A Comparison of the Therapeutic Effectiveness
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Lung Abscess: Analysis of 252 Consecutive Cases Diagnosed Between 1968 and 2004
136 Moreira JS, Camargo JJP, Felicetti JC, Goldenfun PR, Moreira ALS, Porto NS Artigo Original Abscesso pulmonar de aspiração: análise de 252 casos consecutivos estudados de 1968 a 2004* Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and 2004 JOSÉ DA SILVA MOREIRA1, JOSÉ DE JESUS PEIXOTO CAMARGO2, JOSÉ CARLOS FELICETTI2, PAULO ROBERTO GOLDENFUN3, ANA LUIZA SCHNEIDER MOREIRA4, NELSON DA SILVA PORTO2 RESUMO Objetivo: Apresentar a experiência de um serviço especializado em doenças respiratórias no manejo de casos de abscesso pulmonar de aspiração. Métodos: Descrevem-se aspectos diagnósticos e resultados terapêuticos de 252 casos consecutivos de pacientes com abscesso de pulmão, hospitalizados de 1968 a 2004. Resultados: Dos 252 casos, 209 ocorreram em homens e 43 em mulheres, com média de idade de 41,4 anos. Eram alcoolistas 70,2% dos pacientes. Tosse, expectoração, febre e comprometimento do estado geral ocorreram em mais de 97% dos casos, 64% tinham dor torácica, 30,2% hipocratismo digital, 82,5% apresentavam dentes em mau estado de conservação, 78,6% tiveram episódio de perda de consciência e 67,5% apresentavam odor fétido de secreções broncopulmonares. Em 85,3% dos casos as lesões localizavam-se nos segmentos posterior de lobo superior ou superior de lobo inferior, 96,8% delas unilateralmente. Em 24 pacientes houve associação de empiema pleural (9,5%). Flora mista foi identificada em secreções broncopulmonares ou pleurais em 182 pacientes (72,2 %). Todos os doentes foram inicialmente tratados com antibióticos (principalmente penicilina ou clindamicina) e 98,4 % deles foram submetidos à drenagem postural. Procedimentos cirúrgicos foram efetuados em 52 (20,6%) pacientes (24 drenagens de empiema, 22 ressecções pulmonares e 6 pneumostomias). -
Respiratory – Aspiration Precautions SECTION: 9.01 Strength of Evidence Level: 3
Respiratory – Aspiration Precautions SECTION: 9.01 Strength of Evidence Level: 3 PURPOSE: 4. Consult speech therapist for patients with Implement and educate patient/caregiver on precautions dysphagia, as needed, and as ordered by that prevent aspiration. healthcare provider. 5. Consult dietitian for diet evaluation, as needed CONSIDERATIONS: (requires physician’s order). 6. If patient receiving enteral feedings, See Digestive - 1. Precautions should be taken with all patients who Gastrostomy or Jejunostomy Tube Feeding. are unable to protect their airway to prevent the 7. Monitor patient when eating/drinking: involuntary inhalation of foreign substances, such a. Instruct family or caregiver to do the same. as gastric contents, oropharyngeal secretions, b. Observe adequacy of swallowing. food or fluids, into the tracheobronchial passages. c. SN: order ST eval for tube fed patients for 2. Patients at particular risk for aspiration include those swallow eval as appropriate. whose normal protective mechanisms are impaired. 8. Maintain calm environment when the patient is 3. Major risk factors include: eating or drinking. a. Decreased level of consciousness (confusion, 9. If patient is unable to manage own oral secretions, coma, sedation). nasopharyngeal suctioning may be indicated, b. Documented previous episode of aspiration. consult with healthcare provider and refer to c. Neuromuscular disease and structural nasopharyngeal suctioning policy as needed. abnormalities of the aerodigestive tract. 10. Keep wire cutters at HOB of patient with wired jaws d. Depressed protective reflexes (cough or gag). and instruct patient and caregiver in use. e. Presence of an endotracheal tube. 11. Notify healthcare provider immediately for any signs f. Persistently high gastric residual volumes. -
Chest Physiotherapy Page 1 of 10
