Effectiveness of sustained maximal inspiration along with transcutaneous electrical nerve stimulation in patients with malignant pleural effusion with intercostal drainage tube: a randomized controlled trial

Background: Malignant pleural effusion (MPE) is one of the most common causes of an exudative pleural effusion. It is the most common cause of a unilateral massive pleural effusion. Most MPE s are secondary to metastases to the pleura, most often from lung or breast cancer.  Medical management includes aspiration of fluid with the insertion of a chest tube, which may be necessary to relieve dyspnea. Hypoventilation does occur in certain areas of the lungs because of pain and muscle guarding after intercostal drainage tube (ICD) tube placements in pleural effusion. Therefore, it is important to emphasize pain management and expansion of affected areas of the lungs and chest wall. SMI is the basic maneuver of incentive spirometry and is mainly given to prevent atelectasis and lung collapse in postoperative patients. TENS is a method of producing an electro-analgesic effect and is effective in providing post-operative pain control. Methods: The study design of the study was a randomized controlled trial. A total of 44 participants with a diagnosis of MPE with an intercostal drainage tube were included in this study. The study duration was 5 years with an intervention period of 2 weeks and the outcome measures were pulmonary functions and intercostal pain severity using the NRS Scale. Results: There was a significant improvement in pulmonary functions in the control group and a highly significant improvement in pulmonary functions in the experimental group after 2 weeks of interventions and pain severity (NRS) was significantly reduced in the experimental group only (p<0.001) Conclusions: This study concluded that sustained maximal inspiration (SMI) along with TENS significantly improves pulmonary functions and reduces pain at the site of ICD in patients with MPE

Effect of manually assisted cough technique on cough strength in extubated patients with organophosphorus poisoning

Background: Organophosphate (OP) ingestion is one of the most common emergencies treated at poisoning control centers worldwide. In an extubated patient with OPP, the abdomen and chest muscles are affected, it also affects a person's ability to breathe on their own, rendering them dependent on a ventilator. Intubation weakens the abdominal muscles and diaphragm making it difficult to cough and clear the chest. A manual cough-assisted technique is used to enhance the cough strength, to help with the clearance of secretions it can be carried out in lying, side-lying, or sitting positions. Objectives were to find the effect of a manually assisted cough (MAC) technique on cough strength (Peak cough flow (PCF) and maximum expiratory pressure) in extubated patients with organophosphorus poisoning.  Methods: According to the selection criteria, 50 participants extubated with organophosphorus poisoning were included. A baseline assessment was done of all individuals and MAC techniques were given. outcome measures were assessed with PCF meter and PEmax manometer. MAC techniques are given for 1 week to each patient. Results: Pre and post-intervention PCF and maximal expiratory pressure (MEP) was compared and analyzed with paired t tests and which shows an extremely significant difference with p<0.0001 which indicates significant improvement in cough strength after 1 week of MAC techniques. Conclusions: This study concluded that the MAC. Technique improved the cough strength (PCF and MEP) in extubated patients with organophosphorus poisoning