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      Immediate Effects of Acapella ® on Dynamic Lung Compliance in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome: A Case Series

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          Abstract

          Background and Aims:

          One potential complication of acute respiratory distress syndrome (ARDS) is reduced dynamic compliance, saturation for peripheral oxygenation (SpO 2) and increased sputum in patients that are mechanically ventilated. Airway clearance technique is the treatment given for patients on mechanically ventilator with ARDS. The purpose of the case series is to know the immediate effects of Acapella® on dynamic lung compliance (Cdyn) in subject with ARDS.

          Subjects and Methods:

          Patients who are on ventilator for more than 48hrs were included in the study. Readings for Cdyn, SpO 2 were noted at baseline, immediately post treatment, 10, 20, 30 and 60minutes. Pre and post treatment sputum volume was also noted.

          Results:

          Five patients were included with age range of 25 to 75 years. Clinical improvement was seen immediately after treatment in Cdyn and SpO 2. There was not much change in sputum volume.

          Conclusion:

          Acapella ® increased the dynamic compliance of lungs and sputum clearance in mechanically ventilated ARDS patients.

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          Most cited references13

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          Secretion management in the mechanically ventilated patient.

          Secretion management in the mechanically ventilated patient includes routine methods for maintaining mucociliary function, as well as techniques for secretion removal. Humidification, mobilization of the patient, and airway suctioning are all routine procedures for managing secretions in the ventilated patient. Early ambulation of the post-surgical patient and routine turning of the ventilated patient are common secretion-management techniques that have little supporting evidence of efficacy. Humidification is a standard of care and a requisite for secretion management. Both active and passive humidification can be used. The humidifier selected and the level of humidification required depend on the patient's condition and the expected duration of intubation. In patients with thick, copious secretions, heated humidification is superior to a heat and moisture exchanger. Airway suctioning is the most important secretion removal technique. Open-circuit and closed-circuit suctioning have similar efficacy. Instilling saline prior to suctioning, to thin the secretions or stimulate a cough, is not supported by the literature. Adequate humidification and as-needed suctioning are the foundation of secretion management in the mechanically ventilated patient. Intermittent therapy for secretion removal includes techniques either to simulate a cough, to mechanically loosen secretions, or both. Patient positioning for secretion drainage is also widely used. Percussion and postural drainage have been widely employed for mechanically ventilated patients but have not been shown to reduce ventilator-associated pneumonia or atelectasis. Manual hyperinflation and insufflation-exsufflation, which attempt to improve secretion removal by simulating a cough, have been described in mechanically ventilated patients, but neither has been studied sufficiently to support routine use. Continuous lateral rotation with a specialized bed reduces atelectasis in some patients, but has not been shown to improve secretion removal. Intrapulmonary percussive ventilation combines percussion with hyperinflation and a simulated cough, but the evidence for intrapulmonary percussive ventilation in mechanically ventilated patients is insufficient to support routine use. Secretion management in the mechanically ventilated patient consists of appropriate humidification and as-needed airway suctioning. Intermittent techniques may play a role when secretion retention persists despite adequate humidification and suctioning. The technique selected should remedy the suspected etiology of the secretion retention (eg, insufflation-exsufflation for impaired cough). Further research into secretion management in the mechanically ventilated patient is needed.
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            Performance comparison of two oscillating positive expiratory pressure devices: Acapella versus Flutter.

            Oscillatory positive expiratory pressure (PEP) with the Flutter device facilitates secretion removal. In the Flutter a steel ball vibrates inside a cone, causing air flow vibration. A new device, the Acapella, uses a counterweighted plug and magnet to create air flow oscillation. The Acapella comes in 2 models: one for patients with expiratory flow > or = 15 L/min and one for < or = 15 L/min. We hypothesized that the Acapella and Flutter would produce similar mean PEP, oscillatory pressure amplitude, and frequency over a clinically relevant range of flows.
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              Incidence and outcome of acute lung injury and acute respiratory distress syndrome in the surgical intensive care unit

              Introduction: To determine the incidence and mortality of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in a cohort of patients with risk factors admitted to the Surgical Intensive Care Unit (SICU). Materials and Methods: A prospective observational inception cohort study with no intervention was conducted over 12 months. All patients with at least one known risk factor for ALI/ARDS admitted to the SICU were included in the study. The APACHE II severity of disease classification system scoring was performed within 1 h of admission. The ventilatory parameters and chest radiographs were recorded every 24 h. The P/F ratio, PEEP and Lung Injury Score were calculated each day until the day of discharge from the Intensive Care Unit or for the first 7 days of admission, whichever was shorter. Results: The incidence of ARDS among those who were mechanically ventilated was 11.4%. Sepsis was the most common (34.6%) etiology. Among those with risk factors, the incidence of ARDS was 30% and that of ALI was 32.7%. The mortality in those with ARDS was 41.8%. Those who develop ARDS had higher APACHE II scores, lower pH and higher PaCO2 at admission compared with those who developed ALI or no lung injury. Conclusion: The incidence and mortality of ARDS was similar to other studies. Identifying those with risk factors for ARDS or mortality will enable appropriate interventional measures.
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                Author and article information

                Journal
                Indian J Crit Care Med
                Indian J Crit Care Med
                IJCCM
                Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
                Medknow Publications & Media Pvt Ltd (India )
                0972-5229
                1998-359X
                February 2018
                : 22
                : 2
                : 100-102
                Affiliations
                [1]Department of Physiotherapy, Manipal Academy of Higher Education, Manipal, Karnataka, India
                Author notes
                Address for correspondence: Dr. V. Prem, Department of physiotherapy, Manipal Hospital, 98, Old Airport Road, Bengaluru - 560 017, Karnataka, India. E-mail: prem.v@ 123456manipal.edu
                Article
                IJCCM-22-100
                10.4103/ijccm.IJCCM_157_17
                5842449
                29531450
                d8e5ac18-4bbc-4518-a838-b978849c6993
                Copyright: © 2018 Indian Journal of Critical Care Medicine

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Brief Communication

                Emergency medicine & Trauma
                acapella®,acute respiratory distress syndrome,airways clearance technique,mechanical ventilation

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