Each patient in the interventional arm will be fitted with a RibFx orthosis belt, which is to be worn during the majority of their day (excluding showering/bathing). It will be encouraged (though not mandatory) to wear at night. Patients in both the control and interventional arm will be expected to participate in pulmonary hygiene / toilet exercises with guided and independent incentive spirometry as per our normal routine and standard of care. There are no other interventions or procedures that the patients will be subjected to for the research trial- other procedures/interventions will be performed only if the clinical care team feels they are indicated.

Patients in the control arm receive normal standard of care for rib fractures at the participating institution.
The current standard of care for rib fractures at the University of Vermont (participating institution) is as follows: includes oral and IV analgesia and other multimodal pain control as appropriate, including muscle relaxants such as methocarbamol (robaxin) unless there is a contraindication, pulmonary hygiene/toilet and respiratory care (including frequent evaluations by physicians, respiratory therapists, and nursing staff, early mobilization, and monitoring for pulmonary complication (via vital signs, pulse oximetry, oxygen requirement, chest imaging if appropriate).

Rib Fracture

Rib Fracture Multiple

Trauma

Trauma Chest

Trauma Injury

Trauma, Multiple

RibFx Orthosis Belt

University of Vermont Medical Center

Orthosis of Acute Traumatic Rib Fractures Via RibFx Belt for Pain Alleviation and Improved Pulmonary Function

Orthosis of Acute Traumatic Rib Fractures Via RibFx Belt for Pain Alleviation and Improved Pulmonary Function: A Pre-Post Interventional Trial for Quality Improvement

Compare pain control in patients with non-operatively managed traumatic rib fractures via subjective/qualitative self-reporting of pain control via questionnaires Pain control will be predominantly measured utilizing a likert scale score of 1 to 10, with a score of 1 denoting the lowest amount of pain and a score of 10 indicating the highest amount of pain. This will assist us in comparing patient pain scores in an objective manner.

Pain control will be predominantly measured utilizing a likert scale score of 1 to 10, with a score of 1 denoting the lowest amount of pain and a score of 10 indicating the highest amount of pain. This will assist us in comparing patient pain scores in an objective manner.

Compare pulmonary hygiene and function amongst patients with non-operatively managed traumatic rib fractures via incentive spirometry scores.
Incentive spirometry will be used as a tool to measure and compare patient pulmonary hygiene. The incentive spirometer at the participating institution are scaled to permit quantifiable deep breathing from 0 to 2500 mL (or cc).

As measured in inpatient days for all subjects admitted with rib fracture

As measured in inpatient Intensive Care Unit (ICU) days for all subjects admitted with rib fracture

As measured by clinical diagnosis of pneumonia following rib fracture, either documented in physician note or added to problem list

As measured by a participating blinded radiologist in any images obtained following the rib fractures

As measured by requirement for additional / supplemental oxygen , as determined by clinical treatment team

The pulse oximetry scores of rib fracture subjects will be measured while inpatient as a non-invasive proxy measurement of tissue oxygenation.
These data are regularly recorded during vital signs for all patients admitted to Trauma Surgery service.

The respiratory rate of rib fracture subjects will be measured while they are inpatient in the hospital, as a measure of pulmonary health and pain control. These data are regularly recorded during vital signs for all patients admitted to Trauma Surgery service.

Subject compliance with encouraged use of the incentive spirometer device for pulmonary hygiene following acute rib fractures will be measured by patient self reported frequency on the patient questionnaire, in both frequency (total number of uses) and duration of usage (hours and minutes of usage)

Subject compliance with encouraged use of the RibFx device (if assigned to the intervention group) following acute rib fractures will be measured by patient self reported frequency on the patient questionnaire, in both frequency (total number of uses) and duration of usage (hours and minutes of usage)

This previously validated survey contains 8 questions , each with a likert scale response of 0 (best or most favorable score) to 5 (worse or least favorable score). The total score is then cumulated to serve as a proxy of patient's own self reported respiratory (breathing) health.

There is a series of three questions meant to assess how the rib fractures are affecting patient's sleep, activity, and quality of life as determined by a likert scale from 0 (most favorable, does not interfere with life) to 10 (most unfavorable, totally interferes with life).

Patients will report how frequently they are using over the counter pain medications such as acetaminophen and ibuprofen for acute rib fracture pain. This will be reported by the patients on the questionnaires as a binary yes/no response followed by frequency (total number of times taking the medications).

Patients will report how frequently they are using prescribed pain medications for acute rib fracture pain. This will be reported by the patients on the questionnaires as a binary yes/no response followed by frequency (total number of times taking the medications).

Ajai Malhotra, MD FACS

Chief, Acute Care Surgery Division

PelvicBinder, Inc.

Noninvasive ventilation for 15 minutes with EPAP set at 10 cmH2O and IPAP adjusted to maintain a tidal volume of 6 ml / kg ideal weight.

EPAP through facial mask with valve spring load for 15 minutes set at 10 cmH2O.

Bariatric Surgery

Obesity

Physical Therapy Modalities

Noninvasive Ventilation

Expiratory Positive Air Pressure

Hospital das Clínicas

Acute Effect of EPAP and Noninvasive Ventilation on Pulmonary Function and Lung Regional Ventilation on Bariatric Surgery

Acute Effect of EPAP and Noninvasive Ventilation on Pulmonary Function, Regional Lung Ventilation and Respiratory Mechanics on Patients Submitted Bariatric Surgery Evaluated by Spirometry and Electric Impedance Tomography: A Clinical Trial Controlled Randomized

Assessment of regional ventilation through the variables of electrical impedance tomography , Delta Z (impedance variation) in the anterior and posterior region, and right and left lung.

