Research Team:Michelle Emison

Kim NguyenEdinah Isoe

Raquel SmithAde Adeoso

Lorraine Gonzales

Faculty Advisor:Kelley Buzbee, AAS, RRT-NPS, RCP

Will EzPap at different I:E ratios affect the hemodynamics of a

healthy adult?

EzPap at a pressure of 15 CmH2O with different I:E ratios will cause physiological changes in the

hemodynamics of an adult test subject.

AbstractTo determine the effects of EzPap at different

I:E ratios on the hemodynamics on healthy adults ( n= 10.) Instructions on the procedure was given after consent forms were signed.

The subjects’ baseline heart rate, respiratory rate, Spo2, pulse and Blood Pressure were recorded. Test subjects were instructed to take a few breaths off device to set the therapeutic pressure at 15 cmH2o. Test subjects were given 2 minutes between each I:E ratio.

Vital signs were then recorded after each I:E ratio.

Abstract continuedWe did find some hemodynamic changes but nothing significant or consistent.Heart rates and respiratory rates increased slightly but not in all patients and nothing clinically significant.

Cohort Group

Cohort Group

BackgroundEzPAP is an easy to use and inexpensive device that

provides positive airway pressure on inhalation, exhalation and on breath hold. The resulting action is a positive inspiratory airway pressure as well as positive expiratory airway resistance. The resistance provides collateral ventilation to the airways and creates the backpressure needed to open up collapsed alveoli. According to Continuing Medical Education Corner, this therapy is very helpful in test subjects at risk for developing post-operative atelectasis, as well as the treatment of atelectasis and has also shown effective in lung expansion therapy.

Background con’t.Contraindications include: test subjects who cannot tolerate increased WOB test subjects with ICP greater than 20 mmHg recent facial, oral or skull surgery, or trauma, esophageal surgery untreated pnuemothorax unstable hemodynamics acute sinusitis epitastaxis active hemoptysis nausea impaired venous return hyperoxia gastric distention air trapping, auto-PEEP respiratory alkalosis nosocomial infections untreated tuberculosis (EzPAP clinical performances)

Glossary• Atelectasis: an abnormal condition characterized by the collapse of alveoli, preventing

respiratory exchange of carbon monoxide and oxygen in a part of the lungs.

• Bilateral breath sounds- sounds of the heart and lungs

• Blood pressure-force exerted against the walls of blood vessels

• Brochioectasis: a disease that involves a dilation of bronchioles that produces a large amount of secretions.

• Bronchodilator- a drug that relaxes the bronchial passageways and improves the passages of air into the lungs.

• Cardiac Output – volume of blood pumped per minute by the heart

• Cystic Fibrosis- An inherited condition in which the exocrine glands produce abnormally viscous mucus, causing chronic respiratory and digestive problems

• Epistaxis: bleeding from the nose caused by local irritation of mucous membranes, violent sneezing, fragility of the mucous membrane or of the arterial walls, chronic infection, trauma, hypertension, leukemia, vitamin K deficiency, or most often, picking the nose.

Glossary con't.• Hemodynamics: the study of the physical aspects of blood circulation, including

cardiac function and peripheral vascular physiologic characteristics

• Hemoptysis: coughing up of blood from the respiratory tract

• Hypercapnia- having abnormally high levels of carbon dioxide circulating in the blood.

• Hypoxemia- A lack of oxygen circulating to the tissues.

• Inflammation: swelling caused by an infection

• Intrathoracic pressure- pressure in the chest cavity

• Neuromuscular disorder: disorder affecting both nerve and muscle tissue.

• Nosocomial infections: an infection that is acquired at least 72 hours after hospitalization

Glossary con’t. Oxygen enrichment: Term often used to describe the oxygen level is greater than

in air.

Oxygen Saturation- A measurement of the current percentage of oxygen carried in the blood at a given time

Oxygen therapy: the inhaling of oxygen under pressure, often inside a pressurized chamber, as a treatment for respiratory conditions.

Pneumothorax: collection of air or gas in the pleural space causing the lung to collapse

Preload – The amount of pressure stretching the ventricular walls at the onset of ventricular contraction.

Prophylactic- a medical treatment that is used to prevent a disease state from occurring.

Pulse-rate and strength the heart beats in a minute

Pulse ox- amount of oxygen in blood

Glossary con’t. Respiratory arrest: the cessation of breathing.

Restrictive lung defect: incomplete lung expansion and increased lung stiffness

Stroke volume- volume of blood ejected from the ventricle during contraction.

Systolic blood pressure- blood pressure when the heart is working

Temperature-warmth or coldness of the body

Therapeutic- a medical treatment used to remediate a health problem that has been diagnosed.

Venous Return: the return of the blood to the heart via the vena cava and coronary sinus

MethodologyEzPAP is indicated for test subjects who need lung

expansion therapy to prevent or reverse atelectasis; it can be used as prophylactic or therapeutic device in atelectasis. It can also be used with test subjects with restrictive lung defects, hypercapnia secondary to decreased lung tissue, test subjects at risk for developing pulmonary atelectasis. EzPAP is also intended to optimize delivery of inhaled bronchodilator. The EzPAP can also be used in the removal of excessive mucus from the lungs in cases of test subjects with a history of pulmonary problems like cystic fibrosis, bronchiectasis and lung abscess and thus potentially limiting the bacterial burden and decreasing swelling in the conducting airways.

