Literature Review : Pengaruh Batuk Efektif Untuk Pengeluaran Sputum Pada Pasien Tuberculosis

Tuberculosis (TB) is in infectious disease that attacks the lungs caused by the bacterium Mycobacterium tuberculosis. Tuberculosis patients usually have symptoms of a prolonged cough, from the cought it can cause shortness of breath in someone who experiences these symtoms because there are too many secretions that are difficult to expel, causing a forced expiration. Forced expiration is one of the non-pharmacological interventions carried out to expel secretions, increase lung expansion, mobilize secretions and prevent side effects of retention of secretions. The purpose of this study was to describe the effect of forced expiration for sputum extraction in tuberculosis patients. Used in this study was a literature review from a database that had been determined used the keywoard tuberculosis, forced expiration, and sputum extraction. Obtained after forced expiration was reduced in the number of secretions in the patient. This study is that forced expiration can effectively reduce the amount of secretions in the body of tuberculosis patients. Keywoard: Forced expiration; Sputum extraction; Tuberculosis (Pulponary tuberculosis) AbstrakTuberculosis (TB) adalah salah satu penyakit infeksi yang menyerang bagian paru-paru disebabkan oleh bakteri mycrobacterium tuberculosis. Pendertia tuberculosis biasanya memiliki gejala batuk yang berkepanjangan, dari batuk tersebut dapat menyebabkan sesak nafas pada seseorang yang mengalami gejala tersebut karena terlalu banyak sekret yang susah untuk dikeluarkan sehingga menyebabkan batuk efektif. Batuk efektif adalah salah satu tindakan non farmakologi yang dilakukan untuk pengeluaran sekresi, meningkatkan ekspansi paru, memobilisasi sekret dan mencegah efek samping dari retensi sekresi. Dari karya tulis ilmiah adalah untuk mengetahui gambaran tentang pengaruh batuk efektif untuk pengeluaran sputum pada pasien tuberculosis. Metode yang dilakukan dalam penelitian adalah literature review dari database yang telah ditentukan dengan menggunakan kata kunci Tuberculosis, latihan batuk efektif, dan pengeluaran sputum. Hasil yang didapatkan setelah dilakukan tindakan latihan batuk efektif yaitu banyaknya sekret pada pasien mulai berkurang. Kesimpulan karya tulis ilmiah ini bahwa tindakan latihan batuk efektif dapat mengurangi jumlah sekresi yang ada pada tubuh pasien tuberculosis.Kata kunci: Latihan batuk efektik; Pengeluaran Sputum; Tuberculosis ( TB Paru)

The effects of mechanical insufflation-exsufflation on lung function and complications in cardiac surgery patients: a pilot study

Background Postoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy. Methods This retrospective study included 51 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two types of positive pressure devices, MI-E (n = 21) or IPPB (n = 30). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups. Results Subjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.4 ± 4.74% vs. 46.0 ± 3.70%, p = 0.042), forced expiratory volume in one second (62.4 ± 5.23% vs. 46.8 ± 3.83%, p = 0.017), and peak flow rate (67.1 ± 5.53 L vs. 55.7 ± 4.44 L p = 0.111). However, the incidence of chest pain was higher in the MI-E group (n = 13, 61.9%) than in the IPPB group (n = 4, 16.7%; odds ratio, 0.123, 95% confidence interval, 0.03–0.45; p = 0.002). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups. Conclusion Both IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with better-preserved pulmonary function and higher incidence of chest pain.

Left uniportal VATS for lung decortication after chemical pleurodesis under spontaneous breathing in patient with lymphangiomyomatosis

Pneumothorax can be the first symptom of lymphangioleiomyomatosis. Patients with lymphangioleiomyomatosis have a higher risk of recurrence of pneumothorax. Chemical pleurodesis is a viable option to treat the recurrence, but in rare cases, it is not the solution. We present the case of a patient with lymphangioleiomyomatosis undergoing a talc poudrage via video-assisted thoracoscopic surgery for pneumothorax that failed to reexpand the lung. We proposed to the patient a surgical approach to debride the lung parenchyma with the patient under deep sedation with spontaneous breathing. The patient was discharged on the 5th postoperative day. The chest computed tomography scan showed complete lung reexpansion. We advocate that video-assisted thoracoscopic surgery in patients who are awake is a feasible surgical option that permits the restoration of physiological lung expansion in selected patients who underwent chemical pleurodesis and minimizes the risk of one-lung ventilation.

Fifteen-minute consultation: A structured approach to children with parapneumonic effusion and empyema thoracis

Parapneumonic effusion is defined as the accumulation of pleural fluid associated with lung infection/pneumonia. Parapneumonic effusions can be uncomplicated or complicated. They are caused by the spread of infection and inflammation to the pleural space, and can develop into empyema thoracis—frank pus in the pleural space. Chest radiograph and thoracic ultrasound are the key imaging modalities for the diagnosis of parapneumonic effusion. Management aims are reducing inflammation and bacteria in the pleural cavity, and enabling full lung expansion. Broad-spectrum intravenous antibiotics, with the addition of chest tube drainage and fibrinolytic therapy for larger collections, are the mainstays of management. This article provides a clear, evidence-based and structured approach to the assessment and management of parapneumonic effusion/empyema thoracis in children and young people.

