Effects of positive expiratory pressure on chest wall volumes in subjects with stroke compared to healthy controls: a case-control study

Elis E A Cabral, Vanessa R Resqueti, Illia N D F Lima, Lucien P Gualdi, Andrea Aliverti, Guilherme A F Fregonezi, Elis E A Cabral, Vanessa R Resqueti, Illia N D F Lima, Lucien P Gualdi, Andrea Aliverti, Guilherme A F Fregonezi

Abstract

Background: Alterations in respiratory system kinematics in stroke lead to restrictive pattern associated with decreased lung volumes. Chest physical therapy, such as positive expiratory pressure, may be useful in the treatment of these patients; however, the optimum intensity to promote volume and motion changes of the chest wall remains unclear.

Objective: To assess the effect of different intensities of positive expiratory pressure on chest wall kinematics in subjects with stroke compared to healthy controls.

Methods: 16 subjects with chronic stroke and 16 healthy controls matched for age, gender, and body mass index were recruited. Chest wall volumes were assessed using optoelectronic plethysmography during quiet breathing, 5 minutes, and recovery. Three different intensities of positive expiratory pressure (10, 15, and 20cmH2O) were administered in a random order with a 30 minutes rest interval between intensities.

Results: During positive expiratory pressure, tidal chest wall expansion increased in both groups compared to quiet breathing; however, this increase was not significant in the subjects with stroke (0.41 vs. 1.32L, 0.56 vs. 1.54L, 0.52 vs. 1.8L, at 10, 15, 20cmH2O positive expiratory pressure, for stroke and control groups; p<0.001). End-expiratory chest wall volume decreased in controls, mainly due to the abdomen, and increased in the stroke group, mainly due the pulmonary rib cage.

Conclusion: Positive expiratory pressure administration facilitates acute lung expansion of the chest wall and its compartments in restricted subjects with stroke. Positive expiratory pressure intensities above 10cmH2O should be used with caution as the increase in end-expiratory volume led to hyperinflation in subjects with stroke.

Keywords: Plethysmography; Positive-pressure respiration; Rehabilitation; Respiratory system; Respiratory therapy; Stroke.

Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
(A) Tidal volume of chest wall; (B) tidal volume of pulmonary rib cage; (C) tidal volume of abdominal rib cage; and (D) tidal volume of abdominal compartment in stroke group (closed symbols) and controls (open symbols) during quiet breathing (QB), PEP10, PEP15, PEP20 cmH2O, and recovery (Rec). Data are presented as means and standard deviation. **p < 0.05 for two-way ANOVA interaction between disease and PEP and *p < 0.05 for Bonferroni comparisons.
Figure 2
Figure 2
Operational volumes of total chest wall, pulmonary rib cage, abdominal rib cage, and abdominal compartments in stroke group (upper panels) and control group (lower panels). End-expiratory volume (EEV, open symbols) and end-inspiratory volume (EIV, closed symbols) during quiet breathing (QB), PEP10, PEP15, PEP20 cmH2O, and recovery (Rec). Data are presented as means. Statistics performed using two-way ANOVA with Bonferroni post hoc test to compare EEV and EIV between groups. *p < 0.05 for intragroup differences in EEV and **p < 0.05 for intergroup differences in EEV.
Fig. 3
Fig. 3
(A) Inspiratory time, expiratory time, and total respiratory cycle time for stroke group (light gray) and controls (dark gray) during quiet breathing (QB), PEP10, PEP15, PEP20 cmH2O, and recovery. (B) Δ Inspiratory time, expiratory time, and total respiratory cycle time in subjects with stroke (closed symbols) and healthy controls (open symbols). Data are presented as means and standard deviation. Statistics performed using two-way ANOVA. **p < 0.05 for disease versus PEP interaction and *p < 0.05 for Bonferroni comparisons.
Figure 4
Figure 4
Indexes of shortening velocity for different respiratory muscles groups. (A) Vt,Ab/Ti (shortening velocity index of diaphragm); (B) Vt,Rcp/Ti (shortening velocity index of inspiratory muscles); (C) Vt,Rcp/Te (shortening velocity index of expiratory muscles); (D) Vt,Ab/Te (shortening velocity index of abdominal muscles). Stroke group (closed symbols) and control group (open symbols) during quiet breathing (QB), PEP10, PEP15, PEP20 cmH2O, and recovery (Rec). Data are presented as means and standard deviation. Statistical analysis performed using two-way ANOVA; *p < 0.05 for Bonferroni comparisons in healthy individuals; **p < 0.05 for Bonferroni comparisons in stroke group; #p < 0.05 for intergroup comparisons.

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