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preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng119er7-lrg.png" alt="Cover of Identifying and managing respiratory disorders associated with cerebral palsy: protocols for monitoring respiratory health" /></a></div><div class="bkr_bib"><h1 id="_NBK578092_"><span itemprop="name">Identifying and managing respiratory disorders associated with cerebral palsy: protocols for monitoring respiratory health</span></h1><div class="subtitle">Cerebral palsy in adults</div><p><b>Evidence review C1</b></p><p><i>NICE Guideline, No. 119</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Alliance (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2019 Jan</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3223-8</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div></div><div class="bkr_clear"></div></div><div id="chc1.s1"><h2 id="_chc1_s1_">Identifying and managing respiratory disorders</h2><div id="chc1.s1.1"><h3>Review question</h3><p>C1 What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><div id="chc1.s1.1.1"><h4>Introduction</h4><p>Adults with cerebral palsy are at increased risk of respiratory health problems. This may be due to a variety of co-morbidities, including gastro-oesophageal reflux, aspiration of feed or secretions, reduced functional lung volume, muscle tone in the form of respiratory muscle weakness and some side effects of regularly used medication. Identifying adults with these risks and re-appraising risk may help prevent infection, and delay respiratory failure. This review question looks at the evidence of clinical and cost effectiveness for methods of identification and monitoring respiratory disorders.</p></div><div id="chc1.s1.1.2"><h4>PICO/PIRO table</h4><p>Please see <a class="figpopup" href="/books/NBK578092/table/chc1.tab1/?report=objectonly" target="object" rid-figpopup="figchc1tab1" rid-ob="figobchc1tab1">Table 1</a> for a summary of the Population, Intervention/Index test, Comparison/Reference standard and Outcome (PICO/PIRO) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchc1tab1"><a href="/books/NBK578092/table/chc1.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figchc1tab1" rid-ob="figobchc1tab1"><img class="small-thumb" src="/books/NBK578092/table/chc1.tab1/?report=thumb" src-large="/books/NBK578092/table/chc1.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICO/PIRO table)." /></a><div class="icnblk_cntnt"><h4 id="chc1.tab1"><a href="/books/NBK578092/table/chc1.tab1/?report=objectonly" target="object" rid-ob="figobchc1tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO/PIRO table). </p></div></div><p>For full details see review protocol in <a href="#chc1.appa">appendix A</a>.</p></div><div id="chc1.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual 2014</a>. Methods specific to this review question are described in the review protocol in <a href="#chc1.appa">appendix A</a> and for a full description of the methods see <a href="/books/n/niceng119erbm3/?report=reader" class="toc-item">supplementary document C</a>.</p><p>As GRADE is designed only for RCTs and observational studies, a modified version of this tool was used in order to appraise the confidence in the included diagnostic test accuracy evidence. The QUADAS-2 checklist risk of bias and applicability items were used for evaluating the risk of bias and indirectness, respectively, of the studies. The quality assessment of inconsistency and imprecision were adapted to take into account the methodological features of diagnostic studies.</p><p>GRADE was not used for evidence about clinimetric properties (such as reliability or construct validity), methodological quality was summarised for each publication individually using the consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist for individual studies or the CASP checklist for systematic reviews.</p><p>Declaration of interests were recorded according to NICE’s 2014 conflicts of interest policy from May 2016 until April 2018. From April 2018 onwards they were recorded according to NICE’s 2018 <a href="https://www.nice.org.uk/About/Who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">conflicts of interest policy</a>. Those interests declared until April 2018 were reclassified according to NICE’s 2018 conflicts of interest policy (see Interests Register).</p></div><div id="chc1.s1.1.4"><h4>Clinical evidence</h4><div id="chc1.s1.1.4.1"><h5>Included studies</h5><p>Two studies were included. One was a cross-sectional study (<a class="bibr" href="#chc1.s1.ref1" rid="chc1.s1.ref1">Lampe 2014</a>; number of participants in study, N=46), the other was a systematic review including 7 cross-sectional studies (<a class="bibr" href="#chc1.s1.ref1" rid="chc1.s1.ref1">Lennon 2014</a>; N=117).</p><p><a class="bibr" href="#chc1.s1.ref1" rid="chc1.s1.ref1">Lampe 2014</a> compared chest expansion measured with a tape, lung capacity measured using spirometry and oxygen saturation measured using pulse-oximetry in adults with cerebral palsy. <a class="bibr" href="#chc1.s1.ref1" rid="chc1.s1.ref1">Lennon 2014</a> was a systematic review of the clinical usefulness of aerobic or anaerobic fitness measures in adults with cerebral palsy.</p><p><a class="bibr" href="#chc1.s1.ref1" rid="chc1.s1.ref1">Lampe 2014</a> did not report the sensitivity or specificity of reduced lung capacity for low oxygen saturation, but provided sufficient information for the NGA team to calculate these statistics for a number of threshold values (see <a href="#chc1.appe">appendix E</a>, <a class="figpopup" href="/books/NBK578092/figure/chc1.appe.fig2/?report=objectonly" target="object" rid-figpopup="figchc1appefig2" rid-ob="figobchc1appefig2">Figure 3</a>). The threshold value closest to the threshold agreed in the review protocol for high sensitivity (90%; see <a href="#chc1.appa">appendix A</a>) was used in the modified GRADE analysis.</p><p>The clinical studies included in this evidence review are summarised in <b><a class="figpopup" href="/books/NBK578092/table/chc1.tab2/?report=objectonly" target="object" rid-figpopup="figchc1tab2" rid-ob="figobchc1tab2">Table 2</a> and evidence from these is summarised in the clinical evidence profiles below</b> (<a class="figpopup" href="/books/NBK578092/table/chc1.tab3/?report=objectonly" target="object" rid-figpopup="figchc1tab3" rid-ob="figobchc1tab3">Table 3</a> and <a class="figpopup" href="/books/NBK578092/table/chc1.tab4/?report=objectonly" target="object" rid-figpopup="figchc1tab4" rid-ob="figobchc1tab4">Table 4</a>).</p><p>See also the literature search strategy in <a href="#chc1.appb">appendix B</a>, study selection flow chart in <a href="#chc1.appc">appendix C</a>, sensitivity/specificity plots in <a href="#chc1.appe">appendix E</a> and study evidence tables in <a href="#chc1.appd">appendix D</a>.</p></div><div id="chc1.s1.1.4.2"><h5>Excluded studies</h5><p>No studies were excluded from this review.</p></div></div><div id="chc1.s1.1.5"><h4>Summary of clinical studies included in the evidence review</h4><p><a class="figpopup" href="/books/NBK578092/table/chc1.tab2/?report=objectonly" target="object" rid-figpopup="figchc1tab2" rid-ob="figobchc1tab2">Table 2</a> summarises the characteristics of the included studies</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchc1tab2"><a href="/books/NBK578092/table/chc1.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figchc1tab2" rid-ob="figobchc1tab2"><img class="small-thumb" src="/books/NBK578092/table/chc1.tab2/?report=thumb" src-large="/books/NBK578092/table/chc1.tab2/?report=previmg" alt="Table 2. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="chc1.tab2"><a href="/books/NBK578092/table/chc1.tab2/?report=objectonly" target="object" rid-ob="figobchc1tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div></div><div id="chc1.s1.1.6"><h4>Quality assessment of clinical studies included in the evidence review</h4><p><b>The clinical evidence profiles for this review question are presented in</b>
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<a class="figpopup" href="/books/NBK578092/table/chc1.tab3/?report=objectonly" target="object" rid-figpopup="figchc1tab3" rid-ob="figobchc1tab3">Table 3</a> and <a class="figpopup" href="/books/NBK578092/table/chc1.tab4/?report=objectonly" target="object" rid-figpopup="figchc1tab4" rid-ob="figobchc1tab4">Table 4</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchc1tab3"><a href="/books/NBK578092/table/chc1.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figchc1tab3" rid-ob="figobchc1tab3"><img class="small-thumb" src="/books/NBK578092/table/chc1.tab3/?report=thumb" src-large="/books/NBK578092/table/chc1.tab3/?report=previmg" alt="Table 3. Clinical evidence profile for diagnostic accuracy of reduced lung vital capacity (1 litre or more lower than normal) with spirometry for prediction of low oxygen saturation (<96%) in adults with cerebral palsy." /></a><div class="icnblk_cntnt"><h4 id="chc1.tab3"><a href="/books/NBK578092/table/chc1.tab3/?report=objectonly" target="object" rid-ob="figobchc1tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence profile for diagnostic accuracy of reduced lung vital capacity (1 litre or more lower than normal) with spirometry for prediction of low oxygen saturation (<96%) in adults with cerebral palsy. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchc1tab4"><a href="/books/NBK578092/table/chc1.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figchc1tab4" rid-ob="figobchc1tab4"><img class="small-thumb" src="/books/NBK578092/table/chc1.tab4/?report=thumb" src-large="/books/NBK578092/table/chc1.tab4/?report=previmg" alt="Table 4. Clinimetric properties of bicycle ergometers, wheelchair ergometers and the 6 minute walk test to determine maximal aerobic capacity in adults with cerebral palsy." /></a><div class="icnblk_cntnt"><h4 id="chc1.tab4"><a href="/books/NBK578092/table/chc1.tab4/?report=objectonly" target="object" rid-ob="figobchc1tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinimetric properties of bicycle ergometers, wheelchair ergometers and the 6 minute walk test to determine maximal aerobic capacity in adults with cerebral palsy. </p></div></div></div><div id="chc1.s1.1.7"><h4>Economic evidence</h4><div id="chc1.s1.1.7.1"><h5>Included studies</h5><p>A systematic review of the economic literature was conducted but no studies were identified which were applicable to this review question.