Download Effects of EzPap on Physiologic Changes in the Hemodynamics of

Effects of EzPap on Physiologic Changes
in the Hemodynamics of the Body
Research Team:
Jody Baker
Me’shelle Corbin
Brenda Floyed
Loretta Simmons
Lisa Stansel
Tobyn Strait
Faculty Advisor:
Elizabeth K. Buzbee AAS, RRT-NPS, RCP
Biological Question
Will the use of EzPAP with an I:E ratio of 1:3 at different pressures of 12,
16, and 20 cmH2O cause changes in the hemodynamics of the body of an
adult patient.
Hypothesis
The use of EzPAP at an inspiratory to expiratory ratio (I:E) of 1:3 with
different pressures of 12, 16, and 20 cmH2O will cause physiological changes
in the hemodynamics of the body of an adult patient.
Abstract
Our research team set out to determine the effects of EzPaP on the
hemodynamics of the body of an adult patient. All test subjects were
over the age of 18 and consisted of 3 males and 7 females. After the
10 subjects signed a consent form, they were instructed on how to
perform the procedure.
Before beginning, the test subject’s heart rate, oxygen saturation,
and blood pressure was recorded. The treatment started by giving
EzPaP at a pressure of 12 cmH2O for 2 minutes with a 1 minute break
following. Then the pressure was moved up to 16 cmH2O for another 2
minutes with a 1 minute break following. Finally, the pressure was
increased to 20 cmH2O for 2 minutes. After this final treatment, the
patient rested for 5 minutes before leaving. The heart rate, oxygen
saturation, and blood pressure was also recorded after each pressure
increase.
Although each hemodynamic category underwent some type of
change, the only significant change over 5% was the diastolic blood
pressure in males, which decreased by an average of 8%.
Background
EzPAP is a positive expiratory pressure system that may or may not be used with a
nebulizer. Using a fluidic process, flow is augmented on inspiration with positive
expiratory pressure being provided during expiration. This augmentation provides for a
larger flow and volume with less effort than on unsupported inspiration. EzPap is
indicated to improve lung expansion with clinically evident pulmonary atelectasis to
improve oxygenation. EzPAP is also indicated for patients with the inability to clear
secretions adequately because of pathology that severely limits the ability to ventilate or
cough effectively.
Contraindications for EzPAP include patients who can not tolerate increased work of
breathing, patients with intracranial pressures greater than 20mmHg, recent facial, oral
or skull surgery or trauma, esophageal surgery, untreated pneumothoraax,
hemodynamic instability, acute sinusitis, epistaxis, active hemoptysis, nausea, impaired
venous return, hyperoxia, gastric distension, air trapping, auto-PEEP, respiratory
alkalosis, nosocomial infections, untreated tuberculosis, and radiographic evidence of
blebs. Hazards of EzPap include increased airway resistance and work of breathing,
barotraumas, pneumothorax, nosocomial infection, hypocarbia, hemoptysis, hyperoxia
when oxygen is the gas source, gastric distension, impaction of secretions, psychological
dependence, impedance of venous return, exacerbation of hypoxemia, hypoventilation
or hyperventilation, air trapping, auto-PEEP, and over distended alveoli.
References
DHD Healthcare. (2001). Retrieved September 16, 2005, from
http://www.dhd.com/pdf/Ezpap%20CABG%20Article.pdf
Definition of Terms






ATELECTASIS – Condition characterized by the collapse of the
lungs, preventing the respiratory exchange of carbon dioxide and
oxygen.
EPISTAXIS – Bleeding from the nose caused by local irritation of
mucous membranes.
EXPIRATION- Breathing out, normally a passive process
depending on the elastic qualities of lung tissue and the thorax.
FISTULA – An abnormal passage from an internal organ to the
body surface or between two internal organs.
HEMODYNAMICS – The study of the physical aspects of blood
circulation, including cardiac function and peripheral vascular
physiologic characteristics.
HEMOPTYSIS – Coughing up blood from the respiratory tract.
Definition of Terms continued






