Biomedical subjects

Jennifer Paratz

Publications and source records attributed to Jennifer Paratz.

10 recordsLinked to original sources

PubMed2006

The effect of additional physiotherapy to hospital inpatients outside of regular business hours: a systematic review.

Provision of out of regular business hours (OBH) physiotherapy to hospital inpatients is widespread in the hospital setting. This systematic review evaluated the effect of additional OBH physiotherapy services on patient length of stay (LOS), pulmonary complications, discharge destination, discharge mobility status, quality of life, cost saving, adverse events, and mortality compared with physiotherapy only within regular business hours. A literature search was completed on databases with citation tracking using key words. Two reviewers completed data extraction and quality assessment independently by using modified scales for historical cohorts and case control studies as well as the PEDro scale for randomized controlled trials and quasi-randomised controlled trials. This search identified nine articles of low to medium quality. Four reported a significant reduction in LOS associated with additional OBH physiotherapy, with two articles reporting overall significance and two reporting only for specific subgroups. Two studies reported significant reduction in pulmonary complications for two different patient groups in an intensive care unit (ICU) with additional OBH physiotherapy. Three studies accounted for discharge destination and/or discharge mobility status with no significant difference reported. Quality of life, adverse events, and mortality were not reported in any studies. Cost savings were considered in three studies, with two reporting a cost saving. This systematic review was unable to conclude that the provision of additional OBH physiotherapy made significant improvement to patient outcomes for all subgroups of inpatients. One study in critical care reported that overnight physiotherapy decreased LOS and reduced pulmonary complications of patients in the ICU. However, the studies in the area of orthopaedics, neurology, postcardiac surgery, and rheumatology, which all considered additional daytime weekend physiotherapy intervention, did not provide strong evidence to indicate effective reduction in patient LOS or improving patient discharge mobility status or discharge destination. Investigation should continue in this area, but future trials should ensure factors such as random allocation, groups equal at baseline, blinded investigators, and proven intervention are included in the study design.

Case-Control Studies↗

PubMed2005

Re-admission to intensive care: identification of risk factors.

BACKGROUND AND PURPOSE: The re-admission of patients to intensive care is associated with increased morbidity, mortality, loss of morale for patients and family, and increased health costs. The aim of the present study was to identify factors which place patients at a higher risk of re-admission to intensive care. METHOD: A prospective study of patients who were re-admitted to a 22-bed tertiary level intensive care facility within a 12 month period. Data were kept on every patient re-admitted to intensive care, including standard demographic data, initial admission diagnosis, co-morbidities, re-admission diagnosis, mobility on discharge, secretions, airway, chest X-ray, PaCO2, PaO2, PaO2/FiO2 and time of discharge. Subjects included 74 patients who had been re-admitted to intensive care in 12-month period and a comparison group of patients who were not re-admitted to intensive care. A cross-tabs procedure was initially used to estimate maximum likelihood. Significant factors with an alpha value of <0.10 were entered into a backward conditional binary logistic regression to determine independent factors. RESULTS: The overall percentage of patients who were re-admitted to intensive care compared with total admissions was 7.7%. Significant independent factors for re-admission were found to be age >65 years (p<0.05), colonization (p<0.001), weakness (p<0.001), co-morbidities of cardiac and/or respiratory disease (p<0.001) and depression (p<0.001). CONCLUSIONS: A certain profile of patients has been established who are at increased risk of re-admission to intensive care. These patients could be provided with increased intervention and surveillance on discharge from intensive care.

Age Factors↗

PubMed2005

The effect of positive end-expiratory pressure level on peak expiratory flow during manual hyperinflation.

