Date Published: March 19, 2019
Publisher: Public Library of Science
Author(s): Rêncio Bento Florêncio, Andrea Aliverti, Marina Lyra Lima Cabral Fagundes, Ilsa Priscila dos Santos Batista, Antônio José Sarmento da Nóbrega, Vanessa Regiane Resqueti, Guilherme Augusto de Freitas Fregonezi, Shane Patman.
Chest physiotherapy can be an alternative to increase lung volumes through pulmonary expansion therapies, but there is still inconsistency in the literature in order to determine which device can promote a greater volume increase at the expense of a better ventilatory pattern. Therefore, the aim of this study was to evaluate and compare the chest wall kinematics of healthy subjects submitted to the use of three different devices for pulmonary reexpansion.
Chest wall compartmental and operational volumes, breathing pattern and thoracoabdominal asynchrony were evaluated in 12 healthy individuals through optoelectronic plethysmography during quiet breathing, pulmonary reexpansion and recovery. Three different devices (volume-oriented incentive spirometer–IS-v; positive expiratory pressure–PEP; and incentive spirometer volume and pressure oriented–IS-vp) were administered in a random order with at least 48h between the devices.
A greater volume variation in the chest wall and its compartments was observed when the IS-vp was used in comparison with the other devices (p<0.05). Furthermore, the IS-vp mobilizes a greater amount of volume accompanied by greater synchronism between the compartments when compared to IS-v (p <0.05). The IS-vp may be able to increase total and compartmental chest wall volumes, as well as improve synchrony among compartments when compared to IS-v and PEP devices, thus constituting an important tool for treating patients with restrictive ventilatory pattern.
Several situations in clinical practice favor subjects developing reduced lung volumes, characterizing a restrictive respiratory pattern . Current evidence has already described that several patterns can be observed in the postoperative period of cardiac and abdominal surgeries [2,3], in patients with cystic fibrosis , obesity , Parkinson’s disease  and post-stroke . The reduction in pulmonary volumes can promote pulmonary complications in the postoperative period and leads to worse quality of life for individuals, since simple tasks in daily life become impaired by lower ventilatory efficiency .
Twenty (20) healthy individuals were invited to participate in the present study with the objective to evaluate and compare the kinematics of the CW and its compartments in using three different devices for pulmonary reexpansion: IS-v, PEP and IS-vp. Six subjects only attended the first day and therefore did not complete the protocol and two were excluded due to irregularities in the analysis file. Thus, the final sample consisted of 12 individuals, being 6 males and 6 females. Considering the mean of each group and the difference between standard deviation of VT,CW variable while using the devices, a Cohen’s d = 0.79 (considered large) was found and showed a power (1-β) = 0.98 for this study.
The main results of the present study were: 1) the IS-vp device was able to generate larger volume variations when compared to using it separately from the other two; 2) During pulmonary reexpansion moments, individuals presented lower thoracoabdominal asynchrony with IS-vp when compared to IS-v; 3) A greater inspiratory paradox time (IP) was found for the abdominal rib cage compartment after using the IS-v and IS-vp and a greater expiratory paradox time (EP) only after using the IS-v also in the abdominal rib cage; 4) EIV was higher when using the three devices for all compartments, except in abdominal compartment using IS-v and pulmonary rib cage EIV and EEV were higher in recovery compared to quiet breathing for PEP and IS-vp, and abdominal rib cage EIV and EEV for IS-v.
Based on the findings of the present study, it can be concluded that the IS-vp is able to generate larger volumes in the chest wall and its compartments, thus promoting lower thoracoabdominal asynchrony in healthy subjects. The findings are of great clinical importance, since IS-vp may be indicated for patients with restrictive respiratory pattern and could require an increase in pulmonary volumes, and consequently better performance of daily life activities and quality of life if used in the long term.