Brandao Daniella Cunha, Lima Vitoria Maria, Filho Valdecir Galindo, Silva Thayse Santos, Campos Tania Fernandes, Dean Elizabeth, de Andrade Armele Dornelas
Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, PE, Brasil.
J Asthma. 2009 May;46(4):356-61. doi: 10.1080/02770900902718829.
Jet nebulization (JN) and non-invasive mechanical ventilation (NIMV) through bi-level pressure is commonly used in emergency and intensive care of patients experiencing an acute exacerbation of asthma. However, a scientific basis for effect of JN coupled with NIMV is unclear. Objective. To evaluate the effect of jet nebulization administered during spontaneous breathing with that of nebulization with NIV at two levels of inspiratory and expiratory pressures resistance in patients experiencing an acute asthmatic episode. Methods. A prospective, randomized controlled study of 36 patients with severe asthma (forced expiratory volume in 1 second [FEV(1)] less than 60% of predicted) selected with a sample of patients who presented to the emergency department. Subjects were randomized into three groups: control group (nebulization with the use of an unpressured mask), experimental group 1 (nebulization and non-invasive positive pressure with inspiratory positive airway pressure [IPAP] = 15 cm H(2)O, and expiratory positive airway pressure [EPAP] = 5 cm H(2)O), and experimental group 2 (nebulization and non-invasive positive pressure with IPAP = 15 cm H(2)O and EPAP = 10 cm H(2)O). Bronchodilators were administered with JN for all groups. Dependent measures were recorded before and after 30 minutes of each intervention and included respiratory rate (RR), heart rate (HR), oxygen saturation (SpO(2)), peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), and forced expiratory flow between 25 and 75% (FEF(25-75)). Results. The group E2 showed an increase of the peak expiratory flow (PEF), forced vital capacity (FVC), FEV(1) (p < 0.03) and F(25-75%) (p < 0.000) when compared before and 30 minutes after JN+NIMV. In group E1 the PFE (p < 0.000) reached a significant increase after JN+ NIMV. RR decreased before and after treatment in group E1 only (p = 0.04). Conclusion. Nebulization coupled with NIV in patients with acute asthma has the potential to reduce bronchial obstruction and symptoms secondary to augmented PEF compared with nebulization during spontaneous breathing. In reversing bronchial obstruction, this combination appears to be more efficacious when a low pressure delta is used in combination with a high positive pressure at the end of expiration.
喷射雾化（JN）和通过双水平压力进行的无创机械通气（NIMV）常用于哮喘急性加重患者的急诊和重症监护。然而，JN联合NIMV效果的科学依据尚不清楚。目的。评估在急性哮喘发作患者中，在自主呼吸时进行喷射雾化与在吸气和呼气压力阻力的两个水平下进行无创通气雾化的效果。方法。对36例重度哮喘患者（一秒用力呼气容积[FEV(1)]小于预测值的60%）进行前瞻性随机对照研究，这些患者选自到急诊科就诊的患者样本。受试者被随机分为三组：对照组（使用无压力面罩进行雾化）、实验组1（雾化并采用吸气气道正压[IPAP]=15 cm H(2)O和呼气气道正压[EPAP]=5 cm H(2)O的无创正压通气）和实验组2（雾化并采用IPAP=15 cm H(2)O和EPAP=10 cm H(2)O的无创正压通气）。所有组均通过JN给予支气管扩张剂。在每次干预前和干预30分钟后记录相关指标，包括呼吸频率（RR）、心率（HR）、血氧饱和度（SpO(2)）、呼气峰值流速（PEF）、一秒用力呼气容积（FEV(1)）、用力肺活量（FVC）以及25%至75%之间的用力呼气流量（FEF(25-75)）。结果。与JN+NIMV前和30分钟后相比，E2组的呼气峰值流速（PEF）、用力肺活量（FVC）、FEV(1)（p<0.03）和FEF(25-75%)（p<0.000）有所增加。在E1组中，JN+NIMV后PFE（p<0.000）显著增加。仅E1组治疗前后RR降低（p=0.04）。结论。与自主呼吸时雾化相比，急性哮喘患者中雾化联合NIV有可能减轻支气管阻塞以及因PEF增加引起的症状。在逆转支气管阻塞方面，当在呼气末使用低压差与高正压相结合时，这种联合似乎更有效。
