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Pneumatic performance of the boussignac CPAP system in healthy humans
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.ORCID iD: 0000-0003-1523-1672
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
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
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2011 (English)In: Respiratory care, ISSN 0020-1324, E-ISSN 1943-3654, Vol. 56, no 6, 818-826 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Boussignac CPAP has been found to effectively treat acute pulmonary oedema. However, data on airway pressure in association with the Boussignac CPAP are sparse. We therefore designed this study to evaluate the stability of the Boussignac CPAP in terms of maintaining adequate inspiratory and expiratory pressure levels. We also wanted to evaluate the perceived exertion when breathing with the Boussignac CPAP.

METHODS: Continuous recordings of airway pressure and airflow were made in 18 healthy volunteers during breathing with the Boussignac CPAP at 5, 7.5 and 10 cm H₂O for three sessions of 10 minutes at each CPAP level. Participants were blinded for the sequential order of the investigated CPAP levels. They terminated each session, at the respective CPAP level, by taking 10 forced breaths.

RESULTS: During 10 minutes normal breathing periods, when participants breathed at 20 % of their VC with a peak expiratory airflow of 14 % of FEV₁, the maximal pressure difference was 4.0 cm H₂O between inspiration and expiration at CPAP 10 cm H₂O. Changes in airway pressure were never large enough to reduce airway pressure below zero. When taking forced breaths, expiratory volume was 38-42 % of VC and peak expiratory airflow was 49-56 % of FEV ₁. As airflow increased, both the drop in inspiratory airway pressure and the increase in expiratory airway pressure were enhanced.

CONCLUSIONS: Pressure changes during breathing with CPAP are considered to be associated with increased work of breathing. The pneumatic performance of the Boussignac CPAP is adequate during normal breathing with low airflow. However, during forced breathing resulting in increased airflow, the Boussignac CPAP is unable to maintain stable airway pressure levels, possibly resulting in increased work of breathing and respiratory fatigue. Thus, the Boussignac CPAP system might be less suitable for patients breathing at a higher frequency.

Place, publisher, year, edition, pages
American Association for Respiratory Care , 2011. Vol. 56, no 6, 818-826 p.
Keyword [en]
CPAP, continuous positive airway pressure, noninvasive ventilation, air flow, airway pressure, Borg CR10 scale, flow resistor
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:umu:diva-40872DOI: 10.4187/respcare.01015ISI: 000291779500011PubMedID: 21333088OAI: oai:DiVA.org:umu-40872DiVA: diva2:403542
Available from: 2011-03-14 Created: 2011-03-11 Last updated: 2017-12-11Bibliographically 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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