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2024-05-16Do you know what vital capacity is? How does the size of our vital capacity affect us? The definition and myth of vital capacity Vital capacity is refers to "sniff after aeration amount of air trying to breathe out", and vital capacity is one of the important indicators of lung function. Gender, age, height, all are the factors that affect the vital capacity. In a normal state and on average, adult male has about 3400 ml, women would be 3100 ml, but usually we only use around 1/3 of vital capacity, which is around 1000 milliliters. It is desirable to have as much lung function as possible because vital capacity represents "how much gas the body can store for exchange". When performing high-oxygen exercise, people with good lung capacity can take in enough oxygen to meet their systemic needs and expel the carbon dioxide that is produced, preventing it from remaining in the body and causing hypoxia or lactic acid poisoning. But in people with poor lung capacity, it means that the function of their respiratory muscles is declining, just as the muscles of the arms, legs and other muscles will start to weaken after a long time of not exercising. Therefore, we can use the size of lung capacity as a preliminary judgment of the possibility of the occurrence of physical diseases, if the lung capacity is low, it may be the precursor of some lung diseases. More serious people even taking a bath, eating and other activities of daily life will have a feeling of breathing. A common myth about lung capacity is that increasing lung capacity is a sign of better lung function, but lung capacity isn't just measured by the milliliters of air blown out, it's measured by the force of the breath exhaled during the test. Lung capacity is the key to the flow of air in and out of the airway, so it can tell if there is an obstructive lung disease. If you have obstructive lung disease, you will feel the air flow blocked when you exhale hard because the airway is blocked. However, when you exhale gently, you will not feel the air flow because the airflow is slowly passing through a narrow area. Another type of lung that can cause lung capacity deficiency is localized lung disease, where the space in the lungs doesn't expand completely, so there's a decrease in air flow. Lung capacity is a comparative value and requires sophisticated instruments to measure it. Although most hospitals have lung function tests to confirm lung function, we can also use some preliminary methods to determine whether our lung capacity is sufficient. Easy self-examination Normally, a healthy adult should be able to hold his breath for more than a minute, but anything less than 10 seconds is a sign that lung capacity is really poor and there may be some lung problems or other medical problems. Take a round, unblown balloon and blow hard into it until it's all gone. Look at how long it takes you to exhale, and how big the balloon is over time. A healthy adult should be able to vomit in about six seconds after taking a full breath. If it is less than six seconds, one of two things may happen. The first may be that when the lungs are full of air, there is too little air in the lungs. The second may be that the muscle strength is too bad, so that it can not vomit the gas clean and stops exhaling, so that the gas is trapped in the lungs. If the whole process takes longer than six seconds, the lungs may be a little blocked, so when you exhale, you can't get it out quickly Another is to observe the balloon in the first seconds exhaling. The final balloon volume is 80%, because in the first second of hard exhalation, the gas exhaled by the subject should be about 80% of the maximum lung capacity, so we can observe the change of balloon volume in the first second of exhalation, to judge whether the lung function is normal. How to improve and maintain lung capacity? In addition to illness, people who sit for long periods of time and are not physically active can also have decreased lung capacity. In milder cases, patients can initially train their diaphragm without a device, using abdominal breathing combined with pouty exhalation, combined with chest expansion and aerobic exercises to build breathing muscles. By Incentive Spirometry (breathing trainer) or respiratory muscle trainer for more severe cases, the recovery effect can be achieved with the help of professional equipment. However, it is recommended to use it under the instructions of doctors or respiratory therapists because of the applicable symptoms and contraindications of the equipment. Author : Rose Lin, Assistant Product Specialist Rose Lin is an assistant product specialist for GaleMed ’s Respiratory and homecare solutions portfolio. Her goals are to assist clinicians to improve workflow efficiencies and patient outcomes across the company’s patient homecare product portfolio.
