Stroke
Conditions
Keywords
Noncooperative patients
Brief summary
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.
Detailed description
The survival of patients with lesions in the Central Nervous System is usually accompanied by physical and mental permanents sequelae. This impairment of cognitive status associated with motor injury favors prolonged restriction of these patients to the bed, which may contribute to the emergence of other health damages. In the clinical practice, lung expansion techniques has been used as a prophylaxis and treatment of respiratory conditions that involve volumetric reductions. However, the deficit of awareness and cooperation difficult the use of several therapeutic resources. There are few interventions that could be proposed due to no need the collaboration to be performed, such as Breath Stacking technique (BS) and Expiratory Positive Airway Pressure (EPAP). The BS is characterized by execution of inspiratory cycles through a one way valve, which allows stacked volume of gas during each inspiration, until it reaches values approximate to maximum inspiratory capacity. While in the EPAP, alveolar pressure is elevated to breath against a expiratory flow resistance generated by a spring load valve. The effects on lung volume promoted BS and EPAP can be safely measured using an electrical impedance tomography (EIT). This recent imaging modality offers information about lung air volumes distribution and have a strong linear correlation with regional ventilation within the thorax. The effects on lung volume promoted BS and EPAP can be safely measured using an EIT monitor. This recent imaging modality offers information about lung air volumes distribution and have a strong linear correlation with regional ventilation within the thorax. Until this moment, there is not description about the effect of lung expansion techniques on regional lung parameters.
Interventions
OTHEREPAP
The EPAP will be applied with a Spring Load Valve Resistor (Vital Signs, Totowa, NJ, USA), adjusted with a pressure of 10 cmH2O. The Spring Load Valve Resistor will be connected to the expiratory branch of the T-tube. Duration of intervention: 5 minutes.
OTHERBreath Stacking
The BS will be performed by a T-tube with a one-way inspiratory valve and the expiratory branch occluded. The expiratory occlusion is maintain until observed the presence of a plateau in the impedance plethysmogram by EIT, which corresponds to the absence of inspired air displacement or when a maximum time of 40 seconds was attained. Durantion of intervention:Three BS interventions will be performed at one minute intervals between them.
Sponsors
Universidade Federal de Pernambuco
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
1. Patients undergoing neurosurgery restricted to bed for more than 14 days; 2. Aged between 18 and 65 years; 3. Glasgow Coma Scale \< 10 points; 4. Breathing spontaneously through the tracheostomy tube; 5. No respiratory infection; 6. Chest circumference between 88 and 98 centimeters;
Exclusion criteria
1. Presence of chronic lung diseases; 2. Chest deformity; 3. Rib fracture; 4. Asymmetrical chest expansion; 5. Abdomen distension; 6. Spasticity in any hemisphere with Ashworth Scale score more than 2 points for upper limbs; 7. Uncoordinated movements of the limbs; 8. Cardiorespiratory instability (heart rate \< 60 or \> 120 bpm; respiratory rate \> 35 ipm; mean arterial pressure \< 60 mmHg or \> 120 mmHg; oxygen saturation \< 90%).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Regional Lung Aeration | Before and 1, 5, 10, 15, 30, 60, 90, 120 minutes post-intervention. | Change in Regional Lung Aeration (difference between the End-Expiratory Lung Impedance before and post-intervention). Each image along the time represent the relative change in impedance distribution within the transverse section of the chest, from the first scan (before intervention) to current scan. The pixel values are express as percentage changes of local impedance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Regional Lung Ventilation | Before and 1, 5, 10, 15, 30, 60, 90, 120 minutes post-intervention. | Change in Regional Lung Ventilation (difference between end-inspiratory and end-expiratory lung impedance before and post-intervention). |
| Heart Rate | Before and 1, 5, 10, 15, 30, 60, 90, 120 minutes post-intervention. | Change in Heart Rate (beats per minute). |
| Mean Arterial Pressure | Before and 1, 5, 10, 15, 30, 60, 90, 120 minutes post-intervention. | Change in Mean Arterial Pressure (mmHg) |
| Respiratory Rate | Before and 1, 5, 10, 15, 30, 60, 90, 120 minutes post-intervention. | Change in Respiratory Rate (breath per minute) |
| Periferic Saturation of Oxygen | Before and 1, 5, 10, 15, 30, 60, 90, 120 minutes post-intervention. | Change in Periferic Saturation of Oxygen (fraction of oxygen-saturated hemoglobin relative to total hemoglobin). |
Countries
Brazil
Outcome results
None listed