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Physiological responses to positive expiratory pressure breathing: a comparison of the PEP bottle and the PEP mask
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.ORCID iD: 0000-0003-1523-1672
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.ORCID iD: 0000-0003-3363-7414
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.ORCID iD: 0000-0002-5325-2688
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
2007 (English)In: Respiratory care, ISSN 0020-1324, E-ISSN 1943-3654, Vol. 52, no 8, 1000-1005 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In the intensive care unit we have observed that patients have different adherence to 2 commonly used positive-expiratory-pressure (PEP) therapy devices: the PEP bottle and the PEP mask. The reason for this difference is not clear. METHODS: In a randomized prospective study, we made continuous recordings of airway pressure and airflow, with 20 healthy volunteers, with the PEP bottle and the PEP mask. The measurement sequence consisted of 3 sessions of 10 breaths with the PEP bottle and the PEP mask, in a randomized crossover design. A rest period of 15 min separated the PEP bottle and PEP mask measurements. RESULTS: With the PEP bottle the expiratory phase began with a zero-flow period of 0.39 s, during which airway pressure rose 11.9 cm H2O. With the PEP bottle the mean expiratory pressure was 11.7 cm H2O, and end-expiratory pressure was 9.5 cm H2O. With the PEP mask the initial expiratory zero-flow period was almost nonexistent (0.04 s) and without any change in airway pressure. With the PEP mask the shape of the expiratory pressure curve was different; mean expiratory pressure was 8.6 cm H2O, and end-expiratory pressure was zero. With the PEP bottle the inspiration also began with a zero-flow period of 0.43 s, during which airway pressure decreased 9.6 cm H2O from the end-expiratory airway pressure. With the PEP mask the initial inspiratory zero-flow period was only 0.01 s and there was no concomitant change in airway pressure. CONCLUSIONS: The PEP bottle and the PEP mask showed major differences in the relationship between airflow and airway pressure. These findings might explain the observed differences in patient adherence to these therapies.

Place, publisher, year, edition, pages
Daedalus Enterprises , 2007. Vol. 52, no 8, 1000-1005 p.
Keyword [en]
Positive expiratory pressure, PEP, airflow, airway pressure, Borg scale, chest physiotherapy, flow resistor, threshold resistor
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-7151PubMedID: 17650355OAI: oai:DiVA.org:umu-7151DiVA: diva2:146822
Note

Maria Sehlin RPT MSc presented a version of this paper at the meeting of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, held July 2, 2005, in Reykjavik, Iceland, and at the Swedish Association of Registered Physiotherapists Congress, held October 28, 2005, in Stockholm, Sweden.

Available from: 2008-02-13 Created: 2008-02-13 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Resistance breathing with PEP and CPAP: effects on respiratory parameters
Open this publication in new window or tab >>Resistance breathing with PEP and CPAP: effects on respiratory parameters
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Positive expiratory pressure (PEP) and continuous positive airway pressure (CPAP) are two forms of resistance breathing used in spontaneously breathing patients. With a threshold resistor or a flow resistor, both PEP and CPAP provide a positive (elevated) pressure level during the expiratory phase. With PEP, inspiratory pressure is negative, i.e. lower than ambient air pressure, as during a normal inspiration, but with CPAP, the inspiratory pressure is positive, i.e. higher than ambient air pressure.

Methods: This thesis is based on four separate studies in which four different breathing devices, a PEP-bottle (threshold resistor device), a PEP-mask (flow resistor device), a threshold resistor CPAP and a flow resistor device were investigated. Paper I, II and III are based on studies in healthy volunteers. Paper IV is a bench study performed in a hypobaric chamber. Paper I examined differences between two PEP devices, the PEP-bottle and the PEP-mask. Paper II evaluated the performance of a flow resistor CPAP device, (Boussignac CPAP). Paper III investigated the effect of two PEP-devices, a PEP-bottle and a PEP-mask and two CPAP devices, a threshold resistor CPAP and a flow resistor CPAP, on inspiratory capacity (IC). In paper IV, the effect of changes in ambient pressure on preset CPAP levels in two different CPAP devices was compared.

Results: With the PEP bottle, both expiration and inspiration began with a zero-flow period during which airway pressure changed rapidly. With the PEP-mask, the zero-flow period was very short and the change in airway pressure almost non-existent (paper I). During normal breathing with the Boussignac CPAP, changes in airway pressure were never large enough to reduce airway pressure below zero. During forced breathing, as airflow increased, both the drop in inspiratory airway pressure and the increase in expiratory airway pressure were potentiated (paper II). IC decreased significantly with three of the breathing devices, the PEP-mask and the two CPAP devices (paper III). With the threshold resistor CPAP, measured pressure levels were close to the preset CPAP level. With the flow resistor CPAP, as the altitude increased CPAP produced pressure levels increased (paper IV).

Conclusion: The effect on airway pressure, airflow, IC and the effect of changes in ambient air pressure differ between different kinds of resistance breathing devices. These differences in device performance should be taken into consideration when choosing the optimal resistance breathing device for each patient.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 72 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1674
Keyword
Chest physiotherapy, breathing exercises, PEP, CPAP, airway pressure, airflow, threshold resistor, flow resistor, inspiratory capacity, Borg CR10
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-94650 (URN)978-91-7601-127-0 (ISBN)
Public defence
2014-11-07, Sal B, Unod T, 9tr, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2014-10-16 Created: 2014-10-14 Last updated: 2015-11-30Bibliographically approved

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