in post-operatiewe kroonaaromleidingchirurgiepasiënte sal verbeter. Ontwerp: Prospektiewe, trippel-blinde, ewekansige, gekontroleerde proefneming. Metode: Hierdie studie is uitgevoer in ’n privaat hospitaal in die noordelike voorstede van Kaapstad, Suid-Afrika. Alle pasiënte wat tussen 03/10/2010 en 22/11/2011 gehospitaliseer is vir ongekompliseerde elektiewe kroonaaromleidingchirurgie, kon in aanmerking kom vir die studie. Pasiënte is op ewekansige wyse ingedeel in die intervensie- en kontrolegroepe. ’n Geleidelike-opbou-van-druk-longherwinningstegniek (HT) is op die intervensiegroep toegepas. Die primêre uitkoms was die PaO2 /FiO2 (PF-verhouding). Die sekondêre uitkoms was veiligheid en statiese longvervormbaarheid. ISE-verblyf en hospitaalverblyf is ook genoteer. Die navorsingsassistent het data van bestaande eenheiddokumentasie geneem. Die pre-HT-hemodinamiese stabiliteit van die pasiënte is gemonitor voor en weer 5 minute na die intervensie. Inligting om die statiese longvervormbaarheid te bereken is terselfdertyd genoteer. Kriteria vir veiligheid en vir die staking van die HT is gemonitor tydens uitvoering deur die primêre ondersoeker en die verpleegkundige. Resultate: Van die 69 pasiënte wat in aanmerking kon kom vir die studie is 47 op ewekansige wyse ingedeel in die intervensiegroep (n=22) en die kontrolegroep (n=25). Die groepe was dieselfde by die basislyn. Die herwinningstegniek kon volledig op alle pasiënte uitgevoer word. Die vooraf gedefinieerde kriteria vir staking van die HT is met geen pasiënte bereik nie. Geen nadelige uitwerking is genoteer nie. Die PaO2 /FiO2 (PF-verhouding) het beduidend verminder in beide groepe van pre-operatiewe metings in vergelyking met meting voor die HT (p<0.001). ‘n Neiging is genoteer dat die intervensiegroep binne 12 uur na ekstubasie tot pre-chirurgie PF-metings teruggekeer het. Daar was geen merkbare verskil tussen die groepe vanaf ekstubasie tot 24 uur (p=0.6) nie. Die statiese vervormbaarheid het verbeter teen 5 minute na HT (p<0.001) en het verbeter gebly tot ekstubasie (p<0.001) vir die intervensiegroep. Daar was geen verskil in die statiese vervormbaarheid van die kontrolegroep nie. Die gemiddelde hospitaalverblyf vir die intervensiegroep was 8.61 (95% betroubaarheidsinterval 7.26 tot 9.96 dae) en 10.08 (95% betroubaarheidsinterval 8.52 – 11.63 dae) vir die kontrolegroep. Gevolgtrekking: ’n Geleidelike herwinningstegniek teen 30cmH2O 30 minute voor ekstubasie het statiese longvervormbaarheid beduidend verbeter binne 5 minute, met geen nadelige hemodinamiese newe-effekte nie. Daar was geen verskil in die oksigenasie-indeks tussen die intervensie- en kontrolegroep na ekstubasie nie.

Childhood asthma is one of the commonest chronic respiratory conditions in developed communities. Chest physiotherapy has traditionally been one of the interventions used mainly after an attack and for a relatively short-period on an outpatient basis. The purpose of the study was to determine the perceptions of physiotherapists and caregivers about the importance of chest physiotheraphy in asthmatic children in Kigali. To achieve this aim the author attempted to identify the perceived benefits of chest physiotherapy for asthmatic children among caregivers / to determine the perception of physiotherapists about the importance of chest physiotherapy for asthmatic children and / to identify the physiotherapists experiences with doctors referrals and the caregivers compliance in the management of asthmatic children.

Title: Effect of a comprehensive rehabilitation program of children with asthma bronchiale Objectives: The main objective of this thesis is to show the usefulness and necessity of physical therapy in children with bronchial asthma and how does it affect them. Another objective was to summarize the possible available methods with demonstrations of examples of individual exercises that can be used for this disease. The aim was also monitoring and evaluation of the patient's subjective feelings. Methods: In the thesis we carried out a single arm experiment, where we used comprehensive kinesiology analysis of individual subjects and the methods of lung function tests. From the lung function test, we chose the spirometry test by method of curve flow / capacity and also we used the peak expiratory flow monitoring using peak-flow-meter. We compared the subjective feelings of clients at the beginning and the end of the treatment program. In the period we watched the changes of value in individual measuring techniques. Results: We found that a comprehensive treatment of children asthma has a significant impact on their posture and also on the respiratory functions and subjective perception of individual symptoms investigated clients. All clients received the same treatment and each of them occurred in...

