Comparative Study Between CPAP Mask and Stacked Breathing o Pneumonia
Condition: Pulmonary Function
MeSH terms: Pneumonia
Study type: Interventional

Summary: 
      the study aimed to compare the effect of using NIV with using CPAP mask and stacked breathing
      exercise and its efficacy on chest expansion and pulmonary functions in pneumonic patients.
    

Detailed description: 
      Introduction Pneumonia represents a frequent complication in patients in ICU with rates up to
      56% . Although oxygen therapy is the cornerstone for pneumonia treatment, its efficacy might
      be minimized because of shunt effects due to the presence of pulmonary exudate and
      atelectasis. To improve oxygenation, alveolar recruitment obtained through the application of
      either invasive or non-invasive mechanical ventilation (NIV) might be necessary, especially
      in severe pneumonia .

      The role of NIV as a tool to treat pneumonia has dramatically increased over the past decades
      and its efficacy has been well studied in clinical practice, especially in treating acute
      cardiogenic pulmonary edema and exacerbation of Chronic Obstructive Pulmonary Disease (COPD).
      Concerning NIV treatment in patients with pneumonia, its use has been proved to be effective
      only in patients with COPD and in immunocompromised patients with lung infiltrates . The lack
      of strong evidence in literature led international experts to suggest only cautious trials of
      NIV in well-selected patients with pneumonia and in trained settings with a clear caveat to
      avoid a delay in endotracheal intubation . One method of NIV is Continuous Positive Airway
      Pressure (CPAP) which is used to administer fresh gas pressure to the spontaneously breathing
      patient. By opening more alveolar spaces, CPAP increases the number of functional airways,
      thereby reducing total resistance. The success of CPAP therapy is highly influenced by
      patient compliance and the level of comfort provided by the CPAP mask and headgear. If the
      patient is able to tolerate CPAP and use it correctly, its effective rate is nearly 100% .
      The majority of patients fail the treatment not because of its low efficacy for maintaining
      upper airway patency but because of intolerance .

      There are different types of physiotherapy exercises which can benefit patient with pneumonia
      and help lung recruitment as CPAP ventilation but it is more tolerance to patient than use of
      CPAP mask . one of these exercises is breathing stacking which is a breathing exercise to
      help improve and maintain the size of breath that the patient is able to take and can be used
      regularly to help the patient clear mucus from his chest (secretion clearance).

      It can also be used to help improve the strength of the cough and voice . It is mainly used
      for people with weak breathing muscles which makes breathing and coughing difficult. Patients
      with neuromuscular diseases often have weakness of their breathing (respiratory) muscles
      which affects how well the respiratory system works. It is also used for people with bone or
      structural problems which cause a small / altered chest shape making coughing difficult .

      The aim of this study is to compare the effect of NIV with using CPAP mask versus stacked
      breathing on chest expansion and pulmonary function in patients with pneumonia .

      Research hypothesis:- the investigators hypothesized that stacked breathing exercise is more
      effective on chest expansion and pulmonary function and more tolerant to patients with
      pneumonia than NIV with using CPAP mask.

      Patients and methods Research design:- Quasi experimental research design will be utilized to
      fulfill the aim of this study.

      Study variables:-

        -  The independent variables are NIV with using CPAP mask and stacked breathing exercise .
           -The dependent variables are the patients ' outcomes which include:-

             1. Chest expansion.

             2. Pulmonary functions.

             3. Duration of ICU stay.

             4. Complications as respiratory complications and general complications.

             5. Mortality rate.

                Research settings:

                The study will be conducted in 4 settings include:- Chest intensive care unit at
                Assiut university hospital. General intensive care unit at Assiut university
                hospital. Obstetric intensive care at women health hospital. Trauma intensive care
                unit at Assiut university hospital.

                Sample:- A convenience sample of 60 male and female adult patients will be taken,
                the patients will be classified into two equal groups , 30 patients for each group.
                CPAP mask group will receive NIV with using CPAP mask and stacked breathing group
                who will receive stacked breathing exercise.

                Tools of the study:- The following tools will be used to collect data for study:-
                Tool [1]:- patient assessment sheet which will be developed by the researcher and
                uses to monitor hemodynamic parameters, assessment of respiratory system,
                assessment of laboratory findings , fluid balance in addition to socio-demographic
                and medical data . It includes 5 parts:- Part (1): Socio-demographic and medical
                data as patient code , age , sex , past history

                , present illness, cause of admission , date of admission, date of discharge and
                length of ICU stay. This part also includes assessments of hemodynamic parameters
                system include (Mean arterial pressure (MAP), heart rate (HR), temperature and CVP
                readings) and laboratory findings every day.

                Part (3): Assessment of respiratory system which includes :-

        -  Chest condition as respiratory rate ,cough (dry or productive, strong or weak ), sputum
           characteristics: (amount , viscosity and color), dyspnea , orthopnea , pain with
           breathing and also assessment of sputum and blood culture.

        -  Auscultation of the chest for breathing sounds and determine if there are abnormal
           breathing e.g [wheezing, bronchospasm, crepitation .....] every shift.

        -  chest x-ray and ventilator profile.

        -  Assessment of chest expansion.

        -  Assessment of pulmonary functions Part (4): Fluid balance chart which include fluid
           intake and output. Part (5):Medication chart. Tool [2]: pneumonia treatment sheet which
           will be developed by researcher and uses to assess procedures done to the patient and
           includes 5 parts:- Part (1) : NIV with using CPAP mask. Part (2) : Stacked breathing
           exercise Tool [3]: Outcome evaluation sheet which will be developed by the researcher
           and uses to assess the effect of NIV with using CPAP mask and Stacked breathing on :-

             -  Chest expansion .

             -  Pulmonary functions.

             -  Days of staying in ICU.

             -  Complications such as pulmonary complications as pulmonary edema, bronchitis ,
                pulmonary embolism , respiratory failure ...others and general complications as
                acute renal failure , liver failure , multiple organ failure or …..others.

             -  Mortality rate.
    

Intervention name(s): stacked breathing exercise; NIV by CPAP mask
Intervention type(s): Device; Device
Intervention description(s): • Breath stacking was done using a "bag" which is a simple device used to give artificial breaths..
It is best done in a sitting position but can be done reclining or lying flat whichever position is used, try to avoid slouching. If sitting: rest against the back of a chair and keep the shoulders, arms and hands relaxed.
If using the mouthpiece, place the lips tightly around the mouthpiece to create a tight seal.; provides pressurized air through a mask to help push air into your lungs and help you breathe
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: use of two manner of breathing for patients with pneumonia.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: stacked breathing; CPAP mask; pneumonia