Applicability of Techniques of Lung Expansion

Completed

Phase N/A Results N/A

Trial Description

The survival of patients with lesions in the central nervous system is usually accompanied by physical and mental sequelae. These impairments favor the prolonged restriction to the bed, which may contribute with changes in respiratory function. In this context, lung re-expansion techniques are used to prevent or treat the various respiratory complications.

Detailed Description

The survival of patients with lesions in the Central Nervous System is usually accompanied by physical and mental permanents sequelae. This impairment of cognitive status associated with motor injury favors prolonged restriction of these patients to the bed, which may contribute to the emergence of other health damages. In the clinical practice, lung expansion techniques has been used as a prophylaxis and treatment of respiratory conditions that involve volumetric reductions. However, the deficit of awareness and cooperation difficult the use of several therapeutic resources. There are few interventions that could be proposed due to no need the collaboration to be performed, such as Breath Stacking technique (BS) and Expiratory Positive Airway Pressure (EPAP). The BS is characterized by execution of inspiratory cycles through a one way valve, which allows stacked volume of gas during each inspiration, until it reaches values approximate to maximum inspiratory capacity. While in the EPAP, alveolar pressure is elevated to breath against a expiratory flow resistance generated by a spring load valve. The effects on lung volume promoted BS and EPAP can be safely measured using an electrical impedance tomography (EIT). This recent imaging modality offers information about lung air volumes distribution and have a strong linear correlation with regional ventilation within the thorax. The effects on lung volume promoted BS and EPAP can be safely measured using an EIT monitor. This recent imaging modality offers information about lung air volumes distribution and have a strong linear correlation with regional ventilation within the thorax. Until this moment, there is not description about the effect of lung expansion techniques on regional lung parameters.

Conditions

Interventions

  • EPAP Device
    Other Names: Provent Sleep Apnea Therapy.
    Intervention Desc: The EPAP will be applied with a Spring Load Valve Resistor (Vital Signs, Totowa, NJ, USA), adjusted with a pressure of 10 cmH2O. The Spring Load Valve Resistor will be connected to the expiratory branch of the T-tube. Duration of intervention: 5 minutes.
    ARM 1: Kind: Experimental
    Label: EPAP Group
    Description: The EPAP devices increase the alveolar pressure. This effect is obtained through valves that generate a resistance to airflow during expiration.
  • Breath Stacking Other
    Other Names: Air Stacking
    Intervention Desc: The BS will be performed by a T-tube with a one-way inspiratory valve and the expiratory branch occluded. The expiratory occlusion is maintain until observed the presence of a plateau in the impedance plethysmogram by EIT, which corresponds to the absence of inspired air displacement or when a maximum time of 40 seconds was attained. Durantion of intervention:Three BS interventions will be performed at one minute intervals between them.
    ARM 1: Kind: Experimental
    Label: Breath Stacking Group
    Description: The Breath Stacking consists on the implementation of subsequent inspiratory efforts through a one way valve, which allows stacked volume of gas during each inspiration, until it reaches a maximum lung volume.

Trial Design

  • Allocation: Randomized
  • Masking: Single Blind (Subject)
  • Purpose: Treatment
  • Endpoint: Efficacy Study
  • Intervention: Crossover Assignment

Outcomes

Type Measure Time Frame Safety Issue
Primary Regional Lung Aeration Before and 1, 5, 10, 15, 30, 60, 90, 120 minutes post-intervention. Yes
Secondary Regional Lung Ventilation Before and 1, 5, 10, 15, 30, 60, 90, 120 minutes post-intervention. Yes
Secondary Heart Rate Before and 1, 5, 10, 15, 30, 60, 90, 120 minutes post-intervention. Yes
Secondary Mean Arterial Pressure Before and 1, 5, 10, 15, 30, 60, 90, 120 minutes post-intervention. Yes
Secondary Respiratory Rate Before and 1, 5, 10, 15, 30, 60, 90, 120 minutes post-intervention. Yes
Secondary Periferic Saturation of Oxygen Before and 1, 5, 10, 15, 30, 60, 90, 120 minutes post-intervention. Yes

Sponsors