Noninvasive Ventilation
Coupled With Nebulization During Asthma Crises: A Randomized Controlled Trial
Valdecir C Galindo-Filho,
Daniella C Branda˜o, Rita de Ca´ssia S Ferreira, Maria Jose´ C Menezes, Paulo
Almeida-Filho, Veroˆnica F Parreira, Tayse N Silva, Maria da Glo´ria
Rodrigues-Machado, Elizabeth Dean, and Arme`le Dornelas de Andrade
報告者:王貞慧
報告日期:102.10.23
BACKGROUND:
Despite the clinical improvements attributed
to noninvasive ventilation (NIV) during asthma crises, and the well established
effects of nebulization, there are few studies on the effects of these
interventions together. We hypothesized that nebulization coupled to NIV should
raise radio-aerosol pulmonary deposition in asthmatics. The aims of this study
were to assess the effects of coupling b-agonist nebulization and NIV during asthma
exacerbations on radio-aerosol pulmonary deposition, using scintigraphy and
cardiopulmonary parameters, to correlate pulmonary function with radio-aerosol
deposition index, radio-aerosol penetration index, and pulmonary clearance.
METHODS:
In this controlled trial, 21 adults with
moderate to severe asthma attack were randomized to a control group (n = 11) or experimental group (NIV+ nebulizer group, n =10). All subjects inhaled bronchodilators for
9 minutes, and after particles were counted with a gamma camera to analyze
regions of interest and pulmonary clearance at 0, 15, 30, 45, and 60 min.
RESULTS:
Breathing frequency (P =< .001) and minute ventilation (P = .01) were reduced, and tidal volume was
increased (P =.01) in the NIV+ nebulizer group, compared with the control group. The NIV + nebulizer group had improvement from baseline
values, compared to the control group in the following parameters: FEV1 46.7 ± 0.5% of predicted vs 29.8 ±8.9% of predicted, P =.02), FVC (41.2± 1.5% of predicted vs 23.2 ±7.1% of predicted, P=.02), peak expiratory flow (67.3 ±38.3% of predicted vs 26.9 ±12.1% of predicted, P= .01), and inspiratory capacity (54.9 ±28.8% of predicted vs 31.2 ±9.1% of predicted, P = .01). No differences were observed between
groups regarding radio-aerosol deposition index or pulmonary clearance.
Negative correlations were found between FEV1, forced expiratory flow during the middle
half of the FVC maneuver (FEF25–75%), inspiratory capacity, and radio-aerosol penetration
index.
CONCLUSIONS:
Coupling nebulization and NIV during asthma
exacerbation did not improve radio-aerosol pulmonary deposition, but we
observed clinical improvement of pulmonary function in these subjects.
(ClinicalTrials.gov registration NCT01012050)
Key words: noninvasive
ventilation; asthma; nebulization; pulmonary scintigraphy; radio-aerosol;
pulmonary function. [Respir Care 2013;58(2):241–249]