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Rehabilitation and Chronic Care
The European respiratory journal, 2017
Multidisciplinary Respiratory Medicine, 2017
Information and Communication Technologies applied to health care and advances in sensor and data... more Information and Communication Technologies applied to health care and advances in sensor and data transmission technology allowed tele-medicine based programs of care also for patients with respiratory diseases. Different sensors, transmission devices and interventions are used in tele-medicine for some indications. Patients suffering from Chronic Obstructive Pulmonary Disease, asthma, neuromuscular diseases, ventilator assisted individuals and those undergoing pulmonary rehabilitation programs may benefit from this approach. The legal problems are still unsolved. Economic advantages for health care systems, though potentially high, are still poorly investigated. Despite the hopes, we need more evidence before this modality can be considered as a real progress in the management of patients with respiratory diseases. On one hand, these technologies can improve the care of patients with difficult access to services, particularly those in rural/remote areas, on the other hand, there is the risk that they will be used only to reduce standard services in health systems of developed countries.
Postoperative pulmonary complications (PPC) are a major cause of morbidity, mortality, prolonged ... more Postoperative pulmonary complications (PPC) are a major cause of morbidity, mortality, prolonged hospital stay, and increased cost of care. Physiotherapy programs in post-surgical and critical area patients are aimed to reduce the risks of PPC due to long-term bed-rest, to improve the patient’s quality of life and residual function, and to avoid new hospitalisations. At this purpose, PT programs apply advanced cost-effective therapeutic modalities to decrease complications and patient’s ventilator-dependency. Strategies to reduce PPC include monitoring and reduction of risk factors, improving preoperative status, patient education, smoking cessation, intraoperative and postoperative pulmonary care. Different PT techniques, as a part of the comprehensive management of patients undergoing cardiac, upper abdominal, and thoracic surgery, may prevent and treat PPC such as secretion retention, atelectasis, and pneumonia.
Minerva anestesiologica, 2013
Survival of critically ill patients is frequently associated with significant functional impairme... more Survival of critically ill patients is frequently associated with significant functional impairment and reduced health-related quality of life. Early physiotherapy of acute respiratory distress syndrome (ARDS) patients has recently been identified as an important therapeutical tool and has become an important evidence-based component in the management of these patients. Nevertheless, availability and quality of physiotherapy performed in intensive care units (ICUs) is often inadequate. The aim of this review is to describe recent progresses in application of physiotherapy in ARDS patients. The assessment and evidence-based treatment of these patients should include prevention and reduction of adverse consequences of immobilization and weaning failure. A variety of modalities of early physiotherapy in ICU are suggested by clinical research and should be applied according to the stage of disease, comorbidities, and patient's level of cooperation. Early ICU physiotherapy is an inte...
Noninvasive Ventilation in High-Risk Infections and Mass Casualty Events, 2013
Body: To evaluate the outcomes of a cohort of prolonged weaning patients after thoracic and cardi... more Body: To evaluate the outcomes of a cohort of prolonged weaning patients after thoracic and cardiac surgery, treated in a specialized weaning centre, we retrospectively analyzed characteristics and outcome of patients consecutively admitted to our regional Weaning Center (WC) since December 2007 to August 2012 (56 months). Among overall 585 patients (337 males, age 70.7±11.7yrs, range 18.8-93.9yrs), 35 patients (17 males; age 73.0±10.1yrs, range 43.4-86.2yrs) after isolated (valve replacement or myocardial revascularization) or combined (both) surgery were also admitted. Twelve patients had undergone emergency surgery; ICU Length of stay had been 56.5±32.0 days. Apache II score at WC admission was 13.5±5.8; SAPS score 35.9±8.6, Charlson score 6.8±2.7, PaO2/FiO2 242.2±88.1. The weaning success rate was 65.7% (23 patients), 20 of them being decannulated. Two patients were transferred to ICU for complications, and 6 patients (17.1%) needed prolonged invasive mechanical ventilation at discharge from WC. The WC length of stay was 26.8±11.3 days, the overall mortality rate was 11.4% (4/35). Lower weaning rate (7/16 vs. 16/19; p=0.03) and a tendence to higher mortality (3/16 vs. 1/19; p= n.s.) were observed in combined surgery group. Survival at 6 months is shown in Figure 1. These results suggest the usefulness of dedicated weaning centers for difficult-to wean patients undergone cardiac surgery.
