Randomized crossover trial of a pressure sensing visual feedback system to improve mask fitting in noninvasive ventilation

Abstract Background Serratus anterior (SA) muscle activation may be decreased with subacromial pain syndrome. Determining whether real-time ultrasound (RTUS) can improve SA muscle activation may improve physical therapist interventions for subacromial pain syndrome. Objective The objective of this study was to determine whether the addition of RTUS visual feedback increased the activation of SA in adults with painful shoulders in comparison to manual facilitation alone. Design This was an assessor-masked, 2-period, randomized crossover trial. Setting The setting was a university medical imaging laboratory. Participants Adults with mild to moderate unilateral subacromial pain received both interventions in random order with at least a 1-week washout between interventions. Fourteen participants were randomized to receive manual facilitation with RTUS first, and 13 were randomized to receive manual facilitation only first. Intervention The intervention was 15 repetitions of a supine “serratus punch” facilitated by manual facilitation with RTUS visual feedback or manual facilitation alone. Measurements Levels of SA activation were measured with surface electromyography normalized to a maximal voluntary isometric contraction. Results A total of 25 participants completed the full trial of both interventions. Data from 25 participant periods for RTUS with manual facilitation and data from 26 participant periods for manual facilitation only were analyzed. The predicted marginal mean difference between interventions was 55.5% (95% CI = 13.9% to 97.1%) (P = .009), favoring the addition of RTUS feedback. No adverse effects occurred. Limitations The results are applicable only to mild to moderate levels of shoulder pain, and it is unknown whether the addition of RTUS visual feedback reduces pain or disability. Conclusion Manual facilitation with RTUS visual feedback increased SA activation in adults with painful shoulders compared with manual facilitation alone. Impact Determining if real-time ultrasound (RTUS) can improve SA muscle activation may help clinicians improve physical therapist interventions for subacromial pain syndrome.

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Influence of total face, facial and nasal masks on short-term adverse effects during noninvasive ventilation

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132009000200010 ◽

2009 ◽

Vol 35 (2) ◽

pp. 164-173 ◽

Cited By ~ 29

Author(s):

Marcelo Alcantara Holanda ◽

Ricardo Coelho Reis ◽

Georgia Freire Paiva Winkeler ◽

Simone Castelo Branco Fortaleza ◽

José Wellington de Oliveira Lima ◽

...

Keyword(s):

Adverse Effects ◽

Noninvasive Ventilation ◽

Crossover Trial ◽

Positive Airway Pressure ◽

Ventilator Circuit ◽

Short Term ◽

Air Leaks ◽

Randomized Crossover Trial ◽

Bilevel Positive Airway Pressure ◽

Mask Type

OBJECTIVE: Failure of noninvasive ventilation (NIV) has been associated with short-term adverse effects related to the use of masks. The aim of this study was to compare the incidence, type and intensity of adverse effects, as well as the comfort, of total face masks (TFMs), facial masks (FMs) and nasal masks (NMs) during NIV. METHODS: This was a randomized crossover trial involving 24 healthy volunteers submitted to six sessions of NIV in bilevel positive airway pressure mode using the TFM, FM and NM masks at low and moderate-to-high pressure levels. A written questionnaire was applied in order to evaluate eleven specific adverse effects related to the use of the masks. Comfort was assessed using a visual analog scale. The CO2 exhaled into the ventilator circuit was measured between the mask and the exhalation port. RESULTS: The performance of the TFM was similar to that of the NM and FM in terms of comfort scores. Higher pressure levels reduced comfort and increased adverse effects, regardless of the mask type. When the TFM was used, there were fewer air leaks and less pain at the nose bridge, although there was greater oronasal dryness and claustrophobia. Air leaks were most pronounced when the FM was used. The partial pressure of exhaled CO2 entering the ventilator circuit was zero for the TFM. CONCLUSIONS: The short-term adverse effects caused by NIV interfaces are related to mask type and pressure settings. The TFM is a reliable alternative to the NM and FM. Rebreathing of CO2 from the circuit is less likely to occur when a TFM is used.

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