Acute effects of Expiratory Positive Airway Pressure (EPAP) on different levels in ventilation and electrical activity of sternocleidomastoid and parasternal muscles in Chronic Obstructive Pulmonary Disease (COPD) patients: a randomized controlled trial

Dannuey M Cardoso, Guilherme A F Fregonezi, Renan T Jost, Ricardo Gass, Cristine L Alberton, Isabella M Albuquerque, Dulciane N Paiva, Sérgio S M Barreto, Dannuey M Cardoso, Guilherme A F Fregonezi, Renan T Jost, Ricardo Gass, Cristine L Alberton, Isabella M Albuquerque, Dulciane N Paiva, Sérgio S M Barreto

Abstract

Objective: To investigate the acute effects of EPAP on the activity of sternocleidomastoid (SCM), parasternal muscles and ventilatory parameters in COPD patients.

Method: Twenty-four patients with COPD were studied using surface electromyography (sEMG) and a ventilometer. Patients were randomly assigned to EPAP 10 cmH2O-EPAP10 or 15 cmH2O-EPAP15 for 20 minutes.

Results: The parasternal muscle sEMG activity increased during EPAP10 and EPAP15; however, a greater and significant increase was observed with EPAP10 (mean between-group difference: 12.5% RMS, 95% CI: 9.5 to 15.4, p<0.001). In relation to the baseline, at 10 and 20 minutes and upon recovery, respectively parasternal activity increased by 23.9%, 28.9% and 19.1% during EPAP10 and by 10.7% at 10 and 20 minutes and upon recovery, respectively, 11.4% and 6.9% during EPAP15 at 10 and 20 minutes and upon recovery, respectively. The sEMG activity of SCM muscle showed an opposite pattern, increasing with EPAP15 and decreasing with EPAP10 (mean between-group difference: 15.5% RMS, 95% CI: 12.6 to 18.4, p<0.001). SCM muscle activity during EPAP15, increased by 4.8% and 6.1% at 10 and 20 minutes and decreased by -4.0% upon recovery compared to decreases of -5.6%, -20.6% and -21.3% during EPAP10 at 10, 20 minutes, and recovery. Ventilation at both EPAP intensities promoted significant reductions in respiratory rate (RR) and dyspnea, more pronounced in EPAP15: RR (mean between-group difference: -3,8bpm, 95%CI: -7,5 to -0,2, p=0,015) and dyspnea (mean between-group difference: -1.01, 95%CI: -1.4 to -0.53, p=0.028) .

Conclusion: In COPD patients, the use of EPAP10 was more effective in reducing accessory inspiratory activity and increasing parasternal activity, which was accompanied by an improvement in ventilation and a reduction in dyspnea.

Figures

Figure 1. Flowchart of study. COPD: Chronic…
Figure 1. Flowchart of study. COPD: Chronic Obstructive Pulmonary Disease; BMI: Body mass index; EPAP: Expiratory Positive Airway Pressure.
Figure 2. The sEMG activity of the…
Figure 2. The sEMG activity of the parasternal and sternocleidomastoid (SCM) muscles in COPD Patients during the use of EPAP10 and EPAP15. *p<0.001.
Figure 3. Changes in tidal volume (V…
Figure 3. Changes in tidal volume (VT) in 2 groups of COPD patients during the use of EPAP10 and EPAP15.

