Maree Milross - Academia.edu (original) (raw)

Papers by Maree Milross

Research paper thumbnail of Quantification of changes in lung aeration associated with physiotherapy using lung ultrasound in mechanically ventilated patients: a prospective cohort study

Physiotherapy, Jun 1, 2023

Research paper thumbnail of Therapist-Made Bubble-Positive Expiratory Pressure

Cardiopulmonary physical therapy journal, 2016

Purpose:To determine the current use, rationale for use, and construction of the therapist-made b... more Purpose:To determine the current use, rationale for use, and construction of the therapist-made bubble-positive expiratory pressure (bubble-PEP) device by physiotherapists in Australian public and private hospitals. Methods:Cross-sectional survey of 122 randomly selected Australian hospitals. Physiotherapists employed in these hospitals were invited to participate. Results:Hospital response rate was 88% with 169 participating physiotherapists. Bubble-PEP device was used in 43% of responding hospitals and by 72% of physiotherapists. The rationale for use was to improve secretion clearance (99%) and oxygen saturation (48%) and promote deep breathing (48%). Bubble-PEP device was used for patients with bronchiectasis (86%), pneumonia (74%), chronic obstructive pulmonary disease (70%), and postoperatively (61%). Physiotherapists believed that bubble-PEP device splinted airways open (88%), produced PEP at the mouth (70%), and loosened secretions (66%). Seventy-nine percent of physiotherapists were more likely to use bubble-PEP device than other devices because of accessibility and cost. Materials and methods used to construct bubble-PEP device were a 500-mL plastic bottle (54%), plastic tubing (77%) of 30-cm length (46%), and 10-cm water level (34%). Conclusions:The bubble-PEP device was commonly used by physiotherapists in Australian hospitals to treat respiratory impairments in patients with lung conditions. There was no clear consensus on bubble-PEP device construction.

Research paper thumbnail of Non‐invasive ventilation versus oxygen therapy in cystic fibrosis: A 12‐month randomized trial

Respirology, Jun 17, 2019

Background and objective: No published studies have examined the long-term effects of non-invasiv... more Background and objective: No published studies have examined the long-term effects of non-invasive ventilation (NIV) in cystic fibrosis (CF). Our primary aim was to determine if adults with CF and sleep desaturation were less likely to develop hypercapnia with NIV AE O 2 compared to low-flow oxygen therapy (LFO 2) or meet the criteria for failure of therapy over 12 months. We studied event-free survival, hospitalizations, lung function, arterial blood gases (ABG), sleep quality and health-related quality of life. Methods: A prospective, randomized, parallel group study in adult patients with CF and sleep desaturation was conducted, comparing 12 months of NIV AE O 2 to LFO 2. Event-free survival was defined as participants without events. Events included: failure of therapy with PaCO 2 > 60 mm Hg, or increase in PaCO 2 > 10 mm Hg from baseline, increases in TcCO 2 > 10 mm Hg, lung transplantation or death. Outcomes were measured at baseline, 3, 6 and 12 months, including lung function, ABG, Pittsburgh Sleep Quality Inventory (PSQI), SF36 and hospitalizations. Results: A total of 29 patients were randomized to NIV AE O 2 (n = 14) or LFO 2 (n = 15) therapy for 12 months. Of the 29 patients, 18 met the criteria for event-free survival over 12 months. NIV AE O 2 group had 33% (95% CI: 5-58%) and 46% (95% CI: 10-68%) more event-free survival at 3 and 12 months than LFO 2 group. No statistically significant differences were seen in spirometry, ABG, questionnaires or hospitalizations. Conclusion: NIV AE O 2 during sleep increases event-free survival over 12 months in adults with CF. Further studies are required to determine which subgroups benefit the most from NIV.

Research paper thumbnail of Lung ultrasound has greater accuracy than conventional respiratory assessment tools for the diagnosis of pleural effusion, lung consolidation and collapse: a systematic review

Journal of Physiotherapy, 2021

QUESTION In mechanically ventilated adults in intensive care, what is the accuracy of lung ultras... more QUESTION In mechanically ventilated adults in intensive care, what is the accuracy of lung ultrasound (LUS) for the diagnosis of pleural effusion, lung consolidation and lung collapse when compared with chest radiograph (CXR) and lung auscultation, with computed tomography (CT) as the reference standard? DESIGN Systematic review with meta-analysis of prospective cohort studies. PARTICIPANTS Adult patients admitted to intensive care, with diagnostic uncertainty at enrolment regarding pleural effusion, lung consolidation and/or collapse/atelectasis. INDEX TEST The diagnostic accuracy of LUS as the index test was estimated against CXR and/or lung auscultation as comparators, with thoracic CT scan as the reference standard. OUTCOME MEASURES Measures of diagnostic accuracy. RESULTS Seven eligible studies were identified, five of which (with 253 participants) were included in the meta-analysis. It was found that LUS had a pooled sensitivity of 92% and 91% in the diagnosis of consolidation and pleural effusion, respectively, and pooled specificity of 92% for both pathologies. CXR had a pooled sensitivity of 53% and 42% and a pooled specificity of 78% and 81% in the diagnosis of consolidation and pleural effusion, respectively. A meta-analysis for lung auscultation was not possible, although a single study reported a sensitivity and specificity of 8% and 100%, respectively, for diagnosing consolidation, and a sensitivity and specificity of 42% and 90%, respectively, for diagnosing pleural effusion. CONCLUSION This systematic review with meta-analysis demonstrated high sensitivity of LUS compared with CXR, with similar specificities when diagnosing pleural effusion and lung consolidation/collapse. REGISTRATION PROSPERO CRD42018095555.

