Divisione di Pneumologia Riabilitativa, Fondazione Salvatore Maugeri, I.R.C.C.S., Centro Medico di Veruno, Veruno, NO, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Milano, Milano, MI, Italy.
Divisione di Pneumologia Riabilitativa, Fondazione Salvatore Maugeri, I.R.C.C.S., Centro Medico di Veruno, Veruno, NO, Italy; NEMO Center - Centro Clinico NEMO, Ospedale Niguarda Cà Granda, Milano, Milano, MI, Italy.
Braz J Phys Ther. 2017 Jan-Feb;21(1):15-23. doi: 10.1016/j.bjpt.2016.12.001. Epub 2017 Jan 13.
Airway clearance techniques include positive expiratory pressure, commonly used in our clinical practice, and a recently introduced temporary positive expiratory pressure device called UNIKO. It is unclear which one provides the best benefit to patients.
The aim of this observational 4-year study was to retrospectively compare the efficacy of and specific indications for temporary positive expiratory pressure compared to positive expiratory pressure in a standard rehabilitation program.
We retrospectively collected data from 162 subjects (107 males, mean age 70±9 years, 97 with primary diagnosis of chronic obstructive pulmonary disease, 65 with bronchiectasis), 51 treated with temporary positive expiratory pressure and 111 with positive expiratory pressure.
Subjects showed significant improvement in ratio of partial pressure arterial oxygen and fraction of inspired oxygen (p<0.001), forced vital capacity, forced expiratory volume in one second, peak expiratory flow, arterial oxygen saturation, and partial pressure arterial oxygen with no significant difference between positive expiratory pressure and temporary positive expiratory pressure groups apart from forced expiratory flow, which increased only in the positive expiratory pressure group. Evaluating specific subgroups, temporary positive expiratory pressure was more effective than positive expiratory pressure in improving gas transfer in subjects with emphysema and in those on oxygen therapy, as the effective supplement oxygen flow decreased significantly (p=0.034 and 0.046 respectively for temporary positive expiratory pressure vs. positive expiratory pressure). In subjects on mechanical ventilation, positive expiratory pressure was superior to temporary positive expiratory pressure in increasing forced expiratory flow (p=0.018).
The physiological parameters of both groups improved significantly and similarly. Subgroup analysis suggests that temporary positive expiratory pressure could provide some advantage to subjects with emphysema and those on oxygen therapy, while positive expiratory pressure would benefit patients on mechanical ventilation. Randomized clinical trials are necessary to confirm our preliminary results indicating that different subgroups/phenotypes can benefit more from one type of treatment.
气道清除技术包括正呼气压力,这在我们的临床实践中经常使用,以及最近引入的一种名为 UNIKO 的临时正呼气压力设备。目前尚不清楚哪种方法对患者最有益。
本观察性 4 年研究的目的是回顾性比较临时正呼气压力与标准康复计划中使用的正呼气压力在治疗中的疗效和具体适应证。
我们回顾性地收集了 162 名受试者(107 名男性,平均年龄 70±9 岁,97 名原发性诊断为慢性阻塞性肺疾病,65 名支气管扩张症)的数据,其中 51 名接受临时正呼气压力治疗,111 名接受正呼气压力治疗。
受试者的动脉血氧分压与吸入氧分数比(p<0.001)、用力肺活量、一秒用力呼气量、呼气峰流量、动脉血氧饱和度和动脉血氧分压均显著改善,而在正呼气压力组和临时正呼气压力组之间,除了用力呼气流量外,其他指标均无显著差异,而用力呼气流量仅在正呼气压力组中增加。在评估特定亚组时,临时正呼气压力在改善肺气肿和氧疗患者的气体转移方面比正呼气压力更有效,因为有效补充氧气流量显著降低(p=0.034 和 0.046,分别为临时正呼气压力与正呼气压力相比)。在接受机械通气的患者中,正呼气压力在增加用力呼气流量方面优于临时正呼气压力(p=0.018)。
两组的生理参数均显著改善且相似。亚组分析表明,临时正呼气压力可能对肺气肿和氧疗患者有一定优势,而正呼气压力则对机械通气患者有益。需要进行随机临床试验来证实我们的初步结果,即不同的亚组/表型可以从一种治疗中获益更多。