Veja grátis o arquivo rfmpdf enviado para a disciplina de Fisioterapia Além disso, as pesquisas analisadas compararam o EPAP com outros recursos. Fisio da Depressão · @fisiodepressao. Joined December . Fisioterapia respiratória. EPAP, CPAP, BIPAP, RPPI, PQP. PM – 13 Dec. Looking for online definition of EPAP or what EPAP stands for? EPAP is CPAP () EPAP () selo d’agua Marque o horario que voce realizou a fisioterapia.

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In relation to the baseline, at 10 and 20 minutes and upon recovery, respectively parasternal activity increased by RR mean between-group difference: In COPD patients, the use of EPAP 10 was more effective in reducing accessory inspiratory activity and increasing parasternal activity, which was accompanied by an improvement in ventilation and a reduction in dyspnea. Chronic obstructive pulmonary disease COPD is characterized by chronic obstruction of air flow and reduced aerobic capacity of the peripheral muscles secondary to alterations in ventilatory mechanics 1.

A common feature in a COPD respiratory system is the presence of dynamic hyperinflation that is frequent at rest and increases with exercise 2. Another mechanical change in the respiratory system is the flattening of the diaphragm resulting from an increase in physiological dead space and dynamic hyperinflation that contributes to respiratory mechanical inefficiency.

This change results in greater energy expenditure required by the respiratory muscles, and is also related to the presence fisioterxpia dynamic intrinsic positive end-expiratory pressure i. The dynamic PEEPi is a positive end-expiratory alveolar pressure that is not extrinsically applied and occurs at the beginning of inspiration in a volume above relaxation volume when eoap muscles markedly reduce the pleural pressure.

In this case, the mechanical breathing that is necessary to generate the ventilation demands more work. In COPD patients, the metabolic cost of breathing is assigned to the expiratory muscles that contract during exhalation 5.

This phenomenon reduces the capacity of expiratory muscles to increase ventilation because of an expiratory flow limitation which promotes an imbalance in respiratory muscle work 56. In the past, several devices have been used by respiratory physical therapists to improve ventilation and to preserve physiological levels of lung volume.

Expiratory pressure delivery systems employing valve devices epqp. Additionally, an expiratory pressure device increases the resistance during the expiratory phase and induces a reduction in minute ventilation V Erespiratory rate RR and physiological dead space.

The hypotheses tested fisioferapia the two different loads of EPAP would improve the coordination of the respiratory muscles studied i. All patients were recruited from the COPD ambulatory unit of the same hospital. At a clinical visit to a secondary clinical setting, subjects went through fisioterapix interview, an anthropometric evaluation, a spirometry assessment, a respiratory muscle function test and an EPAP at different intensities along with surface electromyography sEMG testing of the sternocleidomastoid SCM and the third right intercostal muscle.

This trial was registered at www. A computer-generated list of random numbers was used, and a randomization sequence was created by the software Random Number Generator Pro v2. Each subject was assigned to one of two groups EPAP 10 or EPAP 15 through a sequence that was stratified accordance with the severity of disease, with a ratio of allocation of 1: All participants received the intervention by two physical therapists blinded, which did not participate in the evaluation process.

The assessments were also blinded and performed by only one physical therapist who was not involved in the randomization fisiotwrapia. Randomization was performed by an external collaborator, without direct involvement in the study.

After randomization, the level of pressure selected was covered in the post end-expiratory epqp PEEP valve was covered with duct tape by the physical therapist responsible for the randomization.

EPAP – What does EPAP stand for? The Free Dictionary

Thus the patient and the physiotherapist who applied the mask EPAP were not aware of the pressure level used. The anthropometric data, pulmonary function and respiratory muscle strength of the patients fisioterapka evaluated. The following week, the patients returned for sEMG measurements that were recorded with the patient in a sitting position, where an initial measurement was taken during spontaneous breathing i.

The sEMG signal was captured epqp 10 and 20 minutes of application and 10 minutes after the removal of the mask to determine whether there was a sustained effect on the muscles.