Body: Interactive game-based systems, such as Wii Fit™, represent innovative technologies potenti... more Body: Interactive game-based systems, such as Wii Fit™, represent innovative technologies potentially able to increase the effectiveness of Pulmonary Rehabilitation Programmes (PRP). Aim: to evaluate the effectiveness of interactive game-based exercises in addition to PRP. Twenty six patients with chronic lung disease (17 COPD), undergoing a 3 week PRP were prospectively enrolled and randomly submitted to the usual PRP (Control Group: CG) or to PRP + 7 sessions of exercises with Wii Fit™ including Yoga, Muscle Exercises, Aerobic Exercises, and Training Plus (Study Group: SG). Before (T0) and after PRP (T1) we evaluated: maximum inspiratory and expiratory pressure (MIP, MEP), dyspnoea (MRC and Borg Scale), fatigue (Borg Scale), Six-Minute Walking Test (6MWT), leg-and arm-cycle ergometry, Functional Independence Measure (FIM), Baseline (BDI) and Transitional (TDI) dyspnoea index. As expected, both groups showed a significant improvement in exercise tolerance, dyspnoea and health status. In SG compared to CG were found: 1) A greater improvement in dyspnoea as assessed by TDI (3.9±1.5 vs. 2.4±1.0, respectively; p=0.01) 2) A reduced dyspnoea (4.5±1.0 vs. 6.3±1.3; p=0.003) and fatigue (5.4±1.6 vs. 6.8±1.4; p=0.04) during arm exercise Rehabilitation treatment with Wii Fit ™ balance board can be useful as an additional tool to standard PRP in improving dyspnoea and arm exercise tolerance in chronic pulmonary disease. Practical advantages include ability to train at home with or without remote supervision, enjoyability, real-time feedback on performance, healthcare costs reduction. Larger prospective randomized trials are needed to confirm these preliminary results.
Multidisciplinary Respiratory Medicine, 2013
Postoperative pulmonary complications (PPC) are a major cause of morbidity, mortality, prolonged ... more Postoperative pulmonary complications (PPC) are a major cause of morbidity, mortality, prolonged hospital stay, and increased cost of care. Physiotherapy (PT) programs in post-surgical and critical area patients are aimed to reduce the risks of PPC due to long-term bed-rest, to improve the patient's quality of life and residual function, and to avoid new hospitalizations. At this purpose, PT programs apply advanced cost-effective therapeutic modalities to decrease complications and patient's ventilator-dependency. Strategies to reduce PPC include monitoring and reduction of risk factors, improving preoperative status, patient education, smoking cessation, intra-operative and postoperative pulmonary care. Different PT techniques, as a part of the comprehensive management of patients undergoing cardiac, upper abdominal, and thoracic surgery, may prevent and treat PPC such as secretion retention, atelectasis, and pneumonia.
Rehabilitation and Chronic Care
The European respiratory journal, 2017
Multidisciplinary Respiratory Medicine, 2017
Information and Communication Technologies applied to health care and advances in sensor and data... more Information and Communication Technologies applied to health care and advances in sensor and data transmission technology allowed tele-medicine based programs of care also for patients with respiratory diseases. Different sensors, transmission devices and interventions are used in tele-medicine for some indications. Patients suffering from Chronic Obstructive Pulmonary Disease, asthma, neuromuscular diseases, ventilator assisted individuals and those undergoing pulmonary rehabilitation programs may benefit from this approach. The legal problems are still unsolved. Economic advantages for health care systems, though potentially high, are still poorly investigated. Despite the hopes, we need more evidence before this modality can be considered as a real progress in the management of patients with respiratory diseases. On one hand, these technologies can improve the care of patients with difficult access to services, particularly those in rural/remote areas, on the other hand, there is the risk that they will be used only to reduce standard services in health systems of developed countries.
Postoperative pulmonary complications (PPC) are a major cause of morbidity, mortality, prolonged ... more Postoperative pulmonary complications (PPC) are a major cause of morbidity, mortality, prolonged hospital stay, and increased cost of care. Physiotherapy programs in post-surgical and critical area patients are aimed to reduce the risks of PPC due to long-term bed-rest, to improve the patient’s quality of life and residual function, and to avoid new hospitalisations. At this purpose, PT programs apply advanced cost-effective therapeutic modalities to decrease complications and patient’s ventilator-dependency. Strategies to reduce PPC include monitoring and reduction of risk factors, improving preoperative status, patient education, smoking cessation, intraoperative and postoperative pulmonary care. Different PT techniques, as a part of the comprehensive management of patients undergoing cardiac, upper abdominal, and thoracic surgery, may prevent and treat PPC such as secretion retention, atelectasis, and pneumonia.
Minerva anestesiologica, 2013
Survival of critically ill patients is frequently associated with significant functional impairme... more Survival of critically ill patients is frequently associated with significant functional impairment and reduced health-related quality of life. Early physiotherapy of acute respiratory distress syndrome (ARDS) patients has recently been identified as an important therapeutical tool and has become an important evidence-based component in the management of these patients. Nevertheless, availability and quality of physiotherapy performed in intensive care units (ICUs) is often inadequate. The aim of this review is to describe recent progresses in application of physiotherapy in ARDS patients. The assessment and evidence-based treatment of these patients should include prevention and reduction of adverse consequences of immobilization and weaning failure. A variety of modalities of early physiotherapy in ICU are suggested by clinical research and should be applied according to the stage of disease, comorbidities, and patient's level of cooperation. Early ICU physiotherapy is an inte...
