Effect of backpack carrying on forced vital capacity in cystic fibrosis: A randomized crossover-controlled trial.

BACKGROUND: Backpack carrying impacts lung function in healthy children but the effect in children with cystic fibrosis (CF) is unknown. METHODS: Three backpack positions were tested: no backpack (NB), a 12.5% body-weight backpack carried bilaterally (BB) or unilaterally (UB), at rest and during a 10 minute walk. Primary outcome was forced vital capacity (FVC). Secondary outcomes included comparison of cardio-respiratory variables within and between groups. RESULTS: Nine children with CF (13.3±2.6 years; FEV1 66±22%) and 18 healthy children (13.8±1.8 years; FEV1 107±30%) were included. FVC was reduced with UB compared to NB (68.5±23.3% vs 72.1±24.3%, p = 0.024) in children with CF. FEV1, MIP and MEP decreased more with UB in children with CF than in healthy peers. Increases in VO2, VCO2 and minute ventilation with UB were greater in the CF group during walking. CONCLUSIONS: Unilateral backpack wearing affects FVC in children with CF and requires greater cardio-respiratory adjustments compared to healthy peers

Effect of high-flow nasal therapy during acute aerobic exercise in patients with chronic obstructive pulmonary disease after exacerbation: protocol for a randomised, controlled, cross-over trial.

INTRODUCTION: Early pulmonary rehabilitation is recommended after a severe exacerbation of chronic obstructive pulmonary disease (COPD). However, this is difficult to implement, particularly for exercise training. High-flow nasal therapy (HFNT) may reduce the work of breathing and dyspnoea and may improve exercise tolerance. METHODS AND ANALYSIS: This is a single-centre, prospective, controlled, randomised, cross-over study. Eligible patients will have a diagnosis of COPD (postbronchodilator forced expiratory volume in 1 s/forced vital capacity ratio of <0.7). Two constant work rate exercise tests at 80% of the peak work rate will be carried out on two consecutive days with and without HFNT. The primary outcome will be the difference in endurance time between the two conditions. Secondary outcomes will be the change in muscle oxygenation during exercise, dyspnoea and muscle fatigue, respiratory muscle strength after exercise, respiratory rate, cardiac frequency, transcutaneous CO2 pressure and pulsed O2 saturation. Nineteen patients will be included. Data will be analysed as intention to treat by a blinded statistician. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Ethics Committees Nord-Ouest III, Caen, France (N° ID RCB: 2016-A01325-46). The study will begin in April 2017 for a duration of 2 years. The results of the trial will be presented at national and international meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03058081

Reliability of respiratory pressure measurements in ventilated and non-ventilated patients in ICU: an observational study

Abstract Background Assessment of maximum respiratory pressures is a common practice in intensive care because it can predict the success of weaning from ventilation. However, the reliability of measurements through an intubation catheter has not been compared with standard measurements. The aim of this study was to compare maximum respiratory pressures measured through an intubation catheter with the same measurements using a standard mouthpiece in extubated patients. Methods A prospective observational study was carried out in adults who had been under ventilation for at least 24 h and for whom extubation was planned. Maximal respiratory pressure measurements were carried out before and 24 h following extubation. Results Ninety patients were included in the analyses (median age: 61.5 years, median SAPS2 score: 42.5 and median duration of ventilation: 7 days). Maximum respiratory pressures measured through the intubation catheter were as reliable as measurements through a standard mouthpiece (difference in maximal inspiratory pressure: mean bias = − 2.43 ± 14.43 cmH2O and difference in maximal expiratory pressure: mean bias = 1.54 ± 23.2 cmH2O). Conclusion Maximum respiratory pressures measured through an intubation catheter were reliable and similar to standard measures. Clinical trial registration Retrospectively Registered in ClinicalTrials.gov (NCT02363231)

Effects of different early rehabilitation techniques on haemodynamic and metabolic parameters in sedated patients ::protocol for a randomised, single-bind, cross-over trial

