the Effect of Chest Expansion Exercises on Pleural Effusion
Condition: Pulmonary Infection; Complication
MeSH terms: Infections; Pleural Effusion
Study type: Interventional

Summary: 
      the study attempted to assess and evaluate the efficacy of implementing chest expansion
      exercises on patients with pleural effusion and how this programme contribute to reduce
      pulmonary infection and complications.

      To address the objective of the study, the researcher utilized chest expansion exercises
      consisted of stacked breathing exercise, segmental breathing, chest mobility exercises, deep
      breathing exercise with use of incentve spirometer and assess the patient before and after
      exercises by using three tools help to monitor hemodynamic parameters, chest condition,
      laboratory investigations which help to evaluate pulmonary infection score and complications.
    

Detailed description: 
      Introduction Plural effusion is a syndrome occurs frequently in hospitalized patients,
      leading to increased morbidity, mortality, and healthcare expenditure. A plural effusion
      represents the disturbance of the normal mechanisms of formation and drainage of fluid from
      the plural space .

      Plural effusion is defined as a ﬂuid collection between the plural leaves due to
      local/systemic disease of the pleura, lung or extra-pulmonary organs. Normally, 0.1 to 0.2
      ml/kg of ﬂuid is present in the plural leaves to facilitate plural movement. When the balance
      between the production and re-absorption of this ﬂuid deteriorates, it becomes plural
      effusion .

      The accumulation of plural effusion has important effects on respiratory system function. It
      changes the elastic equilibrium volumes of the lung and chest wall, resulting in a
      restrictive ventilatory effect, chest wall expansion and reduced efficiency of the
      inspiratory muscles. The magnitude of these alterations depends on the plural fluid volume
      and the underlying disease of the respiratory system. The decrease in lung volume is
      associated with hypoxemia mainly due to an increase in right to left shunt. The drainage of
      pleural fluid results in an increase in lung volume that is considerably less than the amount
      of aspirated fluid, while hypoxemia is not readily reversible upon fluid aspiration .

      Pleural effusions are traditionally classified as either transudates or exudates. Diseases
      that affect the filtration of pleural fluid result in transudate formation and often occur
      bilaterally. Inflammation or injury increases pleural capillary membrane permeability to
      proteins and various types of cells and lead to the formation of an exudative effusion .

      This study was designed as a randomised controlled trial to determine the effect of chest
      expansion exercises on reducing pulmonary infection and complications on patients with plural
      effusion.

      Methods Design Structured as a randomized-controlled prospective study, the objective of this
      study was to determine the efficacy of the chest expansion exercises on reducing pulmonary
      infection and complications on patients with plural effusion.

      Setting Data was collected from chest ICU and critical ICU in Assiut university hospital .

      Sample The study population consisted of patients eighteen to sixty years old, hospitalized
      and treated in Critical, Chest intensive care units. The inclusion criteria stipulated that
      the patient was between eighteen and sixty years old; both genders were included; diagnosed
      as plural effusion by the physician; and with a symmetrical chest expansion and agreed to
      participate in the study. A power calculation estimated that in order to detect an effect
      size of 0.29 difference in mean of pulmonary function between the two studied groups, with a
      p-value < 0.05 and 80 % power, confidence level 0.95, a sample size of 20 patients for each
      group was needed. However, 60 patients were attempted in this research work to avoid
      non-response rate (30 for each group). This calculated using G Power 3.1 . The study data was
      collected between June 2019 and June 2020.

      Instruments and measurements Three tools used in this study were developed by the researcher
      based on reviewing of the relevant literature.

      The first tool was Plural effusion assessment sheet used to monitor hemodynamic parameters
      included (Mean arterial pressure (MAP) taken from bed side monitor, heart rate (HR),
      temperature, respiratory rate and CVP readings, assessment of respiratory system consisted of
      : Chest examination done every shift before and after exercise, chest x-ray assessment,
      Sputum and blood culture assessment, Ventilator profile assessment , assessment of plural
      procedures done, assessment of clinical pulmonary infection score, fluid balance assessment.,
      assessment of laboratory findings in addition to socio-demographic and medical data.

      The second tool is Chest expansion exercises sheet : was developed by the researcher and used
      to assess exercises done to the patient and included: Chest mobility exercise; Stacked
      breathing exercise; Segmental breathing exercise; Deep breathing exercise and Incentive
      spirometer exercise.

      The third tool is Patients' outcomes evaluation sheet which was developed by the researcher
      and used to assess the effect of chest expansion exercises on pulmonary infection score and
      complications.

      Intervention After getting ethical clearance patients were enrolled in the study, patients
      were selected based on the inclusion and exclusion criteria. Following an initial assessment,
      the patients were assigned to one of the two groups by block randomization.

      Intervention group was received Chest mobility exercises with Incentive spirometer and
      segmental breathing exercise and breath stacking technique . The patient in the intervention
      group was instructed to perform the exercises 3 times per day, 7-8 times per session for one
      week. Ensure that the patient fully hydrated by maintaining normal daily water requirement in
      the form of (30-35 ml/kg/day) with restriction of intravenous fluids.

      Data collection The data were collected from the first day of admission after stabilization
      of the patient's condition and extended to 7 days, every day and every shift then the data
      were recorded in the developed tools.The researcher assigned study sample (30 patients) to
      two groups (Control group, Intervention group).

      For the control group: The researcher assessed patients who were receiving the routine
      hospital care. For Intervention group: The researcher assessed patients then applying chest
      expansion exercises.

      Ethical considerations There was no risk for study subject during application of the study as
      the study followed common ethical principles in clinical research and has been carried out in
      accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki)
      and written consent was obtained from patients or guidance that participated in the study
      after explaining the nature and purpose of the study.

      Patient was assured that the data of this research was not be reused without second
      permission, confidentiality and anonymity was assured and the patients had the right to
      refuse to participate or withdraw from the study without any rational at any time.

      Data analysis Data were computerized and analyzed by computer programmed SPSS (ver.16). Data
      were presented by using descriptive statistics in the form of frequencies and percentages or
      means ± standard deviations for qualitative data. Quantitative data were compared using
      Independent samples t-test for comparisons among two groups. Qualitative variables were
      compared using chi-square test to determine significance. The critical value of the tests "P"
      was considered statistically significant when P less than 0.05.
    

Intervention name(s): chest expansion exercises
Intervention type(s): Procedure
Intervention description(s): Chest mobility exercises with Incentive spirometer and segmental breathing exercise ) and breath stacking technique e.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: implementing chest expansion exercises on patient with pleural effusion to evaluate its efficacy on preventing pulmonary infection and complications
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Chest expansion exercises; complications; pleural effusion; pulmonary infection