Applicability of Techniques of Lung Expansion
Condition: Stroke
Study type: Interventional

Summary: 
      The survival of patients with lesions in the central nervous system is usually accompanied by
      physical and mental sequelae. These impairments favor the prolonged restriction to the bed,
      which may contribute with changes in respiratory function. In this context, lung re-expansion
      techniques are used to prevent or treat the various respiratory complications.
    

Detailed description: 
      The survival of patients with lesions in the Central Nervous System is usually accompanied by
      physical and mental permanents sequelae. This impairment of cognitive status associated with
      motor injury favors prolonged restriction of these patients to the bed, which may contribute
      to the emergence of other health damages. In the clinical practice, lung expansion techniques
      has been used as a prophylaxis and treatment of respiratory conditions that involve
      volumetric reductions. However, the deficit of awareness and cooperation difficult the use of
      several therapeutic resources. There are few interventions that could be proposed due to no
      need the collaboration to be performed, such as Breath Stacking technique (BS) and Expiratory
      Positive Airway Pressure (EPAP). The BS is characterized by execution of inspiratory cycles
      through a one way valve, which allows stacked volume of gas during each inspiration, until it
      reaches values approximate to maximum inspiratory capacity. While in the EPAP, alveolar
      pressure is elevated to breath against a expiratory flow resistance generated by a spring
      load valve. The effects on lung volume promoted BS and EPAP can be safely measured using an
      electrical impedance tomography (EIT). This recent imaging modality offers information about
      lung air volumes distribution and have a strong linear correlation with regional ventilation
      within the thorax. The effects on lung volume promoted BS and EPAP can be safely measured
      using an EIT monitor. This recent imaging modality offers information about lung air volumes
      distribution and have a strong linear correlation with regional ventilation within the
      thorax. Until this moment, there is not description about the effect of lung expansion
      techniques on regional lung parameters.
    

Intervention name(s): EPAP; Breath Stacking
Intervention type(s): Other; Other
Intervention description(s): The EPAP will be applied with a Spring Load Valve Resistor (Vital Signs, Totowa, NJ, USA), adjusted with a pressure of 10 cmH2O. The Spring Load Valve Resistor will be connected to the expiratory branch of the T-tube. Duration of intervention: 5 minutes.; The BS will be performed by a T-tube with a one-way inspiratory valve and the expiratory branch occluded. The expiratory occlusion is maintain until observed the presence of a plateau in the impedance plethysmogram by EIT, which corresponds to the absence of inspired air displacement or when a maximum time of 40 seconds was attained. Durantion of intervention:Three BS interventions will be performed at one minute intervals between them.
Other intervention name(s): Expiratory Positive Airway Pressure; Air Stacking
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Noncooperative patients