Research paper thumbnail of Low-flow Oxygen and Bilevel Ventilatory Support

American Journal of Respiratory and Critical Care Medicine, 2001

We measured ventilation in all sleep stages in patients with cystic fibrosis (CF) and moderate to... more We measured ventilation in all sleep stages in patients with cystic fibrosis (CF) and moderate to severe lung disease, and compared the effects of low-flow oxygen (LFO 2) and bilevel ventilatory support (BVS) on ventilation and gas exchange during sleep. Thirteen subjects, age 26 Ϯ 5.9 yr (mean Ϯ 1 SD), body mass index (BMI) 20 Ϯ 3 kg/m 2 , FEV 1 32 Ϯ 11% predicted, underwent three sleep studies breathing, in random order, room air (RA), LFO 2 , and BVS Ϯ O 2 with recording of oxyhemoglobin saturation (Sp O 2) (%) and transcutaneous carbon dioxide (TcCO 2) (mm Hg). During RA and LFO 2 studies, patients wore a nasal mask with a baseline continuous positive airway pressure (CPAP) of 4 to 5 cm H 2 O. Minute ventilation (I) was measured using a pneumotachograph in the circuit and was not different between wake and non-rapid eye movement (NREM) sleep on any night. However, I was reduced on the RA and LFO 2 nights from awake to rapid eye movement (REM) (p Ͻ 0.01) and from NREM to REM (p Ͻ 0.01). On the BVS night there was no significant difference in I between NREM and REM sleep. Both BVS and LFO 2 improved nocturnal Sp O 2 , especially during REM sleep (p Ͻ 0.05). The rise in TcCO 2 seen with REM sleep with both RA and LFO 2 was attenuated with BVS (p Ͻ 0.05). We conclude that BVS leads to improvements in alveolar ventilation during sleep in this patient group.

Research paper thumbnail of Clinical application of intrapulmonary percussive ventilation: A scoping review

Hong Kong Physiotherapy Journal

Impaired respiratory function secondary to acute or chronic respiratory disease poses a significa... more Impaired respiratory function secondary to acute or chronic respiratory disease poses a significant clinical and healthcare burden. Intrapulmonary percussive ventilation (IPV) is used in various clinical settings to treat excessive airway secretions, pulmonary atelectasis, and impaired gas exchange. Despite IPV’s wide use, there is a lack of clinical guidance on IPV application which may lead to inconsistency in clinical practice. This scoping review aimed to summarise the clinical application methods and dosage of IPV used by clinicians and researchers to provide guidance. A two-staged systematic search was conducted to retrieve studies that used IPV in inpatient and outpatient settings. MEDLINE, EMBASE, CINAHL, Scopus, and Google scholar were searched from January 1979 till 2022. Studies with patients aged ≥16 years and published in any language were included. Two reviewers independently screened the title and abstract, reviewed full text articles, and extracted data. Search yield...

Research paper thumbnail of Survey of Home Cleaning Practices With Noninvasive Ventilation Equipment

Cardiopulmonary physical therapy journal, Nov 7, 2022

Purpose: Home noninvasive ventilation (NIV) equipment is often observed to be dirty, potentially ... more Purpose: Home noninvasive ventilation (NIV) equipment is often observed to be dirty, potentially increasing patients' risk of respiratory infection. This study aimed to describe the cleaning practices of home NIV patients. Methods: This single-site, cross-sectional, observational study surveyed 100 patients from the respiratory failure clinic regarding cleaning instructions, cleaning habits, barriers, and motivators to cleaning. Open-ended responses were analyzed with basic content analysis and closed categorical responses with frequencies and percentages. Results: Of 100 participants, 77% responded. Cleaning instructions most commonly recalled included cleaning with soapy water for masks (26/47, 55%), head straps (19/47, 40%), and tubing (21/47, 45%); vinegar solution for humidifiers (9/39, 23%); and replacing filters (14/39, 36%). Fourteen respondents reported barriers to cleaning, including forgetfulness (7/14, 50%) and physical difficulties (6/14, 43%). Commonly reported cleaning practices included soapy water to soak masks (28/77, 36%) and tubing (35/77, 46%), weekly masks (34/77, 44%) and tubing cleaning (29/77, 38%), vinegar solution to clean humidifiers for the 36 humidifier users (15/36, 44%), monthly humidifier cleaning (13/36, 36%), and monthly filter cleaning/replacement (36/77, 47%). Conclusion: Few respondents could recall specific instructions about when and how to clean their equipment. Many reported routine cleaning, with varied methods and frequencies. Our results will inform future NIV equipment cleaning educational package design.

