Illia Lima

Air Stacking: A Detailed Look Into Physiological Acute Effects on Cough Peak Flow and Chest Wall Volumes of Healthy Subjects

BACKGROUND: Air stacking (AS) is a lung insufflation method that requires the use of a manual insufflator to provide air volumes higher than inspiratory capacity. Neuromuscular patients benefit the most from the maneuver; however, the acute effects of AS in healthy subjects are still unclear. METHODS: Twenty healthy subjects (8 males) were studied by optoelectronic plethysmography to investigate the immediate effects of AS on cough peak flow, operational volume variations, distribution of these volumes in the chest wall compartments (pulmonary rib cage, abdominal rib cage, and abdominal), breathing pattern, and shortening velocity of the respiratory muscles during a protocol that included vital capacity maneuvers and spontaneous coughs before and after AS. RESULTS: Statistically significant increases in cough peak flow (P < .03) and inspiratory capacity (P < .001) were found immediately after AS. During its application, the pulmonary rib cage compartment was the largest contributor (P = .002) to chest wall volume displacement. A significant increase in chest wall tidal volume (P < .001), mainly in the pulmonary rib cage (P < .001), was observed. Significant increases (P < .001) in end-inspiratory chest wall volume were observed with main distribution in pulmonary (P < .001) and abdominal rib cage (P = .01). Significant increases in shortening velocity index of inspiratory muscles (P < .001), expiratory muscles (P < .001), and diaphragm (P < .001) were also observed. In addition, significant decreases in expiratory time (P < .001) and increases in duty cycle (P = .02), breathing frequency (P = .02), minute ventilation (P < .001), maximum inspiratory (P < .001), and expiratory flow (P < .001) were observed. CONCLUSIONS: In healthy subjects, cough peak flow and chest wall volumes can be increased immediately after the application of the AS maneuver.

Educational interventions for improving control of blood pressure in patients with hypertension: a systematic review protocol

Introduction The aim of this review is to evaluate the effectiveness of educational interventions on improving the control of blood pressure in patients with hypertension. Methods Randomised controlled trials including patients over 18 years of age, regardless of sex and ethnicity, with a diagnosis of hypertension (either treated or not treated with antihypertensive medications) will be assessed in our analysis. We will electronically search four databases: MEDLINE, CINAHL, PEDro and ScienceDirect. There will be no language restrictions in the search for studies. The data will be extracted independently by two authors using predefined criteria. Disagreements will be resolved between the authors. The risk of bias will be assessed using the Cochrane risk of bias tool. After searching and screening of the studies, we will run a meta-analysis of the included randomised controlled trials. We will summarise the results as risk ratio for dichotomous data and mean differences for continuous data. Ethics and dissemination The review will be published in a journal. The findings from the review will also be disseminated electronically and at conference presentations. Trial registration number PROSPERO CRD4201401071.

Effects of positive expiratory pressure on chest wall volumes in subjects with stroke compared to healthy controls: a case–control study

Highlights • The PEP device at 10 cmH2O may be a potential home treatment for stroke group.• The intensities above 10 cmH2O may lead to lung hyperinflation in stroke group.• Stroke group reduced shortening velocity index for expiratory muscles during use PEP.

Observational practice of incentive spirometry in stroke patients

Highlights • Stroke patients performed differently to healthy individuals when learning to use incentive spirometry.• Stroke patients can benefit from learning rehabilitation techniques.• Observational techniques improve the performance of tasks in stroke patients.