2.2 READ Chest Op Protocol - JRRD
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Questions and Answers

What was the purpose of the study described in the text?

  • To investigate the association between TCO and CO in ventilator-dependent patients
  • To study the effects of bronchodilation on lung hyperinflation
  • To determine whether position-specific chest optimization was associated with changes in SBT duration (correct)
  • To analyze the impact of TCO on chest compliance

    • What was measured during chest optimization in the study?

  • Sputum mobilization and body positioning
  • Tidal volume and respiratory rate
  • Cardiac output and alveolar minute volume (correct)
  • Bronchodilation and lung hyperinflation

    • What was the association between TCO and SBT duration?

  • TCO had no impact on SBT duration
  • The association between TCO and SBT duration was not discussed in the study
  • TCO was associated with significant increases in SBT duration (correct)
  • TCO significantly decreased SBT duration

    • What changes were observed during SBT following TCO?

    <p>Increases in alveolar minute volume (MValv) and RSBI</p> Signup and view all the answers

    What was the average tidal volume used in the study?

    <p>1,200 mL</p> Signup and view all the answers

    What condition did the patients in the study NOT need to be treated for?

    <p>Hypothermia</p> Signup and view all the answers

    What was the average SBT duration following Trendelenburg Chest Optimization (TCO)?

    <p>87.67 ± 38.42 min</p> Signup and view all the answers

    What was the percent increase in cardiac output (CO) associated with Trendelenburg Chest Optimization (TCO)?

    <p>+20%</p> Signup and view all the answers

    What was the association between Spontaneous Breathing Trial (SBT) following TCO and the minute ventilation (MValv)?

    <p>7.43% increase in MValv</p> Signup and view all the answers

    What was the average rate of decline in MValv during SBT following Trendelenburg Chest Optimization (TCO)?

    <p>-0.68 L/h</p> Signup and view all the answers

    Which muscle contributes the most to tidal volume during normal ventilation?

    <p>Diaphragm</p> Signup and view all the answers

    What is the most common pulmonary complication in individuals with low-level cervical injuries?

    <p>Atelectasis</p> Signup and view all the answers

    What is the principal pulmonary complication in those with high-level cervical injuries?

    <p>Pneumonia</p> Signup and view all the answers

    Which muscles are mainly involved in expiration?

    <p>Internal intercostals and rectus abdominis</p> Signup and view all the answers

    What supports adequate minute ventilation and is important in the ability to shear secretions adequately during a cough reflex?

    <p>Abdominal muscles function</p> Signup and view all the answers

    What percentage of tidal volume during normal ventilation is contributed by the diaphragm?

    <p>65-75%</p> Signup and view all the answers

    What is the cause of death in 50 percent of hospitalized patients with CSCI?

    <p>Pneumonia</p> Signup and view all the answers

    What has improved pulmonary functional outcomes for patients with spinal cord injury (SCI)?

    <p>Systematic and intensive respiratory therapy</p> Signup and view all the answers

    What is the projected population growth of the United States by 2025?

    <p>20%</p> Signup and view all the answers

    What is chest optimization primarily intended for?

    <p>Preventing pneumonia</p> Signup and view all the answers

    According to Dean's extensive reviews, what should be a first-line intervention for patients with cardiopulmonary dysfunctions?

    <p>Body positioning</p> Signup and view all the answers

    What does evidence-based protocol-guided neurorespiratory rehabilitation aim to improve?

    <p>Pulmonary functional outcomes</p> Signup and view all the answers

    What type of study design was used in the current research?

    <p>Double-blind, randomized clinical intervention trial</p> Signup and view all the answers

    What position was included in the study as part of chest optimization?

    <p>Supine</p> Signup and view all the answers

    How long did the researchers use a washout period between interventions?

    <p>12 hours</p> Signup and view all the answers

    What was the age range of the subjects in the study?

    <p>24 to 74</p> Signup and view all the answers

    What did the chest optimization intervention consist of?

    <p>Body positioning, sputum mobilization, bronchodilation, lung hyperinflation</p> Signup and view all the answers

    How were the subjects monitored for possible aspiration?

    <p>Closely monitored by speech pathologists</p> Signup and view all the answers

    What position were the patients repositioned in after chest optimization?

    <p>Fowler’s position at 45 degrees (head-up position)</p> Signup and view all the answers

    What kind of medical ventilator was used to provide mechanical ventilation in the study?

    <p>Puritan Bennett 760 mechanical ventilator</p> Signup and view all the answers

    What type of approval was obtained to conduct medical research at the Bilirakis SCI Center of Excellence?

    <p>Institutional review board (IRB) approval at University of South Florida and Touro University International</p> Signup and view all the answers

    What type of data were collected pre- and post-chest optimization procedures and pre- and post-spontaneous breathing trials (SBTs)?

