Approaches and adjuncts used by physiotherapists when suctioning adult patients who are intubated and ventilated in intensive care units in Australia and New Zealand: A cross-sectional survey

Background: Suctioning is an integral component of care for patients who are intubated and ventilated in an intensive care unit (ICU). There appears to be no published data of physiotherapy suctioning practices in Australia or New Zealand. Objective: To describe suctioning practices and the factors which have shaped these practices, of experienced physiotherapists working with adults who are intubated and ventilated in an ICU across Australia and New Zealand. Areas of investigation focused on: (i) suctioning approach (i.e. open vs. closed system); (ii) use of adjuncts to suctioning such as hyperoxygenation, hyperinflation and saline lavage; (iii) use of subglottic suctioning and; (iv) factors influencing suctioning practices. Methods: Electronic surveys were emailed to experienced physiotherapists working in ICUs across Australia and New Zealand which had the capacity to intubate and ventilate adult patients for =24. h. Results: The participation rate was 84.8% (112/132). Closed suction system was used in most ICUs (97/112, 86.6%). Hyperoxygenation was commonly performed on 'all' or 'most' patients before suctioning (71/112, 63.4%), but less frequently after suctioning (38/112, 33.9%). Hyperinflation was infrequently performed on 'all' or 'most' patients before (22/112, 19.6%) or after suctioning (22/112, 19.6%). Saline lavage and subglottic suctioning were infrequently performed on 'all' or 'most' patients (3/112, 2.7%; 17/112, 15.2%, respectively). 'Personal experience' and 'established practice in the ICU' had the greatest influence on suctioning practices. Conclusions: Most ICUs in Australia and New Zealand are equipped for closed system suctioning. As hyperoxygenation minimises desaturation during suctioning, there may be scope for a larger proportion of physiotherapists to use this adjunct. The practice of hyperinflation before and after suctioning was uncommon despite the emerging evidence for improved lung compliance with this procedure. Subglottic suctioning was infrequently available as a choice for physiotherapists despite the strong evidence, which suggests an evidence-practice gap. © 2017 Australian College of Critical Care Nurses Ltd

Walking-based activity and sedentary behavior in Saudi males with chronic obstructive pulmonary disease

© 2018, Saudi Arabian Armed Forces Hospital. All rights reserved. Objectives: To compare walking-based activity and sedentary behavior between males with chronic obstructive pulmonary disease (COPD) and healthy controls and to examine the association between dyspnea with time spent in walking-based activity and sedentary behavior in males with COPD. Methods: This cross-sectional study of 30 males with COPD (age 62.0±5.0 years; forced expiratory volume in one second [FEV1] 46±15% predicted) and 29 healthy controls (age 63.0±4.3 years; FEV1 91±5% predicted) was conducted at the outpatient pulmonary clinics at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia between February 2013 and March 2014. Walking-based activity and sedentary behavior were evaluated using an activity monitor. Results: Participants with COPD spent less time engaged in walking-based activity (22±8% versus 37±7% of waking hours; p<0.001) and more time engaged in sedentary behavior (78±8% versus 63±6% of waking hours; p<0.001) than healthy controls. In males with COPD, moderate to strong associations were found between the scores of the quality and emotional response components of the Dyspnea-12 (D-12) questionnaire and time spent engaged in walking-based activity and sedentary behavior (r: =0.46, all p<0.01). Conclusion: Males with COPD were less active and more sedentary than healthy controls. The D-12 components were associated with walking-based activity and sedentary behavior in males with COPD

Prevalence of suspected poor bone health in people with chronic obstructive pulmonary disease - A cross-sectional exploratory study

Background: Compared to the general population, adults with chronic obstructive pulmonary disease (COPD) have an increased prevalence of osteoporosis. Despite the known risk factors and potential complications of compromised bone health in COPD, little is known about whether poor bone health is routinely suspected. We measured, in people with COPD, the prevalence of those who had one or more indicators suggestive of suspected poor bone health, and compared the characteristics of those with versus without these indicators. Methods: Data were collected from adults with COPD presenting to three tertiary hospitals. Indicators of suspected poor bone health were defined as any of the following criteria: (i) self-reported problems with bone health, (ii) previous imaging for bone health, (iii) history of fragility fracture or, (iv) advised to use medication/supplements to optimise bone health. Characteristics compared between those with versus without indicators of suspected poor bone health comprised age, sex, body mass index (BMI), FEV1% predicted and recruitment setting. Results: 361 participants were included (age 70 ± 10, BMI 27.9 ± 7.8 kg/m2, FEV1 % predicted 49 ± 20; 161 [45 %] female). Indicators suggestive of suspected poor bone health were present in 53 % (95 % confidence interval [CI] 47-58) of the participants. The odds of this outcome increased with advancing age (odds ratio; OR [95 % CI] 1.05 [1.03 to 1.08]) and being female (OR [95 % CI] 3.4 [2.2 to 5.7]) . Conclusion: In people with COPD, the odds of having indicators suggestive of suspected poor bone health increase with advancing age and in females. Further work is required to promote the importance of bone health in this population

Maximum voluntary ventilation is more strongly associated with energy expenditure during simple activities of daily living than measures of airflow obstruction or respiratory muscle strength in patients with COPD

This is a retrospective analysis of data in which we explored the association between energy expenditure (EE) and lung function in patients with chronic obstructive pulmonary disease (COPD). A total of 36 participants (20 males; forced expiratory volume in 1 second (FEV1) of 48 ± 15% predicted) underwent measures of indirect calorimetry whilst performing five simple activities of daily living. Maximal voluntary ventilation was the only lung function parameter associated with EE. These data highlight the limited extent to which the FEV1 is related to the functional performance of patients with COPD

Comparison of the six-minute walk test with a cycle-based cardiopulmonary exercise test in people following curative intent treatment for non-small cell lung cancer.

