A Unidirectional Breathing Pattern Improves Breathing Efficiency in Subjects With Severe COPD.
BACKGROUND: Unidirectional breathing (UB), nose-in mouth-out (NMB) or vice versa, is thought to create PEEP, stabilize small airways, and increase expiratory flow and exhaled tidal volume (VT) in patients with expiratory obstructive disorders. However, the exact mechanism providing the benefits of U...
| Publicado en: | Respiratory Care Vol. 59; no. 10; pp. 1487 - 1494 |
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| Autores principales: | , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Oct2014
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103899545&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 103899545 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Oct2014 vid: 59 iid: 10 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 103899545 98588129 10.4187/respcare.02899 NLM24782549 103899545 ppf: 1487 ppct: 7 formats: fmt: @attributes: type: P tig: atl: A Unidirectional Breathing Pattern Improves Breathing Efficiency in Subjects With Severe COPD. aug: au: Sulemanji, Demet S. Fangping Bao Yandong Jiang Kacmarek, Robert M. affil: Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts sug: subj: Pulmonary Disease, Chronic Obstructive Therapy Respiration Physiology Positive End-Expiratory Pressure Forced Expiratory Flow Rates Tidal Volume Human Descriptive Statistics Prospective Studies Masks Middle Age Aged Female Male Data Analysis Software Paired T-Tests Post Hoc Analysis Education, Continuing (Credit) Middle Aged: 45-64 years Aged: 65+ years Female Male ab: BACKGROUND: Unidirectional breathing (UB), nose-in mouth-out (NMB) or vice versa, is thought to create PEEP, stabilize small airways, and increase expiratory flow and exhaled tidal volume (VT) in patients with expiratory obstructive disorders. However, the exact mechanism providing the benefits of UB remains unknown. Our hypothesis was that the benefits of UB are achieved mainly through reduction of upper airway dead space. METHODS: Sixteen stable COPD patients requiring oxygen use at home were enrolled in this prospective study at a tertiary health care center. A nasal mask and a mouthpiece were used, each having a removable one-way valve to direct the breathing pattern. Four experimentally defined patterns of spontaneous breathing, NMB, mouth-in nose-out (MNB), nose-in nose-out (NNB), and mouth-in mouth-out (MMB), were compared. Each breathing pattern lasted 5 min followed by a 5-min rest period. A NICO device continuously monitored respiratory parameters. The functional anatomical dead space volume (VD) and expired VT values were determined. Breathing efficiency (BE) was calculated as alveolar VT divided by expired volume. RESUUTS: Functional anatomical VD was higher in bidirectional breathing (BB) (overall: 207.4 ± 7.9 mL; MMB: 232.5 ± 72.7 mL; NNB: 182.2 ± 75 mL) compared to UB (overall: 178.1 ± 87.2 mL; NMB: 176.9 ± 91.3 mL; MNB: 179.3 ± 83.2 mL) (P < .001). BE achieved with UB (overall: 76.2 ± 6.5%; NMB: 76.8 ± 6.8%; MNB: 75.6 ± 6.3%) was higher than that with BB (overall: 66.2 ± 0.09%; MMB: 64.3 ± 0.10%; NNB: 68.1 ± 0.08%) (P < .001). The difference in BE between UB and BB was more pronounced with small VT values (UB: 73.8 ± 0.08; BB: 49.4 ± 0.09) than with large VT values (UB: 77.3 ± 0.06; BB: 63.0 ± 0.07) (P < .001). CONCLUSIONS: Our data suggest that a reduction in functional anatomic VDD may be the underlying mechanism for the benefits associated with UB in COPD patients. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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