HYPEROXIA – Condition of abnormally high oxygen tension in the
blood.
I:E RATIO – Inspiratory – expiratory time ratio; the relationship
between the inspiratory and expiratory time provided during positive
pressure ventilation.
INSPIRATION – The act of drawing air into the lungs in order to
exchange oxygen for carbon dioxide, the end product of tissue
metabolism.
NOSOCOMIAL INFECTION – An infection acquired at least 72
hours after hospitalization often caused by Candida albicans,
escherichia coli, hepatitis, viruses, pseudomonas, or staphylococcus.
PNEUMOTHORAX – Collection of air or gas in the pleural space
causing the lung to collapse.
VENOUS RETURN – The return of the blood to the heart via vena
cava and coronary sinus.
Methodology
EzPAP is indicated for use in conjunction with a medical need for
lung expansion therapy and the treatment and prevention of
atelectasis. Ten adults over the age of 18 with no prior history of
pulmonary disease will be tested in this study. The equipment will
include the EzPAP machine, nose clips, a Datascope Corporation
blood pressure cuff and monitor, an air flow meter, alcohol wipes,
and a pulse oximeter. The research team will use safe hand washing
procedures and will use sterile testing equipment. Investigators
will explain the procedure to the test subject and read them the
consent form. After understanding and signing the consent form, a
Datascope Corporation blood pressure cuff and finger probe pulse
oximeter will be placed on the test subject. These instruments will
measure the blood pressure via the cuff and the heart rate and
oxygen saturation via the finger probe. All information will be
confidential. The test subject’s baseline blood pressure, pulse,
oxygen saturation, and respirations will be checked and documented
by the research team.
Methodology continued
The person will then be instructed on how to inhale and exhale
at a ratio of 1:3 on the EzPAP. After practicing the 1:3 ratio five
times, the test study will begin. Nose clips will be placed on the
person and they will be instructed to remain calm throughout the
procedure. Although oxygen will be used, no medications will be
used with the EzPAP. The patient will initially be placed on an EzPAP
of 12 cmH2O. After 2 minutes, the subject will take a 1 minute
break and then the pressure will be increased to 16 cmH2O for 2
minutes. After another 1 minute break, the pressure will be
increased to 20 cmH2O for 2 minutes. Finally, the test subject’s
blood pressure, heart rate, and oxygen saturation will be taken once
again to determine the hemodynamic physiologic changes the EzPAP
had on their body. After resting for 5 minutes, the test subject will
be free to leave.
Raw Data
Systolic Blood Pressure
Test Subject Baseline
Number
SBP
After 12
cmH2O
After 16
cmH2O
After 20
cmH2O
Pulses
Paradoxus
1
2
3
4
5
6
7
8
9
10
107
130
112
106
84
137
102
146
120
129
101
126
108
144
114
130
128
129
124
124
104
137
117
143
107
134
108
140
128
144
No
No
No
No
No
No
No
Yes
No
No
107
130
120
126
115
141
127
140
138
136
Diastolic Blood Pressure
Test
Subject
Baseline
DBP
After 12
cmH2O
After 16
cmH2O
After 20
cmH2O
Pulses
Paradoxus
1
2
3
4
5
6
7
8
9
10
68
78
73
65
74
93
85
86
82
86
68
78
69
67
32
103
65
90
76
76
64
73
65
77
74
95
98
88
66
68
64
76
71
73
79
92
61
76
76
76
No
No
No
No
No
No
No
Yes
No
No
Heart Rate
Test
Subject
Baseline HR
After 12
cmH2O
After 16
cmH2O
After 20
cmH2O
Pulses
Paradoxus
1
2
3
4
5
6
7
8
9
10
89
88
88
86
85
123
75
64
86
81
89
88
85
78
104
126
86
66
84
98
86
92
88
71
106
111
81
66
74
89
103
101
88
78
91
116
82
66
80
92
No
No
No
No
No
No
No
Yes
No
No
MAP Change in %
(From Lowest to Highest)
Test Subject
Pre Tx MAP
Post Tx MAP
% Change
5
2
89
95
88
96
1% (-)
1% (+)
6
109
106
3% (-)
3
89
86
3% (-)
10
103
99
4% (-)
1
81
77
5% (-)
8
104
97
7% (-)
9
101
93
8% (-)
4
85
96
12% (+)
7
99
76
23% (-)
 The
mean % change in MAP of the
10 test subjects was 6.7%.
 The
medium % change in MAP of the
10 test subjects was 4.5%.
Discussion
When looking at the data received from this study, we are able
to categorize it in several ways. First, the measurements are broken
down and analyzed individually to tell us if certain hemodynamics
changed more than others. Before treatment and after treatment
averages of the systolic blood pressure, diastolic blood pressure,
and heart rate will be compared to determine if significant changes
are present. Male and female measurements will also be compared
to see if one sex went through more changes than the other.
The research project did have its limitations. Not enough test
subjects were readily available to give us a larger, more detailed
view of hemodynamic changes. This turns up being a big problem
because it basically leaves the biological question unanswered. All
of the subjects tested in this study are included in the results; there
were no experiments excluded.
Conclusion
EzPAP is an application of positive pressure to
prevent and treat atelectasis and also aids in lung
expansion. Research was performed in order to discover
whether or not EzPAP would have effects on the
hemodynamics in the body of healthy adults. Ten
healthy adults, picked at random, were asked to breathe
on the EzPAP machine at an I:E ratio of 1:3 and at
differing pressures of 12cmH2O, 16cmH2O and
20cmH2O. Their blood pressures and oxygen
saturations were monitored before the test started and
at the change of every pressure. The test subjects were
also observed for pulsus paradoxus while breathing on
the EzPAP.
Conclusion continued
Upon conclusion, we observed a few changes
in blood pressures and heart rates. Certain test
subjects had increases in hemodynamics while
others showed a decrease in the same
measurements.
On average, the only change considered
significant when looking at males versus females
was the males diastolic blood pressure having an
8% decrease. Individually, test subject number
7 showed the greatest change with the MAP
decreasing by 23%.
Recommendations
More test subjects should be observed.
 The test subjects should be categorized,
such as male and female.
 For ethical reasons, we were unable to
measure invasive hemodynamic
parameters.
