Document Detail


Reversal of bronchial obstruction with bi-level positive airway pressure and nebulization in patients with acute asthma.
MedLine Citation:
PMID:  19484669     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Jet nebulization (JN) and non-invasive mechanical ventilation (NIMV) through bi-level pressure is commonly used in emergency and intensive care of patients experiencing an acute exacerbation of asthma. However, a scientific basis for effect of JN coupled with NIMV is unclear. Objective. To evaluate the effect of jet nebulization administered during spontaneous breathing with that of nebulization with NIV at two levels of inspiratory and expiratory pressures resistance in patients experiencing an acute asthmatic episode. Methods. A prospective, randomized controlled study of 36 patients with severe asthma (forced expiratory volume in 1 second [FEV(1)] less than 60% of predicted) selected with a sample of patients who presented to the emergency department. Subjects were randomized into three groups: control group (nebulization with the use of an unpressured mask), experimental group 1 (nebulization and non-invasive positive pressure with inspiratory positive airway pressure [IPAP] = 15 cm H(2)O, and expiratory positive airway pressure [EPAP] = 5 cm H(2)O), and experimental group 2 (nebulization and non-invasive positive pressure with IPAP = 15 cm H(2)O and EPAP = 10 cm H(2)O). Bronchodilators were administered with JN for all groups. Dependent measures were recorded before and after 30 minutes of each intervention and included respiratory rate (RR), heart rate (HR), oxygen saturation (SpO(2)), peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), and forced expiratory flow between 25 and 75% (FEF(25-75)). Results. The group E2 showed an increase of the peak expiratory flow (PEF), forced vital capacity (FVC), FEV(1) (p < 0.03) and F(25-75%) (p < 0.000) when compared before and 30 minutes after JN+NIMV. In group E1 the PFE (p < 0.000) reached a significant increase after JN+ NIMV. RR decreased before and after treatment in group E1 only (p = 0.04). Conclusion. Nebulization coupled with NIV in patients with acute asthma has the potential to reduce bronchial obstruction and symptoms secondary to augmented PEF compared with nebulization during spontaneous breathing. In reversing bronchial obstruction, this combination appears to be more efficacious when a low pressure delta is used in combination with a high positive pressure at the end of expiration.
Authors:
Daniella Cunha Brandao; Vitoria Maria Lima; Valdecir Galindo Filho; Thayse Santos Silva; Tania Fernandes Campos; Elizabeth Dean; Armele Dornelas de Andrade
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of asthma : official journal of the Association for the Care of Asthma     Volume:  46     ISSN:  1532-4303     ISO Abbreviation:  J Asthma     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-06-01     Completed Date:  2009-07-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8106454     Medline TA:  J Asthma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  356-61     Citation Subset:  IM    
Affiliation:
Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, PE, Brasil.
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Adolescent
Adult
Age Factors
Aged
Airway Obstruction / etiology,  therapy*
Analysis of Variance
Asthma / complications,  diagnosis,  therapy*
Brazil
Bronchodilator Agents / administration & dosage*
Combined Modality Therapy
Continuous Positive Airway Pressure / methods*
Critical Care / methods
Dose-Response Relationship, Drug
Emergency Service, Hospital
Female
Follow-Up Studies
Forced Expiratory Volume
Humans
Male
Middle Aged
Nebulizers and Vaporizers*
Probability
Prospective Studies
Recurrence
Reference Values
Risk Assessment
Severity of Illness Index
Sex Factors
Spirometry
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Bronchodilator Agents

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