Research paper thumbnail of Intrapulmonary percussive ventilation in critical care: a systematic review and meta-analysis

Research paper thumbnail of Barriers and facilitators to achieving competence in lung ultrasound: A survey of physiotherapists following a lung ultrasound training course

Australian Critical Care, Jul 1, 2023

Research paper thumbnail of Non‐invasive ventilation versus oxygen therapy in cystic fibrosis: Long‐term effects – Reply

Respirology, Oct 11, 2019

Research paper thumbnail of Interrater reliability in assigning a lung ultrasound score

Australian Critical Care, Nov 1, 2022

Research paper thumbnail of Effect of intrapulmonary percussive ventilation on intensive care unit length of stay, the incidence of pneumonia and gas exchange in critically ill patients: A systematic review

PLOS ONE

Background Pulmonary complications such as pneumonia, pulmonary atelectasis, and subsequent respi... more Background Pulmonary complications such as pneumonia, pulmonary atelectasis, and subsequent respiratory failure leading to ventilatory support are a common occurrence in critically ill patients. Intrapulmonary percussive ventilation (IPV) is used to improve gas exchange and promote airway clearance in these patients. The current evidence regarding the effectiveness of intrapulmonary percussive ventilation in critical care settings remains unclear. This systematic review aims to summarise the evidence of the effectiveness of intrapulmonary percussive ventilation on intensive care unit length of stay (ICU-LOS) and respiratory outcomes in critically ill patients. Research question In critically ill patients, is intrapulmonary percussive ventilation effective in improving respiratory outcomes and reducing intensive care unit length of stay. Methods A systematic search of intrapulmonary percussive ventilation in intensive care unit (ICU) was performed on five databases from 1979 to 2021....

Research paper thumbnail of Lung ultrasound has greater accuracy than conventional respiratory assessment tools for the diagnosis of pleural effusion, lung consolidation and collapse: a systematic review

Journal of Physiotherapy, 2021

QUESTION In mechanically ventilated adults in intensive care, what is the accuracy of lung ultras... more QUESTION In mechanically ventilated adults in intensive care, what is the accuracy of lung ultrasound (LUS) for the diagnosis of pleural effusion, lung consolidation and lung collapse when compared with chest radiograph (CXR) and lung auscultation, with computed tomography (CT) as the reference standard? DESIGN Systematic review with meta-analysis of prospective cohort studies. PARTICIPANTS Adult patients admitted to intensive care, with diagnostic uncertainty at enrolment regarding pleural effusion, lung consolidation and/or collapse/atelectasis. INDEX TEST The diagnostic accuracy of LUS as the index test was estimated against CXR and/or lung auscultation as comparators, with thoracic CT scan as the reference standard. OUTCOME MEASURES Measures of diagnostic accuracy. RESULTS Seven eligible studies were identified, five of which (with 253 participants) were included in the meta-analysis. It was found that LUS had a pooled sensitivity of 92% and 91% in the diagnosis of consolidation and pleural effusion, respectively, and pooled specificity of 92% for both pathologies. CXR had a pooled sensitivity of 53% and 42% and a pooled specificity of 78% and 81% in the diagnosis of consolidation and pleural effusion, respectively. A meta-analysis for lung auscultation was not possible, although a single study reported a sensitivity and specificity of 8% and 100%, respectively, for diagnosing consolidation, and a sensitivity and specificity of 42% and 90%, respectively, for diagnosing pleural effusion. CONCLUSION This systematic review with meta-analysis demonstrated high sensitivity of LUS compared with CXR, with similar specificities when diagnosing pleural effusion and lung consolidation/collapse. REGISTRATION PROSPERO CRD42018095555.

Research paper thumbnail of Measurement of crackles during sleep may have a role to play in titration of positive airway pressure (PAP) modalities in heart failure

Research paper thumbnail of Measurement of snoring and stertor using the Sonomat to assess effectiveness of upper airway surgery in children

Journal of Clinical Sleep Medicine, 2022

Research paper thumbnail of Attendance vs prescription: Exercise attendance rates for people with COPD: Systematic review

European Respiratory Journal, 2012

The duration, frequency, mode and intensity of exercise programs for people with COPD are recomme... more The duration, frequency, mode and intensity of exercise programs for people with COPD are recommended by international consensus statements. The question for this review was: 9How consistently are a priori criterion and attendance rates reported for people with COPD participating in exercise programs?9 A systematic search of CINAHL, Medline, Embase and CENTRAL (Cochrane), was undertaken in October 2011. Studies were eligible for inclusion if published in English, included people with COPD, assessed the effects of rehabilitation as the primary intervention (+/- adjunctive strategies) and included at least 2 weeks exercise training (+/- education). There were no limits placed on intervention site (hospital, community, home) or publication date. Data extraction processes were confirmed prospectively for consistency (>80% agreement), with pairs of reviewers extracting data independently and disagreements resolved by consensus. The search returned 752 citations (497 citations excluded...