</p></div><div id="chc1.s1.1.7.2"><h5>Excluded studies</h5><p>No studies were identified which were applicable to this review question.</p></div></div><div id="chc1.s1.1.8"><h4>Summary of studies included in the economic evidence review</h4><p>No economic evaluations were included in this review</p></div><div id="chc1.s1.1.9"><h4>Economic model</h4><p>This question was not prioritised for economic modelling as the committee considered that it was unlikely that any recommendation made would place significant additional costs on NHS or PSS budgets.</p></div><div id="chc1.s1.1.10"><h4>Resource impact</h4><p>No unit costs were presented to the committee as these were not prioritised for decision making purposes.</p></div><div id="chc1.s1.1.11"><h4>Evidence statements</h4><div id="chc1.s1.1.11.1"><h5>Monitoring of respiratory health</h5><p>No evidence was found about the impact of regular monitoring of respiratory health on outcomes in adults with cerebral palsy.</p></div><div id="chc1.s1.1.11.2"><h5>Lung vital capacity measured using spirometry</h5><div id="chc1.s1.1.11.2.1"><h5>Critical outcomes</h5><div id="chc1.s1.1.11.2.1.1"><h5>Respiratory health</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.2.1.2"><h5>Overall survival</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.2.1.3"><h5>Hospital admission</h5><p>No evidence was found for this outcome.</p></div></div><div id="chc1.s1.1.11.2.2"><h5>Important outcomes</h5><div id="chc1.s1.1.11.2.2.1"><h5>Secondary conditions</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.2.2.2"><h5>Respiratory function</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.2.2.3"><h5>Health related quality of life</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.2.2.4"><h5>Satisfaction</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.2.2.5"><h5>Diagnostic accuracy</h5><ul id="l215"><li id="lt652" class="half_rhythm"><div>Very low quality evidence from one cross-sectional study in 46 adults with cerebral palsy indicates that lung vital capacity (measured using spirometry) is reduced in adults with cerebral palsy compared to people without cerebral palsy, particularly in those with higher GMFCS scores or scoliosis. Reduced lung vital capacity (of at least 1 litre below the predicted normal value), however, is not a good predictor of oxygen saturation with sensitivity of 86% and specificity of 26% for low oxygen saturation. The positive and negative likelihood ratios of 1.16 and 0.55 respectively suggest this test is not useful for ruling low oxygen saturation in or out.</div></li></ul></div><div id="chc1.s1.1.11.2.2.6"><h5>Clinimetric properties</h5><p>No evidence was found for this outcome.</p></div></div></div><div id="chc1.s1.1.11.3"><h5>Tests for maximal aerobic capacity</h5><div id="chc1.s1.1.11.3.1"><h5>Critical outcomes</h5><div id="chc1.s1.1.11.3.1.1"><h5>Respiratory health</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.3.1.2"><h5>Overall survival</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.3.1.3"><h5>Hospital admission</h5><p>No evidence was found for this outcome.</p></div></div><div id="chc1.s1.1.11.3.2"><h5>Important outcomes</h5><div id="chc1.s1.1.11.3.2.1"><h5>Secondary conditions (e.g. colds, asthma, sleep apnoea, daytime sleepiness)</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.3.2.2"><h5>Respiratory function</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.3.2.3"><h5>Health related quality of life</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.3.2.4"><h5>Satisfaction</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.3.2.5"><h5>Diagnostic accuracy</h5><p>No evidence was found for this outcome.</p></div><div id="chc1.s1.1.11.3.2.6"><h5>Clinimetric properties</h5><p>Very low quality evidence from one systematic review including 7 cohort studies in 117 teenagers or adults with cerebral palsy who were ambulatory or self-propelled wheelchair users indicates that lab-based maximal or sub-maximal bicycle and wheelchair ergometer tests are valid tests of aerobic fitness. The 6-minute walk test however is not a valid measure of maximal aerobic capacity.</p></div></div></div></div><div id="chc1.s1.1.12"><h4>The committee’s discussion of the evidence</h4><div id="chc1.s1.1.12.1"><h5>Interpreting the evidence</h5><div id="chc1.s1.1.12.1.1"><h5>The outcomes that matter most</h5><p>The critical outcomes were respiratory health, overall survival and hospital admission because poor respiratory function can lead to life threatening illnesses requiring hospital admission. There was a lack of evidence about the impact of regular monitoring of respiratory function on these critical outcomes so the committee instead considered evidence about the accuracy of tests for respiratory function with the assumption that early diagnosis and treatment of respiratory problems should improve overall health. Important outcomes were secondary conditions (such as colds), respiratory function, health related quality of life and satisfaction</p></div><div id="chc1.s1.1.12.1.2"><h5>The quality of the evidence</h5><p>For outcomes from one study a GRADE approach was used that was modified for diagnostic accuracy measures. Outcomes for the other study could only be assessed using the CASP quality checklist. Evidence for all outcomes was rated as very low quality. The included study measured oxygen saturation measured at a single point during the day and the committee agreed this would be less informative about early respiratory failure than a nocturnal monitoring protocol.</p><p>The committee considered that evidence about maximal aerobic capacity tests was not relevant to the general population of adults with cerebral palsy, because such tests would be typically used for monitoring the cardiorespiratory fitness of athletes as part of their training programme.</p><p>Due to the limitations of the evidence the committee based their recommendations on their expertise and experience.</p></div><div id="chc1.s1.1.12.1.3"><h5>Benefits and harms</h5><p>The committee based on their experience and knowledge, agreed that there is a lack of awareness about some of the signs and symptoms that may indicate respiratory impairment. They therefore wanted to describe some of the presentations associated with respiratory impairment to improve recognition and identification of the condition. Timely assessment would also ensure prompt discussion about treatment options.</p><p>The committee agreed, based on their experience that respiratory impairment coupled with certain comorbidities could result in respiratory complications. The committee agreed that a referral for a full respiratory assessment was likely to be beneficial in this group as it would afford the chance to prevent or treat respiratory complications. This would also lead to effective management and prevention of further complications. The committee recognised that this recommendation may lead to an increase in the number of referrals, but the resource impact will be balanced by reduced number of complications.</p><p>There was also some evidence that oxygen saturation and lung vital capacity measured using spirometry were reduced in those with GMFCS IV to V or with kyphoscoliosis. However, they could not make a strong recommendation for this because the evidence was very limited and of poor quality.</p><p>Due to the lack of evidence, the committee made a research recommendation on the methods of detection and management of respiratory impairment in adults with cerebral palsy in the community. Based on their experience, the committee were aware that adults with cerebral palsy are at increased risk of respiratory problems particularly people with some pre-existing respiratory conditions and those with high Gross Motor Function Classification System (GMFCS) and are at a high risk of serious adverse effects. Early detection of respiratory impairment, management and appropriate referral for specialist assessment would enable prevention or treatment of respiratory complications in this high-risk group.</p></div></div><div id="chc1.s1.1.12.2"><h5>Cost effectiveness and resource use</h5><p>The committee noted that no relevant published economic evaluations had been identified for this topic.</p><p>The committee acknowledge that the recommendations would lead to an increase in referrals to a limited number of respiratory specialists with experience in adults with cerebral palsy potentially increasing waiting times or diverting the resource from elsewhere. However, improved outcomes, especially in regards to respiration will lead to a significant increase in quality of life. Some additional resource use will be recouped though a decrease in hospital admissions especially expensive unplanned admissions.</p></div></div></div><div id="rl.r8"><h3>References</h3><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="chc1.s1.ref1"><p id="p-132">
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<strong>Lampe 2014</strong>
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</p>Lampe, R., Blumenstein, T., Turova, V., Alves-Pinto, A., Lung vital capacity and oxygen saturation in adults with cerebral palsy, Patient Preference and Adherence, 8, 1691–1697, 2014 [<a href="/pmc/articles/PMC4267512/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4267512</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25525345" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25525345</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc1.s1.ref2"><p id="p-133">
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<strong>Lennon 2015</strong>
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</p>Lennon, N., Thorpe, D., Balemans, A. C., Fragala-Pinkham, M., O’Neil, M., Bjornson, K., Boyd, R., Dallmeijer, A. J., The clinimetric properties of aerobic and anaerobic fitness measures in adults with cerebral palsy: A systematic review of the literature, Research in Developmental Disabilities, 45–46, 316–28, 2015 [<a href="https://pubmed.ncbi.nlm.nih.gov/26296079" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26296079</span></a>]</div></p></li></ul></div></div><div id="appendixes.appgroupc1"><h2 id="_appendixes_appgroupc1_">Appendices</h2><div id="chc1.appa"><h3>Appendix A. Review protocols</h3><p>Review protocol for review question C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><p id="chc1.appa.et1"><a href="/books/NBK578092/bin/chc1-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 5. Review protocol for monitoring respiratory health in adults with cerebral palsy</a><span class="small"> (PDF, 336K)</span></p></div><div id="chc1.appb"><h3>Appendix B. Literature search strategies</h3><p>Literature search strategies for review question C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><p>This appendix is a combined search strategy and will be the same for all the evidence reviews for the C review questions as listed below:
