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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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