The use of Mapleson-C circuit in airway clearance and lung expansion for patients with neuromuscular disease — a case report

Background: Neuromuscular diseases involving respiratory muscles often requires tracheostomy for their airway management this entails ventilation and lung expansion techniques. Physiotherapy plays a vital role in managing these patients for weaning from ventilators, improving lung expansion and airway clearance. In our Indian Critical Care Unit setup there is a lack of evidence supporting the use of Mapleson-C circuit in neuromuscular diseased patients with tracheostomy. The study was to determine the efficacy of Mapleson-C circuit in airway clearance and lung expansion in neuromuscular disease patient. Case presentation: A 63-year-old male patient with the diagnosis of Gullian Barrie syndrome (GBS) required mechanical ventilation support with tracheostomy and had undergone intercostal drainage for pyothorax on the left side. After weaning from mechanical ventilator support the patient required Airway Clearance and Lung expansion Techniques. Mapleson-C circuit applied was for 3 days totaling 18 sessions (for day time 4 sessions, 15 minutes/session, 12 breaths/minute, during night time only 2 sessions). Chest radiograph (Atelectasis Score) and amount of sputum cleared were used as primary outcome measures. Conclusion: Chest radiograph score showed significant improvement from score 4 to 1, and more amount of sputum removed. In the secondary outcome measures, Improvement in saturation of oxygen (86% to 98%), arterial blood gas analysis (PaO2 increased from 70 mm Hg to 94 mm Hg and PaCO2 decreased from 50 mm Hg to 42 mm Hg), reduced use of accessory muscle of respiration and decrease in respiratory rate of about 10 breaths/minute. Finally, the Mapleson-C circuit is a very effective technique for lung expansion and airway clearance. Adv. Pall. Med. 2010; 9, 2: 49–52Background: Neuromuscular diseases involving respiratory muscles often requires tracheostomy for their airway management this entails ventilation and lung expansion techniques. Physiotherapy plays a vital role in managing these patients for weaning from ventilators, improving lung expansion and airway clearance. In our Indian Critical Care Unit setup there is a lack of evidence supporting the use of Mapleson-C circuit in neuromuscular diseased patients with tracheostomy. The study was to determine the efficacy of Mapleson-C circuit in airway clearance and lung expansion in neuromuscular disease patient. Case presentation: A 63-year-old male patient with the diagnosis of Gullian Barrie syndrome (GBS) required mechanical ventilation support with tracheostomy and had undergone intercostal drainage for pyothorax on the left side. After weaning from mechanical ventilator support the patient required Airway Clearance and Lung expansion Techniques. Mapleson-C circuit applied was for 3 days totaling 18 sessions (for day time 4 sessions, 15 minutes/session, 12 breaths/minute, during night time only 2 sessions). Chest radiograph (Atelectasis Score) and amount of sputum cleared were used as primary outcome measures. Conclusion: Chest radiograph score showed significant improvement from score 4 to 1, and more amount of sputum removed. In the secondary outcome measures, Improvement in saturation of oxygen (86% to 98%), arterial blood gas analysis (PaO2 increased from 70 mm Hg to 94 mm Hg and PaCO2 decreased from 50 mm Hg to 42 mm Hg), reduced use of accessory muscle of respiration and decrease in respiratory rate of about 10 breaths/minute. Finally, the Mapleson-C circuit is a very effective technique for lung expansion and airway clearance

The role of non invasive central hemodynamics in patients with heart failure at cardiac rehabilitation

Background: Heart failure is a complex clinical syndrome in which the heart’s ability to pump blood around the body is reduced1. Central hemodynamics is an important factor to be considered for the individuals with heart failure. Disturbance of ventricular functions can worsen heart failure symptoms, impair independence, reduce quality of life and lead to increased health care utilization in patients with heart failure. Previous studies have identified exercise as a possible treatment for impaired ventricular function without other cardiac disease; however, there is limited evidence for the effect of this form of treatment in patients with heart failure. Aim: The primary aim of this study was to examine the effect of a supervised, out patient based exercise training programme on noninvasive central hemodynamics in patients with heart failure. Secondary aims were to examine the reproducibility of the Non invasive Cardiac system and find the effect of exercise on functional capacity, echocardiographic measures and quality of life. Methods: The participants for the study was enrolled from IRCCS San Raffaelle Pisana, Rome, Italy. Patients diagnosed with heart failure in outpatients department for cardiac rehabilitation, who met eligibility criteria, were recruited. Participants were screened by a Cardiac Rehabilitation Specialist at each sessons to ensure exercise safety prior to study enrolment. Demographic data, medical history, medications, functional capacity (six minute walk test), echocardiography parameters (Tricuspid Annular Plane Systolic Excursion, Ejection Fraction), Sort Form-36 Quality of Life Questionnaire and Kansas City Cardiomyopathy Questionnaire were repeated at Baseline and after 8 weeks. We enrolled 50 patients (42 men and 8 women, Mean age 64+9 Years) diagnosed with chronic heart failure.This was a prospective, single-center study. The intervention consisted of 1 hour of aerobic interval training about thrice a week. Program were designed and supervised by Cardiac Rehabilitation Physiotherapists. The primary outcome measure was a change in central hemodynamics measured by Non invasive cardiac system and secondary outcome measure was chages in echocardiographic parameters, six minute walk test and quality of life parameters. Results: The study participants reported significantly greater clinical improvement in central hemodynamics of Stroke Volume (P = 0.005), Cardiac Output (P = 0.054), Stroke Index (P = 0.003), Cardiac Index (P= 0.035), Heart Rate (P= 0.011) Cardiac Power index (p = 0.004) and Granov Goor Index (P= 0.001).These participants also had significant improvements in six minute walk test (p = 0.000), Tricuspid Annular Plane Systolic Excursion (P=0.017), Ejection Fraction (P= 0.001) and Short Form-36 Quality of Life questionnaire (P= 0.001) and also significantly improvement in clinical course of disease byKansas City Cardiomyopathy Questionnaire (P= 0.001). Conclusion: Eight weeks of supervised, outpatient based, aerobic interval training can improve the Non invasive central hemodynamics, echocardiographic parameters, functional capacity and Quality of life in patients with heart failure. According to our study results, the exercise training, part of cardiac rehabilitation is an important component of therapy in patients with Heart failure

Effects of Progressive Muscular Relaxation Combined With Aerobic Continuous Training on Exercise Tolerance, Hemodynamics, and Life Quality in Patients with Chronic Heart Failure

Purpose: To assess if the addiction of progressive muscular relaxation (PMR) to aerobic continuous training (ACT) is more effective than ACT alone in order to improve exercise tolerance of patients with chronic heart failure (CHF).Methods: Thirty CHF patients, age 67±6 years; ejection fraction 34±2. NYHA II–III was enrolled. Fifteen patients were randomized to group 1 and performed PMR and ACT; 15 to group 2 and performed ACT alone. At baseline and after 8 weeks all patients underwent: 6-minute walking test (6 MWT), measurement of blood pressure and heart rate, administration of a quality of life questionnaire (WHOQOL-brief). PMR and ACT were performed 3 times/week.Results: After 8 weeks, 6MWT distance increased in both groups without between groups difference. Patients of the group 1 had a greater decreased of systolic blood pressure and resting heart rate compared to group 2. Patients of the group 1 had a greater significant improvement on psychological domain and a greater, despite not significant, improvement in the social domain.Conclusions: The addiction of PMR to ACT, do not improves exercise tolerance but strengthen the effects of ACT on hemodynamic profile and psychological status of patients with CHF.</p