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Effects of the intermittent intrapulmonary deflation technique on expiratory flow limitation: an in vitro study

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Abstract

Introduction

The intermittent intrapulmonary deflation (IID) technique is a recent airway clearance technique that intends to delay the onset of expiratory flow limitation (EFL) during exhalation. We showed in a previous study that IID increased the expiratory volume of COPD patients compared to quiet breathing and positive expiratory pressure (PEP) therapy. We hypothesized that it was due to the attenuation of the EFL.

Objectives

To verify the physiologic effects of IID and PEP techniques on EFL with a mechanical lung model.

Methods

A mechanical lung model was created to assess the effects of IID and PEP techniques. The thorax was simulated by a plexiglas box in which an adult test lung was connected. A calibration syringe simulated the inspiratory phase. Later, with activation of the IID, the expiratory phase was driven by the deflation generated by the device. With PEP, the expiration occurred maintaining an expiratory pressure between 5 and 10 cmH2O. A pneumotachograph and a pressure transducer were placed in series for flow, volumes and pressure measurements.

Results

The model reproduced physiological characteristics of EFL. However, the deflation of the model was slowed by IID and PEP, and flow remained almost constant, so flow limitation was reduced.

Conclusion

The IID and PEP attenuate EFL and increase exhaled volume in the in vitro model.

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Funding

The Simeox device was lent by the company PhysioAssist for the whole duration of this study. The company had no involvement in this study in any way.

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Authors and Affiliations

  1. Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, 1200, Belgium

    Juliana Ribeiro Fonseca Franco de Macedo, Gregory Reychler, William Poncin & Giuseppe Liistro

  2. Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, 1200, Belgium

    Juliana Ribeiro Fonseca Franco de Macedo, Gregory Reychler & William Poncin

  3. Department of Physical Medicine and Rehabilitation, Cliniques universitaires Saint-Luc, Avenue Hippocrate, Brussels, 10–1200, Belgium

    Juliana Ribeiro Fonseca Franco de Macedo, Gregory Reychler & William Poncin

  4. Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, 1200, Belgium

    Giuseppe Liistro

Authors
  1. Juliana Ribeiro Fonseca Franco de Macedo
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  2. Gregory Reychler
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  3. William Poncin
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  4. Giuseppe Liistro
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Contributions

JRFFM and GL designed and drafted the study, analysed the data, and revised the manuscript. GR and WP provided critical revision.

Corresponding author

Correspondence to Juliana Ribeiro Fonseca Franco de Macedo.

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Conflict of interest

The authors have no affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Ethics approval

The ancillary study mentioned was carried out in accordance with the Helsinki Declaration and approved by Comité d’Éthique Hospitalo-Facultaire Saint-Luc – UCL no. B403201940373 and registered at Clinical Trial as NCT04157972.

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Ribeiro Fonseca Franco de Macedo, J., Reychler, G., Poncin, W. et al. Effects of the intermittent intrapulmonary deflation technique on expiratory flow limitation: an in vitro study. J Clin Monit Comput 38, 69–75 (2024). https://doi.org/10.1007/s10877-023-01093-3

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  • DOI: https://doi.org/10.1007/s10877-023-01093-3

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