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Immediate effects of positive expiratory pressure and continuous positive airway pressure breathing on changes in inspiratory capacity as an indirect measure of induced changes in functional residual capacity in healthy individuals
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. 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 Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
Umeå University, Faculty of Medicine, Department of Radiation Sciences.ORCID iD: 0000-0003-3363-7414
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: Positive expiratory pressure (PEP) and continuous positive airway pressure (CPAP) are used to enhance breathing parameters such as functional residual capacity (FRC) in patients. Studies comparing effects of PEP and CPAP on FRC are sparse. One reason for this may be that sophisticated equipment, not suitable in the clinical setting, is required. Total lung capacity consists of inspiratory capacity (IC) and FRC and a change in IC should therefore result in a corresponding change in FRC. We aimed to investigate if PEP and CPAP induced changes in IC could be used as an indirect measure of changes in FRC and also to evaluate immediate effects of PEP and CPAP devices, with different kinds of resistors, on IC. 

Methods: 20 healthy volunteers breathed with two PEP devices, a PEP-mask (flow resistor) and a PEP-bottle (threshold resistor) and two CPAP devices, a flow resistor device and a threshold resistor device, in a randomized order. The measurement sequence consisted of 30 breaths with an IC measurement performed before and immediately after the 30th breath, while the participants were still connected to the respective breathing device. Perceived exertion of the respective 30 breaths was measured with Borg CR10 scale.

Results: Three of the four breathing devices, the PEP-mask and the two CPAP devices, significantly decreased IC (p < 0.001). Median perceived exertion was quite low for all four breathing devices but the difference in perceived exertion within the different breathing devices was large.

Conclusion: When measured in direct continuation of PEP and CPAP breathing, changes in IC could be used as an indirect measure of changes in FRC. All investigated breathing devices except the PEP-bottle decreased IC, i.e. increased FRC.

Keyword [en]
PEP, CPAP, Threshold resistor, Flow resistor, Inspiratory capacity, Borg CR10 scale.
National Category
Physiotherapy Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:umu:diva-93677OAI: oai:DiVA.org:umu-93677DiVA: diva2:750797
Available from: 2014-09-30 Created: 2014-09-30 Last updated: 2015-11-30Bibliographically 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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