CPAP Has No Effect on Clearance, Sputum Properties, or Expectorated Volume in Cystic Fibrosis

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Citações na Scopus
12
Tipo de produção
article
Data de publicação
2012
Título da Revista
ISSN da Revista
Título do Volume
Editora
DAEDALUS ENTERPRISES INC
Autores
AQUINO, Evanirso Silva
SHIMURA, Francine
SANTOS, Adriana Silveira
COELHO, Cristiane Cenachi
FUCCIO, Marcelo Bicalho de
RUBIN, Bruce K.
Citação
RESPIRATORY CARE, v.57, n.11, p.1914-1919, 2012
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
BACKGROUND: Positive expiratory pressure (PEP) is used for airway clearance in cystic fibrosis (CF) patients. Hypertonic saline (HTS) aerosol increases sputum expectoration volume and may improve respiratory secretion properties. CPAP may also be used to maintain airway patency and mobilize secretions. To evaluate if CPAP would increase the beneficial clearance effect of HTS in subjects with CF, we investigated the effects of CPAP alone and CPAP followed by HTS on sputum physical properties and expectoration volume in CF subjects. METHODS: In this crossover study, 15 CF subjects (mean age 19 y old) were randomized to interventions, 48 hours apart: directed coughs (control), CPAP at 10 cm H2O, HTS 7%, and both CPAP and HTS (CPAP+HTS). Sputum collection was performed at baseline and after interventions. Expectorated volume was determined and in vitro sputum properties were analyzed for contact angle and cough clearability. RESULTS: There were no significant differences between any treatment in arterial blood pressure, heart rate, or pulse oximetry, between the 2 time points. HTS and CPAP+HTS improved cough clearability by 50% (P = .001) and expectorated volume secretion by 530% (P = .001). However, there were no differences between control and CPAP on sputum contact angle, cough clearability, or volume of expectorated secretion. CONCLUSIONS: CPAP alone had no effect on mucus clearance, sputum properties, or expectorated volume, and did not potentiate the effect of HTS alone in CF subjects.
Palavras-chave
cough clearance, hypertonic saline, continuous positive airway pressure, sputum, cystic fibrosis
Referências
  1. Albers GM, 1996, J APPL PHYSIOL, V81, P2690
  2. Albertini-Yagi CS, 2005, RESP PHYSIOL NEUROBI, V145, P101, DOI 10.1016/j.resp.2004.08.010
  3. American Association for Respiratory Care (AARC), 1993, RESP CARE, V38, P516
  4. Beardsmore CS, 1995, ARCH DIS CHILD, V73, P519
  5. Boucher RC, 2007, J INTERN MED, V261, P5, DOI 10.1111/j.1365-2796.2006.01744.x
  6. Bradley J, 2001, EUR RESPIR J, V17, P712, DOI 10.1183/09031936.01.17407120
  7. Bush A, 2006, CHEST, V129, P118, DOI 10.1378/chest.129.1.118
  8. Chan HK, 2002, J AEROSOL MED, V15, P307, DOI 10.1089/089426802760292654
  9. Chatmongkolchart S, 2002, CRIT CARE MED, V30, P2515, DOI 10.1097/01.CCM.0000034558.03726.66
  10. Darbee JC, 2004, PHYS THER, V84, P524
  11. Davis PB, 2006, AM J RESP CRIT CARE, V173, P475, DOI 10.1164/rccm.200505-840OE
  12. Daviskas E, 2010, CHEST, V137, P861, DOI 10.1378/chest.09-2017
  13. Dhand R, 2007, CURR OPIN CRIT CARE, V13, P27, DOI 10.1097/MCC.0b013e328012e022
  14. Donaldson SH, 2006, NEW ENGL J MED, V354, P241, DOI 10.1056/NEJMoa043891
  15. Elkins MR, 2006, NEW ENGL J MED, V354, P229, DOI 10.1056/NEJMoa043900
  16. Fauroux B, 1999, PEDIATRICS, V103, part. no., DOI 10.1542/peds.103.3.e32
  17. Hess DR, 2007, J AEROSOL MED, V20, pS85, DOI 10.1089/jam.2007.0574
  18. Holland AE, 2003, THORAX, V58, P880, DOI 10.1136/thorax.58.10.880
  19. KING M, 1985, J APPL PHYSIOL, V58, P1776
  20. Moran F, 2009, COCHRANE DB SYST REV, V21
  21. Nakagawa NK, 2000, CRIT CARE MED, V28, P312, DOI 10.1097/00003246-200002000-00004
  22. O'Connell OJ, 2011, RESP CARE, V56, P771, DOI 10.4187/respcare.00866
  23. Parkes SN, 1997, THORAX, V52, P171
  24. Placidi G, 2006, RESPIR CARE, V51, P1145
  25. PRYOR JA, 1994, RESP MED, V88, P677, DOI 10.1016/S0954-6111(05)80066-6
  26. PUCHELLE E, 1987, European Journal of Respiratory Diseases Supplement, V71, P281
  27. REGNIS JA, 1994, CHEST, V106, P1717, DOI 10.1378/chest.106.6.1717
  28. Riedler J, 1996, J PAEDIATR CHILD H, V32, P48, DOI 10.1111/j.1440-1754.1996.tb01541.x
  29. Robinson M, 1996, AM J RESP CRIT CARE, V153, P1503
  30. Rubin BK, 1998, CILIA, MUCUS, AND MUCOCILIARY INTERACTIONS, P317
  31. Rubin BK, 2007, PAEDIATR RESPIR REV, V8, P4, DOI 10.1016/j.prrv.2007.02.004
  32. Schmidt HJ, 2010, RESPIROLOGY, V15, P733, DOI 10.1111/j.1440-1843.2010.01745.x
  33. Smaldone Gerald C, 2005, Respir Care, V50, P1151
  34. SOLYMAR L, 1980, EUR J RESPIR DIS, V61, P275
  35. Wagner JS, 2003, RESP CARE, V48, P234
  36. Wanger J, 2005, EUR RESPIR J, V26, P511, DOI 10.1183/09031936.05.00035005