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In vivo studies of physiotherapy on tissue oxygenation
Başlık:
In vivo studies of physiotherapy on tissue oxygenation
Yazar:
Birks, Susan E., author.
ISBN:
9780438043459
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (324 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 76-08C.
Özet:
In a previous study, leading to an M.Sc. degree from this University, I showed that chest physiotherapy regimes employed on the Intensive Care Unit (ICU) in patients mechanically ventilated with a diagnosis of Acute Respiratory Distress Syndrome (ARDS) could lead to changes in peripheral plasma lactate concentration in a way that suggested poor tissue oxygenation. Others have noticed a similar deterioration in some patients in a variety of other clinical situations. The hypothesis to be tested in this thesis was based on these observations and states "Currently employed chest physical therapy may lead to a reduction in tissue oxygenation that can be prevented or managed if greater information were available to the practitioner". Reports in the literature indicate that changes in position may be the most important single factor leading to alterations in physiological parameters. The problem encountered by the practitioner is in recognising which patients will respond badly to changes in position with or without physiotherapy manoeuvres. Clinical assessment may pick up changes but only late and the complex technology available on the ICU is inappropriate in ambulant or ordinarily hospitalised patients, which inhibits the introduction of objective, evidence-based clinical practice. The objectives of the studies presented in this thesis were to investigate and test methods that allow simple objective measurements of "patient condition" that could be applied in clinical practice and to see whether they might be employed to alter patient management. The literature is full of studies that have examined the complex inter-relationships between posture, physiotherapy, cardiac and/or pulmonary function and it is stated that measuring the effect of position change or other parameter on cardiorespiratory function is difficult because of the complexity of these interactions. After literature review a proposal was made, which is the basic premise of this study, that improved peripheral oxygen delivery is the most important end effect of chest physical therapy and one that can be used as the major outcome parameter of the techniques employed without need to understand the intermediate steps that may be affected by the techniques. The studies presented here examined the validity of two instruments, a Radiometer TCM3 and Space Labs Pulse Oximeter in assessing meaningful alterations in this parameter. The TCM3 gave the values of the oxygen tension within trunk skin which paralleled arterial blood gas measurements and the Pulse Oximeter, applied to a finger, supplied oxygen saturation measurements. The TCM3 has been used to extend the observations from my original study on patients with ARDS and to investigate patients with Chronic Obstructive Obstructive Disease (COAD). The major findings are that patients with ARDS respond in a certain way to position changes that has lead to alterations in positional management of patient on the ICU at Trafford General Hospital. Patients with COAD fall into two groups; 20% who respond with a fall in tissue oxygenation to position change and 80% who respond in the same way as normal controls. A very preliminary study has suggested that it is simple to identify the 20% of poor responders and that they may benefit from oxygen treatment during chest physiotherapy. The observations in this necessarily limited study show how evidence-based physiotherapy practice could be established and specifically indicate that if peripheral oxygen measurement is employed as part of early patient assessment, chest physiotherapy practice can be changed to the advantage of the patient.
Notlar:
School code: 1543
Tüzel Kişi Ek Girişi:
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(684282.1) | 684282-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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