Chest Physiotherapy and Cystic Fibrosis: Continuous Positive Airway Pressure and Nocturnal Intermittent Positive Pressure Ventilation
Falk et al (1984) found that PEP and FET were more effective in clearing sputum and improving functional residual capacity and transcutaneous oxygen than conventional CPT. In subjects who routinely produce large amounts of sputum (greater than 20 g of sputum every 24 h), it has been shown that PD plus FET produced significantly greater amounts of sputum than PEP treatments, without significant changes in either PFTs or oxygen saturation levels. Further studies comparing PEP with other physiotherapy techniques disclose no significant improvement in lung volume, mucociliary clearance, and isotopic clearance from the use of PEP canadian neighbor pharmacy viagra
In spontaneously breathing patients, the application of a continuous, rapid flow of gas, via a nose or face mask, maintains continuous positive airway pressure (CPAP) throughout the entire respiratory cycle. Continuous positive airway pressure prevents the collapse of compliant airways, improves arterial oxygenation, increases functional residual capacity and decreases the work of breathing. Additionally, it may increase collateral airflow and assist in the clearance of secretions. Continuous positive airway pressure is currently being tested in the treatment of acute respiratory failure, particularly in those patients in whom conventional mechanical ventilation holds significant risks. Currently, the use of CPAP during CPT in CF is limited as an adjunct during exercise and acute respiratory exacerbations of the disease. In patients in whom the work of breathing is increased due to retained secretions and fatigue, CPAP reduces this respiratory effort and assists in ventilation. Physical therapy regimens may be administered while the patient is using CPAP or intermittently between periods of CPAP. The progressive respiratory deterioration seen in CF may benefit from nocturnal ventilatory support particularly in the end stage of the disease where hypercapnia is present. Nocturnal ventilatory support can include CPAP or intermittent positive pressure ventilation using a nose or face mask. Patients with end stage CF find CPT difficult due to their breathlessness and ever increasing tenacious secretions. Nocturnal ventilation may offer essential support to CPT by improving daytime respiratory function and decreasing the hypoxic and hypercap-nic effects on respiratory muscles.