Research paper thumbnail of Effects of positive airway pressure (PAP) modalities on central apnea and crackles in heart failure

European Respiratory Journal, 2020

Research paper thumbnail of Feasibility and safety of intrapulmonary percussive ventilation in spontaneously breathing, non-ventilated patients in critical care: A retrospective pilot study

Journal of the Intensive Care Society, 2020

Background Intrapulmonary percussive ventilation is used in various clinical settings to promote ... more Background Intrapulmonary percussive ventilation is used in various clinical settings to promote secretion clearance, reverse or treat atelectasis and improve gas exchange. Despite a few studies reporting the use of intrapulmonary percussive ventilation in critical care, the available data remain insufficient, contributing to weaker evidence toward its effectiveness. Also, there is a paucity of studies evaluating the safety and feasibility of intrapulmonary percussive ventilation application in critical care. This retrospective pilot study has evaluated the safety and feasibility of intrapulmonary percussive ventilation intervention in non-intubated patients admitted to an intensive care unit. Methods The medical records of 35 subjects were reviewed, including 22 subjects who received intrapulmonary percussive ventilation intervention and 13 subjects matched for age, sex, and primary diagnosis who received chest physiotherapy. The records were audited for feasibility, safety, change...

Research paper thumbnail of Bubble‐positive expiratory pressure device and sputum clearance in bronchiectasis: A randomised cross‐over study

Physiotherapy Research International, 2020

OBJECTIVES The bubble-positive expiratory pressure (PEP) device may be used for sputum clearance ... more OBJECTIVES The bubble-positive expiratory pressure (PEP) device may be used for sputum clearance in people with daily sputum production. However, this device has never been studied in people with bronchiectasis. Hence, the objective of this study was to compare the effect of bubble-PEP device, the active cycle of breathing technique (ACBT) and no intervention (control) on sputum clearance in people with bronchiectasis. METHODS This was a prospective, randomised cross-over trial with concealed allocation, assessor blinding and intention-to-treat analysis. Adult participants with stable bronchiectasis and productive of sputum daily were recruited. Participants performed 30-min of bubble-PEP, ACBT or control in random order whilst sitting, followed by 60-min of quiet sitting, on three separate days at the same time within a 10-day period. Primary outcome measure was wet weight of expectorated sputum during 30-min intervention, 60-min post intervention and total wet weight (30 min plus 60 min). RESULTS Thirty-five-participants (11 males, mean [standard deviation] age 75 [8] years, forced expiratory volume in 1 s 72 [20] % predicted) were recruited and 34 completed the study. There was no significant difference in sputum wet weight between bubble-PEP and ACBT during 30-min intervention (mean difference [95% confidence interval]) -0.59 g [-1.37, 0.19] and total wet weight (0.74 g [-0.54, 2.02]). Sputum wet weight was significantly greater in bubble-PEP than ACBT at 60-min post intervention (1.33 g [0.19, 2.47]). CONCLUSION Sputum wet weight was significantly greater with bubble-PEP than control at all time periods, and greater than ACBT at 60-min-post. Bubble-PEP could be considered an alternative sputum clearance technique to ACBT.

Research paper thumbnail of Physiotherapy mobility and walking management of uncomplicated coronary artery bypass graft (CABG) surgery patients: a survey of clinicians’ perspectives in Australia and New Zealand

Physiotherapy Theory and Practice, 2018

ABSTRACT Background: This study aimed to determine current mobility and walking management by phy... more ABSTRACT Background: This study aimed to determine current mobility and walking management by physiotherapists of patients undergoing coronary artery bypass graft (CABG) surgery, the clinical milestones expected and physiotherapists’ perception of the severity of pain experienced by patients after surgery. Design: Cross sectional study using a questionnaire. Methods: All hospitals in Australia and New Zealand that perform cardiac surgery (n = 54) were invited to complete a questionnaire. Findings: Forty-one questionnaires were returned and analysed (response rate 76%). Walking distance was a clinical milestone after CABG surgery. Walking and transferring patients from bed to chair required the most time of physiotherapists during one treatment session. Physiotherapists perceived that patients experienced most pain on day one after surgery [mean (SD)] visual analogue scale (VAS) 41 (16) mm and this reduced by day four to VAS 15 (10) mm. Patients’ pain was perceived to be significantly higher after physiotherapy sessions compared with before (p < 0.01). Thirty-seven respondents (90%) believed that patients’ pain was well managed for physiotherapy treatments. A majority of the respondents (68%) believed that pain was not a limiting factor in the distance patients walked in a physiotherapy session and most (90%) believed that general fatigue limited walk distance. Conclusion: This research provides current mobility and walking management by physiotherapists of patients undergoing CABG surgery in Australia and New Zealand.