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2024-05-16“From the breath we take at birth, loudly crying to announce our existence to the world, to the last mile of life, the last breath of life, even if we ignore it, breathing is happening all the time, breathing is more important than we think!” When normal inhale, the intercostal muscles contract to raise and expand the ribs, so that the volume of the chest becomes larger, and the pressure in the chest becomes smaller, forming a pressure difference. The pressure difference allows the air to be humidified and heated by the nose first, and pass through the pharynx, larynx, trachea, bronchi, and then reach the final destination - alveolar, so it can complete the gas exchange successfully. On the contrary, exhalation is intercostal muscles relaxation and the ribs drop, reducing the volume of the chest cavity and increasing the pressure, forcing air and carbon dioxide out of the lungs. Chest breathing, in which only the upper third of the lungs are dilated, is shallower than abdominal breathing and allows for rapid breathing during strenuous exercise or when more oxygen is needed for a short period of time. However, if only the upper part of the lungs is used for gas exchange over a long period of time, the elasticity of the lower and middle areas of the lungs will deteriorate, respiratory function will begin to decline, and respiratory and lung diseases will be prone to. At ordinary times, therefore, one should be used to do abdominal breathing, abdominal breathing and the difference between thoracic breathing, abdominal breathing will be particularly emphasize the movement of the diaphragm, inspiratory when deliberately let the diaphragm more down, epigastrium will be raised at the same time, make the chest to expand the scope of more big, let the gas goes deep into the lungs more at the end of the alveolar area of the part. What group of people needs abdominal breathing more? Abdominal breathing can be used by the general public for maintenance and prevention of lung diseases. It is also recommended for people with the following symptoms to use abdominal breathing as part of training and rehabilitation Obstructive sputum causes trouble clearing and lung dilatation. A person potentially loses their airway clearing function by buying something. Confer a barrier to gas exchange. Relaxation causes poor muscular endurance. Or patients with the following diseases or conditions are also suitable for abdominal exercises Obstructive pulmonary disease (COPD). Lent interstitial lung disease. Alveolar pulmonary fibrosis. A patient who spends long periods of time relying on a respirator causes respiratory muscle function to deteriorate after extubation. The practice of abdominal breathing Sit in a sitting position or lie flat and bend your knees in a comfortable position. Wear loose clothing to allow free movement of the chest and abdomen. Placing one hand in the center of the chest and the other hand under the rib cage allows people to see if they are moving correctly in real time. Inhale slowly through the nose, and do the largest abdominal bulge, that is, to put the hand on the abdomen and has the feeling of lifting. When exhaling, exhale through the mouth, the hand placed on the abdomen can feel the abdomen dropping, and the other one hand can press the abdomen slightly inward and upward to help lift the diaphragm. Note： A person takes about 10 to 12 breaths per minute at a rate of 1:2 to 1:4 between inhale and exhale. Repeat the breathing pattern for one minute, followed by a two-minute rest; perform this operation several times a day for about 30 minutes. Anyway, if you feel mildly dizzy or uncomfortable, change the length and depth of your breath, or stop training to breathe normally at once. People with COPD spend time relaxing their airway by breathing out gently and slowly to slow down the flow rate and increase the duration of exhalation. Abdominal breathing can achieve better results if it can be combined with pouting. The purpose of pouting is to maintain the respiratory pressure during the exhalation period, reduce the occurrence of lung collapse and make the respiratory tract unblocked. The practice of pouting Pucker your lips as if to whistle. Lean forward slightly into your thighs or rest your hands on your thighs or tabletop to help smooth exhalation. Pucker your lips slowly and silently count to 6 seconds. Slow, deep breathing keeps the lungs healthy As mentioned earlier, abdominal breathing takes time to practice. The diaphragm, like any other muscle in the body, needs long-term training to strengthen its ability to contract. Abdominal breathing is also known as "deep breathing," but it involves more diaphragm movement than normal deep breathing, which effectively increases the amount of air taken in. Although our breathing pattern cannot be 100% abdominal breathing, by repeating 10-20 times a day and making the diaphragmatic movement a habit, we can slowly increase the depth of breathing and eventually increase the proportion of abdominal breathing, resulting in healthier lungs. Author : Rose Lin, Assistant Product Specialist Rose Lin is an assistant product specialist for GaleMed ’s Respiratory and homecare solutions portfolio. Her goals are to assist clinicians to improve workflow efficiencies and patient outcomes across the company’s patient homecare product portfolio.
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2024-05-16Breathing is so easy for healthy people to do that it doesn't even require conscious control. However, there are many patients with respiratory failure who cannot wean from the ventilator successfully after their condition improves, which leads to long-term dependence on respirator. Some simple respiratory muscle training exercises are helpful for muscle weakness, decreased ventilation, and poor airway sputum removal caused by prolonged bed rest. In addition, recent studies have pointed out that the training of respiratory muscles can improve metabolic rate and respiratory efficiency, and also increase endurance and maximal oxygen uptake. Therefore, respiratory muscle training is no longer just for patients with difficulty in weaning from the ventilator, but also for healthy people to improve their health and quality of life. 1. Principles of breathing and muscles Respiratory muscles are mainly divided into inspiratory muscles and expiratory muscles. Since the lungs don't have any muscles of their own, they can't regulate the movement of air in and out of the lungs by themselves, so they need the help of breathing muscles. The diaphragm is the main inspiratory muscle of the body. When inspiratory, the diaphragm contracts and moves down. At this time, the volume of the chest increases, and the outside air enters the lungs for gas exchange. When exhaling, the diaphragm relaxes and rises in position, the volume of the chest decreases, and air is expelled from the lungs. In addition to the inspiratory muscles, the human body also has other muscles to help with inspiration, we call them: inspiratory auxiliary muscles, such as: intercostal muscles, pectoralis major, trapezius, sternocleidomastoid and so on. In general, the auxiliary inspiratory muscles are not used when inhaling normally. Only when inhaling forcefully, the auxiliary inspiratory muscles will contract, such as respiratory failure and deep breathing. Exhaling muscles include: rectus abdominis, external oblique, internal intercostal muscles and so on. Natural exhalation does not need to use the exhalation muscle, only in movement, spontaneous ventilation, forced cough when the exhalation muscle will contract. 