Effects of Respiratory Therapy (bagging) on Respiratory Function, Swallowing Frequency and Vigilance in Tracheotomized Patients in Early Neurorehabilitation^[*]

Abstract

Objective: Tracheotomized patients often suffer from impairments in mucociliary clearance and limited capacities for active expectoration of secretions. We investigated the effects of a specific respiratory intervention method (bagging) for tracheotomized patients on respiratory parameters (pO₂, pCO_2, SpO_2, respiratory rates), swallowing frequency, vigilance and secretion viscosity. Methods: The bagging method supports enforced mobilization and expectoration of secretions by application of a series of manual hyperinflations with a resuscitation bag during active inspiration and manual cough support on the chest. 30 tracheotomized neurological patients participated in a multiple-baseline study including a three-weeks intervention period and a follow-up measurement three weeks after termination of the treatment. Results: Most outcome parameters improved significantly during the intervention period: pO₂ (p < .01), SpO₂ (p < .01), respiratory rates (p < .01), swallowing rates (p < .01), and vigilance scores (p < .01). The quality of bronchial secretions improved in all participants. All effects were sustained up to the follow-up measurements. Conclusion: This preliminary data indicates positive effects for a respiratory intervention method (bagging) on respiratory function and additional respiration-related functions in tracheotomized neurological patients. This easy-to-learn and inexpensive method might expand the range of treatment options for tracheotomized and non-responsive patients.

Zusammenfassung

Ziel: Bei tracheotomierten Patienten sind die mucociliäre Clearance und die Möglichkeiten zur aktiven Sekretexpektoration eingeschränkt. Wir untersuchten Effekte einer spezifischen atemtherapeutischen Methode (Bagging) für tracheotomierte Patienten auf respiratorische Funktionsparameter (PCO₂, PO₂, SPO₂, Atemfrequenz, bronchiale Sekretqualität), die Schluckfrequenz und die Vigilanz. Methoden: Die Bagging-Methode unterstützt die Mobilisation und Expektoration von Bronchialsekret durch Anwendung von manueller Hyperinflation und nachfolgender thorakaler Hustenunterstützung. In einer Multiple-Baseline-Studie mit Follow-up-Messung erhielten 30 tracheotomierte neurologische Patienten über einen Zeitraum von 3 Wochen täglich eine Bagging Anwendung. Ergebnisse: In fast allen Parametern zeigten sich nach der Intervention signifikante Verbesserungen: pO₂ (p < .01), SpO₂ (p < .01), Atemfrequenz (p < .01), Schluckfrequenz (p < .01) und Vigilanz (p < .01). Die Viskosität des Bronchialsekrets veränderte sich bei allen Patienten positiv. Alle Therapieeffekte waren zur Follow-up-Messung stabil. Schlussfolgerung: Diese ersten Daten zeigen positive Effekte einer spezifischen Atemtherapie für tracheotomierte neurologische Patienten auf Atemfunktion und weitere Funktionsbereiche. Durch diese kostengünstige und leicht zu erlernende Methode kann das Spektrum atemtherapeutischer Behandlungsmöglichkeiten für tracheotomierte Patienten effektiv ergänzt werden.

^* This study was presented (oral presentation) at the Annual Meeting of the German Interdisciplinary Society for Dysphagia (Deutsche interdisziplinäre Gesellschaft für Dysphagie), Hamburg, Germany, April 3^rd – 5^th 2014 and at the 8^th Annual Meeting of the Patholinguistic Society (8. Herbsttreffen des Verbandes für Patholinguistik) (poster presentation).
The german abstract will be published in the conference proceedings of the 8^th Annual Meeting of the Patholinguistic Society (8. Herbsttreffen des Verbandes für Patholinguistik) (Spektrum Patholinguistik 8, in press).
The study was supported by a grant by the “Stiftung für Forschung und Evaluation in der Physiotherapie des Deutschen Verbandes für Physiotherapie (ZVK)” (Foundation to support research and evaluation in physiotherapy).

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