Effects of intermittent positive pressure breathing on emphysematous patients |
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| Authors: | M L Birnbaum E M Cree H Rasmussen P Lewis J K Curtis |
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| Affiliation: | 1. Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan;2. General Education Center, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan;3. Department of Recreation and Health-Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan city, Taiwan;4. Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;5. Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;6. Department of Oral and Maxillofacial Surgery, Chi Mei Hospital, Liouying, Tainan City, Taiwan;7. Department of Emergency Medicine, E-Da Hospital, Kaohsiung City, Taiwan;8. College of Medicine, I-Shou University, Kaohsiung City, Taiwan;1. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Cambridge, MA;2. Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada;3. Department of Medicine, University of Toronto, Toronto, ON, Canada;4. Department of Physical Therapy, University of Toronto, Toronto, ON, Canada;1. Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan;2. Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan;3. School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan;4. Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan;5. Department of Anesthesiology, Tri-Service General Hospital & National Defense Medical Center, Taipei, Taiwan;6. Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan;7. Department of Physical Therapy, College of Health Care, China Medical University, Taichung, Taiwan;8. Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan;9. Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan;1. Department of Respiratory Medicine, Department of Medicine, University of Toronto, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, England;2. Department of Respiratory Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada;3. Department of Respiratory Medicine, Department of Physical Therapy, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Cambridge, MA;4. Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada;5. Department of Respiratory Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada;6. Department of Health Sciences, University of Leicester, Leicester, England;7. Department of Respiratory Medicine, Department of Physical Therapy, University of Toronto, Toronto, ON, Canada;1. Naval Medical Center Portsmouth, Portsmouth, VA;2. Florida Hospital Cancer Institute, Orlando, FL;3. Sarasota Memorial Institute for Cancer Care, Sarasota, FL;4. Sarasota Memorial Institute for Cancer Care, Florida State University College of Medicine, Sarasota, FL;2. Department of Pharmacology, Université de Montréal, Montreal, Quebec, Canada;3. Critical Care Division, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada |
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| Abstract: | Eight subjects free of pulmonary disease and eighteen with moderate to severe pulmonary emphysema were subjected to 15 minutes of continuous intermittent positive pressure breathing (IPPB) and followed for 2 hours after cessation of therapy. Continuous measurements of ventilation, expiratory gas composition and frequent determinations of arterial blood gases were made. As indicated by improvement of PaCO2 which persisted throughout the 2 hour recovery period, IPPB was shown to be therapeutically beneficial when properly utilized in patients with moderate to severe pulmonary emphysema. Data are presented which demonstrate that IPPB produces passive hyperventilation and a resultant ventilatory CO2 loss in patients with moderate disease. In patients with severe disease, slight if any ventilatory loss of CO2 occurred but improvement in PaCO2 was shown to be augmented by decreased metabolic CO2 production related to decreased work of breathing produced by IPPB. Patients in this latter group were found to breathe at an improved level of efficiency following IPPB. The clinical rationale for IPPB therapy in emphysematous patients is presented. |
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