Development of a physiotherapy-led bronchoscopy service: a regional hospital perspective.

This report describes the development and implementation of a physiotherapy-led bronchoscopy service from a regional hospital perspective.What is known about the topic?Although ESoP and ASoP physiotherapy roles are well established in the UK, such services appear to be only just evolving in Australia. Clarity on the definitions of extended and advanced physiotherapy roles have been articulated by the Australian Physiotherapy Association. However, there is a paucity of evidence published on the practicalities of establishing advanced or extended scope cardiorespiratory physiotherapy services within Australian ICUs.What does this paper add?One of the main emerging areas of ESoP and/or ASoP in the cardiorespiratory field is the use of bronchoscopy by physiotherapists. This paper describes the framework, implementation, limitations and barriers of developing a physiotherapy-led bronchoscopy service from a regional hospital perspective.What are the implications for practitioners?This paper allows the potential for our credentialing and practice framework model to be transferred in other public hospitals commencing or considering implementing physiotherapy-led bronchoscopy services within their ICU. PMID: 31826799 [PubMed - as supplied by publisher]
Source: Australian Health Review - Category: Hospital Management Authors: Tags: Aust Health Rev Source Type: research

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AbstractMicroaspiration of bacteriologically contaminated oropharyngeal secretions alongside the cuff of an endotracheal tube (ETT) is a key mechanism for development of ventilator-associated pneumonia. We have constructed a prototype double-cuffed ETT equipped with a supplemental port in-between the cuffs through which continuous positive airway pressure (CPAP) is delivered. Pressure in the intercuff space propels secretions upwards and produces 100% tracheal sealing in an in vitro model. We conducted a 24  h study to investigate the sealing effect of this ETT in 12 critically ill mechanically ventilated patients. Me...
Source: Journal of Anesthesia - Category: Anesthesiology Source Type: research
Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast ...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Articles: ERS statement Source Type: research
We report a case of a neglected foreign body present in the bronchus of an adult for 23 years and treated as intermittent asthma. The diagnosis was revealed following the development of severe sepsis of a pulmonary origin. The foreign body was removed by rigid bronchoscopy, antibiotic therapy instituted and pre- and post-interventional respiratory physiotherapy carried out. Satisfactory progress was marked by the complete clearing of pulmonary suppuration, with only a small localized and asymptomatic focus of bronchial dilatation remaining. The persistence of chronic, unexplained respiratory complaints should prompt t...
Source: Revue des Maladies Respiratoires - Category: Respiratory Medicine Tags: Rev Mal Respir Source Type: research
ConclusionWe introduce this novel technique of reopening the atelectased left lung as a rapid, safe, and practical alternative for bronchoscopic clear away.This article is protected by copyright. All rights reserved.
Source: The Clinical Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Article Source Type: research
Semin Respir Crit Care Med 2018; 39: 667-673 DOI: 10.1055/s-0038-1676571Excessive central airway collapse (ECAC) is characterized by excessive narrowing of the airway lumen during exhalation leading to dyspnea, cough, mucostasis, recurrent respiratory infections, and poor quality of life. Tracheobronchomalacia and excessive dynamic airway collapse are heterogeneous entities of ECAC and are characterized by a diverse nonspecific symptom profile. Although the pathophysiology of airway mechanics as well as morphology in both entities is different, current evidence so far shows no practical benefit in making such distinction s...
Source: Seminars in Respiratory and Critical Care Medicine - Category: Respiratory Medicine Authors: Tags: Review Article Source Type: research
Kapil Gupta, Mayank Mehrotra, Parul Kumar, Anoop Raj Gogia, Arun Prasad, Joseph Arnold FisherIndian Journal of Critical Care Medicine 2018 22(3):180-188 Smoke inhalation injury is a major determinant of morbidity and mortality in fire victims. It is a complex multifaceted injury affecting initially the airway; however, in short time, it can become a complex life-threatening systemic disease affecting every organ in the body. In this review, we provide a summary of the underlying pathophysiology of organ dysfunction and provide an up-to-date survey of the various critical care modalities that have been found beneficial in ...
Source: Indian Journal of Critical Care Medicine - Category: Intensive Care Authors: Source Type: research
Conclusions: The study showed the strong independent positive effect of intensive rehabilitation in patients with lung tumors treated by thoracic surgery. PMID: 29181076 [PubMed]
Source: Archives of Medical Science - Category: General Medicine Tags: Arch Med Sci Source Type: research
CONCLUSIONS: Preoperative exercise training may reduce the risk of developing a postoperative pulmonary complication, the duration of intercostal catheter use, postoperative length of hospital stay, and improve both exercise capacity and FVC in people undergoing lung resection for NSCLC. The findings of this review should be interpreted with caution due to disparities between the studies, risk of bias, and small sample sizes. This review emphasises the need for larger RCTs. PMID: 28589547 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
CONCLUSION This case highlights, the importance of recognizing, the rare and often forgotten respiratory symptoms of EFB body to avoid diagnostic delay especially in unwitnessed FB ingestion.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
A 13-month-old infant was referred for evaluation of a severe, therapy-resistant asthma. He presented with daily wheezing, recurrent acute exacerbations, chronic dry-to-wet cough and failure to thrive. His mother had severe allergic asthma with recent admission to the intensive care unit. Initial chest X-rays were normal and skin prick tests were negative. It was decided to undertake a comprehensive work-up to exclude differential diagnoses. Paediatric radiologists initially interpreted the chest CT scan as normal. Bronchoscopic examination revealed an accessory cardiac bronchus (ACB) originating from the medial wall of th...
Source: Thorax - Category: Respiratory Medicine Authors: Tags: Images in Thorax, Hemoptysis, Child health, Inflammation, Physiotherapy, Asthma, Sports and exercise medicine, Cardiothoracic surgery, Radiology (diagnostics) Chest clinic Source Type: research
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