Influência da técnica de pressão expiratória positiva oscilante utilizando pressões expiratórias pré-determinadas na viscosidade e na transportabilidade do escarro em pacientes com bronquiectasia

Abstract

OBJETIVO: Verificar a efetividade da técnica de pressão expiratória positiva oscilante (PEPO) utilizando pressões expiratórias pré-determinadas sobre a viscosidade e a transportabilidade do escarro em pacientes com bronquiectasia. MÉTODOS: Foram incluídos no estudo 15 pacientes estáveis com bronquiectasia (7 homens; média de idade = 53 ± 16 anos), submetidos a duas intervenções PEPO consecutivas, com 24 h de intervalo entre si, utilizando pressões expiratórias de 15 cmH2O (P15) e 25 cmH2O (P25). O protocolo consistiu de tosse voluntária; nova expectoração voluntária após 20 min, denominado tempo zero (T0); repouso de 10 min; e utilização da técnica em duas séries de 10 min (S1 e S2) de PEPO em P15 e P25, com intervalo de 10 min entre si. A viscosidade e transportabilidade do escarro foram avaliadas pela viscosimetria, velocidade relativa de transporte no palato de rã, deslocamento em máquina simuladora de tosse e ângulo de adesão. As amostras de escarro foram coletadas em T0, após S1 e após S2. Testes estatísticos específicos foram aplicados de acordo com a distribuição dos dados. RESULTADOS: Houve diminuição significante da viscosidade do escarro após S1 em P15 e após S2 em P25. Não houve diferenças significantes entre todas as amostras para a transportabilidade. CONCLUSÕES: Houve diminuição da viscosidade do escarro quando a PEPO foi realizada em P15 e P25, o que sugere que não seja necessário gerar alta pressão expiratória para obter o resultado desejado.

The effects of oscillating positive expiratory pressure therapy in adults with stable non-cystic fibrosis bronchiectasis

“…Oscillating PEP devices generate oscillating waves on expiration with varying frequencies which are transmitted through the airways, resulting in shearing forces which reduce the viscoelasticity of bronchial secretions 15 and improve mucus transport. 16,17 In addition, the positive pressure generated during expiration facilitates collateral ventilation to maintain airway patency and facilitate movements of secretions centrally. 10 Intrathoracic oscillating PEP therapy is commonly applied using the Flutter 1 valve and Acapella 1 , with similar pressure flow characteristics generated for each device.…”

Effects of an Airway Clearance Device on Inflammation, Bacteriology, and Mucus Transport in Bronchiectasis

“…The studies reported improvement in the transport indexes of respiratory secretions after 4 weeks in subjects with cystic fibrosis and bronchiectasis. 11,12,17 Besides improvement of transport indexes or rheological properties, 11,14,15 previous studies in subjects with bronchiectasis have also found improvements in expectorated volume, 11,25,26 lung function, 11,[25][26][27] and acceptability of the technique. 28 We also found that there was a reduction in the variables in sputum bacterial colony counts in both the flutter valve and control groups.…”

“…12 In subjects with bronchiectasis, previous research has studied the effectiveness of the flutter in relation to expectorated secretion volume, 13 mucociliary transport by the frog palate method, displacement in the simulated cough machine, contact angle, and respiratory secretion viscosity. 10,14,15 Tambascio et al 12 demonstrated an improvement in respiratory secretion transport after exercises with Flutter VRP1 in subjects with bronchiectasis. It has been speculated that this increase in the displacement by coughing and a reduction in the contact angle could be attributed to thixotropic flow, 16,17 and this effect had been demonstrated by App et al 17 and Ramos et al 14 in subjects with bronchiectasis and cystic fibrosis, respectively.…”

“…10,14,15 Tambascio et al 12 demonstrated an improvement in respiratory secretion transport after exercises with Flutter VRP1 in subjects with bronchiectasis. It has been speculated that this increase in the displacement by coughing and a reduction in the contact angle could be attributed to thixotropic flow, 16,17 and this effect had been demonstrated by App et al 17 and Ramos et al 14 in subjects with bronchiectasis and cystic fibrosis, respectively. Because hypersecretion and/or mucus stasis contributes to the perpetuation of the inflammatory process, 3,18 we hypothesized that favoring the removal of secretions with the flutter valve technique, which is capable of increasing the volume of sputum, could also modify the inflammatory and microbiological profile of respiratory secretions.…”

Compared to maximal current management standards, oscillating positive expiratory pressure devices have not been shown to improve clinically relevant outcomes in COPD patients with acute exacerbation

“…There were 31 results, most of which were investigating bronchiectasis or cystic fibrosis patients, which were again excluded. [5][6][7][8][9][10][11] We felt that the anatomical and pathophysiological processes were too dissimilar to inform the management of our patient. Additionally, we found a trial incorporating COPD patients, but the article had been retracted.…”