Research paper thumbnail of Quantification of changes in lung aeration associated with physiotherapy using lung ultrasound in mechanically ventilated patients: a prospective cohort study

Physiotherapy, Jun 1, 2023

Research paper thumbnail of Therapist-Made Bubble-Positive Expiratory Pressure

Cardiopulmonary physical therapy journal, 2016

Purpose:To determine the current use, rationale for use, and construction of the therapist-made b... more Purpose:To determine the current use, rationale for use, and construction of the therapist-made bubble-positive expiratory pressure (bubble-PEP) device by physiotherapists in Australian public and private hospitals. Methods:Cross-sectional survey of 122 randomly selected Australian hospitals. Physiotherapists employed in these hospitals were invited to participate. Results:Hospital response rate was 88% with 169 participating physiotherapists. Bubble-PEP device was used in 43% of responding hospitals and by 72% of physiotherapists. The rationale for use was to improve secretion clearance (99%) and oxygen saturation (48%) and promote deep breathing (48%). Bubble-PEP device was used for patients with bronchiectasis (86%), pneumonia (74%), chronic obstructive pulmonary disease (70%), and postoperatively (61%). Physiotherapists believed that bubble-PEP device splinted airways open (88%), produced PEP at the mouth (70%), and loosened secretions (66%). Seventy-nine percent of physiotherapists were more likely to use bubble-PEP device than other devices because of accessibility and cost. Materials and methods used to construct bubble-PEP device were a 500-mL plastic bottle (54%), plastic tubing (77%) of 30-cm length (46%), and 10-cm water level (34%). Conclusions:The bubble-PEP device was commonly used by physiotherapists in Australian hospitals to treat respiratory impairments in patients with lung conditions. There was no clear consensus on bubble-PEP device construction.

Research paper thumbnail of Non‐invasive ventilation versus oxygen therapy in cystic fibrosis: A 12‐month randomized trial

Respirology, Jun 17, 2019

Background and objective: No published studies have examined the long-term effects of non-invasiv... more Background and objective: No published studies have examined the long-term effects of non-invasive ventilation (NIV) in cystic fibrosis (CF). Our primary aim was to determine if adults with CF and sleep desaturation were less likely to develop hypercapnia with NIV AE O 2 compared to low-flow oxygen therapy (LFO 2) or meet the criteria for failure of therapy over 12 months. We studied event-free survival, hospitalizations, lung function, arterial blood gases (ABG), sleep quality and health-related quality of life. Methods: A prospective, randomized, parallel group study in adult patients with CF and sleep desaturation was conducted, comparing 12 months of NIV AE O 2 to LFO 2. Event-free survival was defined as participants without events. Events included: failure of therapy with PaCO 2 > 60 mm Hg, or increase in PaCO 2 > 10 mm Hg from baseline, increases in TcCO 2 > 10 mm Hg, lung transplantation or death. Outcomes were measured at baseline, 3, 6 and 12 months, including lung function, ABG, Pittsburgh Sleep Quality Inventory (PSQI), SF36 and hospitalizations. Results: A total of 29 patients were randomized to NIV AE O 2 (n = 14) or LFO 2 (n = 15) therapy for 12 months. Of the 29 patients, 18 met the criteria for event-free survival over 12 months. NIV AE O 2 group had 33% (95% CI: 5-58%) and 46% (95% CI: 10-68%) more event-free survival at 3 and 12 months than LFO 2 group. No statistically significant differences were seen in spirometry, ABG, questionnaires or hospitalizations. Conclusion: NIV AE O 2 during sleep increases event-free survival over 12 months in adults with CF. Further studies are required to determine which subgroups benefit the most from NIV.

Research paper thumbnail of Lung ultrasound has greater accuracy than conventional respiratory assessment tools for the diagnosis of pleural effusion, lung consolidation and collapse: a systematic review

Journal of Physiotherapy, 2021

QUESTION In mechanically ventilated adults in intensive care, what is the accuracy of lung ultras... more QUESTION In mechanically ventilated adults in intensive care, what is the accuracy of lung ultrasound (LUS) for the diagnosis of pleural effusion, lung consolidation and lung collapse when compared with chest radiograph (CXR) and lung auscultation, with computed tomography (CT) as the reference standard? DESIGN Systematic review with meta-analysis of prospective cohort studies. PARTICIPANTS Adult patients admitted to intensive care, with diagnostic uncertainty at enrolment regarding pleural effusion, lung consolidation and/or collapse/atelectasis. INDEX TEST The diagnostic accuracy of LUS as the index test was estimated against CXR and/or lung auscultation as comparators, with thoracic CT scan as the reference standard. OUTCOME MEASURES Measures of diagnostic accuracy. RESULTS Seven eligible studies were identified, five of which (with 253 participants) were included in the meta-analysis. It was found that LUS had a pooled sensitivity of 92% and 91% in the diagnosis of consolidation and pleural effusion, respectively, and pooled specificity of 92% for both pathologies. CXR had a pooled sensitivity of 53% and 42% and a pooled specificity of 78% and 81% in the diagnosis of consolidation and pleural effusion, respectively. A meta-analysis for lung auscultation was not possible, although a single study reported a sensitivity and specificity of 8% and 100%, respectively, for diagnosing consolidation, and a sensitivity and specificity of 42% and 90%, respectively, for diagnosing pleural effusion. CONCLUSION This systematic review with meta-analysis demonstrated high sensitivity of LUS compared with CXR, with similar specificities when diagnosing pleural effusion and lung consolidation/collapse. REGISTRATION PROSPERO CRD42018095555.