References

    1. Global Initiative for Chronic Obstructive Lung Disease – GOLD Pocket guide to COPD diagnosis, management, and prevention. 2014. cited 2015 Mar 1. Available from: .
    1. Gary TF. Why does the lung hyperinflate? Proc Am Thoracic Soc. 2006;3(2):176–179.
    1. Aliverti A, Stevenson N, Dellaca RL, Lo MA, Pedotti A, Calverley PM. Regional chest wall volumes during exercise in chronic obstructive pulmonar disease. Thorax. 2004;59(3):210–216.
    1. Jones A, Dean E, Chow C. Comparison of the oxygen cost of breathing exercises and spontaneous breathing in patients with stable chronic obstructive pulmonary disease. Phys Ther. 2003;83(5):424–431.
    1. Ninane V, Rypens F, Yernault JC, De Troyer A. Abdominal muscle use during breathing in patients with chronic airflow obstruction. Am Rev Respir Dis. 1992;146(1):16–21.
    1. Grimby G, Goldman M, Mead J. Respiratory muscle action inferred from rib cage and abdominal V-P partitioning. J Appl Physiol. 1976;41(5 pt.1):739–751.
    1. Lien T, Wang J, Chang M, Kuo CD. Comparison of BiPAP nasal ventilation and ventilation via iron lung in severe stable COPD. Chest. 1993;104(2):460–466.
    1. van der Schans C, de Jong W, de Vries G, Kaan WA, Postma DS, Koëter GH, et al. Effects of positive expiratory pressure breathing during exercise in patients with COPD. Chest. 1994;105(3):782–789.
    1. Su C, Chiang L, Chiang T, Yu CT, Kuo HP, Lin HC. Domiciliary positive expiratory pressure improves pulmonary function and exercise capacity in patients with chronic obstructive pulmonary disease. J Formos Med Assoc. 2007;106(3):204–211.
    1. Winter DA, Fuglevand AJ, Archer SE. Crosstalk in surface electromyography: theoretical and practical estimates. J Electromyogr Kinesiol. 1994;4(1):15–26.
    1. Leduc D, De Troyer A. The effect of lung inflation on the inspiratory action of the canine parasternal intercostals. J Appl Physiol. 2006;100(3):858–863.
    1. Norman RW. Standardizing biomechanical testing in sport. Res Q Exerc Sport. 1987;58:286–287.
    1. Falla D, Dall'Alba P, Rainoldi A, Merletti R, Jull G. Location of innervation zones of sternocleidomastoid and scalene muscles--a basis for clinical and research electromyography applications. Clin Neurophysiol. 2002;113(1):57–63.
    1. Gross RD, Atwood CW, Jr, Ross SB, Olszewski JW, Eichhorn KA. The coordination of breathing and swallowing in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009;179(7):559–565.
    1. Hug F, Raux M, Prella M, Morelot-Panzini C, Straus C, Similowski T. Optimized analysis of surface electromyograms of the scalenes during quiet breathing in humans. Respir Physiol Neurobiol. 2006;150(1):75–81.
    1. Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000;10(5):361–374.
    1. Brazilian Society of Pneumology and Tisiology Guidelines for pulmonary function tests. Braz J Pneumol. 2002;28(3):237. [in Portuguese]
    1. Pereira CAC, Sato T, Rodrigues SC. New reference values for forced spirometry in white adults. Braz J Pneumol. 2007;33(9):397–406. [in Portuguese]
    1. Souza RB. Maximum static respiratory pressures: e Guidelines for pulmonary function tests. Braz J Pneumol. 2002;28(Supl 3):S155–65. [in Portuguese]
    1. Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999;32(6):719–727.
    1. Hall KD, Reeser FH., Jr Calibration of wright spirometer. Anesthesiology. 1962;23(1):126–129.
    1. Daykin AP, Nunn GF, Wright BM. The measurement of vital capacity and minute volume with the wright respirometer. Br J Dis Chest. 1978;72(4):333–335.
    1. Ilsley AH, Hart JD, Withers RT, Roberts JG. Evaluation of five small turbine-type respirometers used in adult anesthesia. J Clin Monit. 1993;9(3):196–201.
    1. Nemer SN, Barbas CS, Caldeira JB, Cárias TC, Santos RG, Almeida LC, et al. A new integrative weaning index of discontinuation from mechanical ventilation. Crit Care. 2009;13(5):R152.
    1. Boniatti VM, Boniatti MM, Andrade CF, Zigiotto CC, Kaminski P, Gomes SP, et al. The modified integrative weaning index as a predictor of extubation failure. Respir Care. 2014;59(7):1042–1047.
    1. Wilson RC, Jones PW. A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise. Clin Sci. 1989;76(3):277–282.
    1. Duiverman ML, van Eykern LA, Vennik PW, Koëter GH, Maarsingh EJ, Wijkstra PJ. Reproducibility and responsiveness of a noninvasive EMG technique of the respiratory muscles in COPD patients and in healthy subjects. J Appl Physiol. 2004;96(5):1723–1729.
    1. Simkovitz P, Brown K, Goldberg P, Milic-Emili J, Gottfried SI. Interaction between intrinsic and externally applied PEEP during mechanical ventilation. Am Rev Respir Dis. 1987;135:202.
    1. O'Donoghue FJ, Catcheside PG, Jordan AS, Bersten AD, McEvoy RD. Effect of CPAP on intrinsic PEEP, inspiratory effort, and lung volume in severe stable COPD. Thorax. 2002;57(6):533–539.
    1. Legrand A, Schneider E, Gevenois P, De Troyer A. Respiratory effects of the scalene and sternomastoid muscles in humans. J Appl Physiol. 2003;94(4):1467–1472.
    1. Appendini L, Patessio A, Zanaboni S, Carone M, Gukov B, Donner CF, et al. Physiologic effects of positive end-expiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1994;149(5):1069–1076.
    1. Tobin MJ, Lodato RF. PEEP, auto-PEEP, and waterfalls. Chest. 1989;96(3):449–451.
    1. Cardoso DM, Paiva DN, Albuquerque IM, Jost RT, Paixão AV. Effects of expiratory positive airway pressure on the electromyographic activity of accessory inspiratory muscles in COPD patients. Braz J Pulm. 2011;37(1):46–53.
    1. van der Schans C, de Jong W, de Vries G, Postma DS, Koëter GH, van der Mark TW. Effect of positive expiratory pressure on breathing pattern in healthy subjects. Eur Respir J. 1993;6(1):60–66.
    1. De Troyer A, Peche R, Yernault JC, Estenne M. Neck muscle activity in patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1994;150(1):41–47.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel