title: Physiological responses to positive expiratory pressure breathing: a comparison of the PEP bottle and the PEP mask.
abstract: BACKGROUND
  In the intensive care unit we have observed that patients have different adherence to 2 commonly used positive-expiratory-pressure (PEP) therapy devices: the PEP bottle and the PEP mask. The reason for this difference is not clear.
  
  
  METHODS
  In a randomized prospective study, we made continuous recordings of airway pressure and airflow, with 20 healthy volunteers, with the PEP bottle and the PEP mask. The measurement sequence consisted of 3 sessions of 10 breaths with the PEP bottle and the PEP mask, in a randomized crossover design. A rest period of 15 min separated the PEP bottle and PEP mask measurements.
  
  
  RESULTS
  With the PEP bottle the expiratory phase began with a zero-flow period of 0.39 s, during which airway pressure rose 11.9 cm H2O. With the PEP bottle the mean expiratory pressure was 11.7 cm H2O, and end-expiratory pressure was 9.5 cm H2O. With the PEP mask the initial expiratory zero-flow period was almost nonexistent (0.04 s) and without any change in airway pressure. With the PEP mask the shape of the expiratory pressure curve was different; mean expiratory pressure was 8.6 cm H2O, and end-expiratory pressure was zero. With the PEP bottle the inspiration also began with a zero-flow period of 0.43 s, during which airway pressure decreased 9.6 cm H2O from the end-expiratory airway pressure. With the PEP mask the initial inspiratory zero-flow period was only 0.01 s and there was no concomitant change in airway pressure.
  
  
  CONCLUSIONS
  The PEP bottle and the PEP mask showed major differences in the relationship between airflow and airway pressure. These findings might explain the observed differences in patient adherence to these therapies.
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Operationscentrum, Umeå University Hospital, S-901 85 Umeå, Sweden. maria.sehlin@vll.se
authors.forename: Maria
authors.initials: M
authors.lastname: Sehlin
authors.forename: Fredrik
authors.initials: F
authors.lastname: Ohberg
authors.forename: Göran
authors.initials: G
authors.lastname: Johansson
authors.forename: Ola
authors.initials: O
authors.lastname: Winsö
mesh_terms: D000328:Adult; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D011446:Prospective Studies; D013548:Sweden