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Randomized Controlled Trial
. 2017 Nov-Dec;43(6):409-415.
doi: 10.1590/S1806-37562017000000088.

Impact of continuous positive airway pressure on the pulmonary changes promoted by immersion in water

[Article in English, Portuguese]
Danize Aparecida Rizzetti  1 , Janayna Rodembuch Borba Quadros  1 , Bruna Esmerio Ribeiro  1 , Letícia Callegaro  1 , Aline Arebalo Veppo  2 , Giulia Alessandra Wiggers  1 , Franck Maciel Peçanha  1
Affiliations
Randomized Controlled Trial

Impact of continuous positive airway pressure on the pulmonary changes promoted by immersion in water

[Article in English, Portuguese]
Danize Aparecida Rizzetti et al. J Bras Pneumol. 2017 Nov-Dec.

Abstract
in English, Portuguese

Objective: To determine whether different levels of CPAP improve the lung volumes and capacities of healthy subjects immersed in water.

Methods: This was a randomized clinical trial, conducted between April and June of 2016, involving healthy female volunteers who were using oral contraceptives. Three 20-min immersion protocols were applied: control (no CPAP); CPAP5 (CPAP at 5 cmH2O); and CPAP10 (CPAP at 10 cmH2O). We evaluated HR, SpO2, FVC, FEV1, the FEV1/FVC ratio, peak expiratory flow rate (PEFR), and FEF25-75%) at three time points: pre-immersion; 10 min after immersion; and 10 min after the end of each protocol.

Results: We evaluated 13 healthy volunteers. The CPAP10 protocol reversed the restrictive pattern of lung function induced by immersion in water, maintaining pulmonary volumes and capacities for a longer period than did the CPAP5 protocol.

Conclusions: When the hemodynamic change causing a persistent lung disorder, only the application of higher positive pressures is effective in maintaining long-term improvements in the pulmonary profile.

Objetivo:: Verificar se continuous positive airway pressure (CPAP, pressão positiva contínua nas vias aéreas) em diferentes pressões melhora os volumes e capacidades pulmonares de sujeitos saudáveis em imersão em água.

Métodos:: Estudo clínico randomizado realizado entre abril e junho de 2016 com voluntárias saudáveis em uso de anticoncepcional oral. Foram aplicados três protocolos em imersão em água, todos com duração de 20 min: controle (sem aplicação de CPAP); CPAP5 (CPAP de 5 cmH2O); e CPAP10 (CPAP de 10 cmH2O). Avaliaram-se FC, SpO2, CVF, VEF1, relação VEF1/CVF em % do previsto, taxa de pico de fluxo expiratório e FEF25-75% em três momentos distintos: pré-imersão, 10 min após a imersão e 10 min após o final dos protocolos.

Resultados:: Foram avaliadas 13 voluntárias saudáveis. O protocolo CPAP10 foi capaz de reverter o padrão restritivo pulmonar induzido pela imersão em água em indivíduos saudáveis, mantendo normais os volumes e as capacidades pulmonares por um período mais prolongado quando comparado ao protocolo CPAP5.

Conclusões:: Nossos resultados indicam que, em condições cuja alteração hemodinâmica causadora do distúrbio pulmonar seja persistente, apenas a aplicação de pressões positivas mais elevadas é efetiva para manter as melhoras no quadro pulmonar por um maior tempo após a sua aplicação.

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Figures

Figure 1
Figure 1. Study design and outline of the application of non-invasive positive pressure ventilation protocols (VNIPP). CPAP: continuous positive airway pressure; and PEFR: peak expiratory flow rate.
Figure 2
Figure 2. FVC and FEV1 in the control protocol (in A and D, respectively), the CPAP5 (5 cmH2O) protocol (in B and E, respectively), and the CPAP10 (10 cmH2O) protocol (in C and F, respectively), at the time points evaluated (data expressed as mean ± SD). CPAP: continuous positive airway pressure; PI: pre-immersion; I10’: 10 min after immersion; I40’: 10 min after the end of the (20-min) protocol. *p < 0.05 vs. PI (one-way repeated-measures ANOVA and Fisher’s post-hoc test).
Figure 3
Figure 3. FEV1/FVC ratio in the control protocol (in A), the CPAP5 (5 cmH2O) protocol (in B), and the CPAP10 (10 cmH2O) protocol (in C), at the time points evaluated (data expressed as mean ± SD). CPAP: continuous positive airway pressure; PI: pre-immersion; I10’: 10 min after immersion; I40’: 10 min after the end of the (20-min) protocol. *p < 0.05 vs. PI (one-way repeated-measures ANOVA and Fisher’s post-hoc test).
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