Including positive end-expiratory pressure (PEEP) in the manual resuscitation bag (MRB) may render manual hyperinflation (MHI) ineffective as a secretion maneuver technique in mechanically ventilated patients. In this study we aimed to determine the effect of increased PEEP or decreased compliance on peak expiratory flow rate (PEF) during MHI. A blinded, randomized study was performed on a lung simulator by 10 physiotherapists experienced in MHI and intensive care practice. PEEP levels of 0-15 cm H(2)O, compliance levels of 0.05 and 0.02 L/cm H(2)O, and MRB type were randomized. The Mapleson-C MRB generated significantly higher PEF (P < 0.01, d = 2.72) when compared with the Laerdal MRB for all levels of PEEP. In normal compliance (0.05 L/cm H(2)O) there was a significant decrease in PEF (P < 0.01, d = 1.45) for a PEEP more than 10 cm H(2)O in the Mapleson-C circuit. The Laerdal MRB at PEEP levels of more than 10 cm H(2)O did not generate a PEF that is theoretically capable of producing two-phase gas-liquid flow and, consequently, mobilizing pulmonary secretions. If MHI is indicated as a result of mucous plugging, the Mapleson-C MRB may be the most effective method of secretion mobilization.

Adult↗

PubMed2005

Reduced inspiratory muscle endurance following successful weaning from prolonged mechanical ventilation.

STUDY OBJECTIVES: Respiratory muscle weakness and decreased endurance have been demonstrated following mechanical ventilation. However, its relationship to the duration of mechanical ventilation is not known. The aim of this study was to assess respiratory muscle endurance and its relationship to the duration of mechanical ventilation. DESIGN: Prospective study. SETTING: Tertiary teaching hospital ICU. PATIENTS: Twenty subjects were recruited for the study who had received mechanical ventilation for > or = 48 h and had been discharged from the ICU. MEASUREMENTS: FEV1, FVC, and maximal inspiratory pressure (P(I(max)) at functional residual capacity were recorded. The P(I(max)) attained following resisted inspiration at 30% of the initial P(I(max)) for 2 min was recorded, and the fatigue resistance index (FRI) [P(I(max)) final/P(I(max))initial] was calculated. The duration of ICU length of stay (ICULOS), duration of mechanical ventilation (MVD), duration of weaning (WD), and Charlson comorbidities score (CCS) were also recorded. Relationships between fatigue and other parameters were analyzed using the Spearman correlations (rho). RESULTS: Subjects were admitted to the ICU for a mean duration of 7.7 days (SD, 3.7 days) and required mechanical ventilation for a mean duration of 4.6 days (SD, 2.5 days). The mean FRI was 0.88 (SD, 0.13), indicating a 12% fall in P(I(max)), and was negatively correlated with MVD (r = -0.65; p = 0.007). No correlations were found between the FRI and FEV1, FVC, ICULOS, WD, or CCS. CONCLUSIONS: Patients who had received mechanical ventilation for > 48 h have reduced inspiratory muscle endurance that worsens with the duration of mechanical ventilation and is present following successful weaning. These data suggest that patients needing prolonged mechanical ventilation are at risk of respiratory muscle fatigue and may benefit from respiratory muscle training.

Adult↗

PubMed2004

Standing with assistance of a tilt table in intensive care: a survey of Australian physiotherapy practice.

Although tilt tables are used by physiotherapists to reintroduce patients to the vertical position, no quantitative evidence is available regarding their use within intensive care units (ICUs) of Australian hospitals. The purpose of this study was to evaluate the use of tilt tables in physiotherapy management of patients in ICUs across Australia. Ninety-nine physiotherapists working in Australian public ICUs were contacted via mail and asked to complete a questionnaire regarding their use of tilt tables in practice. Reasons for the use of the tilt table, contraindications, commonly used adjuncts, monitoring, and outcome measures were also investigated. Eighty-six questionnaires were returned (87% response). The tilt table was used by 58 physiotherapists (67.4%). The most common reasons for inclusion of tilt table treatment were to: facilitate weight bearing (94.8% of those who tilt); prevent muscle contractures (86%); improve lower limb strength (81%); and increase arousal (70%). The tilt table was most frequently applied to patients with neurological conditions (63.8%) and during long-term ICU stay (43.1%). Techniques often combined with tilt table treatment included upper limb exercises (93.1%) and breathing exercises (86.2%). Standing with assistance of the tilt table is used by the majority of physiotherapists working in Australian ICUs. A moderate level of agreement is demonstrated by physiotherapists regarding indications to commence tilt table treatment and adjunct modalities combined with standing with assistance of the tilt table.

