AnÃlise dos efeitos da associaÃÃo da nebulizaÃÃo à ventilaÃÃo nÃo-invasiva na deposiÃÃo do radiaerossol atravÃs de cintilogragia pulmonar durante as exacerbaÃÃes agudas da asma

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

Background: Asthma is a multifatorial and chronic disease, characterized by airflow obstruction and airways hyperresponsiveness. Inhalation therapy is the first option to revert the bronchospasm presented by patients and noninvasive ventilation (NV) through positive pressure have been used coupling to nebulizations, but there are few and controversial data available in the literature about NV in asthma crisis. Objectives: Analyze inhalation and NV efficacy during asthma crisis, as well scientific evidence levels reached by using these resources; and assess the effects of coupling nebulization to NV during asthma exacerbations on radioaerosol pulmonary deposition and cardiopulmonary parameters; correlate pulmonary function with radioaerosol deposition index (RDI), radioaerosol penetration index (RPI) and pulmonary clearance (PC). Methods: The review included articles published in scientific periodicals and technical books gathered through dada from Medline, Lilacs and PubMed. After, were studied 21 asthmatic patients from both sexes, mean age of 46.71 Â 9.83 years and treated at a public emergency service in Recife. Patients were randomized into two groups: control group to receive nebulization (NEB - 11 patients) and experimental group, coupling nebulization to NV (NEB + NV, 10 patients). We measured cardiopulmonary parameters (breathing rate â BR; peripheral oxygen saturation â SpO2; tidal volume â TV; minute ventilation â MV; heart beating â RB; systolic blood pressure â SBP and diastolic blood pressure â DBP), pulmonary function test and through pulmonary scintigraphy were measured RDI, RPI and PC. Results: In the article reviews we discussed about the types of inhalers and their efficacy treating asthma, apart the NV coupling to nebulizations during asthma exacerbations. Regarding to the original article, we observed a reduction in RB (p=0.00) and MV (p=0.01), as well as a rise in TV (p=0.01) in the VNI + NEB group when compared to NEB group. Similarly NV group presented percentage gains in the VEF1 of 24.05Â7.86 (p=0.00), in the FVC of 20.67Â8.88 (p=0.00), in the PEF of 27.26Â11.14 (p=0.00) and in the IC of 32.82Â17.55 (p=0.01). None difference was found regarding RDI and RPI between groups, but we found intra-group variation to ID. Thus, negative correlations were presented by some spirometric data and a higher pulmonary deposition in central region for both groups. PC was observed after 34 min to VNI + NEB group and 39 min to NEB group. ConclusÃo: Inhalation therapy seems to be efficient to treat asthma exacerbations, but coupling nebulizations to NV still needs further more information due to the few studies published in the literature. We demonstrated that despite pulmonary deposition reduction, the main effect of coupling nebulization to NV is the mechanical bronchodilation due to positive pressure directly applied to the obstructed airways

ASSUNTO(S)

fisioterapia e terapia ocupacional terapia inalatÃria exacerbaÃÃes da asma aerossÃis nebulizers nebulizadores inhalation therapy ventilaÃÃo nÃo-invasiva asthma exacerbations cintilografia pulmonar e deposiÃÃo do radioaerossol aerosols noninvasive ventilation pulmonary scintigraphy and radioaerosol deposition

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