UTMB RESPIRATORY CARE SERVICES Policy 7.3.9 PROCEDURE - Chest Physiotherapy Page 1 of 10 Chest Physiotherapy Effective: 10/12/94 Revised: 04/05/18 Formulated: 11/78 Chest Physiotherapy Purpose To standardize the use of chest physiotherapy as a form of therapy using one or more techniques to optimize the effects of gravity and external manipulation of the thorax by postural drainage, percussion, vibration and cough. A mechanical percussor may also be used to transmit vibrations to lung tissues. Policy Respiratory Care Services provides skilled practitioners to administer chest physiotherapy to the patient according to physician’s orders. Accountability/Training • Chest Physiotherapy is administered by a Licensed Respiratory Care Practitioner trained in the procedure(s). • Training must be equivalent to the minimal entry level in the Respiratory Care Service with the understanding of age specific requirements of the patient population treated. Physician's A written order by a physician is required specifying: Order Frequency of therapy. Lung, lobes and segments to be drained. Any physical or physiological difficulties in positioning patient. Cough stimulation as necessary. Type of supplemental oxygen, and/or adjunct therapy to be used. Indications This therapy is indicated as an adjunct in any patient whose cough alone (voluntary or induced) cannot provide adequate lung clearance or the mucociliary escalator malfunctions. This is particularly true of patients with voluminous secretions, thick tenacious secretions, and patients with neuro- muscular disorders. Drainage positions should be specific for involved segments unless contraindicated or if modification is necessary. Drainage usually in conjunction with breathing exercises, techniques of percussion, vibration and/or suctioning must have physician's order. -
Effects of Intrapulmonary Percussive Ventilation on Airway Mucus Clearance: a Bench Model 11/2/17, 7 22 AM
Effects of intrapulmonary percussive ventilation on airway mucus clearance: A bench model 11/2/17, 7'22 AM World J Crit Care Med. 2017 Aug 4; 6(3): 164–171. PMCID: PMC5547430 Published online 2017 Aug 4. doi: 10.5492/wjccm.v6.i3.164 Effects of intrapulmonary percussive ventilation on airway mucus clearance: A bench model Lorena Fernandez-Restrepo, Lauren Shaffer, Bravein Amalakuhan, Marcos I Restrepo, Jay Peters, and Ruben Restrepo Lorena Fernandez-Restrepo, Lauren Shaffer, Bravein Amalakuhan, Marcos I Restrepo, Jay Peters, Ruben Restrepo, Division of Pediatric Critical Care, Division of Pulmonary and Critical Care, and Department of Respiratory Care, University of Texas Health Science Center and the South Texas Veterans Health Care System, San Antonio, TX 78240, United States Author contributions: All authors contributed equally to the literature search, data collection, study design and analysis, manuscript preparation and final review. Correspondence to: Dr. Bravein Amalakuhan, MD, Division of Pediatric Critical Care, Division of Pulmonary and Critical Care, and Department of Respiratory Care, University of Texas Health Science Center and the South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78240, United States. [email protected] Telephone: +1-210-5675792 Fax: +1-210-9493006 Received 2017 May 7; Revised 2017 Jun 1; Accepted 2017 Jun 30. Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. -
Postural Drainage Fact Sheet 7-28-05
Consumer Fact Sheet An Introduction to Postural Drainage & Percussion Postural Drainage and Percussion (PD & P), also known why PD & P treatments are effective, and how each lung as chest physical therapy, is a widely accepted technique segment is drained. to help people with cystic fibrosis (CF) breathe with less Draining the Lung Segments difficulty and stay healthy. PD & P uses gravity and per- cussion to loosen the thick, sticky mucus in the lungs so it The goal of PD & P is to clear mucus from each of the five can be removed by coughing. Unclogging the airways is lobes of the lungs by draining mucus into the larger air- critical to reducing the severity of lung infections. ways so that it can be coughed out. The right lung is composed of three lobes: the upper lobe, the middle lobe PD & P is easy to perform using the techniques you will and the lower lobe. The left lung is made up of only two learn here. For the child with CF, PD & P can be lobes: the upper lobe and the lower lobe. performed by physical therapists, respiratory therapists, nurses, parents, siblings and even friends. The lobes are divided into smaller divisions called seg- ments. The upper lobes on the left and right sides are PD & P is sometimes used along with other types of treat- each made up of three segments: apical, posterior and ments, such as inhaled bronchodilators and antibiotics. If anterior. The left upper lobe includes the lingual, which ordered, bronchodilators should be taken before PD & P corresponds to the middle lobe on the right. -
