Effects of Positive Expiratory Pressure on Gas Exchange, Atelectasis, Hemodynamics, and Dyspnea in Spontaneously Breathing Critically Ill Subjects.
Background: The EzPAP Positive Airway Pressure System (EzPAP) is a noninvasive positive expiratory pressure (PEP) device designed to promote lung expansion. The aim of this study was to evaluate the effects of PEP on gas exchange. Secondary objectives included assessing the early effects of PEP on r...
| Publicado en: | Respiratory Care Vol. 70; no. 3; pp. 233 - 244 |
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| Autores principales: | , , , , , , , , , , , , , |
| Formato: | CEU clinical trial research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Mar2025
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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=183410943&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 183410943 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Mar2025 vid: 70 iid: 3 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 183410943 183410943 183410943 10.4187/respcare.12000 183410943 ppf: 233 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Effects of Positive Expiratory Pressure on Gas Exchange, Atelectasis, Hemodynamics, and Dyspnea in Spontaneously Breathing Critically Ill Subjects. aug: au: Masuello, Denise Servetti, Adriano Caiffa, Salvatore Cara, Robertina Pieri, Chiara Arriagada, Ricardo Al-Husinat, Lou'i Ball, Lorenzo Robba, Chiara Brunetti, Iole Patroniti, Nicolò Silva, Pedro Leme Rocco, Patricia RM Battaglini, Denise affil: Ms. Masuello is affiliated with Hospital General de Agudos D. F. Santojanni, Buenos Aires, Argentina sug: subj: Positive End-Expiratory Pressure Pulmonary Gas Exchange Pulmonary Atelectasis Therapy Hemodynamics Dyspnea Therapy Tracheostomy Critically Ill Patients Treatment Outcomes Patient Safety Education, Continuing (Credit) Italy Human Academic Medical Centers Clinical Trials Pretest-Posttest Design Scales Middle Age Aged Male Female Intensive Care Units T-Tests Mann-Whitney U Test Chi Square Test Spearman's Rank Correlation Coefficient Data Analysis Software Descriptive Statistics Length of Stay Protocols Respiratory Tract Physiology Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background: The EzPAP Positive Airway Pressure System (EzPAP) is a noninvasive positive expiratory pressure (PEP) device designed to promote lung expansion. The aim of this study was to evaluate the effects of PEP on gas exchange. Secondary objectives included assessing the early effects of PEP on radiological atelectasis score (RAS), hemodynamics, and dyspnea. These outcomes were compared between spontaneously breathing subjects with and without tracheostomy. Methods: This observational single-center study was conducted at a university hospital. Inclusion criteria were spontaneously breathing adult subjects with RAS ≥ 2 and a worsened PaO2/FIO2. Exclusion criteria included life-threatening conditions, intracranial hypertension, hemodynamic instability, and pneumothorax. Gas-exchange, hemodynamic parameters, and dyspnea measured with the Respiratory Distress Observation Scale (RDOS) were assessed at 3 time points: T0 (before PEP), T1 (immediately after PEP), and T2 (2 h after PEP). RAS was assessed at T0 and 1-week post treatment (T3). Results: Of 213 patients assessed for eligibility, 186 were excluded for various reasons, leaving 27 subjects (19 without and 8 with tracheostomy) enrolled in the study. The median [interquartile range] age was 65 [58–74] y, with 66.7% being male. In the overall sample and in subjects without tracheostomy, PaO2/FIO2 did not differ significantly between T1 and T0 (P =.52 and P =.54, respectively) or between T2 and T0 (P =.47 and P =.85, respectively). In subjects with tracheostomy, PaO2/FIO2was higher at T1 compared to T0 (P =.039) but not between T2 and T0 (P =.58). Arterial PaO2 and hemodynamic parameters remained unchanged in the overall cohort. The RAS improved within 1 week of treatment in the overall cohort (T3 vs T0, P < .001) and in subjects without tracheostomy (T3 vs T0, P =.001). However, PEP therapy did not improve RDOS. Conclusions: In critically ill, spontaneously breathing subjects, PEP therapy significantly improved RAS without affecting hemodynamic stability or respiratory symptoms. pubtype: Academic Journal doctype: CEU clinical trial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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