Short-Term Effects of Positive Expiratory Airway Pressure in Patients Being Weaned from Mechanical Ventilation

Abstract

Rieder M de M, da Costa AD, Vieira SRR. Short-term effects of positive expiratory airway pressure in patients being weaned from mechanical ventilation. Clinics. 2009;64(5):403-8. OBJECTIVE:To investigate the feasibility and the cardiorespiratory effects of using positive expiratory airway pressure, a physiotherapeutic tool, in comparison with a T-tube, to wean patients from mechanical ventilation. METHODS/DESIGN: A prospective, randomized, cross-over study. SETTING: Two intensive care units. PATIENTS AND INTERVENTIONS:We evaluated forty patients who met weaning criteria and had been mechanically-ventilated for more than 48 hours, mean age 59 years, including 23 males. All patients were submitted to the T-tube and Expiratory Positive Airway Pressure devices, at 7 cm H 2 O, during a 30-minute period. Cardiorespiratory variables including work of breathing, respiratory rate (rr), peripheral oxygen saturation (SpO 2 ), heart rate (hr), systolic, diastolic and mean arterial pressures (SAP, DAP, MAP) were measured in the first and thirtieth minutes. The condition was analyzed as an entire sample set (n=40) and was also divided into subconditions: chronic obstructive pulmonary disease (n=14) and non-chronic obstructive pulmonary disease (non-chronic obstructive pulmonary disease) (n=26) categories. Comparisons were made using a t-test and Analysis of Variance. The level of significance was p < 0.05. RESULTS: Our data showed an increase in work of breathing in the first and thirtieth minutes in the EPAP condition (0.86+ 0.43 and 1.02+1.3) as compared with the T-tube condition (0.25+0.26 and 0.26+0.35) (p<0.05), verified by the flow-sensor monitor (values in J/L). No statistical differences were observed when comparing the Expiratory Positive Airway Pressure and T-tube conditions with regard to cardiorespiratory measurements. The same result was observed for both chronic obstructive pulmonary disease and non-chronic obstructive pulmonary disease subconditions. CONCLUSIONS: Our study demonstrated that, in weaning patients from mechanical ventilation, the use of a fixed level of Expiratory Positive Airway Pressure caused an increase in work of breathing that was not accompanied by any other significant cardiorespiratory changes. Therefore, we have to be cautious when using Expiratory Positive Airway Pressure as a physiotherapeutic tool during weaning from mechanical ventilation.

Pressão expiratória positiva na via aérea por máscara facial na hemodinâmica de pós-operatórios cardíacos

“…Despite an increased respiratory muscle workload resulting from the use of EPAP 10 , it presents good results in the reversal of atelectasis, removal of secretions 15 and recovery of muscle strength in patients RHS 11,16 as well as significant improvements in FEV1 and FVC after one month of hospital discharge 16 . However, a recent study did not report differences in the evolution of RHS as to pulmonary function, radiological findings and length of hospital stay when compared with physical therapy versus conventional therapy with EPAP…”

Avaliação dos artigos de pneumologia publicados em periódicos Brasileiros além do Jornal Brasileiro de Pneumologia

“…(26) Fonseca et al compared two respiratory an increase in the work of breathing, but no changes in other cardiorespiratory variables. (10) In the article published by Sena et al, in which postoperative cardiac patients were evaluated, the use of PEEP (10 cmH 2 O), applied with a face mask, was well tolerated by the patients, there being an increase in right and left ventricular filling pressure, as well as in mean arterial pressure.…”

A Eficácia da Utilização de Reexpansão por EPAP, para Prevenção e Reversão de Atelectasia: Revisão de Literatura

“…3 A pressão positiva na expiração (EPAP) é considerada como técnica alternativa segura e eficaz dentro da Fisioterapia Respiratória, onde no transcorrer de uma terapia utilizando-se EPAP, o paciente exala contra um resistor de limiar, gerando pressões positivas durante a expiração. 4 O objetivo deste trabalho foi verificar a eficácia da pressão expiratória positiva nas vias aéreas (EPAP) na reversão e prevenção de atelectasia.…”