1、Positive Expiratory Pressure Therapy,PEP Overview,What is PEP? History of PEP Current PEP Devices Clinical Evaluation Conclusion,What is PEP?,PEP is a form of bronchial hygiene, and is one of the 3 adjuncts of positive airway pressure (PEP, CPAP, and EPAP). PEP involves active expiration through a o

2、ne-way valve against a variable flow resistor. In modern PEP devices, flow resistance can be manipulated to adjust for a desired pressure.,What does PEP do?,Enhances secretion mobilization and removal Helps prevent infections Helps mitigate atelectasis Improved pulmonary mechanics and gas exchange H

3、ow does PEP accomplish this? 2 ways: Filling under-inflated or collapsed alveoli via collateral ventilation (pores of Kohn, Canals of Lambert).* Helping to stint the airways open during expiration.,History of PEP,Origin of PEP -Traditional CPT with manual percussion, postural drainage, and vibration

4、 was first introduced in 1901 to assist airway clearance in children with bronchiectasis. -In the 1970s PEP devices were developed in Denmark, as a means to aid the patients airway clearance with an effective, self-administered low-pressure device (mouth piece 5-20 cm H20). -High-pressure PEP therap

5、y was developed in Austria (face mask 26-102 cm H20). -In 1991, PEP was introduced in the U.S. by Louise Lanafours from Sweden. -Since 1991, PEP devices have been modified and improved upon, which have produced devices such as the TheraPEP and Acapella.,Current PEP Devices,Airway Oscillation Devices

6、 (AOD) Provide standard PEP with the added benefit of oscillating pressure within the airway Oscillations reduce the viscoelasticity of mucus Oscillations provide short bursts of increased expiratory airflow to help with secretion mobilization Flutter Valve TheraPEP Acapella,Current PEP Devices,Flut

7、ter Valve Developed in Switzerland Pipe-shaped AOD with a steel ball resting in an angled bowl. On exhalation, the ball oscillates at approximately 15 Hz, and provides 10-25 cm H20. Gravity dependent,Current PEP Devices,TheraPEP Designed by Smiths Medical Company Standard low-flow PEP device Built i

8、n pressure indicator Can be used with a mask or mouthpiece Has a 22mm OD which allows it to be docked with a nebulizer Inspiratory and expiratory valves Provides 10-20 cm H20,Current PEP Devices,Acapella Designed by Smiths Medical Company Similar to the flutter valve but with greater functionality (

9、AOD) Utilizes a counterweighted plug and magnet to achieve valve closure (not gravity dependent) 3 Models: Low flow ( 15 L/min, adjustable resistance) Choice (any flow, adjustable frequency),Whats so great about PEP?,Readily accepted by patients Shorter treatment time compared to CPT Independent use

10、 Inexpensive (Acapella $32.00 Amazon) Portable BUTis it as effective as other methods of bronchial hygiene? VS,What does the research say?,Cystic Fibrosis Standard PEP Mortensen et al: PEP vs. PD12(4):211220. Kacmarek, R.M., Stoller, J.K., Wilkins, R.L. (2009). Egans Fundamentals of Respiratory Care

11、 (9th ed.). St. Louis, MO: Mosby Inc. Myers, Timothy R. Positive expiratory pressure and oscillatory positive expiratory pressure therapies. Respiratory Care Oct. 2007: 1308+. Academic OneFile. Web. 25 Nov. 2011. University of Wisconsin-Madison. (2011). Health Informatin: TheraPEP Data file. Retriev

12、ed from /healthfacts/B_EXTRANET HEALTH_INFORMATION-FlexMember-Show_Public_HFFY_1115126486611.html Wilson, Richard., (Feb-March 1999) Positive Expiratory Pressure Therapy: The Key to Effective, Low-Cost Removal of Bronchial Secretions. RT Magazine. Retrieved from ,References,Bel

13、lone A, Lascioli R, Raschi S, Guzzi L, Adone R. Chest physical therapy in patients with acute exacerbation of chronic bronchitis: effectiveness of three methods. Arch Phys Med Rehabil 2000;81(5): 558-560. Christensen EF, Nedergaard T, Dahl R. Long-term treatment of chronic bronchitis with positive e

14、xpiratory pressure mask and chest physiotherapy. Chest 1990;97(3):645-650. Darbee JC, Kanga JF, Ohtake PJ. Physiologic evidence for high-frequency chest wall oscillation and breathing in hospitalized subjects with cystic fibrosis. Phys Ther 2005;85(12):1278-1289. Gondor M, Nixon PA, Mutich R, Rebovi

15、ch P, Orenstein DM. Comparison of flutter device and chest physical therapy in the treatment of cystic fibrosis pulmonary exacerbation. Pediatr Pulmonol 1999; 28(4):255-260. Homnick DN, Anderson K, Marks JH. Comparison of the flutter device to standard chest physiotherapy in hospitalized patients wi

16、th cystic fibrosis. A pilot study. Chest 1998;114(4):993-997. Konstan MW, Stern RC, Doershuk CF. Efficacy of the Flutter device for airway mucus clearance in patients with cystic fibrosis. J Pediatr 1994;124(5 Pt 1):689-693. McIlwaine PM, Wong LT, Peacock D, Davidson AG. Long-term comparative trial

17、of conventional postural drainage and percussion versus positive expiratory pressure physiotherapy in the treatment of cystic fibrosis. J Pediatr 1997;131(4):570-574. Mortensen J, Falk M, Groth S, Jensen C. The effects of postural drainage and positive expiratory pressure physiotherapy on tracheobro

18、nchial clearance in cystic fibrosis. Chest 1991;100(5):1350-1357. Myers, Timothy R. Positive expiratory pressure and oscillatory positive expiratory pressure therapies. Respiratory Care Oct. 2007: 1308+. Academic OneFile. Web. 22 Nov. 2011. Newhouse PA, White F, Marks JH, Homnick DN. The intrapulmonary percussive ventilator and flutter device com