2. Respiratory muscle training benefits Reduce the number of breaths, learn to regulate breathing, slow down fatigue and improve aerobic metabolism. Diaphragmatic training increases lung volume and maximal oxygen uptake with every centimeter decrease. Improve the strength of core muscle group, increase the instantaneous ventilation, improve the tolerance of cardiopulmonary function during activities. Deep and long breathing can promote parasympathetic activation and stable mood. Help ventilator-dependent patients strengthen their breathing muscles so they can wean from the ventilators. 3. Respiratory muscle training Upper limb chest expansion: Increase the upper arm and chest muscles by upper limb movement, and train the triceps and trapezius muscles. Abdominal pressure: The sandbag is placed on the diaphragm of the abdomen to increase resistance to breathing, thus achieving the training effect. Respiratory muscle trainer: Use adjustable impedance and correct breathing style to enhance the strength of respiratory muscles. Respiratory muscle training exercises can guide patients who are chronically dependent on ventilator to exert their remaining lung functions. Although the factors affecting ventilator disengagement are complex, it may be helpful to start breathing exercises and train respiratory muscles as early as possible when the condition is stable. In addition, athletes and musicians can improve their professional performance by training their breathing muscles. As for the chronic fatigue that the person often has now and sedentary, little movement, long-term pressure is nervous... There are not a few office workers in Taiwan who sit for a long time and lack exercise. By training respiratory muscles, they are not only healthier, but also can improve their quality of life and work efficiency. Author : Adina Su, Market Monitor Specialist Adina Su is a market watcher and trend monitor at GaleMed. With a background in Respiratory Therapy, she provides technical solution support across the care continuum. She has a passion for product training, and likes to share her knowledge that contributes to the clinical environment.
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2024-05-16Most modern people use chest breathing, which is easy and effortless. They take it for granted that breathing is easy. Breathing in this way, the chest rises and falls as you inhale, and most of the air only goes into the upper part of the lungs, making effective ventilation impossible. However, the correct breathing should be the use of abdominal breathing, when inhaling abdominal bulge, will make the diaphragm below the lungs down, a lot of air in the lungs, when exhaling the abdomen naturally concave, so that the diaphragm rises, compression of the lungs, out of the air. Use the diaphragm to rise and fall for more efficient breathing, receiving more oxygen. How to practice abdominal breathing? Sit or prostrate in a comfortable position with knees bent, and wear loose clothing to allow free movement of the chest and abdomen. Placing one hand in the middle of your chest and the other on the lower edge of your ribs will allow you to notice and check if you are doing the right thing. When inhaling, breathe in slowly through the nose, and make the abdomen bulge to the maximum extent, that is, the hand on the abdomen has the feeling of lifting. Exhale, exhale from the mouth, placed in the abdomen of the hand can feel the lower belly concave, at the same time the abdominal hand can be slightly inward, upward pressure, help diaphragm up. Breathing muscle training, more benefits Because the lungs have no muscles of their own, they do not breathe actively, so they need the help of breathing muscles to complete the breathing action. Breathing muscle training is directly aimed at the respiratory muscle group used in breathing, after exercise can improve muscle elasticity, drive circulation, sculpture muscle memory, has a significant help to breathing. The benefits are as follows: Reduce the number of breaths, learn to regulate breathing, slow down fatigue and improve aerobic metabolism. Diaphragmatic muscle training increases lung volume and maximal oxygen uptake by every centimeter decrease. Improve the strength of core muscle group, increase instantaneous ventilation, and improve the tolerance of cardiopulmonary function during activities. Deep and long breathing can promote the activation of parasympathetic nerve and stabilize mood. Feeling like you've got phlegm in your throat forever? Learn ACBT respiration for easy expectoration ACBT -- Active Cycle of Breathing Technique -- is a Breathing Technique that allows the air sacs to expand more completely by keeping the Breathing passages open at the end of exhalation, increasing the vibration of air in the airway to help clear mucus. It is mainly divided into three stages: abdominal breathing, chest expansion exercise and hard breathing. First, take abdominal breathing, in an upright or sitting position, and relax. Repeat three to five times. This is followed by pleural dilation, which is mainly used to loosen sputum. Put your hands to the waist and inhale deeply. At the same time, your hands will feel the expansion of your chest when you inhale and hold your breath for 2-3 seconds. Then slowly exhale and repeat this action 3-5 times. The final stage is to exhale forcefully, after a brief inhalation, to expel the sputum. Author : Adina Su, Market Monitor Specialist Adina Su is a market watcher and trend monitor at GaleMed. With a background in Respiratory Therapy, she provides technical solution support across the care continuum. She has a passion for product training, and likes to share her knowledge that contributes to the clinical environment.
