China
Africa
Explore chapters and articles related to this topic
Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Oxygen therapy can be used for symptomatic individuals, particularly those whose pulse oxygenation drops below 90% at rest, or with activity. An incentive spirometer, a hand-held device with a one-way valve mouthpiece and a piston-type gauge that measures inspiration at levels (units usually range from 2,500 to 5,000 mL volume) with set goals for repetitions, duration, and frequency per day, can help promote oxygenation and reduce fluid accumulation in the lungs. Also, controlling and thinning secretions by staying hydrated and using a vaporizer and/or humidifier may help to allow for a productive cough and improved respiratory airflow. Physical activity, and in particular participation in a comprehensive pulmonary rehabilitation program, can be vital to controlling symptoms and maintaining functional mobility for individuals with breathlessness associated with chronic illness.
Ventricular Assistance as a Bridge to Cardiac Transplantation
Published in Wayne E. Richenbacher, Mechanical Circulatory Support, 2020
Patients with end stage heart failure have an excess of total body water. Intake is minimized by concentrating all intravenous infusions and eliminating maintenance intravenous fluids. As the systemic perfusion is determined by VAD flow there is no need for frequent cardiac output determinations. A thermodilution cardiac output may be obtained once or twice daily to ensure that it correlates with the VAD flow reported by the drive console. A continuous furosemide infusion ensures a forced diuresis during the first 24–48 hours following VAD implantation. One hundred milligrams of furosemide are mixed in 100 ml of 5% dextrose solution. The infusion is started at 10 ml/hour and increased while carefully monitoring intake and output. The goal is for total output to exceed intake by 1–2 liters over the first 24 hours. The furosemide infusion is titrated to achieve this endpoint. With aggressive diuresis the patient will develop a metabolic alkalosis. The metabolic alkalosis is corrected with acetazolamide sodium (250–500 mg IV q6h). Correction of the metabolic alkalosis permits early extubation. Thereafter, patients are instructed in the use of incentive spirometry. Respiratory treatments are employed if indicated. Chest physical therapy is gentle, if necessary, but rarely required.
Treatment of a ventral thoracic dural defect
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Ibrahim Hussain, Peter F. Morgenstern, Ali A. Baaj
A lumbar drain should be placed either preoperatively or intraoperatively following ventral thoracic dural defect repair. Because our technique does not achieve a watertight closure, high-volume drainage should be considered initially. We typically start draining immediately following surgery at 15 mL/hour, or the maximum volume tolerated by the patient (whichever is greater). At minimum, we will continue draining for 5 days, with strict bed rest. Postoperative imaging (MRI or CT myelogram) can be considered to confirm closure of the defect (Figure 34.2). If at that point there is no clinical or radiographic evidence of CSF leak, then a clamp trial for a minimum of 24 hours is performed. At that point, if there is still no evidence of a leak, then the drain is removed. If there is low concern for hematoma and no underlying coagulopathy, then all patients should be started on DVT chemoprophylaxis in addition to lower-extremity sequential compression devices. Incentive spirometry should be encouraged hourly while patients are awake to prevent atelectasis.
Post-acute physical therapy for a patient with critical illness associated with COVID-19: A case report
Published in Physiotherapy Theory and Practice, 2022
Ya-Ting Hsu, Kristen Turner, Szu-Ping Lee
Activities of daily living (ADL) safety and functional mobility were established as the early treatment focus. The treating therapists planned to incorporate progressive overload into functional mobility training (i.e. transfer, walking, and stair climbing) as the primary treatment activities. Individualized exercise prescription (strength and endurance) was developed to improve the patient’s physiological tolerance to exertion. Specifically, the treating physical therapist determined the dosage of the exercises (duration and intensity) should be sufficiently challenging but without overburdening the patient’s compromised cardiopulmonary system. This meant the exercise end points were largely determined by the cardiopulmonary parameters and patient’s symptoms (SpO2, HR, and levels of dyspnea). Additional treatments included breathing techniques (e.g. pursed lip and diaphragmatic breathing) and respiratory muscle training including both the inspiratory and expiratory muscles (i.e. abdominal muscles and diaphragm) as stated in an early COVID-19 recommendation (Zhao, Xie, and Wang, 2020). Incentive spirometer was used for the breathing training. The physical therapists and physical therapy assistants (PTA) treated him 5 days a week for 90 minutes per session during his length of stay (16 days).
Evidence-based medicine: A data-driven approach to lean healthcare operations
Published in International Journal of Healthcare Management, 2021
In conclusion, the application of evidence-based medicine has greatly improved clinical outcomes, but has been shown to have variable adoption curves by healthcare practitioners. Here we demonstrate that the application of evidence-based medicine principles can also be used as a tool to eliminate financial waste and improve hospital operations. The broad clinical use of incentive spirometry despite evidence demonstrating efficacy is just one example of wasteful practices in modern healthcare delivery. The use of adjunctive technologies in healthcare delivery is a key driver of increased healthcare costs and the adoption and use should of technology should be based on a systematic assessment of the value provided [13]. Before offering new therapeutic modality, it is common practice for healthcare administrators to perform a value analysis of the intervention, including a review of the recent scientific research data to support its therapeutic efficacy. This practice should also be applied by health system administrators as a tool to eliminate ineffective and costly legacy interventions. The ability to provide financially sustainable healthcare care is a global crisis that is impacting healthcare quality and access worldwide. The use of Lean operation principles in the management of healthcare delivery practices is applicable across all boarder and regions of the globe and is critical for providing high-quality, affordable and sustainable healthcare worldwide.
Postoperative respiratory muscle training in addition to chest physiotherapy after pulmonary resection: A randomized controlled study
Published in Physiotherapy Theory and Practice, 2020
Harun Taşkin, Orçin Telli Atalay, Gökhan Yuncu, Betül Taşpinar, Ali Yalman, Hande Şenol
IMT started at an intensity of 15% of the PImax as determined in the preoperative assessment and incrementally increased by 2 cmH2O daily, according to the patients’ tolerance, with a target training load of 45% of the preoperative assessment PImax. EMT was applied at a beginning intensity of 15% of the preoperative assessment PEmax and incrementally increased by 2 cmH2O daily, according to the patients’ tolerance. The target training load for EMT was 25% of the preoperative assessment PEmax. For the IMT, the subjects were asked to perform a strong inspiration in a comfortable seated position, at the adjusted pressure, followed by a normal expiration. Similarly, for the EMT, the subjects were asked to perform strong expirations after a normal inspiration. A total of six sessions were performed in a day, with each session consisting of three sets of 10 breaths with a 2-min rest between each set for both IMT and EMT (Weiner et al, 1998). Chest physiotherapy and early mobilization were given to the subjects in the CG once a day by the treating physiotherapist postoperatively until discharge. The subjects were also recommended to use incentive spirometer without supervision.