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<ul id="l216" class="simple-list"><li id="lt653" class="half_rhythm"><div>C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</div></li><li id="lt654" class="half_rhythm"><div>C2: Does assisted ventilation improve quality of life for adults with cerebral palsy who have a chronic respiratory disorder (including respiratory failure)?</div></li><li id="lt655" class="half_rhythm"><div>C3: Are prophylactic treatments (for example, antibiotics, chest physiotherapy, cough assistance) effective in preventing respiratory infections in adults with cerebral palsy?</div></li></ul></p><div id="chc1.appb.s1"><h4>Database: Medline & Embase (Multifile)</h4><p>Database(s): Embase 1974 to 2018 March 22, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to Present</p><p id="chc1.appb.tab1"><a href="/books/NBK578092/table/chc1.appb.tab1/?report=objectonly" target="object" rid-ob="figobchc1appbtab1" class="figpopup">Table 6. Last searched on 22 March 2018</a></p></div><div id="chc1.appb.s2"><h4>Database: Cochrane Library</h4><p id="chc1.appb.tab2"><a href="/books/NBK578092/table/chc1.appb.tab2/?report=objectonly" target="object" rid-ob="figobchc1appbtab2" class="figpopup">Table 7. Last searched on 22 March 2018</a></p></div><div id="chc1.appb.s3"><h4>Database: Web of Science</h4><p id="chc1.appb.tab3"><a href="/books/NBK578092/table/chc1.appb.tab3/?report=objectonly" target="object" rid-ob="figobchc1appbtab3" class="figpopup">Table 8. Last searched on 22 March 2018</a></p></div></div><div id="chc1.appc"><h3>Appendix C. Clinical evidence study selection</h3><p>Clinical evidence study selection for review question C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><p id="chc1.appc.fig1"><a href="/books/NBK578092/figure/chc1.appc.fig1/?report=objectonly" target="object" rid-ob="figobchc1appcfig1" class="figpopup">Figure 1. Flow diagram of clinical article selection for this review</a></p></div><div id="chc1.appd"><h3>Appendix D. Clinical evidence tables</h3><p>Clinical evidence tables for review question C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><p id="chc1.appd.et1"><a href="/books/NBK578092/bin/chc1-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 9. Studies included in monitoring respiratory health in adults with cerebral palsy</a><span class="small"> (PDF, 320K)</span></p></div><div id="chc1.appe"><h3>Appendix E. Forest plots</h3><p>Forest plots for review question C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><div id="chc1.appe.s1"><h4>Lung vital capacity measured with spirometry</h4><p id="chc1.appe.fig1"><a href="/books/NBK578092/figure/chc1.appe.fig1/?report=objectonly" target="object" rid-ob="figobchc1appefig1" class="figpopup">Figure 2. Diagnostic accuracy of different thresholds for reduced lung vital capacity (measured with spirometry) for prediction of low oxygen saturation (<96%) in adults with cerebral palsy</a></p><p id="chc1.appe.fig2"><a href="/books/NBK578092/figure/chc1.appe.fig2/?report=objectonly" target="object" rid-ob="figobchc1appefig2" class="figpopup">Figure 3. ROC curve of deviation of lung vital capacity from normal to predict low oxygen saturation (<96%) in adults with cerebral palsy</a></p></div></div><div id="chc1.appf"><h3>Appendix F. GRADE tables</h3><p>GRADE tables for review question C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><p id="chc1.appf.et1"><a href="/books/NBK578092/bin/chc1-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 10. Clinical evidence profile for diagnostic accuracy of reduced lung vital capacity (1 litre or more lower than normal) with spirometry for prediction of low oxygen saturation (<96%) in adults with cerebral palsy</a><span class="small"> (PDF, 228K)</span></p></div><div id="chc1.appg"><h3>Appendix G. Economic evidence study selection</h3><p>Economic evidence study selection for review question C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><p>No economic evidence was identified for this review.</p></div><div id="chc1.apph"><h3>Appendix H. Economic evidence tables</h3><p>Economic evidence tables for review question C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><p>No economic evidence was identified for this review.</p></div><div id="chc1.appi"><h3>Appendix I. Health economic evidence profiles</h3><p>Health economic evidence profiles for review question C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><p>No economic evidence was identified for this review.</p></div><div id="chc1.appj"><h3>Appendix J. Health economic analysis</h3><p>Health economic analysis for review question C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><p>No economic analysis was included in this review.</p></div><div id="chc1.appk"><h3>Appendix K. Excluded studies</h3><p>Clinical and economic lists of excluded studies for review question C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><div id="chc1.appk.s1"><h4>Clinical studies</h4><p>No studies were excluded from this review.</p></div><div id="chc1.appk.s2"><h4>Economic studies</h4><p>No economic evidence was identified for this review.</p></div></div><div id="chc1.appl"><h3>Appendix L. Research recommendations</h3><p>Research recommendations for review question C1: What is the most effective protocol for monitoring respiratory health in adults with cerebral palsy?</p><p>Can detection and management of respiratory disorder in adults with cerebral palsy be improved in primary and community care?</p><p id="chc1.appl.tab1"><a href="/books/NBK578092/table/chc1.appl.tab1/?report=objectonly" target="object" rid-ob="figobchc1appltab1" class="figpopup">Table 11. Research recommendation rationale</a></p><p id="chc1.appl.tab2"><a href="/books/NBK578092/table/chc1.appl.tab2/?report=objectonly" target="object" rid-ob="figobchc1appltab2" class="figpopup">Table 12. Research recommendation modified PICO table</a></p></div></div><div style="display:none"><div style="display:none" id="figchc1appefig2"><img alt="Image chc1appef2" src-large="/books/NBK578092/bin/chc1appef2.jpg" /></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews</p><p>These evidence reviews were developed by the National Guideline Alliance, hosted by the Royal College of Obstetricians and Gynaecologists</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div><div class="small"><span class="label">Bookshelf ID: NBK578092</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35192270" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35192270</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobchc1tab1"><div id="chc1.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO/PIRO table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578092/table/chc1.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc1.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_chc1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_chc1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adults aged 25 years and over with cerebral palsy.</td></tr><tr><th id="hd_b_chc1.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention / Index test</th><td headers="hd_b_chc1.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Protocol for monitoring respiratory health defined by:
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<ul id="l200"><li id="lt609" class="half_rhythm"><div>Setting
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<ul id="l201" class="circle"><li id="lt610" class="half_rhythm"><div>residential</div></li><li id="lt611" class="half_rhythm"><div>primary care</div></li><li id="lt612" class="half_rhythm"><div>secondary care</div></li></ul></div></li><li id="lt613" class="half_rhythm"><div>Tests used, for example:
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<ul id="l202" class="circle"><li id="lt614" class="half_rhythm"><div>assessment of vital capacity</div></li><li id="lt615" class="half_rhythm"><div>sleep disordered breathing</div></li><li id="lt616" class="half_rhythm"><div>assessment of fatigue</div></li><li id="lt617" class="half_rhythm"><div>cough peak flow</div></li><li id="lt618" class="half_rhythm"><div>aspiration risk</div></li><li id="lt619" class="half_rhythm"><div>infections</div></li><li id="lt620" class="half_rhythm"><div>oxygen saturation</div></li></ul></div></li><li id="lt621" class="half_rhythm"><div>Who carries out the monitoring, for example
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<ul id="l203" class="circle"><li id="lt622" class="half_rhythm"><div>GP</div></li><li id="lt623" class="half_rhythm"><div>specialist</div></li></ul></div></li><li id="lt624" class="half_rhythm"><div>Frequency of monitoring</div></li></ul></td></tr><tr><th id="hd_b_chc1.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison / Reference standard</th><td headers="hd_b_chc1.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l204"><li id="lt625" class="half_rhythm"><div>Any other monitoring protocol</div></li><li id="lt626" class="half_rhythm"><div>No formal monitoring</div></li></ul></td></tr><tr><th id="hd_b_chc1.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_chc1.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Critical</b>
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<ul id="l205"><li id="lt627" class="half_rhythm"><div>Respiratory health</div></li><li id="lt628" class="half_rhythm"><div>Overall survival</div></li><li id="lt629" class="half_rhythm"><div>Hospital admission</div></li></ul>
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<b>Important</b>
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<ul id="l206"><li id="lt630" class="half_rhythm"><div>Secondary conditions (e.g. colds, asthma, sleep apnoea, daytime sleepiness (Epworth Scale), etc.)</div></li><li id="lt631" class="half_rhythm"><div>Respiratory function</div></li><li id="lt632" class="half_rhythm"><div>Health related quality of life</div></li><li id="lt633" class="half_rhythm"><div>Satisfaction</div></li></ul>
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<i>In the absence of test and treat studies<sup>1</sup>:</i>
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<ul id="l207"><li id="lt634" class="half_rhythm"><div>Diagnostic accuracy:
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<ul id="l208" class="circle"><li id="lt635" class="half_rhythm"><div>Sensitivity</div></li><li id="lt636" class="half_rhythm"><div>Specificity</div></li><li id="lt637" class="half_rhythm"><div>Positive/Negative likelihood ratios</div></li></ul></div></li><li id="lt638" class="half_rhythm"><div>Clinimetric properties</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">GP: General Practitioner</p></div></dd></dl><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chc1.tab1_1"><p class="no_margin">The review question was framed as an intervention review but in the absence of test and treat studies diagnostic accuracy studies would be included, with the assumption that accurate identification of respiratory health problems is likely to improve outcomes.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchc1tab2"><div id="chc1.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578092/table/chc1.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc1.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chc1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_chc1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Design</th><th id="hd_h_chc1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Participants</th><th id="hd_h_chc1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Index Test</th><th id="hd_h_chc1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Reference standard</th><th id="hd_h_chc1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_chc1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc1.s1.ref2" rid="chc1.s1.ref2">Lennon 2015</a>
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</td><td headers="hd_h_chc1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review of cross-sectional studies</td><td headers="hd_h_chc1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>117 teenagers or adults with cerebral palsy (ages ranged from 16 to 67 years), reported in 7 studies.</p>
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<p>All were ambulatory or self-propelled wheelchair users. GMFCS I (N=45), II (N=25), not reported (N=57)</p>
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<p>3 studies (N=42) included only athletes.</p>
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<p>USA & Netherlands</p>
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</td><td headers="hd_h_chc1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lab based aerobic capacity tests:
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<ul id="l209"><li id="lt639" class="half_rhythm"><div>Bicycle ergometer</div></li><li id="lt640" class="half_rhythm"><div>Wheelchair ergometer</div></li></ul>
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Field based aerobic capacity tests:
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<ul id="l210"><li id="lt641" class="half_rhythm"><div>6 minute walk test</div></li></ul></td><td headers="hd_h_chc1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lab based maximal aerobic capacity tests measuring
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<ul id="l211"><li id="lt642" class="half_rhythm"><div>VO<sub>2</sub> plateau</div></li><li id="lt643" class="half_rhythm"><div>Heart rate</div></li><li id="lt644" class="half_rhythm"><div>Respiratory exchange ratio</div></li></ul></td><td headers="hd_h_chc1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l212"><li id="lt645" class="half_rhythm"><div>Feasibility</div></li><li id="lt646" class="half_rhythm"><div>Validity</div></li><li id="lt647" class="half_rhythm"><div>Reliability</div></li></ul></td></tr><tr><td headers="hd_h_chc1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc1.s1.ref1" rid="chc1.s1.ref1">Lampe 2014</a>
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</td><td headers="hd_h_chc1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cross-sectional study</td><td headers="hd_h_chc1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>46 adults with CP, age 22 to 59 years.</p>
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<p>GMFCS I (N=4), II (N=3), III (N=18) and IV (N=21).</p>
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<p>16/46 had scoliosis.</p>
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<p>Germany</p>
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</td><td headers="hd_h_chc1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l213"><li id="lt648" class="half_rhythm"><div>Lung vital capacity (using spirometer)</div></li><li id="lt649" class="half_rhythm"><div>Chest expansion</div></li></ul></td><td headers="hd_h_chc1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Oxygen saturation (pulse oximeter)</td><td headers="hd_h_chc1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l214"><li id="lt650" class="half_rhythm"><div>Sensitivity</div></li><li id="lt651" class="half_rhythm"><div>Specificity</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">CP: cerebral palsy; GMFCS: Gross Motor Function Classification System; N: number of participants in study; USA: United States of America; VO<sub>2</sub>, oxygen volume</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchc1tab3"><div id="chc1.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence profile for diagnostic accuracy of reduced lung vital capacity (1 litre or more lower than normal) with spirometry for prediction of low oxygen saturation (<96%) in adults with cerebral palsy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578092/table/chc1.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc1.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chc1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_chc1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">N</th><th id="hd_h_chc1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias<sup>1</sup></th><th id="hd_h_chc1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_chc1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness<sup>3</sup></th><th id="hd_h_chc1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision<sup>4</sup></th><th id="hd_h_chc1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sensitivity (95% CI)</th><th id="hd_h_chc1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Specificity (95% CI)</th><th id="hd_h_chc1.tab3_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Positive likelihood ratio<sup>5</sup></th><th id="hd_h_chc1.tab3_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Negative likelihood ratio<sup>5</sup></th><th id="hd_h_chc1.tab3_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><td headers="hd_h_chc1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 observational study</td><td headers="hd_h_chc1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46</td><td headers="hd_h_chc1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_chc1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td><td headers="hd_h_chc1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>7</sup></td><td headers="hd_h_chc1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>8</sup></td><td headers="hd_h_chc1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>0.86</p>
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<p>(0.42 to 1.00)</p>
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</td><td headers="hd_h_chc1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>0.26</p>
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<p>(0.12 to 0.45)</p>
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</td><td headers="hd_h_chc1.tab3_1_1_1_9" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.16</td><td headers="hd_h_chc1.tab3_1_1_1_10" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.55</td><td headers="hd_h_chc1.tab3_1_1_1_11" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">CI: confidence interval; N: number of participants in study</p></div></dd></dl><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chc1.tab3_1"><p class="no_margin">Risk of bias evaluated using risk of bias items of QUADAS-2 checklist</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chc1.tab3_2"><p class="no_margin">Unclear risk of bias in patient selection, index test and flow & timing.</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="chc1.tab3_3"><p class="no_margin">Indirectness was evaluated using the applicability items of QUADAS-2</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="chc1.tab3_4"><p class="no_margin">Judgement of imprecision was based on consideration of the 95% CIs of test sensitivity as this was considered to be the primary measure of interest as a false negative - missing patients with respiratory health problems, was considered more important than a false positive - indicating risks of respiratory health problems when there is none. Studies were considered to be of high sensitivity (and not imprecise) if the 95% CI was above 0.9 or of low sensitivity if it was below 0.75. Studies were assessed as subject to serious imprecision if the 95% CI crossed either 0.75 or 0.9, or subject to very serious imprecision if it crossed both 0.75 and 0.9</p></div></dd></dl><dl class="bkr_refwrap"><dt>5</dt><dd><div id="chc1.tab3_5"><p class="no_margin">Positive and negative likelihood ratios calculated from sensitivity and specificity estimates</p></div></dd></dl><dl class="bkr_refwrap"><dt>6</dt><dd><div id="chc1.tab3_6"><p class="no_margin">Unclear risk of review bias (lack of blinding in the interpretation both of the index test and reference standard – no details are given in the text) and patient selection; with flow and timing of participants and tests unclear</p></div></dd></dl><dl class="bkr_refwrap"><dt>7</dt><dd><div id="chc1.tab3_7"><p class="no_margin">Measurement of oxygen saturation at a single point in the daytime is not a good predictor of early respiratory failure</p></div></dd></dl><dl class="bkr_refwrap"><dt>8</dt><dd><div id="chc1.tab3_8"><p class="no_margin">95% CI for sensitivity crosses 0.75 and 0.90</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchc1tab4"><div id="chc1.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinimetric properties of bicycle ergometers, wheelchair ergometers and the 6 minute walk test to determine maximal aerobic capacity in adults with cerebral palsy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578092/table/chc1.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc1.