Introdução: As complicações respiratórias, somadas a baixos volumes pulmonares e tosse ineficiente, decorrentes da fraqueza da musculatura respiratória nas doenças neuromusculares (DNM), são as principais causas de morbidade e mortalidade. Objetivo: Verificar os efeitos do treinamento de empilhamento de ar na função respiratória de pacientes com DNM. Métodos: Estudo prospectivo em 21 pacientes com DNM, idade entre 7 e 23 anos. Todos foram submetidos a avaliações respiratórias a cada 4 e 6 meses. Realizou-se espirometria e medida do pico de fluxo de tosse não assistido e assistido (PFTNA e PFTASS) com insuflações e empilhamento de ar com ressuscitador manual. Os pacientes e cuidadores foram treinados e orientados a realizar o treinamento das manobras de empilhamento de ar diariamente no domicílio. A análise estatística utilizou o pacote estatístico como médias ± desvios-padrão, foram submetidas ao teste de normalidade de D\'Agostino-Pearson. Utilizou-se ANOVA para medidas repetidas, seguidas do teste Post Hoc de Tukey. O pico de fluxo expiratório (PFE) não exibiu distribuição normal e, por isso, foi submetido ao teste de Friedman seguido do teste Post Hoc de Dunn. Os coeficientes de correlação de Pearson foram calculados e nível de significância estabelecido foi p < 0,05. Resultados: Houve aumento na estatura média dos pacientes de 2,5 cm (p < 0,0001). A média da capacidade de insuflação máxima (CIM) foi maior que a capacidade vital forçada (CVF) basal em todas as avaliações (p < 0,0001). Houve aumento na média da CVF e CIM (p < 0,01), PFTNA (p < 0,05) e no PFTASS após período de treinamento nos pacientes com escoliose não estruturada ou ausente. Conclusão: O treinamento domiciliar com insuflações e empilhamento de ar deve ser enfatizado nas DNM, pois aumenta o PFT. Tal treinamento aumenta a CVF basal e o PFTNA nos pacientes sem deformidades torácicas. / Introduction: Respiratory complications, low lung volumes and inefficient cough, resulting from weakness of respiratory muscles are the major causes of morbidity and mortality in neuromuscular patients (NMD). Objective: To assess the effects of air stacking training on lung function in patients with NMD. Methods: Prospective study in 21 patients with NMD aged 7 to 23 years. Al patients underwent respiratory evaluations every 4 to 6 months. Was performed spirometry and measurement of unassisted peak cough flow (UPCF) and assisted peak cough flow (APCF) with insufflations and air stacking with manual resuscitator. The patients and caregivers were trained and were prescribed lung insufflations by air stacking three times each day at home. The statistical analysis used the statistical package GraphPad Prism 5.0 for Windows. Spirometric variables were expressed as means ± standard deviations, were subject to normality test D\'Agostino-Pearson. We used ANOVA for repeated measures followed by post hoc Tukey test. The peak expiratory flow (PEF) did not exhibit normal distribution and therefore was subjected to the Friedman test followed by Dunn´s post hoc test. The Pearson correlation coefficients were calculated and significance level was set at p < 0.05. Results: There was in increase in the average height of 2.5 cm, of the patients (p < 0.0001). The mean maximum insufflation capacity (MIC) was greater than forced vital capacity (FVC) baseline for all evaluations (p < 0.0001). There was increase in mean FVC and MIC (p < 0.001), UPCF (p < 0.05) and APCF (p < 0.01) after air stacking training period in patients without scoliosis or unstructured. Conclusion: The air stacking training home should be emphasized in NMD. This training increases the FVC and UPCF in patients without scoliosis or unstructured.