Australia↗

PubMed2004

Peripheral muscle strength training in COPD: a systematic review.

BACKGROUND: Skeletal muscle weakness, and the associated impact on exercise tolerance, provides a strong theoretical rationale for strength training intervention for people with COPD. AIM: The purpose of this review was to examine systematically the current evidence for peripheral muscle strength training in people with COPD. METHOD: Empirical trials and reviews relating to strength training in COPD were obtained by searching electronic databases and citation tracking, using the keywords of COPD with strength/resistance training and skeletal muscle. Two reviewers completed data extraction and quality assessment independently, using the PEDro (physiotherapy evidence database) scale and a checklist for review articles. Effect sizes and 95% confidence intervals were determined for empiric trials and metaanalysis used where appropriate. RESULTS: The search strategy yielded 13 articles (9 empirical trials and 4 reviews). Strength training was found to have strong evidence for improving upper body and leg strength. However, no strong evidence for strength training was found for other outcome measures. CONCLUSIONS: Further research is required to investigate the effects of strength training on functional activities, such as balance, upper limb function, self care, and participation in daily life.

Exercise Therapy↗

PubMed2003

Effect of manual hyperinflation on haemodynamics in an animal model.

BACKGROUND AND PURPOSE: Manual hyperinflation is a physiotherapy technique that improves static compliance and mobilizes secretions, but has the potential to alter haemodynamic function. The aim of the present study was to investigate the effects of manual hyperinflation on haemodynamic function in a healthy animal model, without the usual confounding effects inherent in an heterogeneous intensive care population. METHOD: The study used a within-subjects design, in an animal research theatre. Nine healthy sheep (eight Border Leicester, one Merino, mean weight 39.5 kg, standard deviation (SD) 1.6 kg) completed the study. The sheep were induced (thiopentane 15-20 ml), intubated, ventilated and surgically instrumented for an arterial line and pulmonary artery catheter. Anaesthesia was maintained by 1.5% halothane/oxygen. Manual hyperinflation was delivered for two minutes with a Mapleson C circuit, using a peak inspiratory pressure of 35 cmH2O and an inspiratory:expiratory ratio of 2:1. RESULTS: Mean tidal volume during manual hyperinflation was 294% (SD 22%) of the ventilator tidal volume. A paired Student's t-test demonstrated that cardiac output (thermodilution method) decreased significantly (p < 0.05) and systemic vascular resistance increased significantly (p < 0.01) after manual hyperinflation. A repeated-measures analysis of variance (ANOVA) and a least-significant difference pairwise comparison revealed that mean arterial pressure and pulse pressure decreased significantly during (p < 0.01) and increased significantly (mean arterial pressure, p < 0.05 and mean pulse pressure p < 0.001) after the technique. Pulmonary artery pressure also increased significantly during manual hyperinflation (p < 0.01). There were no significant effects on right atrial pressure, pulmonary artery occlusion pressure or heart rate. CONCLUSION: Significant haemodynamic changes occurred in this animal model. The increased intrathoracic pressure, applied for an increased period during inspiration, decreased cardiac output with compensatory vasoconstriction evident by the increased systemic vascular resistance and mean arterial pressure. The results suggest that there may be a decrease in cardiac output after increased positive pressure in subjects with normal cardiac and respiratory function.

Animals↗

PubMed2002

Ventilatory effects of neurophysiological facilitation and passive movement in patients with neurological injury.

