EzPap at different I:E ratios and how they affect hemodynamics

Report
Research Team:
Jason Jubert, BS, NRP, SRT
Jessica Straker, NRP, SRT
Tuan Nguyen, BS, NRP, SRT
Maria Schumann Pereira, BS, NRP, SRT
Faculty Advisors:
Kelley Buzbee, AAS, RRT-NPS, RCP
Conchita Cameron, AAS, RRT
How will changes in compliance and
resistance affect airway pressures while
using EzPAP?
The difference between the minimum and the maximum
airway pressures tends to decline when lung compliance
decreases or resistance increases out of normal ranges.
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Indicated for lung expansion therapy
Treatment and prevention of atelectasis
Produces positive airway pressure throughout the
breathing cycle via flow meter
May be used with nebulizer between patient and
device
Aids in mobilization of retained secretions
Contraindications include:
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patients who cannot tolerate increased WOB
patientswith ICP greater than 20 mmHg
recent facial, oral or skull surgery, or trauma, esophageal surgery
untreated pnuemothorax
unstable hemodynamics
acute sinusitis
epitastaxis
active hemoptysis
nausea
impaired venous return
hyperoxia
gastric distention
air trapping, auto-PEEP
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Acapella – A small PEP device that helps to mobilize secretions by providing positive
expiratory pressure (PEP) therapy and airway vibrations.
Atelectasis: an abnormal condition characterized by the collapse of alveoli, preventing
respiratory exchange of carbon monoxide and oxygen in a part of the lungs.
Barotrauma – Injury caused by increased air or water or pressure
Brochioectasis: a disease that involves a dilation of bronchioles that produces a large amount of
secretions.
Bronchodilator- a drug that relaxes the bronchial passageways and improves the passages of
air into the lungs.
Cardiac Output – volume of blood pumped per minute by the heart
Cystic Fibrosis- An inherited condition in which the exocrine glands produce abnormally
viscous mucus, causing chronic respiratory and digestive problems
Epistaxis: bleeding from the nose caused by local irritation of mucous membranes
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Hemodynamics: the study of the physical aspects of blood circulation, including
cardiac function and peripheral vascular physiologic characteristics
Hemoptysis: coughing up of blood from the respiratory tract
Hypercapnia- having abnormally high levels of carbon dioxide circulating in the
blood.
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Hypoxemia- A lack of oxygen circulating to the tissues.
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Inflammation: swelling caused by an infection
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Intracranial pressure- Pressure of the cerebrospinal fluid in the head with sensor
inserted through the skull
Intrathoracic pressure- pressure in the chest cavity
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IPPB- Intermittent positive pressure ventilation
IS – (incentive spirometry); also referred to as sustained maximal inspiration (SMI), is a
component of bronchial hygiene therapy
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Nebulizer-An apparatus for producing a fine spray or mist.
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PEP – Positive Expiratory Pressure
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Pneumothorax: collection of air or gas in the pleural space causing the lung to collapse
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Prophylactic- a medical treatment that is used to prevent a disease state from occurring.
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Pulse-rate and strength the heart beats in a minute
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Pulse ox- amount of oxygen in blood
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A Lung machine-Series 1101 Breathing simulator (Hans Rudolph, INC 7205
Central Kansas City, MO 64114 U.S.A) was used to simulate the changes in
compliance and resistance at the airway.
EZ-PAP© model 23-0747 (Smiths Medical ASD, INC 10 Bowman Drive,
Keene NH 03431 USA) was attached to the lung machine with a Bacterial
Filter model 864-E (Unomedical, INC 5701-S Ware Rd McAllen, Texas 78503
USA) and a 5’Flexible tube (Sims Portex, INC Fort Myers, FL 33905 USA).
Small Volume Nebulizer model number 301-20 (E-Value Med www.Trianim.com). A flowmeter model # IMPA1001 (Precision medical, INC 300
Held Drive Northhampton,PA 18067) was attached to the oxygen source
was adjusted to deliver 8 lpm.The graph was saved to a floppy disk and
then the data was transfer to Excel software (Microsoft ©).
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Verification procedures were performed to confirm breathing simulator
pressures by connecting to Servo-I (Maquet , Inc Wayne, NJ 07470)
EZ-PAP© was attached to the lung simulator via the 5’ flex tube; the O2 tubing
was attached to the EZ-PAP© and to flowmeter with the 02 flow of 8 lpm.
On the simulator, we entered the values for compliance from 10 to 99
ml/cmH20 using as reference the normal range compliance from 50 to 170
ml/cmH20 ( Pilbeam, S., & Cairo, J. M. 2006. Mechanical Ventilation 4 Th Ed.
Missouri: Mosby Elsevier)
The lung simulator had a limitation on the resistance range between 3
to 200 cmH20/liters per second consequently, we had to start the
simulation resistance at 3 cmH20/L/sec and increased until we
reached 30 cm/H20/L/sec
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The study was performed first without the small inline nebulizer; with
the resistance set at 5cmH20/L, we repeated the process and collected
graphs with the compliance values set at 10, 20, 30, 40, 50, 60, 80, 90 and
99 ml/cmH20. Then we attached a small inline nebulizer with extra an
oxygen flow of 8 lpm and repeated the process with the same compliance
values.
To obtain the graph for resistance, the lung simulator was set to a normal
compliance of 50 ml/cmH20 ; resistance was set to 3cm/H20/L and then
increased to these values: 5, 8, 10, 15, 20,25 and 30 cmH20/L. We repeated
the process with the small inline nebulizer with extra oxygen flow of 8
lpm; the data was collected and saved to be analyzed.
