Use of Heliox Associated With PEEP in Patients With Asthma
Condition: Asthma; Helium; Oxygen; Positive End-Expiratory Pressure
MeSH terms: Asthma
Study type: Interventional

Summary: 
      In patients with obstructive lung disease like asthma aerosol therapy is the most used for
      drug administration. A order to make better use of aerosolized drugs in asthmatic patients,
      studies focus on ways to optimize this administration. Objective: To evaluate the efficacy of
      nebulized bronchodilators carried by heliox associated with positive expiratory pressure
      (PEP) in lung deposition of radiation activity in adult asthmatic patients between episodes
      and its impact on lung function. Methods: A randomized controlled trial involving 32 with a
      mean age of 47.28 ± 9.67 of which 25% of the sample are male, these patients were divided
      into four groups: heliox + PEP, + PEP oxygen, heliox and oxygen in Regarding the
      anthropometric characteristics, parameters and cardiopulmonary baseline spirometry data were
      similar for all groups. For inhalation lung scintigraphy was used a noninvasive delivery
      system - orofacial mask with two unidirectional valves nontoxic - inspiratory and expiratory
      branch - connected to the nebulizer for radioisotopes associated with PEP of 10 cm H2O. At
      the end of inhalation, the images were acquired in a scintillation camera at 0, 15, 30, 45
      and 60 min. In order to analyze the aerosol deposition in different lung areas were
      delineated regions of interest (ROIs) in the vertical - the upper, middle and bottom - and
      horizontal central, intermediate and peripheral. Results: The spirometric data showed an
      increase in the values of forced expiratory volume in one second (FEV1) predicted when
      compared with the heliox group + PEP (80%, p = 0.030) with PEP + O2 (65%, p = 0.030). As for
      CI, there was also an increase in PEP + heliox group (0.05 L, p = 0.012) compared to groups
      without oxygen and heliox PEP (0.03 L, 0.03 L, p = 0.012 respectively) for the total number
      of counts, no differences were seen between groups with heliox and oxygen with PEP PEP
      (482510, 577598, p = 0.262 respectively) for the total number of counts by comparing the
      oxygen group + PEP (577,598) with the heliox group (332,951, p = 0.004) and oxygen without
      PEP (409,526, p = 0.045), there was a greater number of counts in the O2 + PEP group. By
      analyzing the rate of pulmonary deposition (IDP) in the vertical gradient, higher deposition
      in the middle third (p = 0.001) when compared to upper and lower in both groups. With regard
      to IDPs in the horizontal gradient, there was greater deposition in the intermediate region
      when compared to central and peripheral (p = 0.003, 0.001 respectively) in all groups. As the
      penetration rate, no significant differences between groups (p = 0.726). When considering the
      pulmonary clearance, decreased with the number of counts over time within groups (p <0.05)
      but no differences between them: heliox + PEP (20.67%), PEP + oxygen (13.50%), heliox
      (16.27%) and oxygen (16%) - (p> 0.05). Conclusion: Although no differences in the rate of
      penetration and clearance of pulmonary radiation activity between groups, we noted a higher
      number of counts in patients who underwent nebulization with oxygen associated with PEP and a
      functional improvement in patients who underwent nebulization with PEP as spirometric values
      and CI.
    


Intervention name(s): Heliox+PEP; Oxygen+PEP; Heliox; Oxygen
Intervention type(s): Other; Other; Other; Other
Intervention description(s): For the nebulization with heliox was used radioaerosol a noninvasive delivery system that consists of a nontoxic orofacial mask with two unidirectional valves - inspiratory and expiratory branch - connected to the nebulizer for radioisotopes Venticis ® II Medical device, class II, CE 0459 (Ventibox / CIS Bio International, France). This mask was attached to the patient's face to prevent leaks and maintain proper pressurization and better patient compliance to the PEP. PEP was offered to 10 cm H2O through valve (Vital Signs, Totowa, NY) attached to the expiratory branch. The nebulizer was fed by a flow of 11 l / min of heliox for the heliox group according to the protocol of Hess et al. When powered by heliox mixture, the flow was adjusted flowmeter suitable for this mixture.; For nebulization of radioaerosol with oxygen, we used a noninvasive delivery system that consists of a mask with two nontoxic orofacial unidirectional valves - inspiratory and expiratory branch - connected to the nebulizer for radioisotopes Venticis ® II Medical device, class II, CE 0459 (Ventibox / CIS Bio International, France). This mask was attached to the patient's face to prevent leaks and maintain proper pressurization and better patient compliance to PEP (Figure 2). PEP was offered to 10 cm H2O through valve (Vital Signs, Totowa, NY) attached to the expiratory branch. The nebulizer was fed by a stream of 8 l / min oxygen.; For the nebulization with heliox we used a noninvasive delivery system that consists of a nontoxic orofacial mask with two unidirectional valves - inspiratory and expiratory branch - connected to the nebulizer for radioisotopes Venticis ® II Medical device, class II, CE 0459 (Ventibox / CIS Bio International, France). We used a PEP valve without resistance.; For nebulization of radioaerosol with oxygen, we used a noninvasive delivery system that consists of a mask with two nontoxic orofacial unidirectional valves - inspiratory and expiratory branch - connected to the nebulizer for radioisotopes Venticis ® II Medical device, class II, CE 0459 (Ventibox / CIS Bio International, France). We used a PEP valve without resistance.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment