title: Short-term effects of expiration under positive pressure in patients with acute exacerbation of chronic obstructive pulmonary disease and mild acidosis requiring non-invasive positive pressure ventilation.
abstract: OBJECTIVE
  To investigate the feasibility and the efficacy of expiration under positive pressure (PEP mask) as a chest physiotherapy in patients with exacerbation of chronic obstructive pulmonary disease (COPD) and acute hypercapnic respiratory failure (AHRF) requiring non-invasive positive pressure ventilation (NIPPV).
  
  
  METHODS
  A prospective, randomised, controlled study.
  
  
  METHODS
  A respiratory intensive care unit.
  
  
  METHODS
  Twenty-seven patients with large amounts of bronchial secretions on clinical examination due to exacerbation of COPD and mild acidosis were randomly divided into two groups. Group A (13 patients) received PEP mask plus assisted coughing. The controls (group B, 14 patients) received assisted coughing alone.
  
  
  METHODS
  The primary end point was to compare total sputum wet weight and to assess the feasibility of the PEP mask. Secondary outcomes were: (a) the time required for weaning patients from NIPPV, (b) treatment failure expressed as mortality within 2 months after discharge from the respiratory intensive care unit (RICU) or the need for endotracheal intubation (ETI).
  
  
  RESULTS
  The amount of sputum production at the end of physiotherapy was significantly ( p<0.01) higher in group A (9.6+/-3.9 g) compared with group B (4.7+/-2.5 g). The total length of weaning time was significantly lower in group A (4.9+/-0.8 days) versus group B (7.0+/-0.7 days), p<0.01. Mortality and ETI were not significantly different in the two groups of patients (0 versus 1 and 0 versus 1, respectively).
  
  
  CONCLUSIONS
  Expiration under positive pressure was effective in acutely removing secretions in patients with exacerbation of COPD and mild acidosis requiring NIPPV. In conclusion, we suggest that this chest physiotherapy technique represents a useful therapeutic option for such patients and it should often be performed in addition to NIPPV.
authors.affiliation: Respiratory Intensive Care Unit, San Sebastiano Hospital, Emilia, Italy. andreabellone@libero.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Bellone
authors.forename: Liliana
authors.initials: L
authors.lastname: Spagnolatti
authors.forename: Monica
authors.initials: M
authors.lastname: Massobrio
authors.forename: Elena
authors.initials: E
authors.lastname: Bellei
authors.forename: Rossana
authors.initials: R
authors.lastname: Vinciguerra
authors.forename: Andrea
authors.initials: A
authors.lastname: Barbieri
authors.forename: Emilio
authors.initials: E
authors.lastname: Iori
authors.forename: Stefano
authors.initials: S
authors.lastname: Bendinelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Nava
mesh_terms: D000138:Acidosis / Q000150:complications / Q000503:physiopathology; D000208:Acute Disease; D000704:Analysis of Variance; D003371:Cough; D005240:Feasibility Studies; D006801:Humans; D007362:Intensive Care Units; D008397:Masks; D026741:Physical Therapy Modalities; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012129:Respiratory Function Tests; D013183:Sputum / Q000378:metabolism; D016896:Treatment Outcome