Assessment of maximum inspiratory pressure by manometer before and after bariatric surgery .

Evaluation by applying the Global Quality of recovery -40 questionnaire (QoR -40) at 24 and 48 hours after the surgical procedure.

Evaluation by spirometry, considering the variables, CV, FEV1, FVC, PEF, FEV1/FVC, FEF 25-75 %.

Through evaluation of open questions about the occurrence of adverse effects during the technique, such as headache, nausea, dizziness, discomfort, nausea and vomiting.

Quantify the therapeutic effect of time of the technical EPAP and NIV by analyzing the variables of the impedance electrical tomography , Average electrical impedance at the end of expiration (MIEFE) and monitoring this baseline during the post technique period at times 5 and 30 minutes post intervention.

Sóstynis José de Albuquerque Silva

Acute Effect of Epap and Noninvasive Ventilation on Pulmonary Function and Lung Regional Ventilation on Bariatric Surgery

Universidade Federal de Pernambuco

Acute Dyspnea

Echocardiography will be performed before any therapy is initiated by a fully trained operator, according to the READ method. The results of this ultrasound will not be communicated to the clinician managing the patient in the emergency room.
A blood sample will be taken during the routine work-up for centralized evaluation of NT-proBNP levels.

Echocardiography according to the READ method.

Evaluation of Rapid Emergency Echography for Acute Dyspnoea

Evaluation of Rapid Emergency Echography for Acute Dyspnoea for the Diagnosis of Acute Left-sided Heart Failure in Elderly Subjects Admitted to the Emergency Room (READ Protocol)

The diagnosis of ALSHF will be established post hoc by two experts based on a specialised echocardiography performed within 7 days after inclusion, or before discharge (whichever occurs first) and on the patient's medical file.
The presence of ALSHF using the READ method is defined as presence of diffuse B-lines on lung ultrasound, combined with a restrictive pattern on analysis of transmitral profile.
A diagnosis of ALSHF will be retained if the NT-proBNP level is greater than the threshold value of 1800 pg/mL, which is the appropriate threshold for patients aged >75 years.

The diagnostic value of the test, assessed in terms of sensitivity and specificity, will be calculated based on the optimal combination of the results of the two tests, namely the READ method and NT-proBNP assessment.

We will investigate the possible presence of a spectrum effect, mainly in terms of age and gender, in the population.

We will evaluate agreement between the results of the READ approach interpreted immediately in the emergency setting, vs deferred evaluation (outside the emergency setting) of the same images by a different expert operator.

Centre Hospitalier Universitaire de Besancon

Centre Hospitalier Germon et Gauthier

University Hospital, Clermont-Ferrand

Centre Hospitalier de PAU

University Hospital, Strasbourg, France

Centre Hospitalier Général de Toulon

placebo of oseltamivir phosphate and placebo of Banlangen(Radix Isatidis) granules.

Banlangen(Radix Isatidis) granules and placebo of oseltamivir phosphate

oseltamivir phosphate and placebo of Banlangen(Radix Isatidis) granules

Influenza

placebo of oseltamivir phosphate

oseltamivir phosphate

Banlangen (Radix Isatidis) granules

placebo of Banlangen(Radix Isatidis) granules

Guangzhou Institute of Respiratory Disease

Banlangen Granules Anti-seasonal Influenza Study

Banlangen Granules Anti-seasonal Influenza Study: a Randomized, Double Blind, Positive and Placebo Controlled，Clinical Study.

The primary end point was the duration of illness which was defined as the time from onset of symptoms to the alleviation of the ten influenza-like symptoms including , nasal obstruction, running nose, cough, sore throat, headache, fatigue, myalgia, chills and sweating.

The time to defervescence, defined as the time from the first dose of study medication to the time when the body temperature declined to lower than 37.4ºC and was sustained for at least 24 hours.

viral shedding duration, defined as the time from the illness onset to the first time the viral nucleic acid test was negative

the severity of the disease,assessed by an area under the curve (AUC) analysis of a total of nine influenza-like symptom scores, the AUC was calculated as the product of the daily symptom scores times the duration of illness

incidence of secondary complications of influenza

Hutchison Whampoa Guangzhou Baiyunshan Chinese Medicine Company Limited

The intervention group will be called EGHEM - Echo Guided HEmodyanmic Management - and will receive their intraoperative maintenance fluid and possible drug therapy (furosemide) based on their hourly intraoperative LVDD grade.

The control group will be
called SHEM - Standard HEmodynamic Management - and will NOT receive the study intervention, but will receive standard anesthesia and hemodynamic management based on current standards within the institution.

pleural effusion/fetma

Orthosis of Acute Traumatic Rib Fractures Via RibFx Belt for Pain Alleviation and Improved Pulmonary Function

Acute Effect of EPAP and Noninvasive Ventilation on Pulmonary Function and Lung Regional Ventilation on Bariatric Surgery

Evaluation of Rapid Emergency Echography for Acute Dyspnoea

Banlangen Granules Anti-seasonal Influenza Study

Echocardiography Management for Patients Requiring Care for Non-Cardiac Surgery

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