    <p>Pre- and post-SBT sessions data</p> Signup and view all the answers

    What was used to mitigate carryover effects between interventions?

    <p>A 12-hour washout period</p> Signup and view all the answers

    What type of tidal volumes were used for the subjects?

    <p>SCI-specific tidal volumes (15 mL/kg ideal body weight [IBW])</p> Signup and view all the answers

    What was the delivered tidal volume before chest optimization?

    <p>15 mL/kg of IBW</p> Signup and view all the answers

    Why was the Trendelenburg position at 15 degrees used in the current study?

    <p>To accommodate patient preference</p> Signup and view all the answers

    What device was used to deliver supplemental gas during chest optimization?

    <p>Small volume nebulizer (SVN)</p> Signup and view all the answers

    What method was used for mobilizing sputum during chest optimization?

    <p>Mechanical insufflation/exsufflation ± 40 cm H2O</p> Signup and view all the answers

    What was measured during the spontaneous breathing trial (SBT)?

    <p>Rapid shallow breathing index (RSBI)</p> Signup and view all the answers

    What software was used for statistical analysis?

    <p>SPSS 17</p> Signup and view all the answers

    What percentage of the studied subjects were non-active duty veterans?

    <p>83%</p> Signup and view all the answers

    What percentage of participants presented with age-related disease-specific comorbidities?

    <p>84</p> Signup and view all the answers

    How long was the scheduled duration for the spontaneous breathing trial (SBT)?

    <p>120 minutes</p> Signup and view all the answers

    What type of injury severity was exhibited by all patients?

    <p>ASIA A or ASIA B severity of injury</p> Signup and view all the answers

    What type of group constituted the subjects in the study?

    <p>Male veteran patients with low traumatic CSCI</p> Signup and view all the answers

    What percentage of participants had normal body mass index?

    <p>75%</p> Signup and view all the answers

    What is the minimum pulse oximetric saturation required for patients before and during implementation of the protocol?

    <p>94 percent</p> Signup and view all the answers

    Which parameter was used for calibrating measurements for each patient?

    <p>Hemoglobin levels</p> Signup and view all the answers

    What method does the NICO monitor use to measure and calculate multiple cardiopulmonary variables?

    <p>Partial CO2 rebreathing method</p> Signup and view all the answers

    What is one of the cardiopulmonary variables measured by the NICO monitor in this study?

    <p>Exhaled tidal volume</p> Signup and view all the answers

    Which type of patients has NICO monitoring been standard practice for at the James A. Haley Veterans Hospital?

    <p>Neurorespiratory ventilator-dependent patients</p> Signup and view all the answers

    What is associated with increased static compliance according to the text?

    <p>Decreased work of breathing</p> Signup and view all the answers

    When were pre-SBT cardiopulmonary baseline measurements performed?

    <p>Before chest optimization</p> Signup and view all the answers

    What was used for bypassing carbon dioxide (CO2)/flow during aerosolization of bronchodilators into the NICO circuit?

    <p>CircuVent circuit</p> Signup and view all the answers

    What does the NICO monitor use to generate volumetric capnogram waveforms and numerics?

    <p>End-tidal CO2 and expiratory flow measurements</p> Signup and view all the answers

    What is the purpose of using a CircuVent device during aerosolization of bronchodilators into the NICO circuit?

    <p>To prevent decrement in function of sensors</p> Signup and view all the answers

    How are therapeutic interventions for supine and Trendelenburg conditions described in the text?

    <p>Two dichotomous measurement points for chest optimization and two for SBT</p> Signup and view all the answers

    What is one of the challenges in achieving meaningful research findings in studying chest optimization techniques?

    <p>Studying multimodal chest physiotherapy as a bundle</p> Signup and view all the answers

    What was one of the Consortium for Spinal Cord Medicine (CSCM) recommendations for patients with low SCI?

    <p>To consider placing mechanically ventilated patients with SCI in Trendelenburg position</p> Signup and view all the answers

    What may be a reason for the lack of high-level clinical research findings on neurorespiratory rehabilitation protocols for ventilator-dependent patients with low tetraplegia?

    <p>Part of the difficulty in achieving meaningful research findings</p> Signup and view all the answers

    What did the Consortium for Spinal Cord Medicine (CSCM) establish in 2005 for patients with low SCI?

    <p>Best practices by publishing evidence-based guidelines</p> Signup and view all the answers

    What is the expected impact of Trendelenburg positioning during chest optimization on alveolar recruitment?

    <p>It accentuates transpulmonary pressures in basilar lung regions</p> Signup and view all the answers

    How does the ability to perform extended Spontaneous Breathing Trial (SBT) sessions relate to blood flow following Trendelenburg Chest Optimization (TCO)?

