The effects of IPPB on ventilation distribution in high risk adults following open upper abdominal surgery using electrical impedance tomography

Ross, Nicolette Hayley (2015-04)

Thesis (MScPhysio)--Stellenbosch University, 2015.

Thesis

ENGLISH ABSTRACT: Question: What are the effects of Intermittent Positive Pressure Breathing (with and without a Positive End Expiratory Pressure [PEEP] Valve), compared to deep breathing exercises, on ventilation distribution in high-risk adults following open upper abdominal surgery (UAS)? Design: This study comprised an observational descriptive component as well as a prospective triple blind randomised controlled crossover trial with concealed allocation and patient, assessor and statistician blinding Participants: Seven patients at high risk for postoperative pulmonary complications following UAS Intervention: Deep breathing exercises (DBExs) were compared to Intermittent Positive Pressure Breathing (IPPB), with IPPB further applied with and without a PEEP Valve, using a randomised cross-over design with 30 minute washout duration between periods. Outcome measures: Global and regional impedance changes in the lungs were measured using Electrical Impedance Tomography. Vital signs, visual analogue pain scale (VAS) and modified Borg scale (MBS) were measured pre– and post-intervention. Results: A greater mean global lung impedance change ( Z) was detected with IPPB compared to DBExs (mean difference in Z 2803.8; 95% CI 5189.9 to 8512.5 and 2046 to 96047.9; P<0.01). These changes in lung impedance lasted 30 minutes before returning to baseline. There was no difference in Z when patients received IPPB with 5cmH20 PEEP compared to IPPB with no PEEP. No specific regional ventilation changes were noted. IPPB did not increase VAS, MBS scores or adversely affect vital signs. Conclusion: IPPB is an effective technique to improve lung volumes compared to deep breathing exercises. Further studies are required to investigate the effect of IPPB on clinical outcome.

AFRIKAANSE OPSOMMING: Vraag: Watter uitwerking het onderbroke positiewe-drukasemhaling (met én sonder ’n positiewe-endekspiratoriesedruk-[PEEP-]klep) in vergelyking met diepasemhalings-oefeninge op ventilasieverspreiding by hoërisikovolwassenes ná bo-buikchirurgie? Ontwerp: ’n Waarnemingsgegronde, vergelykende en ondersoekende, driedubbelblinde, verewekansigde gekontroleerde oorskakelproef, met verborge toewysing en blinding van pasiënte, die assesseerder en statistikus Deelnemers: Sewe pasiënte met ’n hoë risiko vir post-operatiewe pulmonêre komplikasies na bo-buikchirurgie Intervensie: Diepasemhalingsoefeninge (DBEx) is vergelyk met onderbroke positiewedrukasemhaling (IPPB), wat op sy beurt met én sonder ’n PEEP-klep toegepas is, met behulp van ’n verewekansigde oorskakelstudie met ’n halfuur lange uitspoeling tussen oorskakelings. Uitkomsmetings: Algehele en regionale impedansieveranderinge in die longe is met behulp van elektriese impedansietomografie gemeet. Vitale tekens, die visuele analoogskaal (VAS) en die aangepaste Borg-skaal (MBS) is voor, sowel as na die intervensie afgeneem. Resultate: ’n Groter gemiddelde algehele impedansieverandering ( Z) is opgemerk met IPPB in vergelyking met DBEx (gemiddelde verskil 2803.8; 95% CI 5189.9: 8512.5 en 2046: 96047.9; P<0.01). Hierdie veranderinge in longimpedansie het ’n halfuur of langer geduur voordat dit na die basislyn teruggekeer het. Daar was geen verskil in Z toe pasiënte IPPB met ’n PEEP-klep van 5cmH20 ontvang het teenoor IPPB sonder ’n PEEP-klep nie. Geen spesifieke regionale voorkeure is opgemerk nie. IPPB het nie die VAS- of MBS-tellings verhoog of vitale tekens verswak nie. Stellenbosch University https://scholar.sun.ac.za iv Gevolgtrekking: In vergelyking met DBEx, is IPPB ’n doeltreffende tegniek om longvolumes te verbeter. Verdere studies word vereis om die uitwerking van IPPB op kliniese uitkomste te ondersoek.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/97086
This item appears in the following collections: