机械通风儿童的胸部物理治疗:系统性审查
Emma Shkurka1, Jo Wray2, Mark Peters3
1Physiotherapy Department, Hospital for Children NHS Foundation Trust, London, United Kingdom.
Journal of pediatric intensive care
|June 26, 2024
概括
机械通风儿童的胸部物理治疗显示出不同的结果. 虽然一些技术稍微改变了氧和和潮体积,但证据仍然不确,需要进一步进行高质量的研究.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 呼吸系统疗法 呼吸系统疗法
- 基于证据的实践.
背景情况:
- 机械通风是重症儿童的关键干预措施.
- 胸部物理治疗经常用于改善这些患者的呼吸结果.
- 各种胸部物理治疗技术的有效性和安全性需要彻底评估.
研究的目的:
- 在需要机械通风的儿科患者中系统地审查和评估胸部物理治疗的影响.
- 总结关于胸部物理治疗干预措施的有效性和安全性的证据.
主要方法:
- 通过使用主要医疗数据库 (Medline,Embase,Cinahl Plus,PEDro,Web of Science) 进行了系统审查,截至2021年2月.
- 包括的研究重点是儿童 (0-18岁) 在接受机械通风和物理治疗的儿科重症监护病房.
- 质量评估使用了Cochrane偏差风险和批判性评估技能计划工具.
主要成果:
- 氧和率在手动高通胀 (MHI) 和胸壁振动 (CWV) 中显示非临床显著的下降,在呼气增加流量技术中显示非显著的改善.
- 在MHI和CWV之后的30分钟内,呼气潮量增加,在招募机动后没有持续的变化.
- 随着肺内冲击通风,MHI和CWV的治疗,Atelectasis得分有所改善,但在MHI和CWV后,呼吸合规性和死空间增加.
结论:
- 目前支持机械通风儿童胸部物理治疗的证据由于缺乏高质量的研究和干预措施和人群的异质性而不明确.
- 需要进一步的研究来调查多种物理治疗干预对短期和长期结果的影响.
相关概念视频
Chest Physiotherapy
435
Chest Physiotherapy (CPT) is a therapeutic technique used in respiratory care to improve ventilation, clear bronchial secretions, and enhance the efficiency of respiratory muscles. This therapy includes three primary procedures: postural drainage, percussion, and vibration. It can be performed on spontaneously breathing patients and those who are intubated and mechanically ventilated.
Purpose
CPT is primarily used for patients with excessive bronchial secretions who have difficulty clearing...
Purpose
CPT is primarily used for patients with excessive bronchial secretions who have difficulty clearing...
435
Flail Chest-II
162
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
162
Acute Respiratory Failure-V
130
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
130
Factors Affecting Pulmonary Ventilation
1.3K
Besides the pressure difference between the external environment and the lungs, the airflow rate and ease of pulmonary ventilation are also influenced by three other factors: surface tension of the fluid in the alveoli, compliance of the lungs, and airway resistance.
Alveolar Surface Tension
The alveolar fluid lines the luminal surface of the alveoli and exerts a force called surface tension. This force is caused by the polar water molecules in the liquid being more strongly attracted to each...
Alveolar Surface Tension
The alveolar fluid lines the luminal surface of the alveoli and exerts a force called surface tension. This force is caused by the polar water molecules in the liquid being more strongly attracted to each...
1.3K
Mechanical Ventilation I: Indication and Settings
267
Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can...
267
Mechanical Ventilation III: Noninvasive Ventilation
97
Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let's explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation...
Noninvasive Positive-Pressure Ventilation...
97


