| Reversal of bronchial obstruction with bi-level positive airway pressure and nebulization in patients with acute asthma. | |
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MedLine Citation:
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PMID: 19484669 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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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:
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Created Date: 2009-06-01 Completed Date: 2009-07-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8106454 Medline TA: J Asthma Country: United States |
Other Details:
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Languages: eng Pagination: 356-61 Citation Subset: IM |
Affiliation:
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Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, PE, Brasil. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Bronchodilator Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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