Research paper thumbnail of Low-flow Oxygen and Bilevel Ventilatory Support

American Journal of Respiratory and Critical Care Medicine, 2001

We measured ventilation in all sleep stages in patients with cystic fibrosis (CF) and moderate to... more We measured ventilation in all sleep stages in patients with cystic fibrosis (CF) and moderate to severe lung disease, and compared the effects of low-flow oxygen (LFO 2) and bilevel ventilatory support (BVS) on ventilation and gas exchange during sleep. Thirteen subjects, age 26 Ϯ 5.9 yr (mean Ϯ 1 SD), body mass index (BMI) 20 Ϯ 3 kg/m 2 , FEV 1 32 Ϯ 11% predicted, underwent three sleep studies breathing, in random order, room air (RA), LFO 2 , and BVS Ϯ O 2 with recording of oxyhemoglobin saturation (Sp O 2) (%) and transcutaneous carbon dioxide (TcCO 2) (mm Hg). During RA and LFO 2 studies, patients wore a nasal mask with a baseline continuous positive airway pressure (CPAP) of 4 to 5 cm H 2 O. Minute ventilation (I) was measured using a pneumotachograph in the circuit and was not different between wake and non-rapid eye movement (NREM) sleep on any night. However, I was reduced on the RA and LFO 2 nights from awake to rapid eye movement (REM) (p Ͻ 0.01) and from NREM to REM (p Ͻ 0.01). On the BVS night there was no significant difference in I between NREM and REM sleep. Both BVS and LFO 2 improved nocturnal Sp O 2 , especially during REM sleep (p Ͻ 0.05). The rise in TcCO 2 seen with REM sleep with both RA and LFO 2 was attenuated with BVS (p Ͻ 0.05). We conclude that BVS leads to improvements in alveolar ventilation during sleep in this patient group.

Research paper thumbnail of Clinical application of intrapulmonary percussive ventilation: A scoping review

Hong Kong Physiotherapy Journal

Impaired respiratory function secondary to acute or chronic respiratory disease poses a significa... more Impaired respiratory function secondary to acute or chronic respiratory disease poses a significant clinical and healthcare burden. Intrapulmonary percussive ventilation (IPV) is used in various clinical settings to treat excessive airway secretions, pulmonary atelectasis, and impaired gas exchange. Despite IPV’s wide use, there is a lack of clinical guidance on IPV application which may lead to inconsistency in clinical practice. This scoping review aimed to summarise the clinical application methods and dosage of IPV used by clinicians and researchers to provide guidance. A two-staged systematic search was conducted to retrieve studies that used IPV in inpatient and outpatient settings. MEDLINE, EMBASE, CINAHL, Scopus, and Google scholar were searched from January 1979 till 2022. Studies with patients aged ≥16 years and published in any language were included. Two reviewers independently screened the title and abstract, reviewed full text articles, and extracted data. Search yield...

Research paper thumbnail of Survey of Home Cleaning Practices With Noninvasive Ventilation Equipment

Cardiopulmonary physical therapy journal, Nov 7, 2022

Purpose: Home noninvasive ventilation (NIV) equipment is often observed to be dirty, potentially ... more Purpose: Home noninvasive ventilation (NIV) equipment is often observed to be dirty, potentially increasing patients' risk of respiratory infection. This study aimed to describe the cleaning practices of home NIV patients. Methods: This single-site, cross-sectional, observational study surveyed 100 patients from the respiratory failure clinic regarding cleaning instructions, cleaning habits, barriers, and motivators to cleaning. Open-ended responses were analyzed with basic content analysis and closed categorical responses with frequencies and percentages. Results: Of 100 participants, 77% responded. Cleaning instructions most commonly recalled included cleaning with soapy water for masks (26/47, 55%), head straps (19/47, 40%), and tubing (21/47, 45%); vinegar solution for humidifiers (9/39, 23%); and replacing filters (14/39, 36%). Fourteen respondents reported barriers to cleaning, including forgetfulness (7/14, 50%) and physical difficulties (6/14, 43%). Commonly reported cleaning practices included soapy water to soak masks (28/77, 36%) and tubing (35/77, 46%), weekly masks (34/77, 44%) and tubing cleaning (29/77, 38%), vinegar solution to clean humidifiers for the 36 humidifier users (15/36, 44%), monthly humidifier cleaning (13/36, 36%), and monthly filter cleaning/replacement (36/77, 47%). Conclusion: Few respondents could recall specific instructions about when and how to clean their equipment. Many reported routine cleaning, with varied methods and frequencies. Our results will inform future NIV equipment cleaning educational package design.