Noninvasive Ventilation in High-Risk Infections and Mass Casualty Events, 2013
Body: To evaluate the outcomes of a cohort of prolonged weaning patients after thoracic and cardi... more Body: To evaluate the outcomes of a cohort of prolonged weaning patients after thoracic and cardiac surgery, treated in a specialized weaning centre, we retrospectively analyzed characteristics and outcome of patients consecutively admitted to our regional Weaning Center (WC) since December 2007 to August 2012 (56 months). Among overall 585 patients (337 males, age 70.7±11.7yrs, range 18.8-93.9yrs), 35 patients (17 males; age 73.0±10.1yrs, range 43.4-86.2yrs) after isolated (valve replacement or myocardial revascularization) or combined (both) surgery were also admitted. Twelve patients had undergone emergency surgery; ICU Length of stay had been 56.5±32.0 days. Apache II score at WC admission was 13.5±5.8; SAPS score 35.9±8.6, Charlson score 6.8±2.7, PaO2/FiO2 242.2±88.1. The weaning success rate was 65.7% (23 patients), 20 of them being decannulated. Two patients were transferred to ICU for complications, and 6 patients (17.1%) needed prolonged invasive mechanical ventilation at discharge from WC. The WC length of stay was 26.8±11.3 days, the overall mortality rate was 11.4% (4/35). Lower weaning rate (7/16 vs. 16/19; p=0.03) and a tendence to higher mortality (3/16 vs. 1/19; p= n.s.) were observed in combined surgery group. Survival at 6 months is shown in Figure 1. These results suggest the usefulness of dedicated weaning centers for difficult-to wean patients undergone cardiac surgery.
Body: Interactive game-based systems, such as Wii Fit™, represent innovative technologies potenti... more Body: Interactive game-based systems, such as Wii Fit™, represent innovative technologies potentially able to increase the effectiveness of Pulmonary Rehabilitation Programmes (PRP). Aim: to evaluate the effectiveness of interactive game-based exercises in addition to PRP. Twenty six patients with chronic lung disease (17 COPD), undergoing a 3 week PRP were prospectively enrolled and randomly submitted to the usual PRP (Control Group: CG) or to PRP + 7 sessions of exercises with Wii Fit™ including Yoga, Muscle Exercises, Aerobic Exercises, and Training Plus (Study Group: SG). Before (T0) and after PRP (T1) we evaluated: maximum inspiratory and expiratory pressure (MIP, MEP), dyspnoea (MRC and Borg Scale), fatigue (Borg Scale), Six-Minute Walking Test (6MWT), leg-and arm-cycle ergometry, Functional Independence Measure (FIM), Baseline (BDI) and Transitional (TDI) dyspnoea index. As expected, both groups showed a significant improvement in exercise tolerance, dyspnoea and health status. In SG compared to CG were found: 1) A greater improvement in dyspnoea as assessed by TDI (3.9±1.5 vs. 2.4±1.0, respectively; p=0.01) 2) A reduced dyspnoea (4.5±1.0 vs. 6.3±1.3; p=0.003) and fatigue (5.4±1.6 vs. 6.8±1.4; p=0.04) during arm exercise Rehabilitation treatment with Wii Fit ™ balance board can be useful as an additional tool to standard PRP in improving dyspnoea and arm exercise tolerance in chronic pulmonary disease. Practical advantages include ability to train at home with or without remote supervision, enjoyability, real-time feedback on performance, healthcare costs reduction. Larger prospective randomized trials are needed to confirm these preliminary results.
Multidisciplinary Respiratory Medicine, 2013
Postoperative pulmonary complications (PPC) are a major cause of morbidity, mortality, prolonged ... more Postoperative pulmonary complications (PPC) are a major cause of morbidity, mortality, prolonged hospital stay, and increased cost of care. Physiotherapy (PT) programs in post-surgical and critical area patients are aimed to reduce the risks of PPC due to long-term bed-rest, to improve the patient's quality of life and residual function, and to avoid new hospitalizations. At this purpose, PT programs apply advanced cost-effective therapeutic modalities to decrease complications and patient's ventilator-dependency. Strategies to reduce PPC include monitoring and reduction of risk factors, improving preoperative status, patient education, smoking cessation, intra-operative and postoperative pulmonary care. Different PT techniques, as a part of the comprehensive management of patients undergoing cardiac, upper abdominal, and thoracic surgery, may prevent and treat PPC such as secretion retention, atelectasis, and pneumonia.