No abstract

This clinical practice guideline (CPG) is the fourth edition of the Korean guideline for stroke rehabilitation, which was last updated in 2016. The development approach has been changed from a consensus-based approach to an evidence-based approach using the Grading of Recommendations Assessment Development and Evaluation (GRADE) method. This change ensures that the guidelines are based on the latest and strongest evidence available. The aim is to provide the most accurate and effective guidance to stroke rehabilitation teams, and to improve the outcomes for stroke patients in Korea. Fifty-five specialists in stroke rehabilitation and one CPG development methodology expert participated in this development. The scope of the previous clinical guidelines was very extensive, making it difficult to revise at once. Therefore, it was decided that the scope of this revised CPG would be limited to Part 1: Rehabilitation for Motor Function. The key questions were selected by considering the preferences of the target population and referring to foreign guidelines for stroke rehabilitation, and the recommendations were completed through systematic literature review and the GRADE method. The draft recommendations, which were agreed upon through an official consensus process, were refined after evaluation by a public hearing and external expert evaluation.

Background: Mechanical insu ation-exsu ation (MI-E) applied through the endotracheal tube (ET) can effectively eliminate airway secretions in intubated patients. However, the effect of the interface (ET vs. facemask) on expiratory air ow generated by MI-E has not been investigated. This study aimed to investigate the effect of the ET on peak expiratory ow (PEF), along with other associated factors that could in uence PEF generated by MI-E. Methods: Intubated participants received two sessions of MI-E via ET therapy per day for two consecutive days. One MI-E session consisted of ve sets of either constant (+40/-40 cmH 2 O) or incremental (+30/-30 to +50/-50 cmH 2 O) pressure applications. Following extubation, MI-E sessions were repeated using facemask. Expiratory air ow during MI-E therapy was measured, and repetitive PEF measurements during each session were analysed using linear mixed-effect and generalised linear mixed models. Results: A total of 12 participants (9 [75.0%] men; mean [SD] age, 74.0 [10.2] years) completed all MI-E sessions with both ET and facemask interfaces. The PEF generated during MI-E treatment was in uenced by the pressure gradient, number of session repetitions, and interface (ET vs. facemask). Adjusted mean PEF values for MI-E via ET and facemask at +40/-40 cmH 2 O were -2.521 and -3.114 L/s, respectively, and -2.956 and -3.364 L/s at +50/-50 cmH 2 O, respectively. At a pressure gradient of +40/-40 cmH 2 O, only 172 of 528 MI-E trials via ET (32.6%) achieved a PEF faster than -2.7 L/s, whereas 304 of 343 MI-E trials via facemask (88.6%) exceeded the PEF cut-off value.Conclusions: MI-E via ET generated slower PEF than via facemask, suggesting that a higher-pressure protocol should be prescribed for intubated patients. An insu ation-exsu ation pressure of at least +50/-50 cmH 2 O should be considered to produce a PEF faster than 2.7 L/s, and the applications were safe and feasible for patients under invasive mechanically ventilation.