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Research ArticleOriginal Research

The Short-Term Effects of Intermittent Positive Pressure Breathing Treatments on Ventilation in Patients With Neuromuscular Disease

Claude Guérin, Bernard Vincent, Thierry Petitjean, Pierre Lecam, Christiane Luizet, Muriel Rabilloud and Jean-Christophe Richard
Respiratory Care July 2010, 55 (7) 866-872;
Claude Guérin
Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France.
Créatis Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) 5515, Institut National de la Santé et de la Recherche Médicale (INSERM) U630, Université de Lyon, Lyon, France.
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  • For correspondence: [email protected]
Bernard Vincent
Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France.
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Thierry Petitjean
Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France.
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Pierre Lecam
Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France.
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Christiane Luizet
Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France.
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Muriel Rabilloud
Service de Biostatistique, Hospices Civils de Lyon; Equipe Biostatistique Santé, Laboratoire de Biométrie et Biologie Evolutive, Pierre-Bénite, and Université de Lyon, Lyon, France.
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Jean-Christophe Richard
Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France.
Créatis Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) 5515, Institut National de la Santé et de la Recherche Médicale (INSERM) U630, Université de Lyon, Lyon, France.
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Abstract

BACKGROUND: The effects of intermittent positive-pressure breathing (IPPB) and abdominal belt on regional lung ventilation in neuromuscular patients are unknown. We conducted a prospective physiologic short-term study in stable neuromuscular patients to determine the effects of IPBB, with and without abdominal belt, on regional lung ventilation.

METHODS: IPPB was performed as 30 consecutive deep breaths up to 30 cm H2O face-mask pressure each: 10 in supine position, 10 in left-lateral position, and 10 in right-lateral position. Each patient received IPPB sessions with and without an abdominal belt, in a random order, at one-day intervals. Patients were then followed-up to 3 hours after IPPB. Lung ventilation was measured via electrical-impedance tomography (tidal volume via electrical-impedance tomography [electrical-impedance VT], which is reported in arbitrary units) in 4 lung quadrants. Baseline VT and exhaled VT after each deep breath were also measured. The primary outcome was maintenance of regional ventilation after 3 hours.

RESULTS: Global electrical-impedance VT remained significantly higher than at baseline as long as 3 hours after the IPPB sessions. Global and regional electrical-impedance VT at the end of the 3-hour study period was significantly higher with the abdominal belt in place. Regional ventilation did not change significantly. With IPPB in the supine position, electrical-impedance VT was significantly greater in the anterior than the posterior lung regions (P < .001). With IPPB in supine position, median and interquartile range VT values increased from 0.25 L (0.20–0.30) to the exhaled VT of 1.50 L (1.08–1.96) (P < .001). There were no differences in regional ventilation.

CONCLUSIONS: In patients with neuromuscular disease, supine IPPB treatments, with or without abdominal belt, increased ventilation to anterior lungs regions, compared to the left-lateral and right-lateral positions. Global ventilation 3 hours after IPPB treatments remained higher than at baseline and was best preserved with the use of an abdominal belt.

  • intermittent positive-pressure breathing
  • hyperinsufflations
  • neuromuscular dystrophy
  • regional lung ventilation
  • electrical-impedance tomography

Footnotes

  • Correspondence: Claude Guerin MD PhD, Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France. E-mail claude.guerin{at}chu-lyon.fr.
  • This research was partly supported by a grant from Association Française Contre les Myopathies.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2010 by Daedalus Enterprises Inc.
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Respiratory Care: 55 (7)
Respiratory Care
Vol. 55, Issue 7
1 Jul 2010
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The Short-Term Effects of Intermittent Positive Pressure Breathing Treatments on Ventilation in Patients With Neuromuscular Disease
Claude Guérin, Bernard Vincent, Thierry Petitjean, Pierre Lecam, Christiane Luizet, Muriel Rabilloud, Jean-Christophe Richard
Respiratory Care Jul 2010, 55 (7) 866-872;

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The Short-Term Effects of Intermittent Positive Pressure Breathing Treatments on Ventilation in Patients With Neuromuscular Disease
Claude Guérin, Bernard Vincent, Thierry Petitjean, Pierre Lecam, Christiane Luizet, Muriel Rabilloud, Jean-Christophe Richard
Respiratory Care Jul 2010, 55 (7) 866-872;
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Keywords

  • intermittent positive-pressure breathing
  • hyperinsufflations
  • neuromuscular dystrophy
  • regional lung ventilation
  • electrical-impedance tomography

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