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2024-05-16Weight training has become more popular in recent years, but weight training is weight-bearing training, which can cause more serious injuries if the movement is not accurate. The core muscles help stabilize the spine and make the body less vulnerable to injury. Basic core activation starts with breathing exercises, because good breathing activates the core, and keeping the body in the right position reduces the risk of injury. In addition to the function of respiration, diaphragm is more useful than you think Breathing activates the core muscles because it uses the diaphragm when you inhale. In addition to its best known function as the muscle responsible for breathing, the diaphragm has another function that stabilizes the trunk of the body. Because the diaphragm can connect the fascial system connected many core paravertebral muscles (e.g., transverse abdominal muscle, the waist muscle, psoas major, etc.), so when the diaphragm with the breathing exercise, also with the relevant core muscle group for coordinating role will shrink together, make the intra-abdominal pressure rise, to the spine, stretching, stable support, in order to prevent sports injury. Ways to activate the core muscles There are many actions that can activate the transversalis muscle and then activate the core muscle. Here we will introduce some elementary actions: Abdominal breathing to awake the transverse abdominis muscles Step 1 - Find the center of the spine: Lie on your yoga mat with your legs arched and your feet flat on the floor. First do a pelvis forward movement, then let the pelvis backward tilt repeat 3-5, find forward and backward tilt in the middle point is the spine center point. Step 2-practice abdominal breathing: It is possible to move your spine during abdominal breathing, so first retract your chin (push your chin slightly toward your throat) and place your hands on your chest and abdomen. When you inhale, imagine inhaling below your navel. At this time, your hands will feel the hands on the abdomen and chest rise; when you exhale, you will feel the belly go down, and the hands on the abdomen and chest will drop. A good breathing chest and abdomen will be in a synchronized state. Step 3 - Induce transverse abdominis muscles: This is similar to abdominal breathing, except that when you exhale, you continue to exhale even when you are out of breath. There is a lot of pressure on your abdomen from the contraction of your left and right transverse abdominis muscles, rather than from the contraction of your rectus abdominis muscles during sit-ups and planks. draw-in Step 1 - Relax diaphragm: Lie on a yoga mat with your legs arched and your feet flat against the floor. A pillow or towel can be placed behind your head for comfort. Touch the lower edge of the rib, press inward and upward with four fingers along the rib, then press on both sides along the rib, from the middle to the sides. A slight pain and tightness associated with pressure indicates correct positioning of the diaphragm. A common mistake is that there is no pressure on the inside of the ribs. If the four fingers are pressed straight down without a curve, they will not achieve the effect of pressing and relaxing because the diaphragm is deeper. Step 2--draw-in: Maintain the position of lying on a yoga mat with your hands on your abdomen. When inhaling for the first time, relax and satiate, slowly lift the abdomen, and when exhaling, the abdomen sinks. At this time, there will be tension and a feeling of tightening the lower abdomen. Maintain this tension and repeat 3 to 5 times of inhaling and exhale, and then relax the abdominal muscles to rest. Step 3 -- Advanced version of draw-in (with actions): Take the original draw-in inhale and exhale technique, plus raise your legs in sequence as you exhale. Keep the hip and knee joints at 90 degrees, then lower one leg and touch the ground gently with the heel, but do not apply the full force of the leg to the ground, only gently lean on the leg, then lift the leg back, switch legs to continue the movement. Note that the breathing during the period is smooth, cannot have the occurrence of holding your breath; the lumbar spine and pelvis should also be kept as still as possible; and the gap behind the waist can neither reduce nor increase, because this indicates that the pelvis has forward or backward tilt of the situation. These exercises not only work the core muscles, but also, as mentioned earlier, the diaphragm works together to contract the other core muscles, and can even improve lower back pain. Author : Rose Lin is an assistant product specialist Rose Lin is an assistant product specialist for GaleMed ’s Respiratory and homecare Solutions portfolio. Her goals are to assist clinicians to improve the workflow efficiencies and patient outcomes across the company’s patient homecare product portfolio.
