The objective of this study was to determine whether protocolized triage using the Rib Injury Guidelines (RIG) can safely reduce intensive care unit (ICU) admissions and improve institutional resource utilization in a rural, Appalachian, level 1 trauma center. This was a single-center retrospective cohort study that included a total of 1148 adult patients who presented to the institution with radiographically confirmed rib fracture(s) over the course of 2 years (557 pre-RIG, 591 post-RIG). Prior to RIG implementation, triage decisions were made at the discretion of the attending provider using a protocol based on three factors: ≥3 rib fractures, age >65, and incentive spirometry (IS) <1L or <15 mL/kg ideal body weight (IBW). Patients in the post-RIG group were of higher acuity with a significantly higher percentage having ≥3 rib fractures (53.3% vs 45.2%, P = 0.006) and thoracic injuries as their highest Abbreviated Injury Scale (AIS) score (56.0% vs 24.6%, P < 0.001). Despite this higher acuity, implementation of RIG was associated with a 28.9% decrease in ICU admissions from the ED (OR 0.711, 95% CI: 0.563-0.899, P = 0.004) without a corresponding increase in floor-to-ICU transfers (P = 0.166), unplanned intubations (P = 0.803), morbidity, or mortality (P = 0.364). Additionally, it reduced the hospital charges incurred by each patient. These findings suggest that protocolized triage using RIG is feasible and safe in rural settings, improving resource utilization without compromising patient outcomes.

The objective was to analyze the effect of pulmonary expansion exercises on pulmonary functional capacity in patients undergoing cardiac surgery. An integrative review with a quantitative approach was conducted, structured based on methodological principles of PRISMA 2020. The research question was formulated using the PIO framework. The literature search was performed in PubMed, BVS, Journal of PeriAnesthesia Nursing, Epistemonikos, SciELO, ScienceDirect, and EBSCO, using DeCS and MeSH terms combined with Boolean operators. A total of 45 potentially relevant studies were identified, of which 12 met the inclusion criteria, incorporating both primary studies and systematic reviews. Methodological quality was assessed using the FLC instrument version 3.0 and the Oxford Centre for Evidence-Based Medicine classification. Risk of bias was evaluated according to study design, using RoB 2 for randomized controlled trials and ROBIS for systematic reviews. The synthesis considered comparisons across levels of evidence to minimize potential duplication of results. Findings suggest that inspiratory muscle training is associated with improvements in respiratory muscle strength, pulmonary function, and functional capacity. Additionally, the use of volume-oriented incentive spirometry, particularly when guided by nursing staff, is associated with favorable pulmonary outcomes in the postoperative period.

The objective was to analyze the effect of pulmonary expansion exercises on pulmonary functional capacity in patients undergoing cardiac surgery. An integrative review with a quantitative approach was conducted, structured based on methodological principles of PRISMA 2020. The research question was formulated using the PIO framework. The literature search was performed in PubMed, BVS, Journal of PeriAnesthesia Nursing, Epistemonikos, SciELO, ScienceDirect, and EBSCO, using DeCS and MeSH terms combined with Boolean operators. A total of 45 potentially relevant studies were identified, of which 12 met the inclusion criteria, incorporating both primary studies and systematic reviews. Methodological quality was assessed using the FLC instrument version 3.0 and the Oxford Centre for Evidence-Based Medicine classification. Risk of bias was evaluated according to study design, using RoB 2 for randomized controlled trials and ROBIS for systematic reviews. The synthesis considered comparisons across levels of evidence to minimize potential duplication of results. Findings suggest that inspiratory muscle training is associated with improvements in respiratory muscle strength, pulmonary function, and functional capacity. Additionally, the use of volume-oriented incentive spirometry, particularly when guided by nursing staff, is associated with favorable pulmonary outcomes in the postoperative period.

Acute chest syndrome (ACS) is the leading cause of death and a major cause of hospitalization in sickle cell disease (SCD). Despite advances in care, ACS remains a life-threatening complication with no FDA-approved targeted therapy for established disease. This review examines the current evidence base for supportive care, preventive strategies, and emerging therapies.

An 86-year-old woman presented to the emergency department following a ground-level fall with fractures of the left posterior ribs 9-11 and right posterior ribs 5-8. She was admitted, and multimodal pain management, including acetaminophen, methocarbamol, oxycodone, and hydromorphone, was initiated. On the second day of hospitalization, she developed somnolence and confusion attributed to opioid administration. She was unable to receive a thoracic epidural due to recent clopidogrel administration, and bilateral erector spinae plane catheters were shown to be a reasonable alternative. This intervention provided effective pain relief, leading to improved mental status, pain control, and incentive spirometry.

Acute chest syndrome (ACS) is a common pulmonary complication in children with sickle cell disease, defined by a new pulmonary infiltrate on imaging accompanied by fever and/or respiratory symptoms. ACS pathophysiology is multifactorial and incompletely understood, involving vaso-occlusion, pulmonary infarction, inflammation, hypoventilation, and infection-the latter being a frequent trigger in children. While most pediatric cases are mild, ACS can be life-threatening and requires prompt diagnosis and management to prevent progression into respiratory failure. Mild cases are managed with pain control, IV hydration, empiric antibiotics, incentive spirometry, and supplemental oxygen when needed. More severe cases may require simple or exchange transfusion to reduce hemoglobin S levels and limit further vaso-occlusion. ACS is associated with neurologic events and long-term pulmonary complications, making prevention a clinical priority. Disease-modifying therapies include hydroxyurea and chronic transfusion. This review summarizes current evidence on the pathophysiology, risk factors, clinical presentation, diagnosis, acute management, and preventative therapies for ACS in children.