Patients were enrolled if they showed at least one of the following signs: tachypnea (respiratory rate [greater than or equal to] 24), use of accessory muscles of respiration (defined as contraction of sternocleidomastoid and intercostal, suprasternal, or supraclavicular retractions during inhalation), paradoxical respiration, pH < 7.35 with no metabolic component, and finally PaC[O.sub.2] > 45 mmHg while breathing room air.
The included patients were intensively monitored for signs of respiratory insufficiencies like respiratory rate of >30 breaths/minute, accessory muscles of respiration in action, O2 saturation<90%, Arterial Blood Gas Analysis (ABG)--PaO2 <50 mmHg, PCO2 >50 mmHg.
Physical examination was relevant for tachypnea (20-24 breaths per minute) with obvious use of her accessory muscles of respiration and bilateral diffuse crackles appreciated on auscultation of her lung fields, the patient required respiratory support and was placed on mechanical ventilation.
Blood was suctioned from her mouth, but stridor continued with respiratory distress evidenced by inspiratory descent of the larynx, paradoxical movement of the chest and use of accessory muscles of respiration. Her pulse oximeter saturation declined to 94% while using a Hudson face mask with oxygen 6 1/min.
When an individual experiences stress physiology due to a stressful event, the expectation of a stressful event, or a memory or recurrence of the event, there is inhibition of the accessory muscles of respiration. The blood supply to the frontal lobe of the cerebral cortex is inhibited, is diminished.
We hypothesized that if walking frames were beneficial to patients with a respiratory disability, much of the benefit would arise from the ability of the patient to lean on the frame during walking, thus bracing the accessory muscles of respiration and allowing them to be engaged in respiratory activities.