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2024-05-16In response to COVID-19, a global epidemic in recent years, Taiwan Cardiopulmonary Rehabilitation Association formed an expert group to hold a consensus meeting and draw up rehabilitation plans for patients. Patients were divided into five categories according to the severity of the disease, and different pulmonary rehabilitation guidelines were given. Outpatient patients with mild disease and no risk factors Out-patients with mild disease and epidemiological risk factors Inpatients with moderate and severe diseases Ventilatory support for conscious patients Ventilator-supported unconscious patients The following two articles, we will be introducing rehabilitation and treatment in each categories respectively. 1. Outpatient patients with mild disease and no risk factors At least 10 days after onset of symptoms No fever within 24 hours without taking antipyretic medicine There are no other COVID-19-related symptoms. The pulmonary rehabilitation plan for such mild patients is mainly to prevent complications through physical training. Training should consist of three parts: warm-up, exercise, relaxation and stretching. First, warm up with light endurance activity for at least 5 to 10 minutes before entering the main workout, which includes cardio and resistance training: Aerobic exercise: rhythmic exercise that stimulates large muscle groups, such as treadmill, cycling and swimming, while training breathing and boosting lung capacity. Frequency: more than 5 days per week Intensity: Maintain 40% to 59% reserve heart rate (reserve heart rate = maximum predicted heart rate - calm heart rate) Training time: 30-60 minutes Resistance training: for specific limbs or core muscles (biceps, triceps, pectoralis, gluteus, quadriceps, etc.) to carry out single-joint or multi-joint movement, without weight bearing or using heavy training equipment to increase training intensity. Frequency: 2-3 days per week, at least 48 hours apart. Intensity: Strength training uses 60%-70% of 1RM weight; Endurance training uses less than 50% of the 1RM weight. (1RM stands for "one repeated maximum weight", which refers to the maximum muscle force generated by a single muscle contraction). Training time: strength training 8-12 times per group, 2-4 sets; Do endurance training 15 to 25 times per set, up to 2 sets. After exercise, patients should perform 5 to 10 minutes of low-intensity, moderate exercise followed by at least 10 minutes of stretching. At present, self-regulated home lung rehabilitation is recommended as the main method. As long as proper environmental disinfection is carried out and family monitoring is safe, patients can also achieve the effect of lung rehabilitation by self-training at home without going to clinical units in hospitals. It is important to note that training should be stopped immediately in the event of unstable vital signs or respiratory distress. In addition, based on what is currently known about COVID-19, pregnant women can follow the ACSM's recommendations to maintain exercise and implement a rehabilitation program, but after the 16th week of pregnancy, supine exercise should be avoided to avoid blocking maternal venous return due to fetal weight compression. In addition, unlike adults, children need at least 60 minutes of aerobic exercise a day, but should avoid training in hot and humid environments because of their immature thermoregulation mechanisms. 2. Out-patients with mild disease and epidemiological risk factors People with chronic COVID-19 conditions, such as hypertension, cardiovascular disease, chronic respiratory disease or diabetes, have a higher chance of becoming severe and of dying compared to those without comorbid conditions. However, under careful supervision and stable conditions, such patients can still be engaged in a rehabilitation program including aerobic exercise and resistance training: Hypertension: Patients should be specially monitored for hypotension after exercise, especially in older patients receiving antihypertensive medications. Cardiovascular disease: Exercise training is safe and effective for most patients with cardiovascular disease. After cardiopulmonary exercise test or physician evaluation, adjust the training intensity to the range of body can compound, and do lung training step by step. And monitor for symptoms such as dyspnea, dizziness, palpitations, chest tightness or chest pain. Pulmonary disease: Patients with chronic pulmonary disease have more respiratory secretions than those without lung disease. Airway clearance techniques should include flutter breathing, postural drainage, effective cough technique and chest physical therapy such as Huffing. Patients can also carry out abdominal breathing health education, reduce the use of auxiliary muscles to breathe hard, normal life that is to develop a correct and good way of breathing. Specific exercises, such as yoga, tai chi and core muscle training, can also help stabilize the torso to promote effective breathing. In addition, inspiratory muscle training has been shown to reduce dyspnea and improve exercise performance and quality of life in COPD patients. Resistance is recommended to start at 30% of the maximum inspiratory pressure (MIP) and to avoid training in cold environments and environments with allergens or contaminants that may cause tracheal constriction. Diabetes: Blood sugar should be evaluated before and after exercise for symptoms of hypoglycemia, including tingling in the mouth and fingers, tremors, abnormal sweating, anxiety, confusion, forgetfulness, hunger and visual disturbances. In addition, patients with retinal disease should avoid strenuous exercise and continuous air holding force (Valsalva) to avoid raising blood pressure. Patients with polyneuropathy need to pay attention to foot care to prevent foot ulcers and the risk of amputation. Although such patients can be rehabilitate at home under the above conditions, their health needs to be closely monitored. If any adverse events occur, exercise training should be stopped immediately. If symptoms are severe or do not recover, medical assistance should be sought immediately. In our next article, we will introduce a lung rehabilitation program for patients with moderate to severe COVID-19 whose symptoms are well suited. Next article Article source： Cheng Y-Y et al., Rehabilitation programs for patients with CoronaVirus Disease 2019: consensus statements of Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation, Journal of the Formosan Medical Association, https://doi.org/10.1016/j.jfma.2020.08.015 Reference： World Health Organization. Living guidance for clinical management of COVID-19. Available from: World Health Organization. Support for rehabilitation self-management after COVID-19-related illness (2020). World Health Organization. Home care for patients with suspected or confirmed COVID-19 and management of their contacts. Author : Jasmine Chen, Clinical Respiratory Therapist Jasmine Chen is a clinical respiratory Therapist. As a Certified Respiratory Therapist, she works with product and marketing teams to help develop solutions and analyzing product market trends to improve product efficiency. Jasmine co-worked a marketing excellence program called GaleMed 3.0 Project. Author : Adina Su, Market Watcher and Trend Monitor Adina Su is a market watcher and trend monitor at GaleMed. With a background in Respiratory Therapy, she provides technical solution support across the care continuum. She has a passion for product training, and likes to share her knowledge that contributes to the clinical environment.
