Acute hemodynamic responses to 30° head-down postural drainage in stable, ventilated trauma patients: a randomized crossover trial.

OBJECTIVE: To determine whether 30° head-down tilt (HDT) used for secretion clearance is safe for acute trauma patients. BACKGROUND: There are concerns that HDT may lead to cardiac irregularities in intubated patients in the ICU. METHODS: Eleven mechanically ventilated trauma patients (25-42 yrs) without cardiovascular problems received two interventions, one supine HDT for 10 min and a control in the horizontal supine position (HS), in a crossover design. RESULTS: Compared to baseline there were statistically significant (p < 0.05) increases in SBP (6.3 mm Hg; 95% CI 2.5, 12.7) and CVP (7.3 cm H2O; 5.7, 10.0) during 10 min HDT although these were not of clinical concern. Heart rate and oxygen saturation were unchanged. No episodes of arrhythmia or hypoxemia were observed. All values returned close to baseline during 10 min horizontal recovery. There were no significant changes during the control HS intervention. CONCLUSION: 30° HDT entails minimal risk for trauma patients who have no underlying cardiovascular disease.

Breathing exercise using a new breathing device increases airway secretion clearance in mechanically ventilated patients.

OBJECTIVES: To evaluate the efficacy and safety of a new device (BreatheMAX) that humidifies and oscillates inspired air to increase secretion clearance in mechanically ventilated patients. BACKGROUND: Poor secretion clearance is a serious problem for intubated patients leading to lung complications and delayed weaning. METHODS: Double blinded crossover; fifteen patients, median age 60 years, range 16-75. Interventions consisted of spontaneous deep breathing with (treatment) and without (sham) humidification and oscillation of inspired air. Airway secretions were aspirated for 3 h before and after each intervention and wet weight and viscosity determined. RESULTS: The sham intervention caused no change in secretion clearance (95% CI: -1.8, 1.8 g) but after treatment secretions increased by 4.0 g (95% CI: 1.3, 6.7; p < 0.05). Viscosity decreased 30% after treatment and was unchanged after sham. Changes in cardiopulmonary function were not clinically significant and the patients reported only mild perceptions of breathlessness. CONCLUSIONS: Breathing exercise with a device that includes vibration and humidification of inspired air is effective for increasing secretion clearance with patients dependent on mechanical ventilation and was without any adverse effects.

An inspiratory load enhances the antihypertensive effects of home-based training with slow deep breathing: a randomised trial.

QUESTION: Can adding an inspiratory load enhance the antihypertensive effects of slow breathing training performed at home? DESIGN: Randomised trial with concealed allocation. PARTICIPANTS: Thirty patients with essential hypertension Stage I or II. INTERVENTION: Experimental groups performed slow deep breathing at home, either unloaded or breathing against a load of 20 cmH(2)O using a threshold-loaded breathing device. Participants trained for 30 min, twice daily for 8 weeks. A control group continued with normal activities. OUTCOME MEASURES: Resting blood pressure and heart rate were measured at home and in the laboratory before and after the training period. RESULTS: Compared to the control group, systolic and diastolic blood pressure decreased significantly with unloaded breathing by means of 13.5 mmHg (95% CI 11.3 to 15.7) and 7.0 mmHg (95% CI 5.5 to 8.5), [corrected] respectively (laboratory measures). With loaded breathing, the reductions were greater at 18.8 mmHg (95% CI 16.1 to 21.5) and 8.6 mmHg (95% CI 6.8 to 10.4), respectively. The improvement in systolic blood pressure was 5.3 mmHg (95% CI 1.0 to 9.6) greater than with loaded compared to unloaded [corrected] breathing. Heart rate declined by 8 beats/min (95% CI 6.5 to 10.3) with unloaded breathing, and 9 beats/min (95% CI 5.6 to 12.2) with loaded breathing. Very similar measures of blood pressure and heart rate were obtained by the patients at home. CONCLUSION: Home-based training with a simple device is well tolerated by patients and produces clinically valuable reductions in blood pressure. Adding an inspiratory load of 20 cmH(2)O enhanced the decrease in systolic blood pressure. TRIAL REGISTRATION: NCT007919689.

Conical-PEP is safe, reduces lung hyperinflation and contributes to improved exercise endurance in patients with COPD: a randomised cross-over trial.

QUESTION: Does a new positive expiratory pressure device (conical-PEP) decrease lung hyperinflation during exercise in patients with chronic obstructive pulmonary disease compared to normal breathing? Does it increase the duration of exercise? DESIGN: A randomised, cross-over trial with concealed allocation. PARTICIPANTS: Thirteen patients with moderate to severe chronic obstructive pulmonary disease (mean FEV1 61% predicted). INTERVENTION: THE experimental intervention was conical-PEP breathing with a positive expiratory pressure of 4-20 cmH2O during 30% of 1 RM alternate knee extension exercise at 70% age-predicted HRmax to fatigue. The control intervention was normal breathing. OUTCOME MEASURES: Total lung capacity (inspiratory capacity and slow vital capacity), breathlessness, and leg discomfort were measured pre and post exercise. Cardiorespiratory function was measured pre and during the last 30 s of exercise. Duration of exercise was recorded. RESULTS: After the experimental intervention, inspiratory capacity increased 200 ml (95% CI 0 to 400) and slow vital capacity increased 200 ml (95% CI 0 to 400) more than the control intervention. Participants exercised for 107 s (95% CI -23 to 238) more during the experimental intervention than the control intervention. Conical-PEP breathing during exercise resulted in 6.1 fewer breaths/min (95% CI 1.4 to 10.8) than normal breathing; it did not have any adverse effects on CO2 retention or oxygen saturation. CONCLUSION: The novel conical-PEP device decreases lung hyperinflation, is safe to use, and tends to increase the duration of exercise. TRIAL REGISTRATION: NCT00741832.