Perioperative Pulmonary Atelectasis: Part II. Clinical Implications

The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. A specific risk assessment is critical to allow clinicians to optimally choose the anesthetic technique, prepare appropriate monitoring, adapt the perioperative plan, and ensure the patient’s safety. Bedside diagnosis and management have benefited from recent imaging advancements such as lung ultrasound and electrical impedance tomography, and monitoring such as esophageal manometry. Therapeutic management includes a broad range of interventions aimed at promoting lung recruitment. During general anesthesia, these strategies have consistently demonstrated their effectiveness in improving intraoperative oxygenation and respiratory compliance. Yet these same intraoperative strategies may fail to affect additional postoperative pulmonary outcomes. Specific attention to the postoperative period may be key for such outcome impact of lung expansion. Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis (e.g., obese) or those with clinical presentations consistent with lung collapse (e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions.

TGF-β regulation of the uPA/uPAR axis modulates mesothelial-mesenchymal transition (MesoMT)

Pleural fibrosis (PF) is a chronic and progressive lung disease which affects approximately 30,000 people per year in the United States. Injury and sustained inflammation of the pleural space can result in PF, restricting lung expansion and impairing oxygen exchange. During the progression of pleural injury, normal pleural mesothelial cells (PMCs) undergo a transition, termed mesothelial mesenchymal transition (MesoMT). While multiple components of the fibrinolytic pathway have been investigated in pleural remodeling and PF, the role of the urokinase type plasminogen activator receptor (uPAR) is unknown. We found that uPAR is robustly expressed by pleural mesothelial cells in PF. Downregulation of uPAR by siRNA blocked TGF-β mediated MesoMT. TGF-β was also found to significantly induce uPA expression in PMCs undergoing MesoMT. Like uPAR, uPA downregulation blocked TGF-β mediated MesoMT. Further, uPAR is critical for uPA mediated MesoMT. LRP1 downregulation likewise blunted TGF-β mediated MesoMT. These findings are consistent with in vivo analyses, which showed that uPAR knockout mice were protected from S. pneumoniae-mediated decrements in lung function and restriction. Histological assessments of pleural fibrosis including pleural thickening and α-SMA expression were likewise reduced in uPAR knockout mice compared to WT mice. These studies strongly support the concept that uPAR targeting strategies could be beneficial for the treatment of PF.

A study to assess the effectiveness of nebulization followed by chest physiotherapy among patients with respiratory problem, admitted in era hospital at Lucknow

Acute respiratory infections are a major cause of morbidity and mortality in young adults worldwide. T hey account for nearly 3.9 million deaths every year globally. Chest physiotherapy plays an import ant role by promoting drainage and ensuring normal lung expansion in parenchymal lung diseases and pleural diseases. Hence I was keen to evaluate the effectiveness of nebulisation with chest physiotherapy on respiratory status among adults patients with selected respiratory disorders like bronchitis, bronchiolitis, asthma, COPD and pneumonia. It was a quantit ative approach , Quasi experimental study design used (30) with respiratory disorders within the age group of 20-35 above years receiving nebulisation with chest physiotherapy using purposive sampling technique. Respiratory status assessment of clinical parameters (Rating Scale) and Bio physiological measurements(BPM) was done. For experimental group nebulisation with chest physiotherapy for 6 minutes in 10 positions. For control group nebulisation alone given both morning and evening for 2days. Mean, standard deviation, t -test , pearson chisquare test is used for statistical analysis. In experiment al group the respiratory disorder patients are reduced their clinical parameter distress score from 11.33 t o 4.17 . They are able to reduce 7.16 score from base line score. In control group 11.33 t o 7.90 t hey are able to reduce 3.27 score from base line score. Regarding bio physiological parameter, the reduction is statistically significant (P=0.001***) in both groups. Thus the author concludes that Improvement in respiratory status seen in children who receive nebulisation along with chest physiotherapy . Thus patients with respiratory diseases will benefit from the intervention in improving their respiratory status by clearing the secretions.

Toward a Next-Generation Digital Chest Tube

Chest tubes in patients who have undergone pulmonary resection with pleural air leak are painful, impair ventilatory mechanics, and increase hospital length of stay and costs. Despite these well-documented concerns, current protocols for chest tube management in this setting are not well supported by evidence. Excessive suction applied to chest tubes has been associated with prolonged air leak due to alveolar over-distension, and most practitioners intuit that suction should be minimized to the lowest level needed to maintain desired pleural apposition. Unfortunately, there is no evidence-based protocol for the establishment of minimal adequate suction. Digital suction devices in current clinical use can identify air leak resolution preventing the delay of chest tube removal but cannot guide suction minimization while an air leak persists. We recently described a monitor of lung expansion in a porcine model of pleural air leak that could detect loss of pleural apposition continuously in real-time based on electrical impedance readings obtained directly from the surface of the lung via chest tube-embedded electrodes. The value of the impedance signal was “in-range” when pleural apposition was present but became abruptly “out-of-range” when pneumothorax due to inadequate suction developed. These findings suggested that a digitally controlled suction pump system could be programmed to recognize the development of pneumothorax and automatically identify and set the minimum level of suction required to maintain pleural apposition. We present here preliminary proof of concept for this system.