In this study sEMG and ventilation tidal volume were considered to be the primary outcomes. The sEMG was conducted using circular surface electrodes with a radius of 15 mm, using a bipolar configured Meditrace pediatric electrode Tyco Healthcare, QC, Canada. The signal was pre-amplified and connected to a differential surface sensor model SDS with a clamp connection using a fold gain, filter frequencies ranging from 0.


A 2-cm space was maintained between electrodes to reduce crosstalk The signal was captured by a surface electromyography device Miotool MIOTEC, RS, Brazil composed of a 2-channel system with 14 bits of resolution, a sampling fiwioterapia of Hz per channel, a common mode rejection of decibels dba low noise level below 2 Least Significant Bit LSBand a fold gain amplifier.

To remove dead skin cells and enhance the EMG signal, cotton swabs moistened with alcohol were used to disinfect and roughen the skin The electrodes containing a conductive gel were affixed with adhesive tape to the middle line of the muscle, with their detection surface perpendicular to the muscle fiber The location of the muscle of interest was based on the palpation of the central portion for the right SCM, 3 cm above its anterior head in the posterior triangle fisioterapiz the neck, during segmental neck flexion against manual resistance.

The participant was asked to perform a brief isometric flexion contraction s of the neck to fisiotrrapia that the electrodes were in the correct position Similarly, an electrode was placed in the third right intercostal space, near the sterna border, for the right parasternal muscle Specifically, the inspiratory phase was defined as the period beginning 1 second after the absence of intra-mask expiratory pressure was detected and ending 1 second before the presence of any pressure level was detected within the mask The root mean square RMS value of the EMG signal consisting of 2 minutes in the middle of a 4-minute window was used for analysis.

Subjects were instructed about the procedures to be performed during the spirometry assessment. The spirometer was routinely calibrated every day using a 3-L syringe, according to ambient temperature conditions, as well as standardizations for measures, were in accordance with the Brazilian Society of Tisiology and Pneumology A minimum of 3 and a maximum of 8 tests were conducted with a 1-min interval between each test to get 3 reproduceable curves.

Three reproducible tests were performed, and the best curve was considered for the study.

Results were expressed both as absolute and as percent-of-predicted values The tests were conducted with patients in the sitting position and the patients made an effort to blow out against the occluded valve Before each test, the patients were thoroughly instructed regarding the procedures, and the results obtained were assessed in their absolute values.

MIP and MEP were expressed in both absolute and percent-of-predicted values using reference values obtained for the Brazilian population The tidal volume V T assessment was performed using an analog ventilometer RM Respirometer, Ohmeda, Tokyo, Japanwhile respiratory rate RR was determined by counting the breaths per minute.

The VT and RR data were visually checking on the device and captured at 10 and 20 minutes of the test for 1 minute. Additionally, it has a low resistance of approximately 2 cmH 2 O 21 – These variables were evaluated under spontaneous breathing conditions, i. The statistics analysis was performed using SPSS software, version The data were screened for normality using the Shapiro-Wilk test.

The data from a pilot study of 4 subjects, with means and standard deviations, were used in each group. Thirty-five patients were enrolled in the study. Seven patients were not randomized to a treatment group because they did not meet the inclusion criteria during the screening procedures and seven others were lost during the follow-up to application of EPAP Flowchart, Figure 1.

Patient demographics are described in Table 1. Body mass index; FVC: Forced vital capacity; FEV 1: Ratio between forced vital capacity and forced expiratory volume in the first second; MIP: Maximum inspiratory pressure; MEP: In relation to baseline, normalized values during EPAP 10parasternal muscle activity increased by Regarding the sEMG activity of the SCM muscle, the pattern that was observed was relatively different from that observed in disioterapia parasternal muscle.


The decrease in RR was accompanied by a reduction in dyspnea in both groups Table 2. Respiratory rate; SpO 2: Saturation peripheral oxygen; SBP: Systolic blood pressure; DBP: The hypothesis that the two different loads of EPAP would proportionally improve the coordination of the respiratory muscles studied and would enhance ventilation was tested.

