Peak expiratory flow during mechanical insufflation-exsufflation: endotracheal tube versus facemask

Abstract Background: Mechanical insufflation-exsufflation (MI-E) applied through the endotracheal tube (ET) can effectively eliminate airway secretions in intubated patients. However, the effect of the interface (ET vs. facemask) on expiratory airflow generated by MI-E has not been investigated. This study aimed to investigate the effect of the ET on peak expiratory flow (PEF), along with other associated factors that could influence PEF generated by MI-E. Methods: Intubated participants received two sessions of MI-E via ET therapy per day for two consecutive days. One MI-E session consisted of five sets of either constant (+40/-40 cmH2O) or incremental (+30/-30 to +50/-50 cmH2O) pressure applications. Following extubation, MI-E sessions were repeated using facemask. Expiratory airflow during MI-E therapy was measured, and repetitive PEF measurements during each session were analysed using linear mixed-effect and generalised linear mixed models. Results: A total of 12 participants (9 [75.0%] men; mean [SD] age, 74.0 [10.2] years) completed all MI-E sessions with both ET and facemask interfaces. The PEF generated during MI-E treatment was influenced by the pressure gradient, number of session repetitions, and interface (ET vs. facemask). Adjusted mean PEF values for MI-E via ET and facemask at +40/-40 cmH2O were -2.521 and -3.114 L/s, respectively, and -2.956 and -3.364 L/s at +50/-50 cmH2O, respectively. At a pressure gradient of +40/-40 cmH2O, only 172 of 528 MI-E trials via ET (32.6%) achieved a PEF faster than -2.7 L/s, whereas 304 of 343 MI-E trials via facemask (88.6%) exceeded the PEF cut-off value.Conclusions: MI-E via ET generated slower PEF than via facemask, suggesting that a higher-pressure protocol should be prescribed for intubated patients. An insufflation-exsufflation pressure of at least +50/-50 cmH2O should be considered to produce a PEF faster than 2.7 L/s, and the applications were safe and feasible for patients under invasive mechanically ventilation.

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EFFECT OF BODY MASS INDEX ON PEAK EXPIRATORY FLOW RATE

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i9.570 ◽

2019 ◽

Vol 3 (9) ◽

Author(s):

K. Subramanyam ◽

Dr. P. Subhash Babu

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Peak Expiratory Flow ◽

Flow Rate ◽

Peak Expiratory Flow Rate ◽

Normal Weight ◽

The Body ◽

Health Care Centre ◽

Expiratory Flow ◽

Group B

Obesity has become one of the major health issues in India. WHO defines obesity as “A condition with excessive fat accumulation in the body to the extent that the health and wellbeing are adversely affected”. Obesity results from a complex interaction of genetic, behavioral, environmental and socioeconomic factors causing an imbalance in energy production and expenditure. Peak expiratory flow rate is the maximum rate of airflow that can be generated during forced expiratory manoeuvre starting from total lung capacity. The simplicity of the method is its main advantage. It is measured by using a standard Wright Peak Flow Meter or mini Wright Meter. The aim of the study is to see the effect of body mass index on Peak Expiratory Flow Rate values in young adults. The place of a study was done tertiary health care centre, in India for the period of 6 months. Study was performed on 80 subjects age group 20 -30 years, categorised as normal weight BMI =18.5 -24.99 kg/m2 and overweight BMI =25-29.99 kg/m2. There were 40 normal weight BMI (Group A) and 40 over weight BMI (Group B). BMI affects PEFR. Increase in BMI decreases PEFR. Early identification of risk individuals prior to the onset of disease is imperative in our developing country. Keywords: BMI, PEFR.

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