Min Pressure
Ez- Pap Without Nebulizer
10.00
(Normal compliance range: 50 - 100 ml/cmH2O)
Min Pressure
Max Pressure
12.00
Resistance: 5 cmH2O/l/sec
Compliance
Mean pressure
Mean pressure Max Pressure
10
-2.43
0.08
2.59
20
1.71
5.46
9.21
30
1.61
5.54
9.46
40
1.36
5.39
9.43
50
1.07
5.38
9.68
60
-3.87
0.16
4.19
80
0.32
4.37
8.42
90
0.41
4.43
8.44
99
0.36
4.30
8.25
8.00
6.00
4.00
2.00
0.00
-2.00
0
20
40
60
80
100
120
-4.00
-6.00
Figure 1: Changes in pressure to changes in Compliance at
resitance of 5
Ez- Pap With Nebulizer
Min Pressure
Resistance: 5 cmH2O/l/sec
Min Pressure
Max Pressure
12.00
(Normal compliance range: 50 - 100 ml/cmH2O)
Compliance
Mean pressure
Mean pressure Max Pressure
10
3.77
6.82
9.88
20
3.10
6.62
10.14
30
2.88
6.71
10.53
40
2.46
6.44
10.42
50
2.21
6.39
10.57
60
2.31
6.54
10.77
80
1.74
5.88
10.02
90
1.81
5.91
10.02
99
1.53
5.65
9.78
10.00
8.00
6.00
4.00
2.00
Figure 2: Changes in pressure to changes in Compliance at
resistance of 5
0.00
0
20
40
60
80
100
120
Min Pressure
Ez- Pap Without Nebulizer
9.00
(Normal resistance range: 0.5 - 2.5 cmH2O/l/sec)
Min Pressure
Mean pressure
Max Pressure
3
0.36
4.70
9.04
5
0.63
4.64
8.66
8
0.88
4.79
8.69
10
1.21
4.44
7.68
15
1.74
4.31
6.87
20
1.26
3.72
6.18
25
2.03
3.92
5.81
30
2.18
3.82
5.47
8.00
7.00
6.00
5.00
4.00
3.00
2.00
1.00
Figure 3: Changes in pressure to changes in Resistance at
compliance of 50
0.00
0
Ez- Pap With Nebulizer
(Normal resistance range: 0.5 - 2.5 cmH2O/l/sec)
Min Pressure
Mean pressure
5
10
Min Pressure
Compliance 50 ml/cmH2O
Resistance
Max Pressure
10.00
Compliance 50 ml/cmH2O
Resistance
Mean pressure
15
20
25
Mean pressure
30
35
Max Pressure
12.00
Max Pressure
3
0.36
4.70
9.04
5
2.14
6.36
10.58
8
1.57
5.68
9.80
10
2.53
6.02
9.51
15
2.71
5.82
8.94
20
3.01
5.71
8.42
25
3.30
5.76
8.22
30
3.49
5.76
8.04
10.00
8.00
6.00
4.00
Figure 4: Changes in pressure to changes in Resistance at
compliance of 50
2.00
0.00
0
5
10
15
20
25
30
35
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Study limitation:
Compliance enter on the lung simulator : 10 to 99
ml/cmH20 ( range allow on the simulator = 3 to 99
ml/cmH20)
Normal range compliance from Pilbeam’s: 50 to 170
ml/cmH20
Resistance enter on the lung simulator: 3 to 30
cmH20/liter per second ( range allow on the
simulator 3 to 200 cm/H20/ liter per second).
Normal range resistance from Egan’s: 0.5 to 2.5
cmH20/liter per second
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When Ez-Pap is administered without Nebulizer in case of
fixed resistance, the changes in compliance violated our
Hypothesis.
Reasons might be:
One oxygen flow (8 Lpm) is not enough to compensate the
abrupt change in compliance.
Simulator characteristics differ from human lungs
Other three cases complied with our Hypothesis.
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When compliance varied, whether it increased
or decreased the mean pressure stayed
relatively stable with the nebulizer. Without
the nebulizer, we had a severe drop in
pressure.
When resistance varied with or without the
nebulizer and whether it increased or
decreased the mean pressure stayed relatively
the same.
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American Lung Association. Airway Clearance Devices: Limited Evidence for What is ‘The Best
Method’. Retrieved on February 2, 2009 from
http://www.thoracic.org/sections/chapters/thoracicsocietychapters/ca/publications/resources
/respiratory-disease-adults/Airway%20Clearance%20Devices.pdf
Baker, J., Corbin, M., et al. Effects of EzPap on Physiologic Changes in the Hemodynamics of the Body.
Retrieved on January 30, 2009 from www.appskc.lonestar.edu/programs/respcare/ezpap05.ppt
Daniel, B.M. Respiratory Abstracts: EzPap? An Alternative in Lung Expansion Therapy. Retrieved on
February 2, 2009 from
http://www.cardinal.com/mps/focus/respiratory/abstracts/abstracts/ab2001/A00000193.asp
Donohue, J.F., Sheth, K., & Schwer, W.A. (2000). EzPap. Management Stategies for the Primary Care
Provider. Retrieved on February 3, 2009 from http://www.rtcorner.net/rt_ezpap.htm
EZPap Clinical Performances. (n.d.) Retrieved on January 30, 2009 from virtual.yosemite.cc.ca.us
Mosby, E. (2006) Mosby’s Medical Dictionary (7th ed.) St. Louis, Missouri.
R.L Wilkins, R.L Sheldon, S.J Krider Clinical Assesment in Respiratory Therapy, fifth edition 2000 (Pg
48-60)
Robert L. Wilkins, Robert M. Kacmarek, James K. Stoller. Egan’s Fundamentals of Respiratory. Mosby
Inc 2008 (Pg 831-832)

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