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Volume 3 Supplement 1

ESICM LIVES 2015

Immediate effect of lung expansion techniques in neurosurgery patients detected by electrical impedance tomography: a randomized crossover study

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Introduction

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.

Objectives

To compare the effect of Breath Stacking (BS) and Expiratory Positive Airway Pressure (EPAP) techniques on the regional lung ventilation, aeration and on the maintenance of the therapeutic effect of lung expansion in non-cooperative neurosurgery patients with prolonged bed rest. Secondary aims included to evaluate the influence of these techniques on cardiorespiratory system.

Methods

This was a randomized crossover study. Ten patients were included with Glasgow Coma Scale between 3-10 points, 18-65 years old, undergoing neurosurgery, unable to respond to the command and restricted to bed. The regional lung ventilation and aeration changes were assessed by EIT device (Enligh 1800, Timpel, São Paulo, Brazil). For interventions, EPAP was applied through a Spring Load valve resistor, adjusted with a pressure of 10 cmH2O. BS was performed three times with one minute intervals between them. The volume was stacked and maintained until 40 seconds.

Results

The regional lung ventilation during the BS was significantly higher in the inter-intervention and intra-intervention analyses when compared the baseline with the first minute (all P < 0.001). The regional lung aeration was increased after both techniques significantly (all P < 0.001), however, the BS increase more than EPAP (P < 0.001). There were no differences in the duration of therapeutic effect between the EPAP (4.6 ± 3.7 minutes) and BS (2.3 ± 2.0 minutes) (P = 0.103) and there were no clinically significant differences on cardiorespiratory variables.

Conclusions

The BS and EPAP techniques promoted significant changes on lung volumes, but not maintained the therapeutic effect of lung expansion for a long time, and did not generate adverse effects on the cardiovascular system in non-cooperative neurosurgery patients with prolonged bed rest.

Grant Acknowledgment

This work was supported by grants from the Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil (CNPq), and the Fundação de Amparo a Ciência e Tecnologia do Estado de Pernambuco (FACEPE).

References

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    Baker WL, Lamb VJ, Marini JJ: Breath-stacking increases the depth and duration of chest expansion by incentive spirometry. The American review of respiratory disease. 1990, 141: 343-346. 10.1164/ajrccm/141.2.343.

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    Costa EL, Lima RG, Amato MB: Electrical impedance tomography. Current Opinion in Critical Care. 2009, 15 (1): 18-24. 10.1097/MCC.0b013e3283220e8c.

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    Schans CP, De Jong W, De Vries G, Postma DS, Koeter GH, Van der Mark T, Van der : Effect of positive expiratory pressure on breathing pattern in healthy subjects. Eur Respir J. 1993, 6: 60-66.

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Author information

Correspondence to CCA Morais.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Morais, C., Rattes, C., Bandeira, M. et al. Immediate effect of lung expansion techniques in neurosurgery patients detected by electrical impedance tomography: a randomized crossover study. ICMx 3, A991 (2015) doi:10.1186/2197-425X-3-S1-A991

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Keywords

  • Electrical Impedance Tomography
  • Impedance Tomography
  • Randomize Crossover Study
  • Lung Aeration
  • Lung Expansion