CBL Pulmonology Flashcards
MOPSE study general
Multi-center osteopathic pneumonia study for elderly
Conducted in early 2000s
Double-blinded study, randomized and controlled
Had three groups
1) OMT: patients received OMT twice daily for 15 min
2) light touch: patients received light touch at identical body regions as OMT for 15 minutes twice daily
3) no OMT: conservative care only
How did the MOPSE study measure effectiveness?
Measured time to clinical stability in ICU elderly patients using OMT and not using OMT Clinical stability time was Measured when the following factors all occurred - lowest systolic BP > 90 BP - highest heart rate <100 - highest respiratory rate <24 - highest temperature <38C - lowest oxygen sat > 90% - ability to eat - mental status back to normal levels
Also measured symptomatic and functional recovery score (SFRS) on days 1/14/30/60
- higher the score, worse the symptoms
SFRS score was calculated from the following
- cough
- dyspnea
- sputum production
- pleuritic chest pain
- fatigue
MORPSE study induction criteria
Age > 50
New pulmonary infiltrate on x-ray
Needed at least 2 of the following
- new increased cough
- fever > 38C
- pleuritic chest pain
- new findings on physical examination
- RR > 25 breaths
- mental status change
- WBC > 12,000
MORPSE exclusion criteria
Nosocomial pneumonia (HAP)
Advancing pulmonary fibrosis
Bronchiectasis
pulmonary TB
Lung cancer
Metastatic cancer
Acute rib fracture
A true vertebral fracture
Already praticipated previously
MORPSE protocol for treatment
Could use these techniques only
- thoracolumbar ST
- rib raising
- Cervical ST
- sub occipital decompression
- thoracic inlet myofascial release
- thoracic lymphatic pump
- pedal lymphatic pump
Intention to treat vs per protocol sample sizes in MORPSE study
Intention to treat: all patients who were signed up to be originally treated in the study
Per protocol: all patients who actually completed the entire study all the way through
What effect does elastic recoil have on the lungs and rib cage
Lungs = collapse
Rib cage = expand
The interaction between the lung and rib cage occurs via
Intra pleural space
This interaction determines the lung volume
What is the typical tidal volume?
500 mL
Anatomical dead space
Air that remains in the conducting zone and never reaches the alveoli
Approximately equals 150mL in all normal people
When does gas exchange occur?
17 divisions after the trachea
(Once your hit respiratory alveolelos)
Approximately 350 mL of normal tidal volume goes through gas exchange
What is the neurologic issues with obstructive pulmonary disorders?
1) Inhibitory visceral afferent reflexes kick in (since the body naturally thinks the alveoli are going to burst if it doesnt slow down breathing)
2) cranial nucleus is inhibited (specifically nucleus solitaries) via the vagus nerve
3) makes breathing more shallow and loses tidal volume
Why is cervical OMT useful in respiratory infections?
Helps normalize sympathetic tone via the phrenic nerve (C3-5)
The phrenic Nerve controls the diaphragm which if it is out of wack, decreases ability to breath as well as blood/lymph flow through the thoracic region
Also helps release facial restrictions within the cervical region
Why do we use thoracic OMT in pulmonary dysfunctions
Helps normalize sympathetic tone since the sympathetic chain runs antihero to the rib heads
decreases head and neck sympathetics (T1-4) and lung/thoracic (T2-T6/7)
Also helps release of the thoracic inlet which improves lymphatic and blood flow
Increases proper motion at the costovertebral/transverse junctions.
What changes to the autonomic nervous system does OMT do with regards to pulmonary/thoracic treatments
Decreases sympathetics, increases parasympathetics
Decreases vasoconstriction and changes goblet cell: ciliated cell ratios