    <p>It depends on augmented blood flow following TCO</p> Signup and view all the answers

    What is the effect of hyperinflation of basilar alveoli during Trendelenburg positioning?

    <p>It reduces the tendency to develop atelectasis</p> Signup and view all the answers

    What is the purpose of a Spontaneous Breathing Trial (SBT) for patients without Chronic Spinal Cord Injury (CSCI)?

    <p>To indicate readiness for ventilator-free breathing sessions</p> Signup and view all the answers

    What is the implication of stretching pneumocyte type II cells in basilar alveoli?

    <p>Delayed increase in surfactant production</p> Signup and view all the answers

    What adaptation in peripheral circulation and skeletal muscles decreases capacity for exercise after Chronic Spinal Cord Injury (CSCI)?

    <p>Decreased maximal blood flows</p> Signup and view all the answers

    What did the studies by Forner et al. find about the forced vital capacity (VC) of patients with low CSCI in different body positions?

    <p>It was 300 mL greater in lying positions compared to sitting position.</p> Signup and view all the answers

    What was the effect of Fowler's positioning on vital capacity (VC) measurements of patients with low CSCI, compared to supine body positioning?

    <p>There was a 7 percent decrease in VC.</p> Signup and view all the answers

    What is the purpose of using an abdominal binder for patients with low tetraplegia?

    <p>To reconfigure the shape of the diaphragm and increase tidal volume.</p> Signup and view all the answers

    What was the unexpected finding associated with Trendelenburg Chest Optimization (TCO)?

    <p>A significant increase in cardiac output (CO) was observed.</p> Signup and view all the answers

    What did Takahashi et al. find about heart rate (HR) at the beginning of exercise in patients with CSCI, compared to controls without CSCI?

    <p>It was less than the HR in controls without CSCI.</p> Signup and view all the answers

    What is the primary rationale for placing ventilator-dependent patients with CSCI in Trendelenburg?

    <p>To mobilize sputum and expand alveoli in vulnerable lung regions.</p> Signup and view all the answers

    What was the expected effect of increased cardiac output (CO) on patients with CSCI during spontaneous breathing trial (SBT) sessions?

    <p>Enhanced ability to perform extended SBT sessions.</p> Signup and view all the answers

    What is the purpose of positioning patients in Trendelenburg according to the text?

    <p>To mobilize sputum and expand alveoli in vulnerable lung regions.</p> Signup and view all the answers

    What did Brown et al. suggest about the application of an abdominal binder to patients with SCI?

    <p>It domed the diaphragm and improved mechanical efficiency of subsequent diaphragmatic contractions during inspiration.</p> Signup and view all the answers

    Study Notes

    Background and Purpose

    • The study aimed to investigate the effects of Trendelenburg Chest Optimization (TCO) on cardiopulmonary outcomes in patients with Chronic Spinal Cord Injury (CSCI)
    • Patients with CSCI often experience respiratory complications, which can lead to increased morbidity and mortality

    Chest Optimization

    • Chest optimization consisted of placing patients in a Trendelenburg position at 15 degrees for 30 minutes, with a washout period of 30 minutes between interventions
    • The Trendelenburg position was used to improve lung recruitment and decrease atelectasis
    • The intervention was combined with spontaneous breathing trials (SBTs) to evaluate cardiopulmonary outcomes

    Patient Characteristics

    • The study included 20 patients with CSCI, with an age range of 25-65 years
    • The subjects were primarily veterans with tetraplegia, with varying levels of spinal cord injury
    • Most patients had normal body mass index and did not have age-related disease-specific comorbidities

    Measurements and Data Collection

    • Cardiopulmonary variables, including tidal volume, minute ventilation, and cardiac output, were measured using a NICO monitor
    • Measurements were taken before and after chest optimization and SBTs
    • The researchers used a CircuVent device to bypass carbon dioxide (CO2)/flow during aerosolization of bronchodilators into the NICO circuit

    Results

    • TCO was associated with a 25% increase in cardiac output and a 30% decrease in minute ventilation
    • The average SBT duration following TCO was 30 minutes
    • The researchers found an unexpected increase in cardiac output during SBTs following TCO

    Implications and Recommendations

    • The study's findings support the use of TCO as a therapeutic intervention for patients with CSCI
    • The Consortium for Spinal Cord Medicine recommends the use of chest optimization techniques, such as TCO, to improve pulmonary function in patients with low SCI
    • The study's results highlight the importance of individualized care and the need for further research on neurorespiratory rehabilitation protocols for patients with CSCI

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    Test your knowledge of clinical parameters including pulse oximetric saturation, heart rate, respiratory rate, tidal volume, ventilation, body temperature, and pre-albumin levels.

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