Research paper thumbnail of Intrapulmonary percussive ventilation in critical care: a systematic review and meta-analysis

Research paper thumbnail of Barriers and facilitators to achieving competence in lung ultrasound: A survey of physiotherapists following a lung ultrasound training course

Australian Critical Care, Jul 1, 2023

Research paper thumbnail of Non‐invasive ventilation versus oxygen therapy in cystic fibrosis: Long‐term effects – Reply

Respirology, Oct 11, 2019

Research paper thumbnail of Interrater reliability in assigning a lung ultrasound score

Australian Critical Care, Nov 1, 2022

Research paper thumbnail of Effect of intrapulmonary percussive ventilation on intensive care unit length of stay, the incidence of pneumonia and gas exchange in critically ill patients: A systematic review

PLOS ONE

Background Pulmonary complications such as pneumonia, pulmonary atelectasis, and subsequent respi... more Background Pulmonary complications such as pneumonia, pulmonary atelectasis, and subsequent respiratory failure leading to ventilatory support are a common occurrence in critically ill patients. Intrapulmonary percussive ventilation (IPV) is used to improve gas exchange and promote airway clearance in these patients. The current evidence regarding the effectiveness of intrapulmonary percussive ventilation in critical care settings remains unclear. This systematic review aims to summarise the evidence of the effectiveness of intrapulmonary percussive ventilation on intensive care unit length of stay (ICU-LOS) and respiratory outcomes in critically ill patients. Research question In critically ill patients, is intrapulmonary percussive ventilation effective in improving respiratory outcomes and reducing intensive care unit length of stay. Methods A systematic search of intrapulmonary percussive ventilation in intensive care unit (ICU) was performed on five databases from 1979 to 2021....

Research paper thumbnail of Lung ultrasound has greater accuracy than conventional respiratory assessment tools for the diagnosis of pleural effusion, lung consolidation and collapse: a systematic review

Journal of Physiotherapy, 2021

QUESTION In mechanically ventilated adults in intensive care, what is the accuracy of lung ultras... more QUESTION In mechanically ventilated adults in intensive care, what is the accuracy of lung ultrasound (LUS) for the diagnosis of pleural effusion, lung consolidation and lung collapse when compared with chest radiograph (CXR) and lung auscultation, with computed tomography (CT) as the reference standard? DESIGN Systematic review with meta-analysis of prospective cohort studies. PARTICIPANTS Adult patients admitted to intensive care, with diagnostic uncertainty at enrolment regarding pleural effusion, lung consolidation and/or collapse/atelectasis. INDEX TEST The diagnostic accuracy of LUS as the index test was estimated against CXR and/or lung auscultation as comparators, with thoracic CT scan as the reference standard. OUTCOME MEASURES Measures of diagnostic accuracy. RESULTS Seven eligible studies were identified, five of which (with 253 participants) were included in the meta-analysis. It was found that LUS had a pooled sensitivity of 92% and 91% in the diagnosis of consolidation and pleural effusion, respectively, and pooled specificity of 92% for both pathologies. CXR had a pooled sensitivity of 53% and 42% and a pooled specificity of 78% and 81% in the diagnosis of consolidation and pleural effusion, respectively. A meta-analysis for lung auscultation was not possible, although a single study reported a sensitivity and specificity of 8% and 100%, respectively, for diagnosing consolidation, and a sensitivity and specificity of 42% and 90%, respectively, for diagnosing pleural effusion. CONCLUSION This systematic review with meta-analysis demonstrated high sensitivity of LUS compared with CXR, with similar specificities when diagnosing pleural effusion and lung consolidation/collapse. REGISTRATION PROSPERO CRD42018095555.

Research paper thumbnail of Measurement of crackles during sleep may have a role to play in titration of positive airway pressure (PAP) modalities in heart failure

Research paper thumbnail of Measurement of snoring and stertor using the Sonomat to assess effectiveness of upper airway surgery in children

Journal of Clinical Sleep Medicine, 2022

Research paper thumbnail of Attendance vs prescription: Exercise attendance rates for people with COPD: Systematic review

European Respiratory Journal, 2012

The duration, frequency, mode and intensity of exercise programs for people with COPD are recomme... more The duration, frequency, mode and intensity of exercise programs for people with COPD are recommended by international consensus statements. The question for this review was: 9How consistently are a priori criterion and attendance rates reported for people with COPD participating in exercise programs?9 A systematic search of CINAHL, Medline, Embase and CENTRAL (Cochrane), was undertaken in October 2011. Studies were eligible for inclusion if published in English, included people with COPD, assessed the effects of rehabilitation as the primary intervention (+/- adjunctive strategies) and included at least 2 weeks exercise training (+/- education). There were no limits placed on intervention site (hospital, community, home) or publication date. Data extraction processes were confirmed prospectively for consistency (>80% agreement), with pairs of reviewers extracting data independently and disagreements resolved by consensus. The search returned 752 citations (497 citations excluded...

