Effect of Breather on Hospital Stay in Patients With Acquired Pneumonia

Study Overview
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Brief Summary
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Acquired pneumonia is a sever medical condition that addressed as life-threatening issue require intensive care. Medical Breather device permits activating and strengthening of both inspiratory and expiratory musculatures; thus, it could be useful for pneumatic patients. The aim of the study is to investigate breather effect on hospital stay in pneumatic patients.

Detailed Description
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Sixty participants diagnosed with acquired pneumonia '30 women, 30 men; selected from chest department of Kasr Alaini Intensive Care Unit (ICU) at Cairo University. They were randomly allocated into equal groups; Group A received respiratory training via incentive spirometer, and traditional chest physiotherapy; and Group B received respiratory training via Breather, and traditional chest physiotherapy. both received 3 session daily/2 weeks. Diaphragmatic excursion, Respiratory Distress Observation Scale, and ICU discharge were assessed pre and post treatment. Careful recruitment of participants based on the study criteria by both ICU resident and PT consultant. Identified inclusive criteria include conscious both genders aged 30- 40 years old with BMI ranged from 25 to5 29.9 Kg/m2 had an acquired pneumonia with a mild hypoxemia (O2 saturation was 90 - 95%). Aware participants whom cooperated through accurate understand and perform instructions. Excluding patients through identified inclusive criteria that if they had a history of any malignant tumors, hearing impairment or mental disorder, auto-immune diseases, a history of any surgical transplantation, unstable hemodynamics, rib fracture, a history of neuromuscular disease, spinal injuries, or BMI > 30 Kg/m2. Also, patients receiving mechanical ventilation, or whom require MV, but contraindicated for rehabilitation i.e., pulmonary emboli were excluded.

Official Title
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Effect of Breather on Hospital Stay in Patients With Acquired Pneumonia

Conditions
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Pneumonia Hospital Acquired

Intervention / Treatment
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* Device: The Incentive Spirometer
* Device: The breather respiratory muscle training device


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Sixty patients of both sexes from intensive care unit, Cairo University Hospitals. Their age ranged from 30 to 40 years old. Their BMI were from 25 - 29.9 Kg/m2. Their oxygen saturation 90 - 95% (mild hypoxemia) conscious level. Exclusion Criteria: 1. Patient with a history of any malignant tumors. 2. Patients with hearing impairment or mental disorder. 3. Patients with auto-immune diseases. 4. Patients with a history of any surgical transplantation. 5. Patients with hemo-dynamically unstable patients. 6. Patients with rib fracture. 7. Patients with history of neuromuscular disease. 8. Patients with spinal injuries. 9. Patients with BMI > 30 Kg/m2. 10. Patients receiving mechanical ventilation. -

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Group A (study group): 30 patients (15 males and 15 females) will receive respiratory training using incentive spirometer in addition to traditional chest physiotherapy, 3 sessions per day, for 2 weeks. Group B (study goup): 30 patients (15 males and 15 females) will receive respiratory training using the breather in addition to traditional chest physiotherapy, 3 sessions per day, for 2 weeks.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: The Incentive Spirometer group<br>The respiratory muscle training program has the following parameters: Duration: 20 minutes per session, Intensity: Clinical adjustment of training intensity based on actual participants' status across session time, holding time, and repetitions. Frequency: 30 per set, with each is 5-6 times. The procedure for the respiratory muscle training program is as follows: a deep slow inspiration while lips fitted around mouthpiece. Visual feedback is provided to the patient, such as a ball rising to a preset marker, to motivate them during the exercise. The patient is instructed to get the planned flow at preset amount. The patient is asked to maintain breathing in along 2-3 seconds. These guidelines should be followed during respiratory muscle training | Device: The Incentive Spirometer<br>* Tri-flow device flow-oriented incentive spirometer .<br>|
| Active Comparator: The Breather Respiratory Muscle Trainer group<br>Utilizing a pre-session checklist can improve the success rate of using the breather for respiratory muscle training. The following items should be included in the checklist: Check the patient's posture, ensuring that they are in a comfortable crook lying or sitting position, initial easiest resistances by manipulating both dials to one, ensure the patient is using the diaphragmatic breathing technique, as this is crucial for the proper use of the breather, and make sure that the patient secures lips on mouthpiece. | Device: The breather respiratory muscle training device<br>* The breather respiratory muscle training device which allows for adjustable levels of resistance using easy-to-read dials, which allows to adjust the device to the settings require<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| arterial blood gases (ABG) | potential of hydrogen( pH )(7.35-7.45). the partial pressure of carbon dioxide in arterial blood.(PaCO2 )(35-45 mmHg). Bicarbonate (HCO3)(22-28 meq/L). arterial oxygen saturation (SaO2) (95-100%). pH (7.35-7.45). PaCO2 (35-45 mmHg). HCO3 (22-28 meq/L). SaO2 (95-100%). . Sample was taken from the radial artery to measure the following parameters6: 7.35-7.45 PH, 35-45 mmHg PaCO2, 22-28 meq/L HCO3, and 95-100% SaO2. | Pre and post treatment after 2 weeks | 
| Diaphragmatic excursion | measured diaphragmatic movement for each subject by using the Diaphragmatic ultrasound at 3.5-5MHz probe that aimed at midclavicular line under rib cage aiming posterior 3rd of hemi diaphragm. | Pre and post treatment after 2 weeks | 
| Respiratory distress observation scale (RDOS) | evaluate severity and discomfort experienced by patients who are unable to communicate their dyspnea levels during monitoring for palliative sedation therapy . RDOS score of less than 3 indicates that the patient is breathing comfortably, d) an RDOS value ≥3 means respiratory distress that require palliative measures, and e) higher RDOS scores indicate a worsening of the patient's condition. | Pre and post treatment after 2 weeks | 
| The National Early Warning Score 2 (NEWS2) | ) scoring system for evaluating hospital discharge. It measures six physiological items; respiration and pulse rates, O2 saturation, systolic blood pressure, consciousness level or recent onset confusion, also temperature 9. Each parameter is allocated a score of 0, 1, 2, or 3, elevated values indicate that is far away from normal values. Low risk (aggregate score of 1-4). Low to moderate '3 in a single item' risk. Moderate risk (aggregate score of 5-6). Maximum risk (≥7 value). Critical team of care should perform an emergency assessment, often advice transfer case to a higher dependency unit, and a NEWS2 ≥ 0 i.e., no change, warrants a minimum twice daily check that be a routine monitoring. | Pre and post treatment after 2 weeks | 
| Body mass index (BMI ) | Ranged from 25 to 29.9 Kg/m2. | Pre and post treatment after 2 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Incentive spirometry,Breather, Acquired pneumonia, Arterial blood gases