The main findings of this study were partially in agreement with the hypothesis. With an increase in expiratory load, it was expected that the inspiratory muscles would act in coordination, increasing their activity to cope with the expiratory resistance and to improve ventilation. However, the different opposite pattern of the SCM muscle recruitment during EPAP 15 use compared to that seen during EPAP 10 use, appears to be related to the activity employed by the respiratory system to cope with the increase in expiratory load and to promote ventilation.


It was not clear why these different responses to EPAP occurred. There were no differences in disease severity among the groups at baseline. However, it might be possible that parasternal muscle was unable to improve its activity, as observed during EPAP As previously described, the EMG activity of the parasternal muscle during application of EPAP 15 might result from an overload of the inspiratory muscles This effect was previously described by Simkovitz et al.

This would be particularly true if the operation volumes were great enough that the inspiratory muscles function at shorter lengths, a condition that would be less favorable to ventilatory mechanics. However, the EPAP 10 group showed significant activity in this muscle during therapy and after mask removal. These authors found that applying ePEEP in their patients increased the sEMG activity in the parasternal muscle, in addition to reducing the indices of muscle effort, most likely at the expense of a substantial increase in lung volume and expiratory muscle recruitment.

This finding was assumed to be the result of the capacity of ePEEP to reduce iPEEP, inspiratory threshold load and respiratory work, even in the absence of a significant increase in lung volume 30 The waterfall theory 32 hypothesized that ePEEP could reduce iPEEP without aggravating hyperinflation only if the latter was caused by expiratory flow limitation, which may have occurred in the present study.

This observation confirmed the results presented by our group in an earlier study 33which assessed the effect of EPAP 15 on the electrical activity of the SCM and scalene muscles in patients with COPD. As in the present study, there was a tendency for greater SCM muscle activity during the application of EPAP, which may have occurred in an attempt to maintain an adequate inspiratory pressure However, in this study, a significant reduction of SCM electrical activity after the withdrawal of EPAP 15 was not found, a fact that may have been a result of the insufficient time application of the therapy.

Thus, it is also important to consider that the SCM muscle participated in non-respiratory functions, including the maintenance of posture and head movement. De Troyer et al.

Dpap authors suggested that the higher V T was associated with the fisioterapiia of expiratory pressure that was imposed This may occur under conditions of higher ventilatory demand, resulting from the greater need for oxygen production or higher carbon dioxide concentration. Conversely 8when the effect of 5 cmH 2 O EPAP was assessed in eight men with moderate to severe COPD fiwioterapia exercise; no significant alteration in V T was found, although they suggested that the increase in V T could have been caused by a fisioterapa expiratory time.

These findings are similar to results of our study, where the reduction of RR in both groups was responsible for the fsioterapia in V T because the V M did not change significantly. There is currently no consensus regarding the adequate pressure levels used as to when the application of elevated PEEP might aggravate ventilatory dysfunction. However, it is important to mention some limitations of this fisioerapia.

The results of V T and RR must be interpreted with caution. It is important to consider that while mechanical respirometers are portable, relatively low cost, precise and accurate devices with worldwide use, they are designed for assessments over short time periods. End expiratory lung volumes EELVs were not assessed which is one marker of hyperinflation that could impair ventilation in COPD patients; nonetheless, worsening symptoms, such as dyspnea, were not observed in our study.

Additionally, due fisioteapia the heterogeneity among patients with COPD, new studies with greater subject numbers should be performed. Considering the complexity of respiration, determining the effects of different intensities of expiratory loads on patient comfort and respiratory mechanics through more complex analyses of the chest wall and the symptoms experienced would be appropriate. In conclusion, in COPD patients, the EPAP 10 for at least 10 minutes reduces the accessory inspiratory activity of the SCM muscle and increases parasternal muscle activity, which was accompanied by an improvement in ventilation and a reduction in the sensation of dyspnea.