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chc1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Test</th><th id="hd_h_chc1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Criterion validity<sup>4</sup></th><th id="hd_h_chc1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Construct validity<sup>5</sup></th><th id="hd_h_chc1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Test-retest reliability<sup>6</sup></th><th id="hd_h_chc1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Measurement accuracy<sup>7</sup></th><th id="hd_h_chc1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Test success rate<sup>1</sup></th><th id="hd_h_chc1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of participants (studies)</th><th id="hd_h_chc1.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><td headers="hd_h_chc1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lab based maximal aerobic test: bicycle ergometer</td><td headers="hd_h_chc1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable<sup>3</sup></td><td headers="hd_h_chc1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Good</td><td headers="hd_h_chc1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Good</td><td headers="hd_h_chc1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Good</td><td headers="hd_h_chc1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64 to 100%</td><td headers="hd_h_chc1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">101 (4)</td><td headers="hd_h_chc1.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>2</sup></td></tr><tr><td headers="hd_h_chc1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lab based sub-maximal aerobic test: bicycle ergometer</td><td headers="hd_h_chc1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Good</td><td headers="hd_h_chc1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_chc1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_chc1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_chc1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable (not a maximal test)</td><td headers="hd_h_chc1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 (1)</td><td headers="hd_h_chc1.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>2</sup></td></tr><tr><td headers="hd_h_chc1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lab based maximal aerobic test: wheelchair ergometer</td><td headers="hd_h_chc1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable<sup>3</sup></td><td headers="hd_h_chc1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_chc1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Good</td><td headers="hd_h_chc1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_chc1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">100%</td><td headers="hd_h_chc1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 (3)</td><td headers="hd_h_chc1.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>2</sup></td></tr><tr><td headers="hd_h_chc1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Field based 6 minute walk test</td><td headers="hd_h_chc1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Poor</td><td headers="hd_h_chc1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_chc1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_chc1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_chc1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0%<sup>1</sup></td><td headers="hd_h_chc1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41 (1)</td><td headers="hd_h_chc1.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very low<sup>2</sup></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">CP: cerebral palsy; GMFCS: Gross Motor Function Classification System; VO<sub>2</sub>: oxygen volume</p></div></dd></dl><dl class="bkr_refwrap"><dt>1</dt><dd><div id="chc1.tab4_1"><p class="no_margin">Percentage who reached the maximal aerobic effort criteria</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="chc1.tab4_2"><p class="no_margin">Methodological quality was evaluated using the CASP systematic review checklist</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="chc1.tab4_3"><p class="no_margin">Maximal laboratory based aerobic tests to determine VO<sub>2</sub>max were considered the reference standard</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="chc1.tab4_4"><p class="no_margin">Criteria used to confirm or predict maximal aerobic effort, rated good if correlation with reference standard was >0.7</p></div></dd></dl><dl class="bkr_refwrap"><dt>5</dt><dd><div id="chc1.tab4_5"><p class="no_margin">Rated good if at least 75% of the test results were in accordance with the hypotheses (e.g. VO<sub>2</sub>max is greater for those with GMFCS I compared to GMFCS II)</p></div></dd></dl><dl class="bkr_refwrap"><dt>6</dt><dd><div id="chc1.tab4_6"><p class="no_margin">Rated good if correlation between test and re-test results was>0.7</p></div></dd></dl><dl class="bkr_refwrap"><dt>7</dt><dd><div id="chc1.tab4_7"><p class="no_margin">Rated good when the minimally clinically important change was greater than the minimum detectable change</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchc1appbtab1"><div id="chc1.appb.tab1" class="table"><h3><span class="label">Table 6</span><span class="title">Last searched on 22 March 2018</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578092/table/chc1.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc1.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">#</th><th id="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Cerebral Palsy/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp cerebral palsy/ use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebral or brain or central) adj2 (pal* or paralys#s or pares#s)).tw.</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cerebral palsy.ti,ab.</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">little? disease.tw.</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((hemipleg* or dipleg* or tripleg* or quadripleg* or unilateral*) adj5 spastic*).tw.</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((hemipleg* or dipleg* or tripleg* or quadripleg* or unilateral*) adj3 ataxi*).tw.</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1–6</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 8 to english language</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 9 to (adult <18 to 64 years> or aged <65+ years>) use oemezd [Limit not valid in Ovid MEDLINE(R),Ovid MEDLINE(R) In-Process; records were retained]</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 9 to “all adult (19 plus years)” [Limit not valid in Embase; records were retained]</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/10,12</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Respiration/ or exp Respiration, Artificial/ or exp Respiratory Insufficiency/ or exp Respiration Disorders/ or exp Respiratory Tract Infections/ or exp Respiratory Aspiration/ or exp Pneumonia, Aspiration/ or exp Respiratory System Abnormalities/ or exp Respiratory Therapy/ or exp Respiratory Function Tests/ or exp Respiratory Paralysis/ or exp Respiratory Mechanics /or exp Positive-Pressure Respiration/ or exp Positive-Pressure Respiration, Intrinsic/ or exp Continuous Positive Airway Pressure/ or exp Respiratory Distress Syndrome, Adult/ or exp Respiratory Sounds/ or exp Gastroesophageal Reflux/ or exp Hypoxia/ or exp Sleep Apnea Syndromes/ or exp Sleep Apnea, Obstructive/ or exp Airway Obstruction/ or exp Tracheotomy/ or exp Bronchial Diseases/ or exp Bronchitis/ or exp Bronchiectasis/ or exp Bronchoscopy/ or exp Laryngoscopy/ or exp Tracheobronchomalacia/ or exp Tracheal Diseases/ or exp Adenoidectomy/ or exp Tonsillectomy/ or exp Pulmonary Disease, Chronic Obstructive/ or exp Pulmonary Ventilation/ or exp Airway Management/ or exp Suction/ or exp Airway Resistance/ or exp Cough/ or exp Bronchial Spasm/ or exp Ventilator Weaning/ or exp Ventilators, Mechanical/ or exp Ventilators, Negative-Pressure/ or exp Pulmonary Edema/ or exp Oxygen Consumption/ or exp Oxygen Inhalation Therapy/ or exp Administration, Intranasal/ or exp Catheterization/ or exp Intubation, Intratracheal/ or exp Laryngeal Masks/ or exp Masks/ or exp Catheter Ablation/ or exp Pneumonia/ or exp Pneumonia, Ventilator-Associated/ or exp Ventilator-Induced Lung Injury/ or exp Mouth Breathing/ or exp Phrenic Nerve/ or exp Diaphragm/ or exp Hypoventilation/ or exp Oximetry/ or exp Oxyhemoglobins/ or exp Oxygen/ or exp Carbon Dioxide/ or exp Blood Gas Analysis/ or exp Tidal Volume/ or exp Sleep/ or exp Rest/ or exp Fatigue/ or exp Home Care Services/ or exp Self-Help Devices/ or exp Equipment Failure Analysis/ or exp Intensive Care Units/ or exp Dilatation/ or exp Critical Care/ or exp Self Care/ or exp “Quality of Life”/ or exp Ambulatory Care/ or exp Patient Admission/ or exp Hospitalization/ or exp “Length of Stay”/ or exp Institutionalization/ or exp Physical Therapy Modalities/ or exp Pulmonologists/ or exp Breathing Exercises/ or exp Anti-Bacterial Agents/ or exp Drug Resistance, Bacterial/ or exp Albuterol/ or exp “Nebulizers and Vaporizers”/ or exp Bronchodilator Agents/ or exp Administration, Inhalation/ or exp Saline Solution, Hypertonic/ or exp Influenza Vaccines/ or exp Gastrostomy/ or exp Deglutition Disorders/ or exp Deglutition/ or exp Chest Wall Oscillation/ or exp Asthma/ or exp Bronchopulmonary Dysplasia/ or exp Scoliosis/ or exp Amoxicillin/ or exp Penicillins/ or exp Doxycycline/ or exp Clarithromycin/ or exp Bacterial Infections/co [Complications]</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14 use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp breathing/ or exp artificial ventilation/ or exp respiratory failure/ or exp breathing disorder/ or exp respiratory tract infection/ or exp acid aspiration/ or exp aspiration pneumonia/ or exp respiratory tract malformation/ or exp respiratory care/ or exp oxygen consumption/ or exp diaphragm paralysis/ or exp positive end expiratory pressure/ or exp adult respiratory distress syndrome/ or exp abnormal respiratory sound/ or exp gastroesophageal reflux/ or exp hypoxia/ or exp sleep disordered breathing/ or exp airway obstruction/ or exp dysphagia/ or exp swallowing/ or exp tracheotomy/ or exp lung functioning test/ or exp bronchus disease/ or exp bronchitis/ or exp bronchiectasis/ or exp bronchoscopy/ or exp laryngoscopy/ or exp tracheobronchomalacia/ or exp trachea disease/ or exp adenoidectomy/ or exp apnea monitoring/ or exp tonsillectomy/ or exp chronic obstructive lung disease/ or exp lung ventilation/ or exp breathing mechanics/ or exp respiration control/ or exp suction drainage/ or exp airway suction device/ or exp suction/ or exp tracheal suction catheter/ or exp suction pump/ or exp airway resistance/ or exp coughing/ or exp bronchospasm/ or exp ventilator/ or exp ventilator weaning/ or exp mechanical ventilator/ or exp lung edema/ or exp oxygen therapy/ or exp intranasal drug administration/ or exp catheterization/ or exp endotracheal intubation/ or exp laryngeal mask/ or exp mask/ or exp catheter ablation/ or exp ventilator associated pneumonia/ or exp pneumonia/ or exp ventilator induced lung injury/ or exp mouth breathing/ or exp phrenic nerve/ or exp diaphragm/ or exp hypoventilation/ or exp oximetry/ or exp oxyhemoglobin/ or exp oxygen/ or exp carbon dioxide/ or exp blood gas analysis/ or exp tidal volume/ or exp rest/ or exp sleep/ or exp sleep disordered breathing/ or exp fatigue/ or exp home care/ or exp self help device/ or exp device failure analysis/ or exp intensive care unit/ or exp dilatation/ or exp intensive care/ or exp self care/ or exp “quality of life”/ or exp ambulatory care/ or exp hospital admission/ or exp hospitalization/ or exp “length of stay”/ or exp institutionalization/ or exp physiotherapy/ or exp pulmonologist/ or exp breathing exercise/ or exp antiinfective agent/ or exp bacterial infection/ or exp antibiotic resistance/ or exp antibiotic agent/ or exp salbutamol/ or exp nebulizer/ or exp vaporizer/ or exp bronchodilating agent/ or exp inhalational drug administration/ or exp sodium chloride/ or exp influenza vaccine/ or exp gastrostomy/ or exp asthma/ or exp lung dysplasia/ or exp scoliosis/ or exp amoxicillin/ or exp penicillin derivative/ or exp doxycycline/ or exp clarithromycin/</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(respirat* or breath* or ventilat* or tracheo* or trachea* or intratracheal or intubat* or catheter* or airway* or mask* or tent* or sleep apn?ea or tube* or nasotracheal or CNT or obstruct* or mouth* or nose* or nasal or intranasal or nasogastic or failure or distress or pneumon* or lung* or phrenic nerve* or pulmonary* or diaphragm* or tracheo-bronchomalacia or hypoventilat* or positive airway pressure* or negative pressure* or CPAP or negative pressure chamber* or NPC or assist* or manag* or support* or help* or complicat* or leak* or prevent* or prophyla* or monitor* or assistive technology or hypox* or bronch* or bronchopulmonary or laryn* or adenoid* or tonsil* or resistan* or edema* or oxygen* or carbon dioxide or CO2 or inhal* or oximetr* or oxyhemoglobin* or tidal volume* or sleep* or fatigue* or daytime function* or home care or self-help* or self-care* or dilat* or cough* or chest physiotherapy* or antibiot* or critical or quality or hospital admission* or stay or institutional* or thermoplastic patient-ventilator tubing interface* or bedside percutaneous dilatational tracheostomy or PDT or BIPAP or chest infection* or inflammat* or aspiration* or tachypnoea or bronchial spasm* or phlegm* or wheez* or choking or choke* or swallow* or salbutamol or hyperinflation or deglutition* or oscillation* or nebuli?er* or vapori?er* or oral secretion* or saline or oro-pharyngeal suction* or saturation* or vaccine* or pulmonologist* or gastrostom* or bronchitis or percussion* or chest wall vibration* or kyphoscoliosis or amoxicillin or penicillin or doxycycline or clarithromycin).ti,ab.</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 or 17 or 18</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 and 19</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">conference abstract.pt. use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or LETTER/ use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Letter/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">EDITORIAL/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt. use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NEWS/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp HISTORICAL ARTICLE/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt. use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANECDOTES AS TOPIC/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">COMMENT/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CASE REPORT/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CASE REPORT/ use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CASE STUDY/ use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment* or abstracts).ti.</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/21–34</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RANDOMIZED CONTROLLED TRIAL/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RANDOMIZED CONTROLLED TRIAL/ use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/36–38</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35 not 39</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANIMALS/ not HUMANS/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANIMAL/ not HUMAN/ use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ANIMALS, LABORATORY/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ANIMAL EXPERIMENTATION/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp MODELS, ANIMAL/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp RODENTIA/ use prmz</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NONHUMAN/ use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp ANIMAL EXPERIMENT/ use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp EXPERIMENTAL ANIMAL/ use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ANIMAL MODEL/ use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp RODENT/ use oemezd</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/40–52</td></tr><tr><td headers="hd_h_chc1.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54</td><td headers="hd_h_chc1.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20 not 53</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchc1appbtab2"><div id="chc1.appb.tab2" class="table"><h3><span class="label">Table 7</span><span class="title">Last searched on 22 March 2018</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578092/table/chc1.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc1.appb.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">ID</th><th id="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Search</th></tr></thead><tbody><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Cerebral Palsy] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebral or brain or central) N2 (pal* or paralys?s or pare?s))</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((hemipleg* or dipleg* or tripleg* or quadripleg* or unilateral*) N5 spastic*)</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((hemipleg* or dipleg* or tripleg* or quadripleg* or unilateral*) N3 ataxi*)</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1 or #2 or #3 or #4</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Respiration] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Respiration, Artificial] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Respiratory Insufficiency] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Respiration Disorders] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Respiratory Tract Infections] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Respiratory Aspiration] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Pneumonia, Aspiration] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Respiratory System Abnormalities] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Respiratory Therapy] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Respiratory Paralysis] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#16</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Positive-Pressure Respiration] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Positive-Pressure Respiration, Intrinsic] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#18</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Continuous Positive Airway Pressure] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#19</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Respiratory Distress Syndrome, Adult] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#20</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Respiratory Sounds] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#21</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Gastroesophageal Reflux] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#22</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Hypoxia] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#23</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Sleep Apnea Syndromes] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#24</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Sleep Apnea, Obstructive] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#25</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Airway Obstruction] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#26</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Tracheotomy] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#27</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Bronchial Diseases] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#28</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Bronchitis] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#29</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Bronchiectasis] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#30</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Bronchoscopy] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#31</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Laryngoscopy] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#32</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Tracheobronchomalacia] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#33</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Tracheal Diseases] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#34</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Adenoidectomy] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#35</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Tonsillectomy] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#36</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Pulmonary Disease, Chronic Obstructive] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#37</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Pulmonary Ventilation] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#38</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Pulmonary