Methodology con’t. First the subjects were placed in a comfortable position while

baseline heart rate, respiratory rate, Spo2, pulse and Blood Pressure were all recorded. Then the test subjects were instructed to take a few Breaths off of the EZ Pap device to set the therapeutic pressure at 15 cmH2o. Then the test subjects were expected to rest two minutes prior to the initiation of tests.

After the subjects rested they were instructed when to inhale and when to exhale which was at an I:E ratio of 1:3. The I:E ratio was timed with a clock with a second hand. The test subject continued this for 2 minutes, then Heart rate, respiratory rate, pulse, blood pressure, and SpO2 was measured.

The test subjects were then instructed to rest for two minutes before initiating the next test. The test subjects were again told to sit comfortably in a chair and were instructed when to inhale and when to exhale to set a I:E ratio of 1:4. This was continued for 2 minutes then vital signs again were measured. A period of rest ensued again for 2 minutes, before the next test began at an I:E ratio of 1:5.

Methodology con’t.The entire procedure was carried out using

an EzPap with a mouthpiece, bacteria filter, pressure monometer, O2 flow meter, blood pressure cuff, sphygnomometer, pulse oximeter, and a stethoscope.

EzPap was only used once and disposed of after each test subject.

INITIAL VITAL SIGNSTest Subject Heart Rate RR Blood Pressure SpO2

1AZ2 66 24 132/65 95

2AZ3 81 16 112/80 97

2AZ4 86 16 114/70 98

2AZ5 78 16 122/72 99

2AZ6 71 20 122/78 99

2AZ7 66 16 119/70 98

2AZ8 75 14 140/92 98

2AZ9 59 16 118/60 98

2AZ10 84 18 110/60 97

2AZ11 98 20 120/78 100

Post Vital SignsI:E Ratio of 1:2

Test Subject Heart Rate RR Blood Pressure SpO2

1AZ2 64 12 130/75 97

2AZ3 88 20 116/62 98

2AZ4 82 20 110/78 99

2AZ5 87 28 130/80 99

2AZ6 71* 20* 122/78* 99*

2AZ7 68 20 116/78 99

2AZ8 67 14 130/88 99

2AZ9 67 16 110/60 99

2AZ10 88 18 120/82 99

2AZ11 103 20 133/92 99

Post Vital SignsI:E Ratio of 1:3

  HR RRSystolic

BPDiastolic

BP SpO21AZ2 83 24 124 68 982AZ3 72 14 114 60 992AZ4 74 20 110 78 992AZ5 79 24 124 78 992AZ6 xx xx xx xx xx2AZ7 64 20 110 90 992AZ8 61 20 150 98 992AZ9 64 16 100 50 992AZ10 85 20 112 80 992AZ11 107 22 130 90 99

* XX indicates unable to complete

Post Vital SignsI:E Ratio of 1:4

Heart Rate Respirations Systolic BP Diastolic BPO2

Saturations

1AZ2 84 97

2AZ3 81 17 112 58 99

2AZ4 86 22 116 78 99

2AZ5 75 14 120 90 99

2AZ6 xx xx xx xx xx

2AZ7 66 20 112 90 99

2AZ8 67 18 142 98 99

2AZ9 66 12 100 40 99

2AZ10 93 18 110 82 99

2AZ11 108 24 122 84 99

* XX indicates unable to complete

The % change in the respiratory rate of the 10 test subjects with an I:E ratio of 1:3 was 15.406%

The % change in the heart rate of the 10 test subjects with an I:E ratio of 1:3 was 0.209%

The % change in the respiratory rate of the 10 test subjects with an I:E ratio of 1:4 was 4.587%

The % change in the heart rate of the 10 test subjects with an I:E ratio of 1:4 was 5.589%

DiscussionThe research project did have its limitations. There

were not enough test subjects that were readily available to give us a larger and more detailed view of the effects on hemodynamic at different I:E ratios. All test subjects were healthy so we were unable to study the effects of Ezpap on hemodynamics of persons with obstructive or restrictive defects. There was also not enough supplies due to funding and time was also another factor that is taken into account. A bourdon gauge monometer was used, it might be interesting to see what would have happened with a digital monometer. Pressure waveform was not measured and flow wave forms were also not measured due to lack of equipment.

DiscussionRespiratory rate showed a higher % change

than any other vital sign measured. Heart rate also showed a slight increase but

was not as significant as the respiratory rate.No consistancy was found with Blood

pressure.O2 sats stayed within normal limits.

ConclusionWe did find some hemodynamic changes but nothing significant or consistent.Heart rates and respiratory rates increased slightly but not in all patients and nothing clinically significant.It would be difficult to make generalizations about ezPap and patients’ VS because the number of test subjects was too small.

It would be nice to:

•See someone repeat this study with an obstructive or restrictive defect such as asthma, COPD, someone with increase RAW or decreased compliance, and atelectasis.

•To have a digital monometer as opposed to the bourdon gauge monometer.

•To see the waveforms measured while using the Ezpap.

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