Dos Santos Elinaldo da Conceição, Pontes Campos Achiles Eduardo, do Carmo Odielson Ferreira, Lunardi Adriana Claudia
Master and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
Department of Biological and Health Sciences, Universidade Federal do Amapá, Macapá, Brazil.
Physiother Res Int. 2019 Jan;24(1):e1753. doi: 10.1002/pri.1753. Epub 2018 Oct 30.
We explored the feasibility of use of continuous positive airway pressure (CPAP) with 15- and 4-cmH O for a randomized controlled trial with patients with pleural drainage.
Ten patients with traumatic pleural effusion drained within 24 hr, with controlled pain received randomly CPAP with 0-, 4-, and 15-cmH O. Computed tomography was used to assess the lung aeration. Patients reported the level of tolerability. Air leak was also observed as a parameter of safety. The levels of pressure were compared using the Friedman test followed by the Tukey test as post hoc.
The lung area under CPAP with 15 cmH O (median = 3,913 mm ; IQR = 3,416-4,390 mm ) was greater than 4 (median = 3,495 mm ; IQR = 3,075-3,954 mm ) and 0 cmH O (median = 3,382 mm ; IQR = 2,962-3,658 mm ; p < 0.001). There was no difference between lung areas under CPAP with 4 and 0 cmH O. All levels of pressure were well tolerated by patients. No air leak was observed during the assessments.
CPAP with 15 cmH O is able to expand lungs of patients with pleural drainage. CPAP with 4 cmH O seems not have therapeutic effect. In addition, CPAP with 15 cmH O is well tolerated and safe in this population.
我们探讨了在胸腔引流患者中使用15厘米水柱和4厘米水柱持续气道正压通气（CPAP）进行随机对照试验的可行性。
10例创伤性胸腔积液患者在24小时内进行引流，疼痛得到控制，随机接受0厘米水柱、4厘米水柱和15厘米水柱的CPAP治疗。使用计算机断层扫描评估肺通气情况。患者报告耐受程度。还观察漏气情况作为安全性参数。使用弗里德曼检验比较压力水平，随后进行图基检验作为事后检验。
15厘米水柱CPAP下的肺面积（中位数=3913平方毫米；四分位间距=3416-4390平方毫米）大于4厘米水柱（中位数=3495平方毫米；四分位间距=3075-3954平方毫米）和0厘米水柱（中位数=3382平方毫米；四分位间距=2962-3658平方毫米；p<0.001）。4厘米水柱和0厘米水柱CPAP下的肺面积之间无差异。所有压力水平患者耐受性良好。评估期间未观察到漏气情况。
15厘米水柱的CPAP能够扩张胸腔引流患者的肺部。4厘米水柱的CPAP似乎没有治疗效果。此外，15厘米水柱的CPAP在该人群中耐受性良好且安全。