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2024-05-16In the previous article, we introduced lung rehabilitation for patients with mild COVID-19, while this article focuses on patients with moderate and severe COVID-19. Inpatients with moderate and severe diseases Approximately 14% of COVID-19 patients will develop moderate to severe illness requiring hospitalization for aggressive treatment. These people typically experience fever, cough, difficulty breathing, rapid heartbeat, shortness of breath and decreased oxygen saturation. Studies have shown that early rehabilitation interventions for community and interstitial pneumonia within 2 days of admission can reduce in-hospital mortality. The two main goals of rehabilitation at this stage are to promote airway patency and prevent complications associated with acute illness. About 33.7% of COVID-19 patients produce large amounts of sputum. The incorporation of thoracic physical therapy can effectively help patients discharge airway secretions, enhance mucociliary clearance of upper respiratory secretions, and improve cough effect. Chest physiotherapy includes: Posture drainage: According to the position of the pulmonary lobe where the sputum is blocked, the corresponding posture is performed to drain the sputum from the small airway to the atmospheric airway to facilitate sputum discharge and improve gas exchange. Active Respiratory circulation technique (ACBT) : Expand the chest with a deep inhalation and exhale with huffing. Using the strength of your stomach rather than your throat, you open your mouth and exhale quickly to get rid of sputum more easily than coughing blindly. Chest blow and vibration: caregivers' hands are cup-shaped or manually pat sputum with a sputum cup, or they can use an electric sputum stick, sputum vest and other devices to vibrate the chest wall of the patient from the outside, which helps loosen the sticky sputum. Effective cough: cough is rapid exhalation without glottis closure, and the purpose of controlling cough is to avoid shallow and ineffective laborious cough. Flutter breathing: Using a device containing a movable steel ball in a sealed tube, the patient quickly blows air into the tube, which rapidly vibrates the ball and produces a rhythmic airflow while loosening the sputum. Ventilatory support for conscious patients Recovery in patients with severe COVID-19 on ventilator support is similar to recovery in patients with respiratory failure caused by other viral pneumonia infections. Intubated patients with a closed respirator line have a lower risk of virus transmission than unintubated patients. However, in the process of disconnecting the ventilator (Weaning), it is still necessary to carefully prevent the transmission of gas and material, and the risk of contact between other personnel and patients should be strictly reduced by using negative pressure isolation wards and other protective devices. The pulmonary rehabilitation of these patients is as follows: Bed exercise and getting out of bed as early as possible: bed rehabilitation is a proven safe method of rehabilitation that preserves muscle function and muscle fibers as much as possible and promotes positive psychological effects. Patients are advised to train at a low resistance level (approximately 0.5 Newton-meters) for 30 minutes per day at a self-selected training rate; Upper limb resistance training can also be done with elastic straps and pulleys. In addition, patients in a more stable condition should be encouraged to get out of bed as early as possible, including sitting on the edge of the bed, moving from bed to chair, standing by the bed, and walking around in the company of others, all of which are good ways to restore lung health. Breathing exercises: Inspiratory muscle training can strengthen inspiratory muscles by applying resistance in the process of inspiratory, and can also be used for intubation patients or patients undergoing tracheotomy. Set the training threshold to 50% of the MIP(maximum inspiratory pressure) and recommend five sets of six sessions per day. Finally, thoracic dilation also improves chest wall mobility and thoracic compliance during mechanical ventilation. Pleural physical therapy and airway secretion management: combined with posture drainage, pleural slamming, vibration and airway aspiration, the retention of lung secretions can be significantly reduced and oxygenation can be increased. High-frequency chest Wall oscillations (HFCWO), which use percussion vests instead of manual, better facilitate the movement of mucus toward the central airway. The device typically operates at a frequency of 7 to 15 Hz on intubated patients. Ventilator-supported unconscious patients 5% of COVID-19 patients are critically ill, requiring inpatient intensive care units and ventilator ventilation. The following are recommended strategies for patients in this group who are unable to perform voluntary pulmonary rehabilitation, but can still perform passive exercise with the assistance of medical staff as far as possible and prevent deterioration of their condition: For patients with severe ARDS and cognitive impairment, prone ventilation may be performed for 16 hours per day until the patient's oxygenation improves (PaO2/FiO2 ratio≥150 mmHg under PEEP less than 10 cm H2O), with special attention to the risk of pipeline obstruction caused by prone ventilation. In the case of oversecretion and ineffective mucus removal, airway clearance techniques are widely used in mechanically ventilated patients, such as chest blows every 4-6 hours, vibration, and postural drainage. Percussion ventilation can also be performed in the lung to help relax sputum. Prevention of bedsore: turning over and changing posture for patients regularly is an important key to prevent bedsore. To assist the patient with passive movement of the major joints of the limbs, maintain muscle fibers and prevent joint contracture. Each upper and lower limb joint should be repeated 5-10 times once or twice daily in supine position. And with thoracic dilation to maintain thoracic compliance. In addition, some severe COVID-19 cases may develop sequelae of hypoxia in the future, and some patients may need long-term home oxygen therapy after physician evaluation to maintain their quality of life. The above are the classification of the severity of COVID-19 disease and the corresponding precautions for lung rehabilitation. The purpose of lung rehabilitation is nothing more than to improve lung function