Canadian Neighbor Pharmacy: Protocol of Intermittent Positive Pressure Breathing in Patients with Respiratory Muscle Weakness

Oct-13-2015

respiratory systemAll 14 patients underwent routine pulmonary function testing and measurements of total respiratory system compliance. Lung compliance was then measured in four of the muscular dystrophic and in five of the quadriplegic subjects who agreed to placement of an esophageal balloon. After the above measurements, each subject received 20 minutes of IPPB using a Bennett PR-2 device delivering 20 to 30 cm HaO pressure. Tidal volumes during IPPB were at least triple the resting tidal volume (Table 3). Total respiratory system compliance was measured immediately, 30 and 90 minutes after IPPB in all subjects. Only four subjects (all quadriplegic) agreed to keep the esophageal balloon in place after IPPB; therefore, lung compliance measurements were limited to these volunteers after IPPB.

Six normal subjects recruited from laboratory personnel also had measurements of CRS and CL before and after IPPB.

Results

The effects of IPPB on CRS in the seven muscular dystrophic and seven quadriplegic subjects are shown in Figures 1 and 2. There were no significant alterations in CRS during the 90-minute observation period following IPPB in either group. Five of the subjects (1, 6, 8, 11, and 14) had tidal volumes on IPPB that exceeded inspiratory capacity. Despite this large inflation volume, there were no consistent differences in changes of respiratory system compliance when compared to the other subjects. In addition, the four quadriplegic subjects who agreed to measurements of pleural pressure for 90 minutes following IPPB did not demonstrate any significant change in either CL or CW (Fig 3). The Link – medicine-cnp may become the best provider for you in the medical science together with canadian neighbor Pharmacy.

Baseline CRS was reduced in both the muscular dystrophic patients (0.075 ±0.036 L/cm HaO) (mean±SD) and the quadriplegic patients (0.082 ±0.013 L/cm H20) when compared to six normal subjects similarly tested in our laboratory (0.137±0.017 L/cm HaO) (p<0.01, Tables 2 and 4).

The four muscular dystrophic and five quadriplegic subjects who agreed to measurements of esophageal pressure before IPPB had reductions in both CL (0.175 ±0.040 L/cm HaO) (p<0.01) and CW (0.180±0.096 L/cm H20) (p<0.05) as compared to measurements of CL (0.253 ± 0.024 L/cm H20) and CW (0.304 ± 0.068 L/cm H20) made in six healthy subjects. However, when CRS, CL, and CW were expressed as specific compliance (percent actual TLC/cm H20), their values did not differ from normal values. The values of CRS, CL, and CW for healthy subjects in our laboratory (either expressed as L/cm H20 or percent TLC/cm H20) are consistent with those reported previously for normal subjects.

Figure 1. Changes in respiratory system compliance (CRS) in muscular dystrophy subjects immediately; 30 minutes and 90 minutes after IPPB therapy. Data are presented for each individual. The number in the first circled data point corresponds to the identification number assigned to each patient in Tbbles 1, 3, and 4.

Figure 1. Changes in respiratory system compliance (CRS) in muscular dystrophy subjects immediately; 30 minutes and 90 minutes after IPPB therapy. Data are presented for each individual. The number in the first circled data point corresponds to the identification number assigned to each patient in Tbbles 1, 3, and 4.

Figure 2. Change in respiratory system compliance (CRS) in quadriplegic subjects immediately, 30 minutes, and 90 minutes after IPPB therapy. Patient identification schema is the same as in Figure 1.

Figure 2. Change in respiratory system compliance (CRS) in quadriplegic subjects immediately, 30 minutes, and 90 minutes after IPPB therapy. Patient identification schema is the same as in Figure 1.

Figure 3. Change in lung compliance (CL) in upper panel and chest wall compliance (CW) in lower panel in four quadriplegic subjects immediately, 30 minutes, and 90 minutes after IPPB therapy. Patient identification schema is the same as in Figure 1.

Figure 3. Change in lung compliance (CL) in upper panel and chest wall compliance (CW) in lower panel in four quadriplegic subjects immediately, 30 minutes, and 90 minutes after IPPB therapy. Patient identification schema is the same as in Figure 1.

Table 3—IPPB Delivered Pressures and Volumes for Each Subject

SubjectNo. Tidal Volume, L IPPB Tidal Volume, L IPPB Inflating Pressure, cm HaO
1 0.375 1.0 25
2 0.450 1.9 22
3 0.440 1.5 20
4 0.375 1.3 20
5 0.420 1.4 20
6 0.350 1.0 22
7 0.700 1.7 25
8 0.460 1.6 22
9 0.360 1.8 22
10 0.475 1.3 20
11 0.275 1.2 18
12 0.400 1.7 24
13 0.350 1.6 25
14 0.325 1.8 20

Table 4—Respiratory System, Lung and Chest Watt Compliance in Subjects with Neuromuscular Disease

Subject No. (L/cm H20) CRS(% actual TLC/ cmH20) (L/cmH20) CL(% actual TLC/ cm HaO) (L/cmH20) CW(% actual TLC/ cm H20)
1 0.035 1.40 0.180 7.25 0.044 1.77
2 0.078 2.34 0.200 6.02 0.127 3.82
3 0.039 0.71 0.156 2.86 0.052 0.95
4 0.080 2.35
5 0.092 1.94
6 0.062 2.58
7 0.140 2.37 0.250 4.23 0.318 5.38
8 0.086 1.69 0.143 2.82 0.215 4.24
9 0.083 1.80 0.128 2.77 0.236 5.11
10 0.063 1.34
11 0.069 2.55
12 0.102 1.79 0.166 2.91 0.264 4.63
13 0.080 1.42 0.217 3.85 0.126 2.23
14 0.088 2.17 0.138 3.41 0.243 6.01
Mean + SD 0.078+0.025 1.88 + 0.54 0.175 + 0.040 4.01 + 1.59 0.180 + 0.096 3.79+1.7