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

Research Team:
Michelle Emison
Kim Nguyen
Edinah Isoe
Raquel Smith
Ade Adeoso
Lorraine Gonzales
Faculty Advisor:
Kelley Buzbee, AAS, RRT-NPS, RCP
Will EzPap at different I:E ratios affect the
hemodynamics of a healthy adult?
EzPap at a pressure of 15 CmH2O with
different I:E ratios will cause physiological
changes in the hemodynamics of an adult
test subject.
Abstract
 To determine the effects of EzPap at different I:E ratios
on the hemodynamics on healthy adults ( n= 10.)
Instructions on the procedure was given after consent
forms were signed.
 The subjects’ baseline heart rate, respiratory rate,
Spo2, pulse and Blood Pressure were recorded. Test
subjects were instructed to take a few breaths off
device to set the therapeutic pressure at 15 cmH2o.
Test subjects were given 2 minutes between each I:E
ratio.
 Vital signs were then recorded after each I:E ratio.
Abstract continued
We did find some hemodynamic changes but nothing
significant or consistent.
Heart rates and respiratory rates increased slightly but
not in all patients and nothing clinically significant.
Cohort Group
Cohort Group
Background
 EzPAP is an easy to use and inexpensive device that
provides positive airway pressure on inhalation, exhalation
and on breath hold. The resulting action is a positive
inspiratory airway pressure as well as positive expiratory
airway resistance. The resistance provides collateral
ventilation to the airways and creates the backpressure
needed to open up collapsed alveoli. According to
Continuing Medical Education Corner, this therapy is very
helpful in test subjects at risk for developing post-operative
atelectasis, as well as the treatment of atelectasis and has
also shown effective in lung expansion therapy.
Background con’t.
Contraindications include:
 test subjects who cannot tolerate increased WOB
 test subjects with 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
 respiratory alkalosis
 nosocomial infections
 untreated tuberculosis (EzPAP clinical performances)
Glossary
•
Atelectasis: an abnormal condition characterized by the collapse of alveoli, preventing respiratory
exchange of carbon monoxide and oxygen in a part of the lungs.
•
Bilateral breath sounds- sounds of the heart and lungs
•
Blood pressure-force exerted against the walls of blood vessels
•
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, violent sneezing,
fragility of the mucous membrane or of the arterial walls, chronic infection, trauma, hypertension,
leukemia, vitamin K deficiency, or most often, picking the nose.
Glossary con't.
•
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.
•
Hypoxemia- A lack of oxygen circulating to the tissues.
•
Inflammation: swelling caused by an infection
•
Intrathoracic pressure- pressure in the chest cavity
•
Neuromuscular disorder: disorder affecting both nerve and muscle tissue.
•
Nosocomial infections: an infection that is acquired at least 72 hours after hospitalization
Glossary con’t.
 Oxygen enrichment: Term often used to describe the oxygen level is greater than in air.
 Oxygen Saturation- A measurement of the current percentage of oxygen carried in the blood at
a given time
 Oxygen therapy: the inhaling of oxygen under pressure, often inside a pressurized chamber, as
a treatment for respiratory conditions.
 Pneumothorax: collection of air or gas in the pleural space causing the lung to collapse
 Preload – The amount of pressure stretching the ventricular walls at the onset of ventricular
contraction.
 Prophylactic- a medical treatment that is used to prevent a disease state from occurring.
 Pulse-rate and strength the heart beats in a minute
 Pulse ox- amount of oxygen in blood
Glossary con’t.
 Respiratory arrest: the cessation of breathing.
 Restrictive lung defect: incomplete lung expansion and increased lung stiffness
 Stroke volume- volume of blood ejected from the ventricle during contraction.
 Systolic blood pressure- blood pressure when the heart is working
 Temperature-warmth or coldness of the body
 Therapeutic- a medical treatment used to remediate a health problem that has been
diagnosed.
 Venous Return: the return of the blood to the heart via the vena cava and coronary sinus
Methodology
 EzPAP is indicated for test subjects who need lung
expansion therapy to prevent or reverse atelectasis; it can
be used as prophylactic or therapeutic device in atelectasis.
It can also be used with test subjects with restrictive lung
defects, hypercapnia secondary to decreased lung tissue,
test subjects at risk for developing pulmonary atelectasis.
EzPAP is also intended to optimize delivery of inhaled
bronchodilator. The EzPAP can also be used in the removal
of excessive mucus from the lungs in cases of test subjects
with a history of pulmonary problems like cystic fibrosis,
bronchiectasis and lung abscess and thus potentially
limiting the bacterial burden and decreasing swelling in
the conducting airways.
Methodology con’t.
 First the subjects were placed in a comfortable position while baseline heart
rate, respiratory rate, Spo2, pulse and Blood Pressure were all recorded. Then
the test subjects were instructed to take a few Breaths off of the EZ Pap device to
set the therapeutic pressure at 15 cmH2o. Then the test subjects were expected
to rest two minutes prior to the initiation of tests.