Ventilation] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#39</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Airway Management] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#40</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Suction] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#41</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Airway Resistance] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#42</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Cough] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#43</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Bronchial Spasm] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#44</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Ventilator Weaning] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#45</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Ventilators, Mechanical] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#46</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Ventilators, Negative-Pressure] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#47</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Pulmonary Edema] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#48</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Oxygen Inhalation Therapy] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#49</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Administration, Intranasal] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#50</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Catheterization] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#51</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Intubation, Intratracheal] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#52</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Laryngeal Masks] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#53</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Masks] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#54</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Catheter Ablation] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#55</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Pneumonia] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#56</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Pneumonia, Ventilator-Associated] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#57</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Ventilator-Induced Lung Injury] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#58</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Mouth Breathing] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#59</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Phrenic Nerve] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#60</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Diaphragm] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#61</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Hypoventilation] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#62</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Oximetry] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#63</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Oxyhemoglobins] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#64</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Oxygen] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#65</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Carbon Dioxide] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#66</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Blood Gas Analysis] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#67</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Tidal Volume] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#68</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Sleep] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#69</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Fatigue] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#70</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Home Care Services] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#71</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Self-Help Devices] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#72</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Equipment Failure Analysis] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#73</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Intensive Care Units] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#74</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Dilatation] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#75</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Critical Care] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#76</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Self Care] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#77</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Quality of Life] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#78</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Ambulatory Care] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#79</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Patient Admission] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#80</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Hospitalization] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#81</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Length of Stay] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#82</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Institutionalization] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#83</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Physical Therapy Modalities] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#84</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Pulmonologists] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#85</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Breathing Exercises] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#86</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Anti-Bacterial Agents] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#87</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Drug Resistance, Bacterial] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#88</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Albuterol] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#89</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Nebulizers and Vaporizers] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#90</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Bronchodilator Agents] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#91</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Administration, Inhalation] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#92</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Saline Solution, Hypertonic] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#93</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Influenza Vaccines] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#94</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Gastrostomy] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#95</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Deglutition Disorders] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#96</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Deglutition] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#97</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Chest Wall Oscillation] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#98</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Asthma] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#99</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Bronchopulmonary Dysplasia] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#100</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Scoliosis] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#101</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Amoxicillin] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#102</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Penicillins] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#103</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Doxycycline] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#104</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Clarithromycin] explode all trees</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#105</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Bacterial Infections] explode all trees and with qualifier(s): [Complications - CO]</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#106</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">respirat* or breath* or ventilat* or tracheo* or trachea* or intratracheal or intubat* or catheter* or airway* or mask* or tent* or sleep apn?ea or tube* or nasotracheal or CNT or obstruct* or mouth* or nose* or nasal or intranasal or nasogastic or failure or distress or pneumon* or lung* or phrenic nerve* or pulmonary* or diaphragm* or tracheo-bronchomalacia or hypoventilat* or positive airway pressure* or negative pressure* or CPAP or negative pressure chamber* or NPC or assist* or manag* or support* or help* or complicat* or leak* or prevent* or prophyla* or monitor* or assistive technology or hypox* or bronch* or bronchopulmonary or laryn* or adenoid* or tonsil* or resistan* or edema* or oxygen* or carbon dioxide or CO2 or inhal* or oximetr* or oxyhemoglobin* or tidal volume* or sleep* or fatigue* or daytime function* or home care or self-help* or self-care* or dilat* or cough* or chest physiotherapy* or antibiot* or critical or quality or hospital admission* or stay or institutional* or thermoplastic patient-ventilator tubing interface* or bedside percutaneous dilatational tracheostomy or PDT or BIPAP or chest infection* or inflammat* or aspiration* or tachypnoea or bronchial spasm* or phlegm* or wheez* or choking or choke* or swallow* or salbutamol or hyperinflation or deglutition* or oscillation* or nebuli?er* or vapori?er* or oral secretion* or saline or oro-pharyngeal suction* or saturation* or vaccine* or pulmonologist* or gastrostom* or bronchitis or percussion* or chest wall vibration* or kyphoscoliosis or amoxicillin or penicillin or doxycycline or clarithromycin</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#107</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">{or #6–#106}</td></tr><tr><td headers="hd_h_chc1.