1St Quarter 2002 Medicare a Bulletin
In This Issue... ICD-9-CM Coding for Diagnostic Tests Clarification and examples on reporting the appropriate code for these Services .... 5 New Medicare Enrollment Application New Provider Enrollment Application version CMS 855 has been implemented .... 10 Coverage of Sacral Nerve Stimulation Coverage and Billing Guidelines .............................................................................. 12 Inpatient Rehabilitation Facilities Guidelines for the Implementation of Prospective Payment System ......................... 18 End Stage Renal Disease Blood Pricing for 2002.............................................................................................. 23 Final Medical Review Policies 10060, 11600, 29540, 33282, 76075, 78460, 80061, 80162, 82270, 93224, 93350, 94010, 94240, 95115, J0150, J7190, and J9999 ................................................... 25 Respiratory Services under SNF PPS Bulletin Issues Concerning Billing for Respiratory Therapy ................................................. 81 Outpatient Prospective Payment System Clarification of Activity Therapy and Patient Education/Training Services ............ 88 Features he Medicare A Bulletin From the Medical Director 3 Tshould be shared with all Administrative 4 health care practitioners and managerial members of the General Information 5 provider/supplier staff. General Coverage 11 Publications issued after Fraud and Abuse 16 October 1, 1997, are available at no-cost from our provider Hospital Services 17 Web site at End Stage Renal Disease 23 www.floridamedicare.com. -
Posture in Thoracic Surgery by A
Thorax: first published as 10.1136/thx.3.3.161 on 1 September 1948. Downloaded from Thorax (1948), 3, 161. POSTURE IN THORACIC SURGERY BY A. I. PARRY BROWN From the Thoracic Surgical Unit, Harefield, Middlesex It is important in thoracic surgery to find a pneumonectomy is turned from the lateral to the position upon the operating table which will com- supine position at the end of the operation the bine good surgical access with the minimum pleural pressure on the operation side is also in- interference with respiration. Present practice creased, so that in a well-grown adult it may be favours a postero-lateral approach for most thora- necessary to aspirate 600 to 800 c.cm. of air in cotomies, and for this the patient is placed with the order to produce normal readings and to centralize gobod side of the chest under. The lateral position the mediastinum. These conditions show an is maintained by a pad against the front of the increase in the capacity of the upper hemithorax chest and by pelvic and buttock supports which at the expense of the lower in the lateral position. prevent rolling or slipping if the table is tilted. A Penman (1941), in an investigation of cases who padded wedge or pillow is sometimes placed under had " mediastinal flap," and who were treated by the thorax so as to bow the chest, opening the rib artificial pneumothorax, found the same thing, and spaces on the upper side and so facilitating the in treating mediastinal displacement he used low exposure. Sellors' " chest-rest" combines the pressures and nursed the patients as far as possible wedge and the anterior support in one piece. -
The Short-Term Effect of Breathing Tasks Via an Incentive Spirometer on Lung Function Compared with Autogenic Drainage in Subjects with Cystic Fibrosis