 After the subjects rested they were instructed when to inhale and when to
exhale which was at an I:E ratio of 1:3. The I:E ratio was timed with a clock with a
second hand. The test subject continued this for 2 minutes, then Heart rate,
respiratory rate, pulse, blood pressure, and SpO2 was measured.
 The test subjects were then instructed to rest for two minutes before initiating
the next test. The test subjects were again told to sit comfortably in a chair and
were instructed when to inhale and when to exhale to set a I:E ratio of 1:4. This
was continued for 2 minutes then vital signs again were measured. A period of
rest ensued again for 2 minutes, before the next test began at an I:E ratio of 1:5.
Methodology con’t.
 The entire procedure was carried out using an EzPap
with a mouthpiece, bacteria filter, pressure
monometer, O2 flow meter, blood pressure cuff,
sphygnomometer, pulse oximeter, and a stethoscope.
 EzPap was only used once and disposed of after each
test subject.
INITIAL VITAL SIGNS
Test Subject
Heart Rate
RR
Blood Pressure
SpO2
1AZ2
66
24
132/65
95
2AZ3
81
16
112/80
97
2AZ4
86
16
114/70
98
2AZ5
78
16
122/72
99
2AZ6
71
20
122/78
99
2AZ7
66
16
119/70
98
2AZ8
75
14
140/92
98
2AZ9
59
16
118/60
98
2AZ10
84
18
110/60
97
2AZ11
98
20
120/78
100
Post Vital Signs
I:E Ratio of 1:2
Test Subject
Heart Rate
RR
Blood Pressure
SpO2
1AZ2
64
12
130/75
97
2AZ3
88
20
116/62
98
2AZ4
82
20
110/78
99
2AZ5
87
28
130/80
99
2AZ6
71*
20*
122/78*
99*
2AZ7
68
20
116/78
99
2AZ8
67
14
130/88
99
2AZ9
67
16
110/60
99
2AZ10
88
18
120/82
99
2AZ11
103
20
133/92
99
Post Vital Signs
I:E Ratio of 1:3
1AZ2
2AZ3
2AZ4
2AZ5
2AZ6
2AZ7
2AZ8
2AZ9
2AZ10
2AZ11
HR
83
72
74
79
xx
64
61
64
85
107
* XX indicates unable to complete
RR
24
14
20
24
xx
20
20
16
20
22
Systolic BP Diastolic BP
124
114
110
124
xx
110
150
100
112
130
68
60
78
78
xx
90
98
50
80
90
SpO2
98
99
99
99
xx
99
99
99
99
99
Post Vital Signs
I:E Ratio of 1:4
Heart Rate
Respirations
Systolic BP
Diastolic BP
O2
Saturations
1AZ2
84
97
2AZ3
81
17
112
58
99
2AZ4
86
22
116
78
99
2AZ5
75
14
120
90
99
2AZ6
xx
xx
xx
xx
xx
2AZ7
66
20
112
90
99
2AZ8
67
18
142
98
99
2AZ9
66
12
100
40
99
2AZ10
93
18
110
82
99
2AZ11
108
24
122
84
99
* XX indicates unable to complete
The % change in the respiratory rate of
the 10 test subjects with an I:E ratio of
1:3 was 15.406%
The % change in the heart rate of the 10
test subjects with an I:E ratio of 1:3 was
0.209%
The % change in the respiratory rate
of the 10 test subjects with an I:E
ratio of 1:4 was 4.587%
The % change in the heart rate of
the 10 test subjects with an I:E ratio
of 1:4 was 5.589%
Discussion
 The research project did have its limitations. There were
not enough test subjects that were readily available to give
us a larger and more detailed view of the effects on
hemodynamic at different I:E ratios. All test subjects were
healthy so we were unable to study the effects of Ezpap on
hemodynamics of persons with obstructive or restrictive
defects. There was also not enough supplies due to funding
and time was also another factor that is taken into account.
A bourdon gauge monometer was used, it might be
interesting to see what would have happened with a digital
monometer. Pressure waveform was not measured and
flow wave forms were also not measured due to lack of
equipment.
Discussion
 Respiratory rate showed a higher % change than any
other vital sign measured.
 Heart rate also showed a slight increase but was not as
significant as the respiratory rate.
 No consistancy was found with Blood pressure.
 O2 sats stayed within normal limits.
Conclusion
We did find some hemodynamic changes but nothing
significant or consistent.
Heart rates and respiratory rates increased slightly but
not in all patients and nothing clinically significant.
It would be difficult to make generalizations about
ezPap and patients’ VS because the number of test
subjects was too small.
It would be nice to:
•See someone repeat this study with an obstructive or restrictive
defect such as asthma, COPD, someone with increase RAW or
decreased compliance, and atelectasis.
•To have a digital monometer as opposed to the bourdon gauge
monometer.
•To see the waveforms measured while using the Ezpap.
References
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