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Effects of EzPap on Physiologic

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					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   After 12   After 16   After 20   Pulses
Number       SBP        cmH2O      cmH2O      cmH2O      Paradoxus

1            107        107        101        104        No
2            130        130        126        137        No
3            120        112        108        117        No
4            126        106        144        143        No
5            115        84         114        107        No
6            141        137        130        134        No
7            127        102        128        108        No
8            140        146        129        140        Yes
9            138        120        124        128        No
10           136        129        124        144        No
          Diastolic Blood Pressure
Test      Baseline   After 12   After 16   After 20   Pulses
Subject   DBP        cmH2O      cmH2O      cmH2O      Paradoxus

1         68         68         64         64         No
2         78         78         73         76         No
3         73         69         65         71         No
4         65         67         77         73         No
5         74         32         74         79         No
6         93         103        95         92         No
7         85         65         98         61         No
8         86         90         88         76         Yes
9         82         76         66         76         No
10        86         76         68         76         No
                        Heart Rate
Test      Baseline HR   After 12   After 16   After 20   Pulses
Subject                 cmH2O      cmH2O      cmH2O      Paradoxus

1         89            89         86         103        No
2         88            88         92         101        No
3         88            85         88         88         No
4         86            78         71         78         No
5         85            104        106        91         No
6         123           126        111        116        No
7         75            86         81         82         No
8         64            66         66         66         Yes
9         86            84         74         80         No
10        81            98         89         92         No
              MAP Change in %
          (From Lowest to Highest)
Test Subject   Pre Tx MAP   Post Tx MAP   % Change
5              89           88            1% (-)
2              95           96            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% (-)
 Themean % change in MAP of the
 10 test subjects was 6.7%.

 Themedium % 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.

				
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