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The G5 Vibration Sputum Discharge Apparatus and the hand sputum elimination method comparative study in the ICU (Paper)

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Objective: To discuss the Vibration Sputum Discharge Apparatus clinical effect in the ICU critical patients.  Methods: Forty patients who are the SpO2 less the 90% randomly, then separate to two teams called the experimental and matched group with 20 patients separately. The experimental group is applied the apparatus for sputum discharge, the other one is adopting the hand sputum elimination, and comparison the chest auscultation, SpO2, PaO2, pulse rate, Resp, hawking and sputum suction amount. Results:  No matter rapping, vibration or using both two, both can stimulate the patient cough mechanism, if connecting with the valuable position could get better effects, and it can be promotion on clinical scope.

[Keywords]Vibration sputum discharge apparatus   Hand sputum elimination method   ICU      Critical patient    Sputum elimination

They are critical patients who are with the major operation and general anesthesia in the ICU room, such as brain/chest serious trauma, important organ function failure, poisoning, coma and etc. and in the ICU the coma patient is about 30% and the incompletion sober after the general anesthesia is about 30%, some of them are with endotracheal intubation or tracheostomy, and some are mechanical ventilation, so that they are wick with autonomous sputum discharge, and with various monitoring pipe and drainage, not only difficult turn over, but also difficult pat body for discharging sputum, and it will cause the serious health complication(pulmonary infection) easily. Effect elimination and movement the excreta and metabolic waste timely, it is the key to reduce the pulmonary infection cases [1]. We had been introduced the American G5 Therassist Sputum Discharge Apparatus in the ICU of 2003, and application on the clinic with the obvious results (though the inspection have not found the similar study), we will give the 40 patients comprehension reports:

1 Data and Method

1.1 General data

40 samples were excessive phlegm, both beneath pulmonary respiration sound down, the SpO2 were less 90%, then separate to two teams, called apparatus team (20 samples) and hand team (20 samples), the ages were between 18-70 years old, and the men and female were both 20 samples, and both team have 10 coma samples, sober and could dependent coughing patients 10 samples, except the exterior lung gas exchange function obstacles, subcutaneous infection, lung tumor, phthisis, lung abscess, pulmonary embolism, empsyxis , hemorrhagic disorders or bad clotting mechanism patients.

1.2 Operational Method

1.2.1 Apparatus team

When operation the patients were keeping lateral/semireclining/horizontal position, selecting appropriate therapy head, then connecting with the connector and put the head on the thorax or lung inferior lobe for 30s, then up the head on the other place for tapping, from down to up and exterior to interior all around the lung and rib areas, keep slow and order movement, where is beneath leaf segment and pulmonary infection parts need longer time and heavier pressure for making the sputum shaking drop from the bronchiole flowing to the bigger bronchus then the sputum stimulating the coughing pivot for helping patient eliminating the sputum. Who are extreme weak, immovable and unable turn over patients, depending on the actual situation, changing the suitable heads.

1.2.2 Hand team

When operation the patients were keeping lateral/semireclining/horizontal position, then bending the fingers make the hand have an empty space, put the hand tapping the patient low leaf segment from down to top make the sputum from the surround to center air passage [2],the rate was keeping 20min/times~30min/times, using the vibration elimination the sputum. Sheet 1  Two team patients general data (omit)  Note: The application is SPSS software, the average age was passing the t inspection, the others items were passing X2 treatment.

2  Results

After treatment the PaO2, SpO2, heart rate,Resp, pulmonary respiration sounds, expectation and expectoration amount as comparison indexes, the result reflect the apparatus team was better than the other one obviously, P<0.05 the difference is obvious, see the sheet 2.  The sheet 2   the apparatus team and hand team , the prior treatment and after treatment comparison on the PaO2, SpO2, heart rate,Resp (Omit)

Depend on the sheet 2, the apparatus team about the breath sounds from murmur to none was obviously, sucking and assistance sputum amount was increasing, and the sober patient selfreport ability were better than the hand team.

3  Discuss

3.1 Vibration Sputum Discharge Apparatus

It is applied 20 years in abroad, entered the China market since the Jan. 2003, and its therapy effects, there are no any reported papers, our experience is the American G5 Therassist apparatus with many advantages, such as reasonable design, simple operation, flexible movement, unique low-frequency vibration, deep penetration, tapping-vibration connectable etc., effectively eliminating the patient sputum where are in the air capi-llary, connecting with the spasmolysis and promoting plasmocyte excretive activity, it has obvious advantage on keeping the respiratory tract clear, and filled the medical empty area. The non-invasive and soft vibration action bring the comfortable and effective to the patient, and with unlimited position for multi-type patients.