This study is aimed to (i) compare both the magnitude of impairment in exercise capacity and exercise responses measured during the six-minute walk test (6MWT) and the cardiopulmonary exercise test (CPET) and (ii) investigate the effect of test repetition on six-minute walk distance (6MWD) in people following curative intent treatment for non-small cell lung cancer (NSCLC). Twenty participants (67 ± 10 years; 14 females), 6–10 weeks following lobectomy, underwent a CPET and two 6MWTs. Peak exercise responses, dyspnoea and leg fatigue, as well as heart rate (HR) and oxygen saturation (SpO2) during the 6MWT, were compared to those during the CPET. Compared with exercise capacity when expressed as peak rate of oxygen consumption (%pred) measured during the CPET, exercise capacity when expressed as 6MWD (%pred) was less impaired (81 ± 10 vs. 63 ± 15 %pred; p < 0.001). Compared with the CPET, the 6MWT elicited lower peak HR (119 ± 15 vs. 128 ± 18 beats minute−1; p = 0.02), lower SpO2 (93 ± 2 vs. 95 ± 3%; p < 0.05), less dyspnoea (3.1 ± 1.6 vs. 6.9 ± 2.6; p < 0.01) and less leg fatigue (2.0 ± 1.9 vs. 6.8 ± 2.4; p < 0.01). The 6MWD increased 19 ± 19 metre (4 ± 4%) with test repetition (p < 0.001). In people following curative intent treatment for NSCLC, the 6MWT appears to elicit sub-maximal exercise responses when compared with the CPET. There is a significant effect of test repetition on 6MWD

Quantifying the effect of monitor wear time and monitor type on the estimate of sedentary time in people with COPD: Systematic review and meta-analysis

In studies that have reported device-based measures of sedentary time (ST) in people with chronic obstructive pulmonary disease (COPD), we explored if the monitor type and monitor wear time moderated the estimate of this measure. Five electronic databases were searched in January 2021. Studies were included if \u3e70% of participants had stable COPD, and measures of ST (min/day) were collected using wearable technology. Meta-regression was used to examine the influence of moderators on ST, monitor type, and wear time. The studies identified were a total of 1153, and 36 had usable data for meta-analyses. The overall pooled estimate of ST (mean [95% CI]) was 524 min/day [482 to 566] with moderate heterogeneity among effect sizes (I2 = 42%). Monitor wear time, as well as the interaction of monitor wear time and monitor type, were moderators of ST (p \u3c 0.001). The largest difference (−318 min; 95% CI [−212 to −424]) was seen between studies where participants wore a device without a thigh inclinometer for 24 h (and removed sleep during analysis) (675 min, 95% CI [589 to 752]) and studies where participants wore a device with a thigh inclinometer for 12 h only (356 min; 95% CI [284 to 430]). In people with COPD, the monitor wear time and the interaction of the monitor wear time and the monitor type moderated the estimate of ST

Patterns of sedentary behaviour and physical activity in people following curative intent treatment for non-small cell lung cancer

This study aimed to compare patterns of sedentary behaviour (SB) and physical activity (PA) in people following curative intent treatment for non-small cell lung cancer (NSCLC) with healthy controls. Participants 6-10 weeks following lobectomy for NSCLC and healthy controls wore two activity monitors for 7 days. Waking hours were divided into time spent in SB (<1.5 metabolic equivalent of tasks (METs)), light intensity PA (LIPA ≥ 1.5 to <3.0METs) and moderate-to-vigorous intensity PA (≥3.0METs). Daily steps were also recorded. Data were available in 20 participants with NSCLC (13 females; 68 ± 10 years) and 20 healthy controls (13 females; 69 ± 5 years). The NSCLC group accumulated a greater percentage of time in SB in uninterrupted bouts ≥30 minutes (49% vs. 42%; p = 0.048). Further, the NSCLC group spent a lower percentage of waking hours in LIPA (21 ± 9% vs. 26 ± 8%; p = 0.04) and accumulated a lower percentage of time in this domain in uninterrupted bouts ≥10 minutes (13% vs. 19%; p = 0.025). The NSCLC group also had a lower daily step count (8863 ± 3737 vs. 11,856 ± 3024 steps/day; p = 0.009). Time spent in moderate-to-vigorous intensity PA was similar in both groups (p = 0.92). People following curative intent treatment for NSCLC spend more time in prolonged bouts of SB at the expense of LIPA