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Reversal of bronchial obstruction with bi-level positive airway pressure and nebulization in patients with acute asthma.
J Asthma. 2009 May; 46(4):356-61.JA

Abstract

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+Show Affiliations

Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, PE, Brasil.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19484669

Citation

Brandao, Daniella Cunha, et al. "Reversal of Bronchial Obstruction With Bi-level Positive Airway Pressure and Nebulization in Patients With Acute Asthma." The Journal of Asthma : Official Journal of the Association for the Care of Asthma, vol. 46, no. 4, 2009, pp. 356-61.
Brandao DC, Lima VM, Filho VG, et al. Reversal of bronchial obstruction with bi-level positive airway pressure and nebulization in patients with acute asthma. J Asthma. 2009;46(4):356-61.
Brandao, D. C., Lima, V. M., Filho, V. G., Silva, T. S., Campos, T. F., Dean, E., & de Andrade, A. D. (2009). Reversal of bronchial obstruction with bi-level positive airway pressure and nebulization in patients with acute asthma. The Journal of Asthma : Official Journal of the Association for the Care of Asthma, 46(4), 356-61. https://doi.org/10.1080/02770900902718829
Brandao DC, et al. Reversal of Bronchial Obstruction With Bi-level Positive Airway Pressure and Nebulization in Patients With Acute Asthma. J Asthma. 2009;46(4):356-61. PubMed PMID: 19484669.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reversal of bronchial obstruction with bi-level positive airway pressure and nebulization in patients with acute asthma. AU - Brandao,Daniella Cunha, AU - Lima,Vitoria Maria, AU - Filho,Valdecir Galindo, AU - Silva,Thayse Santos, AU - Campos,Tania Fernandes, AU - Dean,Elizabeth, AU - de Andrade,Armele Dornelas, PY - 2009/6/2/entrez PY - 2009/6/2/pubmed PY - 2009/7/8/medline SP - 356 EP - 61 JF - The Journal of asthma : official journal of the Association for the Care of Asthma JO - J Asthma VL - 46 IS - 4 N2 - 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. SN - 1532-4303 UR - https://www.unboundmedicine.com/medline/citation/19484669/Reversal_of_bronchial_obstruction_with_bi_level_positive_airway_pressure_and_nebulization_in_patients_with_acute_asthma_ L2 - https://www.tandfonline.com/doi/full/10.1080/02770900902718829 DB - PRIME DP - Unbound Medicine ER -