3.2The sputum discharge obstacle and adverse effect

When the respiratory tract mucosa got injured (long time trachea cannule, inhalation gas, respiratory tract burn etc.), mucosa epithelial cell squamous epithelium metaplasia which make cilium less or hypomotility, the secreta viscosity increase (patients dehydration, respiratory tract infection, long-term inhalation dry gas, etc.), respiratory tract grume delivery system sputum scavenging action lower, and there are many reasons caused the respiratory tract secretaropinese, scab and exclude difficulty, the sputum will gather in the tract, causing the grume blocking the tract, lung leaflet or alveolar tiny and no open situation, obstacle the ventilator function seriously, and final causing the patient with dyspnea seriously and even suffocate. The sputum caused respiratory tract jam, and leading the gas uneven distribution in the lung, gas and bleed ratio imbalance, aggravate anoxia. At the situation, the oxygenic therapeutic effect is reducing. In the well medium, the ejectment unsmooth is promoting the bacteric multiply and grow, and the creative inflammation and exacerbation, even mucous membrane, organization necrosis fall off and trachea penetration.

3.3 Measures for promoting sputum elimination

There are several main measurements for promoting sputum elimination in the clinic. The applied promoting medicine: using the medicine; encourage the patient coughing and strength the cough training:  for coughing patient the standing and sitting situation with better effective, for no coughing or incapable coughing patient need postural drainage or tracheal bronchus attract; hand or apparatus sputum elimination: the hand way need professional people to do and could not reach the sputum discharge effects obviously. The apparatus do not need the professional man, and the effective is much better than the hand way.。

3.4  TheApparatus Main Function

There are two force during operation, vibration and tapping. The vibration could make the bronchiectasia, lymphangiectasis, weasandtrafficability characteristic strengthen, secreta absorb strengthen. The tapping with the vertical force could slack, crush, fall off the stick secreta. The tapping effect could stimulate the plasmocyte, attenuation sputum, excitor terminal, reinforce the cilium wriggle, ejectment sputum, stimulate coughing expectoration sputum. So the apparatus the main effects are promoting secreta and sputum elimination, clear the bronchus smooth muscle spasm, remove edema, alleviate block, perfect breath sounds, enhance SpO2 concentration, relieve the lung infection, etc..

3.5  The Apparatus Main Application and Contraindication

The application: Post-operated patients, Bronchiectasia, Asthma, Chronic Bronchitis, Chronic Obstructive Emphysema, Acute Pneumonia, Lung Cystic Fiber Lesion, Geriatric, Tracheotomy, Preoperative Clean, Coma, Burn, Respiratory Failure. The contraindication: Skin and Subcutaneous Infection, Lung Tumor and Vascular Malformation, Phthisis, Pneumothorax and Pleural Effusion, Chest Wall Disease, Pulmonary Abscess, Pulmonary Abscess, Hemorrhagic Disorders or Clotting Mechanism with Abnormal Bleeding Tendency, Lung Clothing, Empsyxis and Hemoptysis, Unable with Vibration Patients.

4  Results

The clinic worker think that the respiratory tract grume tumor is the important reason which causing the lung infection at present, the tracth is attacking by the outside frequently, even with many antibiotic and self-inflammatory response, the bacteria could not be removing, the reason is the bacteria is wrapped by the tract mucous membrane. The neutrophilic granulocyte is stimulating the tract mucous membrane secretion. And someone describe the tract secreta look like the porridge with lactone amine zymic which creating the benefit condition for the bacteria parasitism and multiply in the tract. The tract grume blocking is infecting the lung ventilator function, so eliminating the tract secreta is one of the important way to prevention and treatment lung infection and pulmonary atelectasis. The G5 apparatus could eliminate the secreta by the difference heads effectively, for the treating lung parts giving accurate taping and efficient lung leaf vibration, not only could stimulate the patient coughing mechanism, but also facilitate the tract ciliary exercise. It was shorting the disease course, lower the treatment fee and release the medical staff labour intensity, so that become the good helper.

Through the 40 samples application results, no matter tapping or vibration or both of them, all can stimulate the patient coughing mechanism, and connect with the available position, the results is difference and worth for promoting on the clinic.

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