Thirteen intubated, high dependency patients with neurological injuries were studied in order to investigate the short term respiratory effects of neurophysiological facilitation and passive movement on tidal volume (VT), minute ventilation (VE), respiratory rate (VR) and oxygen saturation (SpO2). The subjects were studied under four conditions: no intervention (control) and during periods of neurophysiological facilitation, passive movement and sensory stimulation. All periods were standardised to three minutes duration and all parameters were recorded before and after each intervention. Neurophysiological facilitation produced significant increases (p < 0.01) in VE and SpO2 (p < 0.05) when compared with control values, with an overall mean increase in VE of 14.6%. Similarly, passive movement increased VE (p < 0.01) by an average of 9.8% and also increased SpO2 (p < 0.01). In contrast, sensory stimulation produced significant increases (p < 0.01) in SpO2 with control levels, with no significant change in VT or VE. There was no significant difference in VR with all treatments. This study provides preliminary evidence of improved short term ventilatory function following neurophysiological facilitation, independent of generalised sensory stimulation, which has not been previously examined in the literature, supporting its use in the management of high dependency neurological patients.

Adolescent↗

PubMedDate not supplied

Manual hyperinflation causes norepinephrine release.

OBJECTIVE: To measure hemodynamics and plasma catecholamines during manual hyperinflation (MHI) in ventilated patients. METHODS: MHI was performed with a Mapleson "C" circuit, 2l-reservoir bag; peak inspiratory pressure was standardized to 35 mL water; and positive expiratory-end pressure of 5 mL water was administered to seven mechanically ventilated patients with septic (6) and cardiogenic (1) shock (67.2 +/- 5.2 years, Acute Physiology Assessment and Chronic Health Evaluation II score 22.1 +/- 3.1). Diastolic (DAP) and mean arterial pressure (MAP), continuous cardiac index, pulmonary artery occlusion pressure, dynamic compliance, plasma norepinephrine and epinephrine, and arterial blood gases were recorded, and systemic vascular resistance index (SVRI) and oxygenation ratio were calculated. RESULTS: There were no significant changes in pulmonary artery occlusion pressure, mean arterial pressure, or PaO2/FiO2. There were significant increases in SVRI (P < .001), DAP (P < .001), dynamic compliance (P < .01), and plasma norepinephrine (P < .001) and a decrease in cardiac index (P < .05) after MHI. CONCLUSIONS: The increases in DAP, SVRI, and plasma norepinephrine suggest a sympathetic vasoconstrictive response during the application of MHI.

Aged↗

PubMedDate not supplied

Comparison of the effectiveness of manual and ventilator hyperinflation at different levels of positive end-expiratory pressure in artificially ventilated and intubated intensive care patients.

BACKGROUND: Manual hyperinflation (MHI) and ventilator hyperinflation (VHI) are two methods of recruitment maneuvers used in ventilated patients to improve lung compliance and secretion mobilization. The use of VHI may minimize the adverse effects of disconnection from the ventilator, but it is uncertain whether high levels of positive end-expiratory pressure (PEEP) would decrease the peak expiratory flow rate (PEFR) and consequently affect secretion clearance. OBJECTIVES: The aim of this study was to compare the effectiveness of MHI and VHI in terms of clearing pulmonary secretions (sputum wet weight and PEFR), improving static respiratory system compliance and oxygenation (arterial oxygen tension/fraction of inspired oxygen), and altering mean arterial pressure, heart rate, and carbon dioxide output at different levels of PEEP. METHODS: This was a randomized crossover study involving 14 general intensive care patients who were intubated and mechanically ventilated. RESULTS: Sputum production was similar in both techniques and levels of PEEP. There were no differences in improvement in oxygenation and static respiratory system compliance between MHI and VHI. However, VHI increased Cst significantly at 30 minutes posttreatment (P = .012), and a significant difference was observed between levels 5 and 7.5 cmH(2)O (P = .02) of PEEP for MHI. MHI generated higher PEFR than VHI (P < .05). No adverse change in heart rate or mean arterial pressure was observed during either technique; however, VCO(2) was significantly different for techniques (P = .045) and over time (P = .05). CONCLUSION: The VHI technique seems to promote greater improvements in respiratory mechanics with less metabolic disturbance compared with MHI. Other variables such as sputum production, hemodynamics, and oxygenation were affected similarly by both techniques.

Adult↗