Introduction: Early rehabilitation has become widespread practice for patients in intensive care; however, the prevalence of intensive care unit-acquired weakness remains high and the majority of physiotherapy is carried out in bed. Several inbed rehabilitation methods exist, but we hypothesise that techniques that provoke muscle contractions are more effective than passive techniques. Methods: A randomised, controlled cross-over study will be carried out to evaluate and compare the effectiveness of early rehabilitation techniques on cardiac output (CO) in sedated patients in intensive care. 20 intubated and sedated patients will undergo 4 10 min rehabilitation sessions. 2 sessions will involve ‘passive’ techniques based on mobilisations and inbed cycle ergometry and 2 involving electrostimulation of the quadriceps muscle and Functional Electrical Stimulation-cycling (FES-cycling). The primary outcome is CO measured by Doppler ultrasound. The secondary outcomes are right ventricular function, pulmonary systolic arterial pressure, muscle oxygenation and minute ventilation during exercise. Results and conclusion : Approval has been granted by our Institutional Review Board (Comité de Protection des Personnes Nord-Ouest 3). The results of the trial will be presented at national and international meetings and published in peer-reviewed journals

Respiratory weakness after mechanical ventilation is associated with one-year mortality - a prospective study

BACKGROUND: Diaphragm dysfunction in mechanically ventilated patients is associated with poor outcome. Maximal inspiratory pressure (MIP) can be used to evaluate inspiratory muscle function. However, it is unclear whether respiratory weakness is independently associated with long-term mortality. The aim of this study was to determine if low MIP is independently associated with one-year mortality. METHODS: We conducted a prospective observational cohort study in an 18-bed ICU. Adults requiring at least 24 hours of mechanical ventilation with scheduled extubation and no evidence of pre-existing muscle weakness underwent MIP evaluation just before extubation. Patients were divided into two groups: low MIP (MIP ≤30 cmH(2)O) and high MIP (MIP >30 cmH(2)O). Mortality was recorded for one year after extubation. For the survival analysis, the effect of low MIP was assessed using the log-rank test. The independent effect of low MIP on post mechanical ventilation mortality was analyzed using a multivariable Cox regression model. RESULTS: One hundred and twenty-four patients underwent MIP evaluation (median age 66 years (25(th)–75(th) percentile 56–74), Simplified Acute Physiology Score (SAPS) 2 = 45 (33–57), duration of mechanical ventilation 7 days (4–10)). Fifty-four percent of patients had low MIP. One-year mortality was 31 % (95 % CI 0.21, 0.43) in the low MIP group and 7 % (95 % CI 0.02, 0.16) in the high MIP group. After adjustment for SAPS 2 score, body mass index and duration of mechanical ventilation, low MIP was independently associated with one-year mortality (hazard ratio 4.41, 95 % CI 1.5, 12.9, p = 0.007). Extubation failure was also associated with low MIP (relative risk 3.0, 95 % CI 1, -9.6; p = 0.03) but tracheostomy and ICU length of stay were not. CONCLUSION: Low MIP is frequent in patients on mechanical ventilation and is an independent risk factor for long-term mortality in ICU patients requiring mechanical ventilation. MIP is easily evaluated at the patient’s bedside. TRIAL REGISTRATION: This study was retrospectively registered in www.clinicaltrials.gov (NCT02363231) in February 2015. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-016-1418-y) contains supplementary material, which is available to authorized users

Comparative effect of backpack carrying on cystic fibrosis and healthy children: a randomized crossover controlled trial

Introduction: Backpack carrying restricts lung function and exercise capacity in healthy children. However, schoolbag consequences are unclear in a chronic respiratory disease context like school-aged cystic fibrosis (CF) children. Objectives: Our main aim was to compare forced vital capacity (FVC) change according to backpack carriage and straps position in children with CF and healthy controls. Secondary objectives were to assess other lung function parameters and track ventilatory response while walking with a backpack. Methods: Lung function was tested in three conditions: without backpack (control condition) and while carrying a 12.5% of child’s body weight backpack with bilateral strap (BB) or with unilateral strap (UB). Ventilatory responses were quantified while performing a mild intensity 10 minutes walking period. Results: Nine CF children (age 13.3±2.6 years and FEV1 66±22% predicted value) and 18 healthy controls (age 13.8±1.8 years) participated in this study. Similar FVC reduction was found in CF children and healthy controls. FVC was lower in UB when compared to NB (68.5±23.3% vs 72.1±24.3%, p=0.024) in CF group. CF children underwent a greater diminution on FEV1 (-6.5±4.3% vs -2.4±3.6%, p=0.017) and maximal inspiratory pressure (-12.5±16 vs -6±11.8cmH2O, p=0,048) with UB compared to their healthy peers. Walking with UB induced greater oxygen consumption, respiratory rate and minute ventilation in CF group than in control group. Conclusion: Unilateral backpack carrying leads to greater change on lung function parameters and ventilatory response in CF children than in healthy children. This position may be discouraged for CF school-aged children