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Abstract
BACKGROUND: Patients with decreased consciousness are prone to prolonged bed rest and respiratory complications. If effective in reducing atelectasis, lung expansion maneuvers could be used to prevent these complications. In comatose, bedridden subjects, we aimed to assess the acute effect on regional lung aeration of 2 lung expansion techniques: expiratory positive airway pressure and the breath-stacking maneuver. Our secondary aim was to evaluate the influence of these lung expansion techniques on regional ventilation distribution, regional ventilation kinetics, respiratory pattern, and cardiovascular system.
METHODS: We enrolled 10 subjects status post neurosurgery, unable to follow commands, and with prolonged bed rest. All subjects were submitted to both expansion techniques in a randomized order. Regional lung aeration, ventilation distribution, and regional ventilation kinetics were measured with electrical impedance tomography.
RESULTS: Lung aeration increased significantly during the application of both expiratory positive airway pressure and breath-stacking (P < .001) but returned to baseline values seconds afterwards. The posterior lung regions had the largest volume increase (P < .001 for groups). Both maneuvers induced asynchronous inflation and deflation between anterior and posterior lung regions. There were no significant differences in cardiovascular variables.
CONCLUSIONS: In comatose subjects with prolonged bed rest, expiratory positive airway pressure and breath-stacking promoted brief increases in lung aeration. (ClinicalTrials.gov registration NCT02613832.)
- physical therapy techniques
- positive-pressure respiration
- electrical impedance
- lung volume measurements
Footnotes
- Correspondence: Armèle Dornelas de Andrade PhD, Phisiotherapy Department, Universidade Federal de Pernambuco, Av. Jorn. Aníbal Fernandes, 173, Recife, Pernambuco, Brazil. E-mail: armeledornelas{at}yahoo.com or armele.andrade{at}ufpe.br
This work was supported in part by FACEPE - Fundação de Amparo a Ciência e Tecnologia do Estado de Pernambuco (0154-4.08/15). Drs Costa and Amato report relationships with Timpel SA. The other authors have disclosed no conflicts of interest.
Supplementary material related to this paper is available at http://www.rcjournal.com.
- Copyright © 2021 by Daedalus Enterprises
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