Research paper thumbnail of Effects of positive airway pressure (PAP) modalities on central apnea and crackles in heart failure

European Respiratory Journal, 2020

Research paper thumbnail of Feasibility and safety of intrapulmonary percussive ventilation in spontaneously breathing, non-ventilated patients in critical care: A retrospective pilot study

Journal of the Intensive Care Society, 2020

Background Intrapulmonary percussive ventilation is used in various clinical settings to promote ... more Background Intrapulmonary percussive ventilation is used in various clinical settings to promote secretion clearance, reverse or treat atelectasis and improve gas exchange. Despite a few studies reporting the use of intrapulmonary percussive ventilation in critical care, the available data remain insufficient, contributing to weaker evidence toward its effectiveness. Also, there is a paucity of studies evaluating the safety and feasibility of intrapulmonary percussive ventilation application in critical care. This retrospective pilot study has evaluated the safety and feasibility of intrapulmonary percussive ventilation intervention in non-intubated patients admitted to an intensive care unit. Methods The medical records of 35 subjects were reviewed, including 22 subjects who received intrapulmonary percussive ventilation intervention and 13 subjects matched for age, sex, and primary diagnosis who received chest physiotherapy. The records were audited for feasibility, safety, change...

Research paper thumbnail of Bubble‐positive expiratory pressure device and sputum clearance in bronchiectasis: A randomised cross‐over study

Physiotherapy Research International, 2020

OBJECTIVES The bubble-positive expiratory pressure (PEP) device may be used for sputum clearance ... more OBJECTIVES The bubble-positive expiratory pressure (PEP) device may be used for sputum clearance in people with daily sputum production. However, this device has never been studied in people with bronchiectasis. Hence, the objective of this study was to compare the effect of bubble-PEP device, the active cycle of breathing technique (ACBT) and no intervention (control) on sputum clearance in people with bronchiectasis. METHODS This was a prospective, randomised cross-over trial with concealed allocation, assessor blinding and intention-to-treat analysis. Adult participants with stable bronchiectasis and productive of sputum daily were recruited. Participants performed 30-min of bubble-PEP, ACBT or control in random order whilst sitting, followed by 60-min of quiet sitting, on three separate days at the same time within a 10-day period. Primary outcome measure was wet weight of expectorated sputum during 30-min intervention, 60-min post intervention and total wet weight (30 min plus 60 min). RESULTS Thirty-five-participants (11 males, mean [standard deviation] age 75 [8] years, forced expiratory volume in 1 s 72 [20] % predicted) were recruited and 34 completed the study. There was no significant difference in sputum wet weight between bubble-PEP and ACBT during 30-min intervention (mean difference [95% confidence interval]) -0.59 g [-1.37, 0.19] and total wet weight (0.74 g [-0.54, 2.02]). Sputum wet weight was significantly greater in bubble-PEP than ACBT at 60-min post intervention (1.33 g [0.19, 2.47]). CONCLUSION Sputum wet weight was significantly greater with bubble-PEP than control at all time periods, and greater than ACBT at 60-min-post. Bubble-PEP could be considered an alternative sputum clearance technique to ACBT.

Research paper thumbnail of Physiotherapy mobility and walking management of uncomplicated coronary artery bypass graft (CABG) surgery patients: a survey of clinicians’ perspectives in Australia and New Zealand

Physiotherapy Theory and Practice, 2018

ABSTRACT Background: This study aimed to determine current mobility and walking management by phy... more ABSTRACT Background: This study aimed to determine current mobility and walking management by physiotherapists of patients undergoing coronary artery bypass graft (CABG) surgery, the clinical milestones expected and physiotherapists’ perception of the severity of pain experienced by patients after surgery. Design: Cross sectional study using a questionnaire. Methods: All hospitals in Australia and New Zealand that perform cardiac surgery (n = 54) were invited to complete a questionnaire. Findings: Forty-one questionnaires were returned and analysed (response rate 76%). Walking distance was a clinical milestone after CABG surgery. Walking and transferring patients from bed to chair required the most time of physiotherapists during one treatment session. Physiotherapists perceived that patients experienced most pain on day one after surgery [mean (SD)] visual analogue scale (VAS) 41 (16) mm and this reduced by day four to VAS 15 (10) mm. Patients’ pain was perceived to be significantly higher after physiotherapy sessions compared with before (p < 0.01). Thirty-seven respondents (90%) believed that patients’ pain was well managed for physiotherapy treatments. A majority of the respondents (68%) believed that pain was not a limiting factor in the distance patients walked in a physiotherapy session and most (90%) believed that general fatigue limited walk distance. Conclusion: This research provides current mobility and walking management by physiotherapists of patients undergoing CABG surgery in Australia and New Zealand.