The Short-Term Effect of Breathing Tasks Via an Incentive Spirometer on Lung Function Compared With Autogenic Drainage in Subjects With Cystic Fibrosis Gil Sokol, Daphna Vilozni PhD, Ran Hakimi, Moran Lavie MD, Ifat Sarouk MD, Bat-El Bar MD, Adi Dagan MD, Miryam Ofek MD, and Ori Efrati MD BACKGROUND: Forced expiration may assist secretion movement by manipulating airway dy- namics in patients with cystic fibrosis (CF). Expiratory resistive breathing via a handheld incentive spirometer has the potential to control the expiratory flow via chosen resistances (1–8 mm) and thereby mobilize secretions and improve lung function. Our objective was to explore the short-term effect of using a resistive-breathing incentive spirometer on lung function in subjects with CF compared with the autogenic drainage technique. METHODS: This was a retrospective study. ؍ Subjects with CF performed 30–45 min of either the resistive-breathing incentive spirometer (n technique on separate days. The spirometer encourages the (32 ؍ or autogenic drainage (n (40 patient to exhale as long as possible while maintaining a low lung volume. The autogenic drainage technique includes repetitive inspiratory and expiratory maneuvers at various tidal breathing magnitudes while exhalation is performed in a sighing manner. Spirometry was performed before and 20–30 min after the therapy. RESULTS: Use of a resistive-breathing incentive spirometer improved FVC and FEV1 by 5–42% in 26 subjects. The forced expiratory flow during the middle half of the FVC maneuver (FEF25-75%) improved by >20% in 9 (22%) subjects. FVC improved the most in subjects with an FEV1 of 40–60% of predicted. -
Facility Reimbursement of Respiratory Therapy Services
Manual: Reimbursement Policy Policy Title: Facility Reimbursement of Respiratory Therapy Services Section: Facility-Specific Subsection: Inpatient Date of Origin: 4/19/2017 Policy Number: RPM047 Last Updated: 7/12/2021 Last Reviewed: 7/14/2021 Scope This policy applies to all Commercial medical plans, Medicare Advantage plans, and Oregon Medicaid plans. This policy applies to inpatient hospital facilities. For contracted facilities, this policy is effective for dates of service 10/01/2017. For out of network facilities, this policy is effective upon initial publication. Reimbursement Guidelines A. General Policy Statements 1. In the inpatient hospital setting Moda Health will limit reimbursement for Respiratory Services to one unit/charge per date of service for each of the following categories of services: a. Respiratory therapy performed by a Respiratory Therapist(s), regardless of the number of times per day a Respiratory Therapist(s) provides care or therapy services. b. Ventilator (invasive or non-invasive) management, regardless of the number of times a Respiratory Therapist(s) reviews the equipment settings Additional units or charges for the same date of service are not eligible for separate reimbursement, regardless of the description variations, HCPCS codes, or revenue codes used. 2. Any respiratory services performed by a registered nurse (RN), are considered part of room and board, and are not eligible to be separately reported or reimbursed. 3. Inpatient hospitals will not be reimbursed, nor allowed to retain reimbursement for services considered to be non-reimbursable or not eligible for separate reimbursement. B. Documentation requirements: In the inpatient hospital setting, Respiratory Therapy must be supported by the following documentation: 1. -
Cystic Fibrosis: Current Trends in Respiratory Care Jeffrey S Wagener MD and Aree a Headley RRT
Cystic Fibrosis: Current Trends in Respiratory Care Jeffrey S Wagener MD and Aree A Headley RRT Introduction Cystic Fibrosis Lung Disease Diagnosis Clinical Monitoring Pulmonary Function Monitoring Radiographic Monitoring Aerosol Therapies and Delivery Devices Inhaled Bronchodilators Inhaled Anti-inflammatory Agents Inhaled Mucolytics Inhaled Antibiotics Delivery Devices Airway Clearance Techniques Chest Physiotherapy Active Cycle of Breathing Autogenic Drainage Positive Expiratory Pressure and Flutter Intrapulmonary Percussive Ventilation High-Frequency Chest Compression Exercise Noninvasive Ventilation Summary Cystic fibrosis is a genetic disease that typically produces malnutrition and chronic respiratory infections. Prolonged bronchial obstruction, infection, and inflammation result in bronchiectstasis and permanent lung damage. Most cystic fibrosis patients die because of this progressive respira- tory disease. Thus, in the absence of a cure, effective respiratory therapy is the primary means to extend and improve the quality of life for the cystic fibrosis patient. Aerosol therapy, airway clearance techniques, and noninvasive ventilation can all improve quality of life and possibly extend survival. Close patient monitoring with pulmonary function testing, chest radiography, and induced sputum can result in earlier treatment, potentially reducing permanent lung damage. Earlier diagnosis has prevented serious complications through early initiation of preventive therapies such as improved nutrition. Key words: pediatric, respiratory, -