"Gaseous nitric oxide, in concentrations between 0 and 20 ppm, is currently being used to treat patients with post-surgical complications and respiratory disorders. Currently available instruments are expensive and have problems that limit their usefulness for this application. This thesis discusses the development of an inexpensive, direct and continuous sensor for the measurement of inhaled nitric oxide. The prototype sensor incorporates a 0.125 cm, gas permeable, flow-thru liquid cell into a probe that can be incorporated into a ventilator circuit. Sensor operation is based on the complexation reaction of NO with cytochrome-c (Fe III), a biologically derived heme. The complex is monitored spectrophotometrically in the visible region of the spectrum at 563 nm by an optical spectrograph card. LabVIEW is used for all hardware control, signal acquisition, data processing, display and storage. The sensor has a sensitivity of 2x10-4 Abs/ppm, where Abs denotes absorbance units, a minimum detectable limit of 1.5 ppm, resolution of 0.5 ppm, is stable over the course of 8 hours, has less than 1 ppm error and a response time of less than 2 minutes. All aspects of sensor design and development will be discussed."

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No description available.

ABSTRACT BACKGROUND: Although Problem-based learning (PBL) approach is a common teaching technique in medical education, its use in the field of respiratory therapy is somewhat controversial. With so many programs adopting PBL strategies, it is important to examine whether there are differences between PBL and traditional teaching approaches in regards to learning outcomes. Therefore, the purpose of this study was to investigate if there are any significant differences between PBL and lecture-based program students in their cognitive abilities in mechanical ventilation. METHODS: Two universities with BS programs in respiratory therapy were chosen—one uses PBL (15 participants) and on uses lecture-based method (24 participants). All 39 participants were given10 multiple-choice questions related to mechanical ventilation derived from the NBRC RRT written exam forms (C & D) as a pre and a post test. RESULTS: The dependent t-test showed a significant difference between the pre and post test of the lecture-based and the PBL groups, resulting in a p value of 0.006 and 0.025 respectively. The independent t-test showed a significant difference in the pre-test favoring the lecture-based group (p = 0.039). However, the independent t-test showed no significant difference in the post-test (p=0.085) CONCLUSIONS: PBL is increasing in popularity despite the fact that studies of its efficacy have been thus far inconclusive. This study has shown PBL to be effective, but not significantly more effective than traditional lecture-based methods in regards to objective test scores.

Respiratory therapy graduate students are going to face a clinical environment that commands greater responsibility and culpability than in years past. Therefore, respiratory therapy educators must prepare graduates for the multidimensional demands of the workplace. PURPOSE: The purpose of this study was to explore the perception of the undergraduate respiratory therapy (BSRT) and integrated graduate respiratory therapy (MSRT) students in the implementation of simulation in the educational laboratory setting. METHODS: Data were collected through a descriptive survey. The survey was distributed to a convenience sample of first year BSRT and MSRT students attending an accredited respiratory therapy program at an urban public research university in the southeast United States. The survey consisted of 10 questions presented in a four-point Likert-type scale to obtain students’ perceptions regarding their simulation experience. The collected data were analyzed using descriptive statistics. RESULTS: Thirty-two students were surveyed, more than two-thirds of the participants were female. Approximately seventy-one percent of respondents were BSRT, females accounted for 87% and males 13%. Graduate MSRT were 28.1% of the total sample with 44.4% females and 55.6% males. More than two-thirds of MSRT students reported previous clinical experience while BSRT students reported less than one-quarter. Additionally, only two students from BSRT indicated that they have previous simulation experience, whereas more than half of MSRT students reported previous simulation experience. The study findings indicate BSRT and MSRT students’ overall perceptions are similar, however, both perceive the experience of nervousness differently. BSRT students indicated high agreement with the statement that they experienced nervousness during the simulation with mean = 3.52 (SD ± .51). MSRT students indicated high agreement with the statement that simulation was a valuable learning experience with mean = 3.33 (SD ± .70). Both of BSRT & MSRT students agreed that simulation should continue to be an integral part of the respiratory therapy program. MSRT students demonstrated higher agreement with mean = 3.55 (SD ± .72). Finally, the majority of responses to a debriefing session after simulation experience supported their understanding and reasoning were positive from both BSRT & MSRT students with means respectively = 3.39 (SD ± .65), and 3.55, (SD ± .52). CONCLUSION: Respiratory therapy educators continue to strive to enhance respiratory therapy students’ clinical reasoning, transference of theory to clinical practice, skills acquisition, and critical thinking. Use of simulation is essential to achieve these objectives. The results of this study support the implementation of simulation course in the curriculum as a mandatory requirement prior to clinical practice as evidenced by positive responses from students. Although students felt positively that simulation should be continued in the curriculum, they did not feel it should totally substitute for all clinical experiences.

Thesis (MD)-University of Natal, Durban, 1967.