and reduce lung injury and complications caused by the disease. Patients should return for regular assessment to adjust the lung rehabilitation plan and implement it for a long time. Improve the health and quality of life of patients. Article source： Cheng Y-Y et al., Rehabilitation programs for patients with CoronaVirus Disease 2019: consensus statements of Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation, Journal of the Formosan Medical Association, https://doi.org/10.1016/j.jfma.2020.08.015 Reference： World Health Organization. Living guidance for clinical management of COVID-19. Available from: World Health Organization. Support for rehabilitation self-management after COVID-19-related illness (2020). World Health Organization. Home care for patients with suspected or confirmed COVID-19 and management of their contacts. Author : Jasmine Chen, Clinical Respiratory Therapist Jasmine Chen is a clinical respiratory Therapist. As a Certified Respiratory Therapist, she works with product and marketing teams to help develop solutions and analyzing product market trends to improve product efficiency. Jasmine co-worked a marketing excellence program called GaleMed 3.0 Project. Author : Adina Su, Market Watcher and Trend Monitor Adina Su is a market watcher and trend monitor at GaleMed. With a background in Respiratory Therapy, she provides technical solution support across the care continuum. She has a passion for product training, and likes to share her knowledge that contributes to the clinical environment.
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2024-05-16Pulmonary rehabilitation after COVID-19 and treatment of pulmonary diseases Oxygen is an essential component of the body. Every cell and organ need oxygen to function properly. Most of the oxygen that your body needs comes from the respiratory system. With the respiratory tract, lung, and respiratory muscles, we breathe to take oxygen into our bodies and send carbon dioxide out. Respiration might be an easy daily routine for healthy people; however, it might be full of challenges for patients with lung injury caused by COVID -19 and some of the patients with lung diseases. There are many factors, such as respiratory muscle weakness, sputum obstruction, abnormal lung tissue function, etc., which may cause low blood oxygen saturation (Hypoxemia) and produce symptoms such as shortness of breath, dizziness, poor activity, and lethargy, which affect not only health but also quality of life. The pulse oximeter is a non-invasive and compact device used to monitor the blood oxygen of patients in clinic and home care as well. It can quickly measure oxygen saturation (SpO2) and heartbeat (PR) by clipping to the fingertips or earlobes of patients. The normal value of SpO2 is greater than 95%, while the normal value of PR is between 60 and 100. In other words, when oxygen saturation is less than 94%, the patient should seek medical attention and be treated with oxygen therapy as soon as possible. Oxygen therapy has a variety of interfaces that provide patients with oxygen concentrations higher than room air (21%) and ameliorate or prevent hypoxemia. Some patients with chronic hypoxemia (e.g., chronic obstructive pulmonary disease, bronchiectasis, congestive heart failure, etc.) may require long-term oxygen therapy at home after evaluation. Most of the oxygen sources used in home care are oxygen concentrators or cylinders. The interfaces commonly used are as follows: Nasal CannulaThe nasal cannula is the most common device for long-term oxygen therapy. It is soft and features two blind tubes placed in the patient's external nostril to provide additional oxygen. Compared with other oxygen therapy devices, the nasal cannula has a smaller surface area that contacts the patient's face, and the patient does not need to take the cannula off when eating, providing a more comfortable and convenient treatment. Patients may experience nasal dryness when the flow rate is greater than 4 liters per minute, and the bubble humidifier can be used to increase humidity and relieve discomfort. Simple Oxygen MaskThe simple oxygen mask is another common low-flow oxygen device. The patient simultaneously inhales oxygen from the oxygen tubing and some room air from the opening of the mask when inhalation, while the air is expelled through the opening of the mask when exhalation. The oxygen mask has a larger oxygen storage capacity than nasal cannula, so it can provide higher oxygen concentrations. When using a simple oxygen mask, it is important to note that the flow rate should be greater than 5 liters per minute to avoid carbon dioxide trapped in the mask, which may cause adverse effects on the patient. In addition, inhalation therapy is often used by many patients with chronic lung diseases. Aerosol drugs, dry powder inhalers or metered-dose inhalers make drug particles enter the lungs through the respiratory tract and action more effectively. Inhalation devices commonly used at home are as follows: Small-Volume Jet Nebulizer It is a commonly used clinical drug spray device. With an oxygen flow rate of 6 to 8 liters per minute, the drug solution or suspension will be converted into aerosol particles by the device and then enter the patient's lower respiratory tract. The device requires less patient coordination and allows the patient to breathe normally through a mouthpiece, mask or breathing circuit during the therapy. Device hygiene: Rinse with distilled water after use and air-dry it. MDI Spacer Metered-dose inhalers (MDI) is a common inhalation device. Due to the need for good hand-breath coordination, the effect of MDI is often decreased due to the patient's breathing pattern or poor coordination. In this case, the MDI spacer will be needed. Studies have shown that the use of MDI spacer can significantly increase drug deposition into the lungs by about 20~50%, reducing oropharyngeal deposition and the need for hand-breath coordination. Device hygiene: Only when there is obvious drug residue or stains in the device should it be cleaned with neutral detergent. Do not scrub the inside of the chamber to avoid damaging the electrostatic coating. Author : Jasmine Chen, Clinical Respiratory Therapist Jasmine Chen is a clinical respiratory Therapist. As a Certified Respiratory Therapist, she works with product and marketing teams to help develop solutions and analyzing product market trends to improve product efficiency. Jasmine co-worked a marketing excellence program called GaleMed 3.0 Project.
