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Li X, Wei J, Shen N, Lu T, Xing J, Mai K, Li J, Hei Z, Chen C. Modified Manual Chest Compression for Prevention and Treatment of Respiratory Depression in Patients Under Deep Sedation During Upper Gastrointestinal Endoscopy: Two Randomized Controlled Trials. Anesth Analg 2023; 137:859-869. [PMID: 37010960 DOI: 10.1213/ane.0000000000006447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND We aimed to determine the preventive and therapeutic efficacy of modified manual chest compression (MMCC), a novel noninvasive and device-independent method, in reducing oxygen desaturation events in patients undergoing upper gastrointestinal endoscopy under deep sedation. METHODS A total of 584 outpatients who underwent deep sedation during upper gastrointestinal endoscopy were enrolled. In the preventive cohort, 440 patients were randomized to the MMCC group (patients received MMCC when their eyelash reflex disappeared, M1 group) or control group (C1 group). In the therapeutic cohort, 144 patients with oxygen desaturation of a Sp o2 < 95% were randomized to MMCC group (patients who subsequently received MMCC, M2 group) or the conventional treatment group (C2 group). The primary outcomes were the incidence of desaturation episodes with an Sp o2 < 95% for the preventive cohort and the time spent below 95% Sp o2 for the therapeutic cohort. Secondary outcomes included the incidence of gastroscopy withdrawal and diaphragmatic pause. RESULTS In the preventive cohort, MMCC reduced the incidence of desaturation episodes <95% (14.4% vs 26.1%; RR, 0.549; 95% confidence interval [CI], 0.37-0.815; P = .002), gastroscopy withdrawal (0% vs 2.29%; P = .008), and diaphragmatic pause at 30 seconds after propofol injection (74.5% vs 88.1%; RR, 0.846; 95% CI, 0.772-0.928; P < .001). In the therapeutic cohort, patients who received MMCC had a significantly shorter time spent below 95% Sp o2 (40 [20-69] seconds vs 91 [33-152] seconds, median difference [95% CI], -39 [-57 to -16] seconds, P < .001), a lower incidence of gastroscopy withdrawal (0% vs 10.4%, P = .018), and more enhanced diaphragmatic movement at 30 seconds after Sp o2 <95% (1.11 [0.93-1.4] cm vs 1.03 [0.7-1.24] cm; median difference [95% confidence interval], 0.16 [0.02-0.32] cm; P = .015). CONCLUSIONS MMCC may exert preventive and therapeutic effects against oxygen desaturation events during upper gastrointestinal endoscopy.
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Affiliation(s)
- Xiaoyun Li
- From the Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Ichiba T, Miyagawa T, Tsuda T, Kera T, Yasuda O. Changes in diaphragm thickness and 6-min walking distance improvement after inspiratory muscle training in patients with chronic obstructive pulmonary disease: Clinical trial. Heliyon 2023; 9:e20079. [PMID: 37809500 PMCID: PMC10559799 DOI: 10.1016/j.heliyon.2023.e20079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Aim Inspiratory muscle training (IMT) improves respiratory muscle function and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD), but the detailed mechanism is unclear. The purpose of this study is to elucidate the mechanism of functional improvement by IMT from P0.1, an index of respiratory central output, and thickness of diaphragm (Tdi), a noninvasive and reliable ultrasound examination. Methods This clinical trial study enrolled 13 elderly patients with COPD. IMT was performed using the POWER breathe® Medic Plus breathing trainer in combination with each participant's outpatient rehabilitation regimen. Starting at 20% of the maximal inspiratory pressure (PImax) and increasing to 50%, the participants performed 30 IMT repetitions twice a day for 2 months. P0.1 is the value of airway-occlusion pressure at 0.1 s after the start of inspiratory flow, and Tdi was measured at rest and maximal breathing. Results PImax and 6-min walking distance(6MWD) significantly increased after training. Tdi at resting inspiration and expiration, and maximal inspiration also significantly increased after training. In addition, the Borg Scale scores for dyspnea and leg fatigue and the respiratory rate of the 1-min recovery period after the 6MWD significantly decreased. There was no significant difference in P0.1. Conclusions These results suggest that the effects of IMT may be attributed to the improved peripheral factors rather than to the central factors in elderly COPD patients.
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Affiliation(s)
- Tomomi Ichiba
- Department of Physical Therapy, Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | - Tetsuo Miyagawa
- Kochi Professional University of Rehabilitation, Kochi, Japan
| | - Toru Tsuda
- Department of Respiratory Medicine, Kirigaoka Tsuda Hospital, Fukuoka, Japan
| | - Takeshi Kera
- Department of Physical Therapy, Takasaki University of Health and Welfare, Gunma, Japan
| | - Osamu Yasuda
- National Institute of Fitness and Sports in Kanoya, Department of Sports and Life Sciences, 1 Shiromizucho, Kanoya-city, Kagoshima, 891-2393, Japan
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Munari AB, Venâncio RS, Gulart AA, Da Silveira JA, Klein SR, Martins AC, Mayer AF. Slow chest compression acutely reduces dynamic hyperinflation in people with chronic obstructive pulmonary disease: a randomized cross-over trial. Physiother Theory Pract 2021; 38:1937-1945. [PMID: 33829946 DOI: 10.1080/09593985.2021.1907824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Strategies to minimize dynamic hyperinflation (DH) and dyspnea, such as slow chest compression (SCC), are relevant in people with chronic obstructive pulmonary disease (COPD).Objectives: To analyze the acute effects of SCC after exercise on DH and dyspnea in people with COPD and to identify responders to the technique.Methods: This is a cross-over study with 40 patients. Two six-minute step tests (6MSTs) were performed followed by a one-minute application of SCC (6MSTSCC) or rest (6MSTCONTROL), at random. End-expiratory lung volume (EELV) and dyspnea were assessed. A difference ≥76 ml in ΔEELV between SCC and control characterized the responders.Results: The performance in 6MSTSCC and 6MSTCONTROL were similar. There was a greater reduction in EELV after 6MSTSCC compared to 6MSTCONTROL (124 ± 193 ml vs. 174 ± 183 ml; p = .049), while there was no difference in change in dyspnea between the SCC and control groups. Twenty-one participants were SCC responders and had higher functional residual capacity [FRC: 5.36 ± 1.09 vs. 4.58 ± 0.94; p = .02; cutoff point: 4.56; sensitivity = 76%; specificity = 53%; AUC = 0.71 (95%CI: 0.54 to 0.87); p = .02].Conclusion: SCC applied immediately after exercise reduced DH, but did not reduce dyspnea in people with COPD. The technique is beneficial only for some patients and FRC can help to identify them.
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Affiliation(s)
- Anelise Bauer Munari
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (Nureab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil.,Graduate Program in Physical Therapy, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Raysa Silva Venâncio
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (Nureab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil.,Graduate Program in Physical Therapy, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Aline Almeida Gulart
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (Nureab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil.,Graduate Program in Human Movement Sciences, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Jaqueline Aparecida Da Silveira
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (Nureab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil.,Graduate Program in Physical Therapy, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Suelen Roberta Klein
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (Nureab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil.,Graduate Program in Human Movement Sciences, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Ana Carolina Martins
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (Nureab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Anamaria Fleig Mayer
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (Nureab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil.,Graduate Program in Physical Therapy, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil.,Graduate Program in Human Movement Sciences, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
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