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#108</td><td headers="hd_h_chc1.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5 and #107</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchc1appbtab3"><div id="chc1.appb.tab3" class="table"><h3><span class="label">Table 8</span><span class="title">Last searched on 22 March 2018</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578092/table/chc1.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc1.appb.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_chc1.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">#4</th><th id="hd_h_chc1.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">(#3) AND LANGUAGE: (English)</th></tr></thead><tbody><tr><td headers="hd_h_chc1.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3</td><td headers="hd_h_chc1.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2 AND #1</td></tr><tr><td headers="hd_h_chc1.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2</td><td headers="hd_h_chc1.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ts=Artificial Respiration or ts=Respiratory Tract Infection* or ts=Aspiration or ts=respirat* failure* or ts=Pneumoni* or ts=Respiratory Therapy or ts=Respiratory Distress Syndrome or ts=Airway* Obstruction* or ts=Bronch* Disease* or ts=Pulmonary Ventilat* or ts=mechanical ventilation* or ts=Breathing Exercise* or ts=antibiotic* or ts=Vaccine* or ts=Bacterial Infection* or ts=breath* or ts=mask* or ts=tent* or ts=sleep apn?ea or ts=tube* or ts=hypoventilat* or ts=positive airway pressure* or ts=negative pressure* or ts=chest infection* or ts=inflammat* or ts=oxygen* or ts=carbon dioxide or ts=CO2 or ts=bronchial spasm* or ts=phlegm* or ts=wheez* or ts=choking or ts=choke* or ts=swallow* or ts=salbutamol or ts=percussion* or ts=chest wall vibration* or ts=scoliosis or ts=amoxicillin or ts=penicillin or ts=doxycycline or ts=clarithromycin</td></tr><tr><td headers="hd_h_chc1.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1</td><td headers="hd_h_chc1.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ts=cerebral palsy</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobchc1appcfig1"><div id="chc1.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20diagram%20of%20clinical%20article%20selection%20for%20this%20review.&p=BOOKS&id=578092_chc1appcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK578092/bin/chc1appcf1.jpg" alt="Figure 1. Flow diagram of clinical article selection for this review." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow diagram of clinical article selection for this review</span></h3></div></article><article data-type="fig" id="figobchc1appefig1"><div id="chc1.appe.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Diagnostic%20accuracy%20of%20different%20thresholds%20for%20reduced%20lung%20vital%20capacity%20(measured%20with%20spirometry)%20for%20prediction%20of%20low%20oxygen%20saturation%20(%3C96%25)%20in%20adults%20with%20cerebral%20palsy.&p=BOOKS&id=578092_chc1appef1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK578092/bin/chc1appef1.jpg" alt="Figure 2. Diagnostic accuracy of different thresholds for reduced lung vital capacity (measured with spirometry) for prediction of low oxygen saturation (<96%) in adults with cerebral palsy." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Diagnostic accuracy of different thresholds for reduced lung vital capacity (measured with spirometry) for prediction of low oxygen saturation (<96%) in adults with cerebral palsy</span></h3><div class="caption"><p>CI: confidence interval; DVC: deviation of lung capacity (below normal value in litres); FN: false negative; FP: false positive; TN: true negative; TP:true positive</p></div></div></article><article data-type="fig" id="figobchc1appefig2"><div id="chc1.appe.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%203.%20ROC%20curve%20of%20deviation%20of%20lung%20vital%20capacity%20from%20normal%20to%20predict%20low%20oxygen%20saturation%20(%3C96%25)%20in%20adults%20with%20cerebral%20palsy.&p=BOOKS&id=578092_chc1appef2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK578092/bin/chc1appef2.jpg" alt="Figure 3. ROC curve of deviation of lung vital capacity from normal to predict low oxygen saturation (<96%) in adults with cerebral palsy." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 3</span><span class="title">ROC curve of deviation of lung vital capacity from normal to predict low oxygen saturation (<96%) in adults with cerebral palsy</span></h3><div class="caption"><p>ROC: receiver operating characteristic</p></div></div></article><article data-type="table-wrap" id="figobchc1appltab1"><div id="chc1.appl.tab1" class="table"><h3><span class="label">Table 11</span><span class="title">Research recommendation rationale</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578092/table/chc1.appl.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc1.appl.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_chc1.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Research question</th><th id="hd_h_chc1.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Can detection and management of respiratory disorder in adults with cerebral palsy be improved in primary and community care?</th></tr></thead><tbody><tr><td headers="hd_h_chc1.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Importance to ‘patients’ or the population</td><td headers="hd_h_chc1.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Improved detection of respiratory impairment</p>
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<p>Reduce risk of respiratory failure</p>
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<p>Reduce respiratory symptom burden</p>
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<p>Reduce hospital admissions</p>
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<p>Reduce acute antibiotic prescriptions</p>
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<p>Improve quality of life</p>
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</td></tr><tr><td headers="hd_h_chc1.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to NICE guidance</td><td headers="hd_h_chc1.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Improve future clinical guidelines for monitoring respiratory health in adults with cerebral palsy</td></tr><tr><td headers="hd_h_chc1.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to the NHS</td><td headers="hd_h_chc1.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Improve early detection of respiratory impairment</p>
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<p>Improve management of risk factors causing respiratory impairment</p>
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<p>Reduce risk of developing respiratory failure and complications</p>
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<p>Reduced costs related to respiratory failure</p>
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</td></tr><tr><td headers="hd_h_chc1.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">National priorities</td><td headers="hd_h_chc1.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reduce variation in treatment</td></tr><tr><td headers="hd_h_chc1.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence base</td><td headers="hd_h_chc1.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence was not clear on respiratory assessment in primary care</td></tr><tr><td headers="hd_h_chc1.appl.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Equality</td><td headers="hd_h_chc1.appl.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Applies to all adults with cerebral palsy particularly those with underlying risk factors</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchc1appltab2"><div id="chc1.appl.tab2" class="table"><h3><span class="label">Table 12</span><span class="title">Research recommendation modified PICO table</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK578092/table/chc1.appl.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc1.appl.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_chc1.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Criterion</th><th id="hd_h_chc1.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Explanation</th></tr></thead><tbody><tr><td headers="hd_h_chc1.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</td><td headers="hd_h_chc1.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adults (16 or over) with cerebral palsy who are at risk of respiratory complications due to underlying comorbidity such as kyphoscoliosis.</td></tr><tr><td headers="hd_h_chc1.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</td><td headers="hd_h_chc1.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Annual respiratory assessment followed by management if necessary</td></tr><tr><td headers="hd_h_chc1.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator</td><td headers="hd_h_chc1.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Usual care</td></tr><tr><td headers="hd_h_chc1.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</td><td headers="hd_h_chc1.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l217"><li id="lt656" class="half_rhythm"><div>Accuracy of tests for respiratory function</div></li><li id="lt657" class="half_rhythm"><div>Hospital admission</div></li><li id="lt658" class="half_rhythm"><div>Overall survival</div></li><li id="lt659" class="half_rhythm"><div>Patient satisfaction</div></li><li id="lt660" class="half_rhythm"><div>Respiratory health</div></li></ul></td></tr><tr><td headers="hd_h_chc1.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</td><td headers="hd_h_chc1.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multicentre test and treat randomised controlled trial</td></tr><tr><td headers="hd_h_chc1.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Timeframe</td><td headers="hd_h_chc1.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 years</td></tr><tr><td headers="hd_h_chc1.appl.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Additional information</td><td headers="hd_h_chc1.appl.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Need to stratify by:</p>
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<p>Severity of cerebral palsy according to the Gross Motor Function Classification System (GMFCS</p>
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<p>Pre-existing co-morbidities (scoliosis, asthma, etc.)</p>
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