Van Fleet Hillary, Dunn Diane K, McNinch Neil L, Volsko Teresa A
Division of Respiratory Care, Rush University College of Health Sciences, Chicago, Illinois and the Department of Respiratory Care, Dayton Children's Hospital, Dayton, Ohio.
Department of Respiratory Care.
Respir Care. 2017 Apr;62(4):451-458. doi: 10.4187/respcare.04570. Epub 2017 Mar 14.
Oscillatory positive expiratory pressure (OPEP) is an airway clearance therapy that delivers positive pressure and air-flow oscillations during exhalation. This study described functional characteristic differences of 4 OPEP devices during an active exhalation in a simulated model. We hypothesized peak pressure (Ppeak), positive expiratory pressure (PEP), oscillatory frequency (f), and pressure amplitude will differ, depending upon the device used, device resistance setting, and time (repeated consecutive active exhalations through the device).
The ASL 5000 was scripted to simulate pulmonary mechanics of a pediatric cystic fibrosis patient with moderate to severe lung disease. Airway resistance was standardized at 17.1 cm HO/L/s, pulmonary compliance at 42.1 mL/cm HO, active exhalation at 22 breaths/min, and tidal volume at 409 mL. Resistance settings for the Acapella, RC-Cornet, Flutter, and Aerobika were adjusted to low, medium, and high. Values for f, Ppeak, PEP, and pressure amplitude were recorded for 1 min and graphically displayed.
Significant effects for time, device, and resistance ( < .01) were noted for Ppeak, PEP, and pressure amplitude at each resistance level, demonstrating that the devices functioned differently as more than one repetition of a series of consecutive active exhalations are performed. Significant interaction effects for device, resistance level, and time indicate inconsistent output for Ppeak ( < .01), PEP ( < .01), and pressure amplitude ( < .01). Oscillatory f values fell within the respective manufacturers' operational parameters. The Aerobika provided the most consistent pressure amplitude across resistance settings and produced the highest mean pressure amplitude at medium and high resistance settings.
Statistically significant and clinically relevant variations in Ppeak, PEP, and pressure amplitude occurred between devices and within a device, as the resistance setting changed. The combination of device, time, and resistance settings affects OPEP device output for pressure, amplitude, and oscillatory frequency. Functional variations may impact therapeutic effectiveness, warranting additional study to determine clinical impact.
振荡呼气正压（OPEP）是一种气道廓清治疗方法，在呼气过程中提供正压和气流振荡。本研究描述了4种OPEP装置在模拟模型中主动呼气期间的功能特性差异。我们假设峰值压力（Ppeak）、呼气正压（PEP）、振荡频率（f）和压力幅度会因所使用的装置、装置阻力设置以及时间（通过该装置连续进行多次主动呼气）而有所不同。
编写ASL 5000程序以模拟患有中度至重度肺部疾病的小儿囊性纤维化患者的肺力学。气道阻力标准化为17.1 cm H₂O/L/s，肺顺应性为42.1 mL/cm H₂O，主动呼气频率为22次/分钟，潮气量为409 mL。将Acapella、RC-Cornet、Flutter和Aerobika的阻力设置调整为低、中、高。记录f、Ppeak、PEP和压力幅度的值1分钟，并以图形方式显示。
在每个阻力水平下，Ppeak、PEP和压力幅度在时间、装置和阻力方面均有显著影响（P <.01），表明在进行一系列连续主动呼气的多次重复时，这些装置的功能有所不同。装置、阻力水平和时间之间的显著交互作用表明，Ppeak（P <.01）、PEP（P <.01）和压力幅度（P <.01）的输出不一致。振荡f值落在各自制造商的操作参数范围内。Aerobika在不同阻力设置下提供了最一致的压力幅度，并且在中高阻力设置下产生了最高的平均压力幅度。
随着阻力设置的变化，不同装置之间以及同一装置内的Ppeak、PEP和压力幅度在统计学上有显著差异且具有临床相关性。装置、时间和阻力设置的组合会影响OPEP装置在压力、幅度和振荡频率方面的输出。功能差异可能会影响治疗效果，需要进一步研究以确定其临床影响。
