Physiospot CardioRespiratory

Clinicians Consistently Exceed a Typical Person’s Short-Term Memory During Preoperative Teaching

Sandberg EH, Sharma R, Wiklund R, Sandberg WS. In the light of short-term memory capacity for information such as preoperative instruction being limited to roughly seven “chunks” of information for a short period of time the authors set out to study information information-giving practices of anesthesiologists and nurse practitioners during preoperative teaching. Anesthesiologists and nurse practitioners vastly exceeded patients’ short-term memory capacity. Nurse practitioners gave significantly more information to patients than did physicians. This higher level of information-giving was not influenced by the question-asking behaviors of the patients. Nurse practitioners and physicians used similar numbers of medical terms, and memory-supporting reinforcements. Given the known limits of short-term memory, clinicians would be well advised to carefully consider their patterns of information-giving and their use of memory-reinforcing strategies for critical information. Anesthesia and Analgesia 2008; 107:972-978 Link to Abstract

Intermittent versus Continuous Exercise: Effects of Perceptually Lower Exercise in Obese Women.

Coquart JBJ, Lemarie C, Dubart A-E, Luttembacher D-P, Douillard C, Garcin M The main aims of this study were to determine which type of exercise (continuous vs intermittent) was perceived less hard; and to analyze the impact of a training program on the basis of this exercise in obese women with and without type 2 diabetes. Twenty type 2 diabetic obese women and 20 obese women without diabetes were recruited. In each group, half the patients exercised and the others did not. Rate of perceived exertion (RPE) was measured during exercise. The training groups performed both a continuous exercise and an intermittent exercise. RPE were significantly lower during the intermittent exercise compared to the continuous exercise in the obese women with or without diabetes. After the training program, significant beneficial effects on the glycosylated haemoglobin, body mass, body mass index, heart rate and the walked distance limit were noticed in the training groups. Medicine & Science in Sports & Exercise. 40(8):1546-1553, August 2008. Link to Abstract

Effects of inspiratory muscle training in cystic fibrosis: a systematic review

Reid, W. D., Geddes, E. L., O'Brien, K., Brooks, D., Crowe, J.

This systematic review was to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnoea and quality of life for adolescents and adults living with cystic fibrosis. The search strategy yielded 36 articles, of which two met the inclusion criteria. Both studies used a targeted or threshold device for IMT. Meta-analyses were limited to forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC), which showed no difference in effect between the IMT group and the sham and/or control group. Individual study results were inconclusive for improvement in inspiratory muscle strength. One study demonstrated improvement in inspiratory muscle endurance.

The benefit of IMT in adolescents and adults with cystic fibrosis for outcomes of inspiratory muscle function is supported by weak evidence. Its impact on exercise capacity, dyspnoea and quality of life is not clear. Future research should investigate the characteristics of the subgroup of people with cystic fibrosis that might benefit most from IMT.

Clinical Rehabilitation, 2008, 22(10-11), 1003-1013

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Longitudinal Change in the BODE Index Predicts Mortality in Severe Emphysema

Martinez FJ, Han MK, Andrei AC, Wise R, Murray S, Curtis JL, Sternberg A, Criner G, Gay SE, Reilly J, Make B, Ries AL, Sciurba F, Weinmann G, Mosenifar Z, DeCamp M, Fishman AP, Celli BR

The authors set out to determine how the mBODE (modified BODE - Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) score changes in patients with lung volume reduction surgery versus medical therapy, and whether there are correlations with survival. The study found that an increase in mBODE of more than 1 point from baseline to 6, 12, and 24 months of follow-up was predictive of subsequent mortality in both groups. It is thought that change in mBODE may prove a good surrogate measure of survival in therapeutic trials in severe chronic obstructive pulmonary disease.

American Journal of Respiratory and Critical Care Medicine 2008; 178: 491-499

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Oxygenation and static compliance is improved immediately after early manual hyperinflation following myocardial revascularisation: a randomised controlled trial

Clarissa Blattner C, Guaragna JC, Saadi E.

This randomised controlled trial of 55 patients undergoing myocardial revascularisation assessed the effect of an early treatment of manual hyperinflation. After an hour in recovery, the experimental group received manual hyperinflation with positive end expiratory pressure followed by suction while the control group received suction only. Oxygenation and static lung compliance were measured immediately after suction.

PaO2 and static compliance were greater in the experimental group than in the control group. The experimental group was extubated 76 minutes earlier than the control group. Hospital length of stay and the incidence of post operative pulmonary complications were similar in the two groups.

Australian Journal of Physiotherapy 2008; 54: 173–178

Heart rate and pulse pressure at rest are major prognostic markers of early postoperative complications after coronary bypass surgery.

Aboyans V, Frank M, Nubret K, Lacroix P, Laskar M.

In this study of 1022 patients admitted for non-urgent coronary artery bypass grafting the authors aimed to assess the predictive value of preoperative HR and PP in the 30-day postoperative period. Heart rate was measured on ECG at admission and preoperative pulse pressure was obtained by the difference of the mean of three consecutive systolic and diastolic blood pressures. The primary outcome combined the 30-day postoperative mortality, myocardial infarction and stroke or transient ischemic attack.

Those meeting the primary outcome (n=146) had a significantly higher HR and a higher proportion presented a PP >70 mmHg. After adjustments for age, gender, systolic blood pressure, preoperative beta-blocker therapy, left ventricular ejection fraction <0.40, unstable cardiac status, redo surgery, peripheral arterial disease, renal failure, and combined vascular surgery, both HR and PP >70 mmHg remained significant risk predictors.

European Journal of Cardiothoracic Surgery 2008;33: 971-6

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Cerebral Perfusion Pressure in Neurotrauma: A Review

White H. and Venkatesh B

This review discusses the issues relating to cerebral blood flow and cerebral perfusion pressure (CPP) in the treatment of patients with traumatic brain injury. Initial studies indicated that increasing CPP may be beneficial and the Brain Trauma Foundation acknowledged this by incorporating a target of 70 mm Hg in the 1996 guidelines. However, the lack of a demonstrable benefit and the increased complication rate associated with this approach led to a reduction in the CPP goal to 60 mm Hg. With the advancement of neuromonitoring techniques, haemodynamic manipulations and their effects on cerebral metabolism may now be monitored furthering the debate on CPP.

Anesthaesthesia and Analgesia 2008; 107: 979-988

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Cough augmentation in Duchenne muscular dystrophy.

Ishikawa Y, Bach JR, Komaroff E, Miura T, Jackson-Parekh R.

The purpose of this study was to compare the relative importance of deep lung insufflation with the abdominal thrust and their combination in augmenting cough peak flows (CPF), in 61 patients with Duchenne muscular dystrophy (DMD).

They found that air stacking was significantly more effective than abdominal thrust in increasing CPF, but the combination was the most effective. The greatest improvements in CPF were for patients with the weakest coughs.

American Journal of Physical Medicine and Rehabilitation 2008; 87: 726-30.

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Lung insufflation capacity in neuromuscular disease.

Bach JR, Mahajan K, Lipa B, Saporito L, Goncalves M, Komaroff E.

This study was a case series of 282 consecutive neuromuscular disease (NMD) clinic patients 7 yrs and older with vital capacity (VC) <70% of the predicted normal value. All patients meeting these criteria were prescribed thrice-daily air stacking and/or maximal passive lung insufflation to pressures of 40-80 cm H2O They underwent measurements of VC, maximal insufflation capacity (MIC), lung insufflation capacity (LIC), and unassisted and assisted cough peak flows (CPF) on every visit.

The authors found that passive lung insufflation can distend the lungs of patients with NMD significantly greater than air stacking, particularly when glottic and bulbar-innervated muscle dysfunction is severe. The patients who benefit the most from insufflation therapy are those who have the lowest VC.

American Journal of Physical Medicine and Rehabilitation. 2008; 87: 720-5.

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COPD as a Systemic Disease: Impact on Physical Functional Limitations

Mark D. Eisner MD, Blanc PD, Yelin EH,Sidney S, Katz PP, Ackerson L, Lathon P, Tolstykh I, Omachi T, Byl N, Iribarren C

The authors of this study aimed to establish the physical functional limitations that are directly attributable to COPD compared to a matched referent group without COPD.
Subjects were matched for age, sex, and race and measures used to study the impact of COPD on the risk of a broad array of functional limitations included: lower extremity function (Short Physical Performance Battery), submaximal exercise performance (Six Minute Walk Test), standing balance (Functional Reach Test), skeletal muscle strength (manual muscle testing with dynamometry), and self-reported functional limitation (standardized item battery).

COPD was associated with poorer lower extremity function, less distance walked during the SMWT, weaker muscle strength in every muscle group tested, including both the upper and lower extremities and carried a greater risk of self-reported functional limitation.
Conclusions

The American Journal of Medicine 2008; 121: 789 – 796

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