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2024-05-16Under normal circumstances, when the human body inhales air, the nasal mucosa heats and humidifies the air to ensure sufficient temperature and humidity in the respiratory tract, keeping the lung temperature at 37°C, relative humidity at 100% and absolute humidity at 44mgH2O/L. However, when the endotracheal tube is inserted and the breathing line is used, the dry and cold gas output by the ventilator cannot be heated and humidified by the patient's own airway mucosa. In this case, moist gas should be used to prevent airway ciliary damage and decline of lung function. Two main types of humidification system: active and passive:Active humidification system: It is connected to the suction end of the breathing pipe near the ventilator, and the target temperature is set by the heating humidifier to atomize the distilled water in the heating tank and send it to the breathing pipe. Heated humidifiersThere are two main types, one can set a specific temperature; the other is to set the temperature range, and both functions are the same, convenient for medical staff to monitor the patient's condition. Most heating humidifiers can be connected to a temperature sensing line to detect the temperature of the respiratory line and adjust the heating degree immediately to ensure patient safety. Heated humidification tank (Humidification Chamber)Add distilled water to the heated humidifier tank and place it on the heated humidifier to provide an active moisture treatment. In addition to the difference between disposable and repetitive, heating and humidifying tank is also divided into manual water supply type and automatic water supply type. Manual water supply type: medical staff need to regularly check and supplement the water in the heating and humidification tank. The disadvantage is that the breathing line needs to be separated temporarily, which may cause temporary instability of the patient's blood oxygen saturation concentration. Too little water may affect patient safety. Automatic water refill type: after the humidification tank is connected to the water bag, the water will be automatically added to the safe range, reducing the burden of medical staff and the risk of cross infection, greatly increasing the safety of patients. This device is especially needed for unstable newborns and patients. Passive humidification system: The humidity and heat exchanger (HME), also known as the artificial nose, is placed between the Y-joint of the tube and the endotracheal tube. As the name suggests, the artificial nose collects the moisture and temperature of the patient's exhaled air, allowing the next breath to inhale the hot and humid air through the artificial nose. Unlike active humidification therapy, the artificial nose can be used without electricity, reducing clinical costs and making it suitable for patients who need humidification therapy temporarily. If there are contraindications, such as large and sticky sputum, hypothermia, too large or too small moisture volume, it should be carefully evaluated before use. Each artificial nose should be discarded and replaced after 96 hours.In addition to patients using ventilators, dry air during oxygen therapy may also cause nasal and mouth discomfort, such as dry nasal cavity, nasal congestion, nosebleeds, sore throat, hoarseness and other symptoms, which can be relieved with a damp bottle. There are two types of active moisture therapy devices commonly used in oxygen therapy: Bubble humidifierIt is most commonly used to relieve the discomfort of nasal dryness when oxygen flow exceeds 4 liters/min. The tube inside the damp bottle has a Diffuser at the bottom, which aims to create smaller bubbles and increase the area of contact between gas and water, thereby increasing the relative humidity. Most of the bubble type moisture bottles have high pressure release valves to avoid excessive device pressure affecting patient safety. Large Volume NebulizerLarge volume moisture bottle is suitable for fog mask, air cutting mask, etc., with oxygen concentration adjustment knob, using the principle of air entrainment to provide different oxygen concentration. When using a large volume moist bottle, observe whether there is still fog around the mask at the end of inhalation. If there is no fog, it indicates that the flow is too small. Most spray bottles have openings that can be inserted into a heating rod to produce higher absolute humidity when heated. Author : Jasmine Chen, Clinical Respiratory Therapist Jasmine Chen is a clinical respiratory Therapist. As a Certified Respiratory Therapist, she works with product and marketing teams to help develop solutions and analyzing product market trends to improve product efficiency. Jasmine co-worked a marketing excellence program called GaleMed 3.0 Project.