(HCP): Use of the Airway Dome
Instructions for Healthcare Provider (HCP): Use of the Airway Dome. The U.S. Food and Drug Administration has issued an Emergency Use Authorization (EUA) for the Airway Dome, for use by healthcare providers (HCP) as an additional layer of barrier protection in addition to personal protective equipment (PPE) to prevent HCP exposure to pathogenic biological airborne particulates by providing isolation of hospitalized patients with suspected or confirmed diagnosis of COVID-19, at the time of definitive airway management, when performing airway-related medical procedures, or during certain transport of such patients during the COVID-19 pandemic. HCP should follow these instructions, as well as procedures at their healthcare facility to use the Airway Dome. Authorized non-transport use of Airway Dome is only for airway management (e.g., intubation, extubation and suctioning airways), or when performing any airway-related medical procedures (e.g., high flow nasal cannula oxygen treatments, nebulizer treatments, manipulation of oxygen mask or CPAP/BiPAP (continuous positive airway pressure/bi-level positive airway pressure) mask use, airway suctioning, percussion and postural drainage). Authorized use of the Airway Dome during patient transport is only within a hospital setting for temporary transfer with direct admission within the hospital in the presence of a registered nurse or physician. The patient should have constant monitoring of vital signs, electrocardiogram (EKG), SpO2% (oxygen saturation), End tidal carbon dioxide (EtCO2) if available throughout transport. For all authorized uses, the patient should always have supplemental oxygen during use of the Airway Dome. The Airway Dome has not been FDA-approved or cleared for this use; The Airway Dome has been authorized only for the duration of the declaration that circumstances exist justifying the authorization of the emergency use of medical devices under section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. -
Pediatric Airway Maintenance and Clearance in the Acute Care Setting: How to Stay out of Trouble
Pediatric Airway Maintenance and Clearance in the Acute Care Setting: How To Stay Out of Trouble Brian K Walsh MBA RRT-NPS FAARC, Kristen Hood RRT-NPS, and Greg Merritt RRT-NPS Introduction Postural Drainage Percussion Chest-Wall Vibration Physiologic and Pathophysiologic Considerations Airway Mucus Airway pH Airway Clearance Mechanisms Airway Maintenance Humidification Airway Suctioning Endotracheal Tube Suctioning Suctioning Preparation Ventilation Mode During Suctioning Open Versus Closed Suctioning Saline Instillation Support of Normal Airway Clearance Airway Alkalization Turning and Positioning Assessing the Need for Airway Clearance Adventitious Breath Sounds Gas Exchange Chest Radiograph Unique Considerations in Infants and Children Gastroesophageal Reflux Neonates and Premature Infants Behavioral Issues Airway Clearance Therapies in the Acute Setting Cystic Fibrosis Asthma Neuromuscular Disease Bronchiolitis Postoperative and Post-Extubation Patients Acute Respiratory Failure Future of Airway Maintenance and Clearance Summary The authors are affiliated with the Department of Respiratory Care, Chil- The authors have disclosed no conflicts of interest. dren’s Medical Center Dallas, Dallas, Texas. Correspondence: Brian K Walsh MBA RRT-NPS FAARC, Department Mr Walsh presented a version of this paper at the 47th RESPIRATORY of Respiratory Care, Children’s Medical Center Dallas, 1935 Medical CARE Journal Conference, “Neonatal and Pediatric Respiratory Care: District Drive, Dallas TX 75235. E-mail: [email protected]. What Does the Future Hold?” held November 5–7, 2010, in Scottsdale, Arizona. DOI: 10.4187/respcare.01323 1424 RESPIRATORY CARE • SEPTEMBER 2011 VOL 56 NO 9 PEDIATRIC AIRWAY MAINTENANCE AND CLEARANCE IN THE ACUTE CARE SETTING Traditional airway maintenance and clearance therapy and principles of application are similar for neonates, children, and adults.